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HomeMy WebLinkAbout13408-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z15115 Date November 20 -- 19 ~ THIS CERTIFIES that the building ... ~..Z.t.~ .~.a.t.J,.q .n ................................. Location of Property .... 1..2.9.5. Highland Road Cutchogue House No. ' ................... 'S't/e~i .................. Hamlet County Tax Map No. 1000 Section .... 1. Q .2 ..... Block 0 8 .Lot 4 .. ' Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... A~.g.... ~ 2 ......... , 1,.9..8.4pursuant to which Building Permit No..1.3. 4. .0.8.Z. ............. dated .... Sep.t,. ~ ................ 19. ~.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 ......... Construct bedroom area from attic storage. The certificate is issued to Frank Mele (ow. er, of the aforesaid building. Suffolk County Departmeut of Health Approval UNDERWRITERS CERTIFICATE NO. N 6 619 7 4 Plumbers Certificate Nov. 17, 1986 Rev. 1/81 l~O~t~ NO. ~ TOWN O~ SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTitOLD, N. Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: _ C ~ ,o..~~....~....~ ..........~-~ ...... .o~.':'~ ....... .~..~ at premises located at ...... 1.~,.~..~. ......... ~L...o~.,.9~...,....~.... .......... ~.....~~ ......... .................................................................................... ............... County Tax Map No. 1000 Sechon .... .~ ................. Block ...... ~ ............ Lot No ........ ...~. ............ pursuant to application dated .... ~.L:~..~.......~.~ .............. , 19.~..~. ,, and approved by the Building Inspector. Building Inspector Re~ 6/30/80 FORM NO. 6 ~TOWN OF SOUTHOLD Building Department. Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This ai3piication 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, Mull;iple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect o~ Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to Aprj.I 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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 or land use $5.00 3. Copy of certificate of occupancy $1.00 Date.. O_~T New Building ............. Old or Pre-existing Building(X) . -..~'~-. -- . XVacant Land Location of Property .......................... ~I-J~PBJ~ RD. , .. O_A.t-r.c-~.~.Gd.~.. House No, Street Hamlet Owner or Owners of Property . ~:~I~AN ( ('~ ., .J. 0. c~. ....... Block ....0.~ ........ Lot .... O. ~.~;/~ ....... County Tax Map No. 1000 Section Subdivision ................................. Filed Map No ........... Lot No ......... No. ~.'~..~. ~¢..~... Date of Permit --~i .P~..~...Applicant...~.o.l~b.~.. ~..O.(~.~.q ................ Permit Health Dept Approval Labor Dept Approval ' Request for Temporary Certificate ..................... Final Certificate · Fee Submitted $ ........................ Construction on above described building and permit~meets all app~i,cabi~codes and regulations. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 86 JOHN STREET, NEW YORK, NEW YORK 10038 T.,S CE.T,~,ES T.^T'~' ]"~ ~..lica.o..No.o..fi,e 2885~/~ N 661974 only the electrical equipment ~ described below and introduced by the applicant named on the able application number ;n the pre,rises of Fl~k ~le~ 1259 Hi~l~d ~ad~ ~tcl~g~e, N.Y. in ~he yotlo~n~ Ioc~io,; ~ B,se,nen~ ~ ;s~ Fl. ~ ~,d FI. Section Block Zo~ was examined on ~ll~l* ~9 1~ and found to be ia compliance with the requirements of this Board. FIXTURE OUTLETS RECEPTACLE~ FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS SWITCHES FLUORESCENT VAFOI~ 3 DRYERS FURNACE FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLE SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: S E R V I C E AW, G, NO OF NEUTRALS A.W.G. OF NEUTRAL OF HI-LEG Paul ]~rns Town t~rhor Lm~e Southo].d~ N,Y, 11971 Lic. 2~ This certificate must not be altered in any manner; return to the office of the Board if Jnco?rect :)R ENT. THI ~E 'IFICATE I may be identified kNY MANNER. TEL. 765-1802 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 CERTIFICATION Building Permit No. Owner_ ~[~ ~ ~ ~ i¥~ g A (please print) (~16ase print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this I'? d~ of ~- , Notary Public, _ ~~ County ber s Signa Notary Public F1ELD INSI~ECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY G~ODE FINAL ADDITIONAL COMMENTS: 477-1095 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tins application must be completely filled in by Wpewriter 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 stYeets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this al?pli- 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 ~nd in building for ~ecessary inspet~on~. > /9 (Sig~ure of a~plicant, or name, if a corporation) .s..