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HomeMy WebLinkAbout13374-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z~ 3837 Date Sept ember q 0 85 ................................................. , 19... THIS CERTIFIES that the building additions. z[5~ 5 Stillwater Ave. Cutchogue Location of Property ............................................... ~ ................ House No. Street Hamlet County Tax Map No. 1000 Section .. q 37 .Block ............... Lot Subdivision. M.S. I-IANI) .Filed Map No. 7..3.0..Lot No. ~-, 5,6~ p/o conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... A.u. ~.u.s.t...2.2 ..... ,19.8.~. pursuant to which B~filding Permit No. ~ 337z[Z dated .... .A.u.g .u .s .t. . 2. .7 ............. 19 .8,4., 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 ......... .. p.~.qk., .m.~.~.~. ?.r..~.e..d.r.o. qm...~. ~..~.~.,.!~..v.~.. ?.o.o.m...w./..~.~..d..~.! o..o.r. ?..~.r.o.o.m.. ?.d.d.~..~±ons. The certificate is issued to ..ROBERT & RITA JOYCE PELI.~EGRINI ................... ?o~'o; '~ ..................... of the aforesaid building. Suffolk County Department of Health Approval .................. .~/.A. .................... UNDERWRITERS CERTIFICATE NO ....................... N. 7.0~.6.6. ? ................... Building Inspector Rev. 1/81 I~OB~ NO. ~ TOWN OF SOUTHOLD BUILDING DIEPARTMI~NT TOWN HALL SOUTHOLD, N. Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1337~ Z is hereby ora : ,.~,,,,o~ ~~ ............................ ~, ~~ ..... ...~-..:.~.....~~~.. ~.~..,...~......~~..~.~ .............. /~ ............. ~ ............ ~ ............................ rem,ses lc>coted at .tJZ....~'...I..~.~......~~..~ ...... (2~ ......... ~...e:::~.. .... ot p ' · .......................... ~..~.....~... ................. County Tax Map No. I000 Sect~'~..L~....~.3 ....... Block ....... .~. .......... Lot No ......................... ~ Building Inspector. Fee $..~........L: ......... 4- 4~77~ Rev. 6/30/80 FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions TOWN OF S0_UTHOLD ~ qOq A. This application must be filled in typewriter OR ink, and submitted ia~ to the Building Inspec- tor with the following; for new buildings or new use: I. 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: 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15 o 0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 Date ....... :2,-~. 7~.~. ........... New Building ............. Old or Pre-existing Building .... vt. ....... Vacant Land ............. Location of Property ¢. ,Ti( ,b. L. ,c~, .¢~, 6. ('~ , .~]~:., House No. Street Ham/et ?.. ?. o.q ¢ ,. ' Owner or Owners of Property .... - ......................... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. I.~.~. ?..q/..~-.. Date of Permit .......... Applicant . Health Dept. Approva{ ........................ Labor Dept. Approval ........................ / Underwriters Approval ..v~. ................... Planning Board Approval ...................... Request for Temporary Certificate ................... Final Certificate ....................... Fee Submitted $...~ ........................ Construction on above described building and permit meets all applicable codes and regulations. ~o,.~_-¥p ~,L,~i "~ I,o ~ Applicant .... ;'"-~, .................... TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. Owner ~ (please print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber' s signature) S/~worn ~to before me this F~ day of, otary /" N~tary P~c County THE NEW YORK BOARD OF FIRE UNDERWRITERS i00004~:; FIXTURES RANGES OVENS FANS FIXTURE SWITCHES OUTLETS FLUORESCENT VAPOR 57 55 40 57 DRYERS E MOTORS FEEDSRS TJMECLOCKS LJNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT S E R V I C NO OF CC, COND. PER ,~ A. WG OF CC COND. 2to NO, OF HI-LEG OF HI-LEG E JNo, OF ~EUTRALS OF NEUTRAL Li¢#2670m Per -~ - ,.. ' _ ~,~1 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. ~ F I F~L D I~IS?ECTION DATE COMMENTS FOUNDATION FOUNDATION (2n~ ROUGH FRAME PLUMBING ' ..~!~ 3. FINAL ADDITIONAL COMMENTS: FIELD INSPECTION FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C,ODE FINAL COMMENTS ADDITIONAL COMMENTS: ~FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 / TEL,: 765-1803 Disappro~ed a/c .... i :. . .~.-~. . . . . .-----~. ......... ~ ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19.. /./.al 85 Date ................... ]9.,. