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HomeMy WebLinkAbout13410-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate O[ Occupancy THIS CERTIFIES that the building ..... .Dp. qt.<..a.d.d. 5. .g.~.o.n. ........................... Location of Property 575 Tarpon Drive Southold County Tax Map No. 1000 Section ..... 0.5.2. .... Block .... .5 .......... Lot ...... 6. .......... Subdivision .S. 0..U.T.H.Q~..D..S.H. 0..~.~.S ............. Filed Map No........3853 .Lot No. .......4 9 ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... H g y..3 fi. ........... 19 .~. ~. pursuant to which Building Permit No...1.3.3. 6. .2 .g ............. dated ....~.a. y,..2.6. ................. 19.8.~., 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 ......... .... De ck .a 0 ~-.t.J, 9 ~..t.~. ~<.~ ¢ ~p.g. ~w.e.~ ~. ~-pg .. .................................. The certificate is issued to ......... ~p.B.E. ~.T..~. ,L.I.N.D.~.. b.~4C. I.~.E.N. ....................... of the aforesaid building. Suffolk County Department of Health Approval N / P~ UNDERWRITERS CERTIFICATE NO .................................................. Rev. 1/81 Building Inspector TOWN OF Sou'rHOLD BUILDING DEPARTMENT TOWN HALL · OUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) County Tax Mop No. 1000 Section 0~'~ Block ........ ~ .........Lot No. ~ " .~ . 19..~...~.., approved the pursuant to application dated ............ ..~. ...................... and by Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This e¢plicstion must be filled in typewriter OR ink, and submitted m laaaaaaa~a 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-iS-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 "pm-existing" land uses: 1. 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 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 $15.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5.Updated C.O. $15.00 Date .......................... New Building ............. Old or Pre-existing Building ...~. ....... Vacant Land ............. Location of Property . ~..7..~. .... '.~./?.~./'..~.~t?...~. ~/..~.~ ...................... .~..~..-¢,~.~..~.~... House No. Street Hamlet Owner or Owners of Property .... /~. ~...~. ~ .~..?....~.-....~./.'~..4 ~ ...... ~ ./J..5~..~., .'~. ....... County Tax Map No. 1000 Section .... ~..~'.~. ...... Block .... ~ ........ Lot ..... .~, ......... Subdivision....-~..~.7./(..g.~. ~ .... ~-~('¢).~ .~..-~...Filed Map No...~..~.~/.~...Lot No.., .z./f ........ Permit No. ,J.&. !.~ .~. ~ Date of Permit .(.~..~. ~...~plicant... z~./~'~:'~', ./~'.~¢ 1~..~..~,~. ...... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval Planning Board Approval Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. Applicant .... ~...~.,¢(¢~.'~ .'~.... ~..*~../~. · .~'. · .~. · ..................... 1000121 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY THIS CERTIFIES THAT only the alee trical eouipment ~ ~scribed be~ a~td introduced.by ~ a~rtt ~amed o~ t~e o~OVe application number ~n the premises of Robe~ B~a~en, 575 Tarpon Dr. and found to be in compliance with the ?equirements of this Board. FIXTURE OUTLETS ~ECEPTACLEE SWITCHES FIXTURES RANGES ~OOKING DECKS OVENS DISH WASHERS EXHAUST FANS DRYERS SYSTEMS OTHER APPARATUS: RelocaCe lOOamp sezvice, S E 213 & OF HI-LEG OF NEUTRAL To~n Ha~bo~: Lane p $ouchold,lq.Y. 11971 11c.2821~ O]L~ANAOiER This certificate must not be altered in any manner;, return to the office of the Board if incorrect. Inspectors ma~ be ~i~y their credentials, cOPY FOR BUILPlNO DEPARTMENT. THIS COPY OF CERTIFICATE MgS~NOT BE;;~'LiERED IN ANY MANNER - F~LD ~NSPECTION FOUNDATION FOUNDATION 2. ROUGH FRAME & FLUMBING INSULATION FERN. STATE ENERGY C,ODE (1st) FINAL COMMENTS (2nd) ADDITIONAL COMMENTS: ! APP~OV.'~D AS NOTED NOTIFY BUILDING DEPARTMENT AT 7~5-1802 9 AM ~O 4 PM FO1~ THE FOLI OWING k~c'~ T · , .-,,C IONS. 1. FOUNqATION - TWO R~LJIRED 2. ROUG!t . FRAMING & PLUMBING 4 F!~'*~ "'q~':'"~'"'!qN MUST All ¢ "'r'¢~ON ?'Al.l_ MFEF , 'r THE N Y STA~-r C~'c~PxljCq-k ~N ,~ FNFRG'¢ COPF fi. N~T RF;SPONS1BLE DE~ O~ CONSTRUCTION ERROR~, ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved .~.~..~.., 19~.t\ · Permit No. ] .~..~ .~.~.... ~ , Disapproved a/c ...................... ............... c~~ ................................ · .......... APPLICATION FOR BUILDING PERMIT -' [ / Datek'/ ....... ~./d?. ..... 19 .~.~. 