HomeMy WebLinkAbout13394-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z13109 Date Jan: 4 ........... 198.5.
THIS CERTIFIES that the building ....... .A.d.d.i..t.i.o.n. ...............................
Location of Property ..9..7.5 .............. ~.e..c.t.a.~., ~. 9~.q~..D?.~.v.e., .~.e.s..L ..... .~.o.~.~.h..o~,,,
House No. Street Hamlet
County Tax Map No. 1000 Section ...0 ~ .0 ...... Block ...0..~ .......... Lot ...0..0.5 ...........
Subdivision..Qe.d..aT. ?.e..ag.h. ?..aT.k' .......... Filed Map No...9. 0. .... Lot No.. 3_37
conforms substantially to the Application for Building Permit heretofore fried in this office dated
.... .A.u.c~:.. 14 19 84 pursuant to which Building Permit No. 3-3394g .
dated ........ A..us......2.9 ........... 19...,84 was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is .........
Addition to E..x.is.t.$.ng. One Fami~x .D.w.e.l. 1..i.n.g.
The certificate is issued to GERARD & MARILYN LANG
(owner, lessee ~r-twrrent~
of the aforesaid building.
N/5.
Suffolk County Department of Health Approval .........................................
UNDERWRITERS CERTIFICATE NO .................. P..e.n.dj:n. g ........................
Building Inspector
Rev. 1/81
TOWN HALL
$OUTHOLD, N. Y.
BUILDING PERMIT
CI"HIS PEPu~IT MUST BE KEPT ON THE PREMISES UNTIL FUII
CO/~APLETION Of: THE WORK AUTHORIZED)
No. 13394 Z
P.rrnission is herlby granted to:
............ :+.....,: ....................... f .................................
lumdlnl Im
:~000314 THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
N 674745
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the abo~e applicatiott nu tuber in the premises of
in the followi~g location; ~ Basement ~ 1st FI. '[] 2nd
Fl.
Section
Block
Lot
was examined on (~a~lLl~t&~/~ 7 ~ 19~5 and found to be in compliance with the r~quirements of this Board,
FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
FIXTURE SWITCHES
34
DRYERS MOTORS TIME CLOCKS UNIT HEATERs MULTI-OUTLET DIMMERS
SYSTEMS
NO. OF FEET
SERVICE DISCONNECT S E R V I C
OTHER APPARATUS:
1-Post llt~
NO OF CC, COND
PER ,~
OF CC COND
3/0
NO, OF HI-LEG
AWG
OF HI-LEG
NO, OF NEUTRALS A. W G
OF NEUTRAL
3/O
Cutc. hog"a~., N Y 11955 ~c 267~ GENEnAL ~N~E~
Per 1 1, ~/ ~'
This cerfifico*e most not be altered in ony mann,r; return to *he office of the Boord if incorrect. Inspectors moy b~ fidenfified by'~h~ir cr~d~nfi~{5.
COPY~FOR BiUILDING DEPARTMENT. THIS COPY, M ANY MANNER.
F1ELD INS~ECTL'ON ~ COMMENTS
FOUNDATION
{1st)
FOUNDATION {2nd)
ROUGH FRAME &
PLUMBING
INSULATION ?ER N.
STATE ENERGY
~ODE
FINAL
Y o
ADDITIONAL COMMENTS:
FORM NO. 1
TOWN OF SOUTHOLD
BUiLDiNG DEPARTMENT
TOWN HALL
~OUTHOLD, N.Y. 11971
TEL,: 765-1803
)isapproved ale .....................................
.....................
. .....
(Building Inspector)
APPLICATION FOR BUILDING
Received ........... ,19...
Date .............. ,
INSTRUCTIONS
a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3
ets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets
,r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli*
ation.
c. The work covered by rids application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit
hall be kept on the premises available for hxspection throughout the work.
e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy
lmll have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pumuant to the
~uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordh~ances or
~.egulations, for the construction of buildh~gs, additions or alterations, or for removal or demolition, as herein described.
i'he applicant agrees to comply with all applicable laws, ordinances, but/ding code, housing code, and regulations, and to
.dmit authorized inspecto~ on premises and in building for necessary inspections.
(Signature o~ app ican, or , ' p )
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general' contractor, electrician, plumber or builder.
..... ..........................................................
Name of owner of premises ~'...~'. ~'.5.. '~7..~ . . ~a~ .......................................
(as on the ta~'roll or latest deed) "
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No .... 5) .3 ................
Plumber's License No .........................
Electrician'i License No .......................
OlltorW~de's License No ......................
1. Location of land on which proposed work will be done ............. :...~ ............ ~ ..................
'7~-..~.,.ex2yO~ffT., ~, I~ ,~-'£- -, ~e.~ .v. .......... ~{..%,! :~-~.:. ;,.,B..~. t ............ %' ........ .~. ,,' ...........