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets 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 or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this 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 shall be kept on the premises available for inspection 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 shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws; ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections, tl ' B (Mailing address of applicant) State wh~t~h~is o~wn~ee,~_ent, architect, engineer, general contractor, electrician, plumber or builder. NameofownerofPremises ...~...~.,iiiiii.~.~.i'"iiiiiiii'iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii~) -(as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... ~.~..~..~ .............. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. q . . ! l. ..... v. .:.:. .................... . . . o. . . .............. House Number Street Hamlet County Tax Map No. 1000 Section .............. Block .... ~. ~ ......... Lot ............. Subdivision. ~...~.~ ..... Jfl/L.~.(/N~~)r ............... FiledMap No ............... Lot .~>.,)~../.~.:: '~...~. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......................................................... b. Intended use and occupancy .... .~..-¢./.~ .--~. ...... .~... [..~... '.~..~....~.~. .................. 3. Nature of work (check which aOplicable): New Building ..... ' ..... Addition .......... Alteration .. . Repair .............. Rem?al .............. Demolition .............. Other Work ............... z .c4. (Description) 4. Estimated Cost ............................... Fee ......................... [ ~" (to be paid on filing this application) 5 Ifdweil ng be ofdweiling'units Numbe ofdw lling units on each floor · 1 , hum r ............... r e ................ number of cars If garage 6. If business, commercial or mixeld occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structurbs, if any: Front...'~.~. ~ .... '... Rear . ~..7. ~. ........ Depth ."&.) ........... Height . [ .~'. ......... Number of Stories ................................................ Dimensions of same structure with alterations or additions: Front . ,~'~ ............ Rear ..~ .............. Depth ....~.O ............ i. · Height . ~..~. ............. Number of Stories .... ~. ................ 8 Dimensions of entire new construction: Front Rear Depth Helg t ............... Ntumbar of Stones ................................. z ................ 9. $izeoflot Front ./...~ ; ......... Rear /~z, Depth~:~.~... 10. Date of Purchase .~.a{~:~? .~.~1 ...... ii ..... i. Nam~ 'o.'f~d~dr'b~v'n'e'r'..6-.o.¢..~,.~}.' i. 11. Zone or use district in which ~r~mises are situated .... Jg~sz~l<e~e~ .................................. 12. Does proposed construction vie,late any zoning law, ordinance or regulation: ....... )Q.O. ..................... 13. Whl 10t be regraded .... 49.~,. ......... .- ........ Will excess fill be removed from premises: ~ No 14. Name:ofOwnerofpremises ~.~.~f"~..Address~;/?}/.W.,q~...t..~.9~-.~...PhoneNo. ~.'~.~...' ........ Name of Architect ~,~-. ~ ....... Address ../-?.e¢./a~[,~.o.~..r~-../)~.*~.. Phone No.~'.z¥ Name of Contractor .~eC~a...../~2'~':~.. ...... Address . . .... Phone No..~.3.5'.~ .~.~'. !."/... PLOT DIAGRAM /, Locate clearly and distinctly alI buildings, whether existing or proposed, and, indicate all set-back dimensions f~6~n property lines. Give street and block number or description according to deed, and show street names and indicate wh~her interior or corner lot. STATE OF NEW YORK, COUNTY OF .......... f S.S ............................ ~ .................... being duly sworn, deposes and says that he is the applicant (Name of individual sigfiing contract) above named. He is the.. ................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is du!y authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the mann!r set forth in the application filed therewith. Sworn to before me this ........... .~. [..z).~.... ...... day o~. ~,i0. 4707878. ~?0~li Cm~l~ ~ (Signature of applicant) ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL · ~OUTHOLD, N.Y. 11971 d .~... TEL.: 765-1802 Examine ~ .~..~... ~.., 19~. q Approved ~ .u~.~...~..-I., 19 ~..~. Permit No.J.~..~.~..L!..