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 st'~eets 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 Bnilding 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 ~a~t~g.e~nl[0~il~all~[~icable laws, ordinances, building code, housing code, and regulations, and to admit authoriz]~/[~t~es ~ building for necessary inspections. uuum m,,,, ,,,, ..... USE IS (Signature ofapplicant, orname, ifacorporation) .................. WI/~'~ Ii (Mailing address of applicant) State whetller fli~icflfl~A~nt, architect, engineer, general contractor, electrician, plumber or builder. Name of owner o f premises .../~,4 Z'...~.../-.4-~. 4~... ~..~.,~.~ .,~.~..~x. ...................................... (as on the tax roll or latest dAq~2~C ',"3 AS NOTED If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No.. ~.~ Plumber's License No ......................... Other Trade's License No ....................... FEE:_~_, ,_"_. BY: ___~,.__~. NOTIFY BUH-DING DEPARTM~-NT AT 76§-~802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: l. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - C~N'STRU~'d~N M'!ST BE C~F~P~ ~TE FOR C O. ALL CONST~JCTION SHAI.L 1. Location of land on which proposed work will be done ................ .T.H.E., .R.E9! t.I .Ri:,. ~.E'.~TS. OF..T.h.. bl. X... STATE CONSTRUCTION & F · .~..75'. ............. £~g/.~,,v/.. ~b~./~ ...................... . ._0~...t~..e..z~..Z..~P. OUS~L~..r.q~,., ttouse Number Street DESI,q~Der~ CONSTRUCTION ERR©qS. County Tax Map No. 1000 Section ..... .J~..~ .......... Block .... ~.. ........... Lot .... ~ .~. ......... Subdivision.._~0.O7'g/0/~2~ .-~.~q¥,-3' ................. Filed Map No. . .J?.ff..~ ....... Lot ...6J. ]. ......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ... ~q.t~m,6~_... dg'.~./44~. ............................................... b. Intended use and occupancy . .4'¢,qJ~4v~.4. ~q~.~../4z- 8. Dimensions of entire new construct/on: Front ........... : .... Rear ............... Depth ............... te~glat ............... Number of Stones ........................... 9. Sizeoflot: Front ..... /.~.. ! ........... Rear .... 10. DateofPurchase ..~.//.q~i ............. Name of Former Owner , . . I I. Zone or use district in which pr~mises are situated ..................................................... 12. Does proposed construction vio!ate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ ~ ................... Will excess fill be removed f/5~n~,remises: Yes .N.o 14. Name of Owner of premises ~°~'F,~'.~..z~z~.4~. ~A, ff.~/ct~dress 3;l-.4/.r.~./~443~.~.,.~..'~bne No..~. ~.-..~ff'4'~.,.g .... Name bf Architect ......... i ................. Address ................... Phone No ................ Name of Contractor ........ 4 ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly ail! buildings, whether existing or proposed, and. indicate ail set-back dimensions from property lines. Give street and blockinumber or description according to deed, and show street names interior or corner lot. 3. Natureofwo, r/l~(check which applicable): New Bulidmg ..... ' ..... Addition .......... Alteration ~ ....... Repair . .. ~ .. '~t~ ' ' ' Remgvai .............. Demolition ... ~j/ ........ Other Work ............... 4. Estimated Cost ~" (to be paid on filing this application) 5. If dwelling, number of dwelling iunits .... ~ ....... Number of dwelling units on each flo~ ..... If garage, number of cars .... ,g. ................................................................ . . 6. If business, commercial or mixed occupancy, specifynature&ndextentofeachtypeofuse ...,.- ................. 7. Dimensions of existing structur{s, if any: Front .... ,ff~./. .... '... Rear ... ~.~'~'. .... Depth .. '~.~../ ......... Height ~/~./. Number of Stories Dimensions of same structure with alterations or additions: Front ..... ~. 0'./. ....... Rear ....~.~'../ ........... I)epthl ..... rZ~?.~. i Height.. .......... · 2.4{. ................ Number of Stories ...,~././Z,- .............. and ind!~,~ ~whether ~ATE OF NEW YORK, COUNTY OF . .ff~.& ........ ..... ~..q~.~..x'.r'....~4~.~4-~. ......i .................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) _ above named. He is the.. ~4/~t~ ............. i ................................................................... I (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dui3/ 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 manne~ set forth in the application filed therewith. Sworn to before me this : · 0101rM~lt RIB[I& State ot Neg, yo?/~ ............................. I~. 470?878, su~01~ Com~ ~ (Signature of applicant) Tg. rm Expires Marcl~ 30, 19~-5