House Number i Street Hamlet
County Tax Map No. 1000 Section ................ Block .... ] Lot..
Subdivision ..................................... Filed Map No ............... I,ot ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy,, ~t~,.~,A'~c '~.
b Inter3eduseandoccupancy ~p.~..td,~w ~.~_
Repair .............. Removal ..............
,'
Estimated Cost '
It' dwelling, number of dwelling uhits ...... ./ ....
3. Nature of work (check which applicable): New Building .......... Addition ....... Alteration ..........
Demolition .............. Other Work ...............
(Description)
{to be paid on filing this~application)
.. Number of dwelling units on each floor ................
If garage, number of cars ~ ' '
6. If busmqss, commermal or m~xed ~ccupancy, specxfy natur%and, extent· of each type ~°f use ........ i~'.. ;, ........
7. Dimensi0ns of existing structures if any: Front ..... ~ ...... Rear .... .t,f.~. .... ;. Depth .. .~{~ .........
Height Numb~er of Stories
.......................... : ..... · 4'i't' .................... t ...........
Dimensions of same structure with alterations or additions: Front ............... Rear ...q.~ .............
Depth 3.O! ,' Height ~r. 5" Number of Stories 0~
10.
11.
13.
14.
Dimensions of entire new constru,ction: Front ......
Height .., ~ ........... r Number of Stories ......
Size 0flor: Front , J.~.l~ ...... i .......... Rear .
Date of Purchase '
Zone or use district in which premises are situated...
property fines. Give street and block
interior or comer
........ Rear ............... Depth ...............
· 7~.~. ·, ·' ........... Depth. .................
~.ame ot~ Former Owner .............................
...................................
Does proposed construction violate any zoning law, ordinance or regulation: ................................
Will lot be regraded .......... , .................. Will excess fill be removed from premises: Yes No
Nmue of Owner of premises ~.t .*J~l.~5.. · .~..~?.._qS · · · Address . .~.~.~. ~ ........... Phone No.. ~,
Name o~ Architect . ~ ]~. ~, ~ ~. ¢ ..... 7 .... Address ,~,qw...~.. Phone No. ¢ ~x .~.%5,~...
N m~e of Contractor ,~ ....... ~.e~ ....... Address $~ ~q~oq~ &. ~V m. Phone No. ~.a ~ 7 ~43.~...
Locate clg~ly ~t dist~efly fll buddings, whether existing or proposed, ~d. indieat~ ri set-back d~ensions from
umber or description according to deed, ~d show street n~es ~d indicate whether
;]['ATE OF NEW YORK,
2OUNTY OF
............................ : .................... being duly sWOrn, deposes and says that he is the applicant
(Name of individual sigqing contract)
,bove named,
is the ................ ' ' '-,'4 i .... -" ................................................................
I (Contractor, agent, corporate officer, etc.)
smd owner or owners, and ;s du!y authorized to perform or have performed the said work and to'make and file this
pplication; that all statements contained in this application are true to the best of iris knowledge and belief; and that the
,,ork will be performed in the manner set forth in the application filed therewith.
.worn to before me this
........ ,,/,t,½. ~ ';" .day of..3~.~ ...... . 19g.~f
~ II/I.. '
,eta1 Public ...... ..,.~..L-. '.ff...g?'~... C un
.5' , .. ,.~-.,-.~-~. . ..~. , . . o ty
, ~;~¥ PtJIILtC, Sl~l~ el ~1~~ ¥or~ ~ (S'~ '' --n '" ' ' ':
No, 4707878. Su,01k l~0unt~ ' arure oI applicaw*~
l[erm [xpl~e~ March 30, IgJ~
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec-
tor with the following; for new buildings or new use:
1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual
natural or topographic features.
2. Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, a certificate of Code compliance from the Architect or Engineer responsible for the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
I. Accurate survey of p~'operty showing all property lines, streets, buildings and unusual natural or
topographic featu res.
2, Sworn statement of owner or previous owner as to use, occupancy and condition of bui[dings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling
$15.00
3. Copy of certificate of occupancy $1.00 ~ .~./,/~t~~.
4.Vacant Land C.O. $5.00
Date ......................
New Building ............. Old or Pre-existing Building ............~' VacantLand ..
Street
Owner or Owners of Property ........... ' ........ ' ............... ~. ...... ; ...."~ ............
County Tax Map No 1000 Section ~..~/ . Block . / .. Lot ...~.~.... ......
Health Dept. Approval ........................ Labor Dept. Approval .......................
Underwriters Approval ........................ Planning Board Approval .....................
Request for Temporary~r~tificate ...... . ............... Final Certificate ......................
Construction on above described build~a-..~. ..... ts all s ns.
~.. ,}. "~ /~,~ ~ Applica ...........