~:.. Disapproved a/c ..................................... Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date..~. 2- 7- , 19 ~.g./ a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets 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 or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this 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 shall be kept on the premises available for inspection 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 shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to thc Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspect~~ (Sign~ure of appl~ant, or name, ifa corporation) T/.¢. . . . . . . . ..... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, elec~r!cian, plumber or builder. ...... ............................................................................... Nmne of owner of premises ,.~ ~-'>.~i.~ }ff... '~....©.~. ~..~.. ~ ~ .4 .' .... .~.[.~..~r~.C..I.D. 1 .................. (as on the tax roll or latest deed)~ If applicant is a corporation, signature of duly authorized officer. ............... ....................... (Name and title of corporate officer) Builder's, License I~o..~..~.~..~-.....~. · .... Plumber s License No ......... .\%....77 ..... \ / Electrician's License No ......... .\¢ .......... /\ Other Trade's License No ........ ~' -- 'k ........ 1. Location of land on which proposed work will be done .................................................. ......... ...... ............................. House Number Street ~ Hamlet County Tax Map No. 1000 Section . /..~. ?. ........... Block ....0..~.: ......... Lot....~..~. ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: .a. Existing use and occupancy . ./. ~.D ~ .................................................. b. Intended use and occupancy . ?~4~ ¢ ./4~./..~... 9. ~..~,-/~-,. 752~?~..// ................. 3. Nature of work (check which apl~licable): New Building .......... Addition .......... Alteration .......... Repair .............. Rem6val ............ Demolition .............. Other Work. ;p~..c.l~. ........ . (Description) 4. Estimated Cost % t~l .'~'' , Fee ~ *" (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor..' .............. If garage, number of cars ..... ................................................................... 6. If b~siness, commercial or mixed occupancy, specify natur,.e and extent of each type of use ..................... 7. Dimensions of existin structures if an ' Front...~.g~5' .... Rear ~' ~' Depth...~.~.'.~... Height ............... Number of Stories ... ! ~.~ ................................................. Bimensi ns of sa t e with'alterati add't' Font Rea o me s ructur ons or 1 ions: r ................. r .................. Depth . Height ~' Number of Stories 8. Dimensions of entire new const.ruction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ........... ~. . . Rear ..i ................... Depth ...................... 10. Date of Purchase .. ~/g/.O/~.~/ . ~ame of Former Owner ~ ~ry. ~ .r2.'.~..r9 ...... 1 I. Zone or use district in which premises are situated ................................................... 12. r)oe.s proposed construction violate any zoning law, ordinance or regulation: ............................... 13. Will lot be regraded ......... .'. .................. Will exce~ fill be r~moved from premises: Yes No 14. Name of Owner of premises .~ ~.~--.I t~V~tli.. Address .~.~ J~... ~;¥Y/./.~..'b..o-Z.. Phone No. ~.w~.~. ~(q.... Name of Architect .......................... Address ................... Phone No.... ............. Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all! buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block :number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual sigr ing contract) above named. He is the ....................................................................................... (Contractor, agent, corporate officer, etc.) of smd owner or owners and is duly authorized to perform or have performed the said work and to make and file this apphcatlon; that all statements contained m this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .............. O~. t~. .... day oi ~ 19 .~.~ Notary Public, .,£t[~ a. .... I)[ V0t~' . .~..~ .~../,J.0~.:/I.~/ .... Count~~..~.~ NOTA~'Y PUBLIC, ~ate ~ ~ ~m'l~ '* ............ $?IL L , I S 7'I L L I'I/ A 7'£ t~ .J cJ