~..~.... £.o?..~....~ .~..~..m~...o~. ~: y.... .... (Mailing address of applicant) ~ ~/3 ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................... .Gc~ .e-¢.~ .~...¢~' .o~.T~.~.~..~..~. .............................................. ~L~ Name Of owner of premises ....... .~.~..~.~ !~. ........................................................... (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 ..... .~. ~.0 ................ Plumber's License No. :i.e. ~.~.O. ......... Electrician's License No....~o~tJ.. ~. ~ r.n R ....... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ...... t ~ .~. 5 ............... /~ ~ ~. ~c~.~.. ~o.~ .................. .C.~ T:.c .~--o.~ ~. ~. ............. House Number Street Hamlet County Tax Map No. 1000 Section .... 3.~)..~w'. ........ Block ...~..~' ............. Lot..©.O..~. ............ 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 ........ .O..~..~... ~'' b. Intended use and occupancy ......... /~T.7~ .ct... ~..6.~J~.../.~ .... ~..~.D..../~.. { .... .~1. {. ~.~. ~ ...... Date ................... 19... I~ ~ k ( h k whi p~l' ); ~ Additi 3. atureofwor cec ch a lcable New Building .......... on .......... Alteration ..... Repair .............. Removal .............. Demolition ............... Other Work ............... 4. Estimated Cost ........ ff ~ ~.-Q ~'~'-~ Fee .~.~. -~, ~..fi/.. . (Description) , *" (to be paid on filing this application) 5. If dwelling number of dwelling ~nits ........... .... Number of dwelling units on each floor ................ If garage, humi~er'of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Nun}ber of Stories ....................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ..... i ........... i · Depth ................. ,~ ..... Height .......... .~ ........... Number of Stories ............ t .......... 8. Dimensions of entire new ~?a:c,n: Front , . t ~....q .... Rear .............. Depth ...I.I.-: P. '.'. ..... Height ............... Number of Stories ...................................................... 9 Size of lot: Front ' Rear Depth 10. Date of Purchase ........... i .................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction vioiate any zoning law, ordinance or regulation: 13. Will lot be regraded ......... i ................... Will excess fill be removed fro~ premises: Yes , No 14. Name of Owner of premises . .'~.?..rt.a(...i.e..~..~.-t.q~.. ..... Address . ~. Otc../.o..~.~.qTq~.u.ePhone No..7.3..~.7 Name of Architect .... ,~+~. · .i ................ Address ................... Phone No ................ Name of Contractor d ol-b4... ~.' .~,Q ........ · · · Address .~T/gt~. l~thO ....... Phone No.. ~.7 ?:.!.°. ~ $-f... PLOT DIAGRAM Locate clearly and distinctly alli buildings, whether existing or proposed, and, indicate all set-back dimensions from interiorPr°pertYorlineS'cornerGivelot.Street and blockinumber~ or description according to deed, and show street names and indicate whether '- ~ ~ · ~ ~ Z " ~*ft~%~ ........ , , S.S H ........................... ; .................... being duly sworn, deposes ~d's~ys that he is thc applicant (Name of individual sigping contract) above named. : He is the ..................... ~ ................................................................... ~ (Contractor, agent, corporate officer, etc.) of said owner or own~, ~d is duly antho~zed to perform or have performed tim said work and to m~c and file this application; that all statements cont~ncd. ~ this application are true to th~ best of his ~owlcdge and belief; and that thc work w~l be pcrfo~ed in thc m~n~r set forth in thc application filed thcrcwith. Sworn to before me this .......... .... .... con,t, No 4707878, Suffolk ~0tmty~ (Signature of applicant) Tern Expires March