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Home My WebLink About13427-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ....... .Z.1.5.0. 0..0 .... Date ...093.qb.e. ?..1.6., .................. 19.86.. THIS CERTIFIESthatthebuilding One Family dwelling & attached deck Location of Property .. l 5.4 5..~/9 9.d.q 1..~.fr..r. .zq ............. :'. ..... House No. Street Hamlet County Tax Map No. 1000 Section 1 07 Block 6 .... Lot 1 7 · 4 . Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore Fried in this office dated 84 13427Z September 6, 19 . . . pursuant to which Building Permit No. September 10, 84 dated ............................ 19..., 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 ......... One Family dwelling with attached deck The certificate is issued to Edward Slaga (owner, ll[&~'g ~f~4t~}~ of the aforesaid building. Suffolk County Department of Health Approval 1 4 -S 0- 1 6 8 N753910 UNDERWRITERS CERTIHCATE NO .................................................. Plumbers Certification dated June 2_~0, 1986 Building Inspector Rev, 1/81 FOB, M NO, ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13427 Z Pe~ission is hereby gronted to: at premises located at ...~.,~.,~,. ...... ..~,.~..,,.~,~lJ~ ....... ~~ ............... pursuon, to oppllcotion doted ..... ~r~xT~......~.-- - ......... , 19..~...~., ond opproved by the Building Inspector. Fee $., !..,~,.?..",,~ .... Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Bu ilding Department Town Hall Southold, N,Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted --~ 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. 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,. 0 0 3. Copy of certificate of occupancy $1.00 5. Updated C.O. $15.00 Date ......... New Cons truc %ion Old or Pre-existing Building Vacant Land Location of Property . /;f/~ ~ L).~/./. ~-~.. ~..~. ...... /~ .~/./.~./- )- [... .....~'~/(f'/~. ~-.~:~*~,, ~.~,,.. House No, Street Hem/et Owner or Owners of Property .......................................... Cou nt~'T~x Map· Nd.' 1000 Section Block Lot Subd v s on.; ";.... ...... Filed Map No. .Lot No. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Applicant .......~'~ ....................~--- ~ Rev. I0-10-78 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 ~(plea~e prznt) Plumber ~,~.'~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber' s signature) Sworn to before me this 19 ~ / ~otary Public R~GINA Ik MAT'rt.,IF,~NS Notary Public County NOTARY PUBLIC, $~o~e of New No. 52-4636665, Suffolk County THE NEW YORK BOARD OF FIRE UNDERWRITERS 10UU66:~ ~[ BUREAU OF ELECTRICITY [.4 86 JOHN STREET, NEW YORK, NEW YORK 10038 June lJ.~ 3385 ..,. ~.~,~.,,o. ~. o,,~.. N 753910 THI~ CERTIFIES THAT only the electrlcaJ.eaui~me~s descrlb~d bel~a~ introduc~ by the a~licant na~ed on the able aoolicatJo~ n~nber in the ~remises o in the following location; [~ Basement was examined on ,}uae 05, 1986 FIXTURE FIXTURES OUTLETS SWITCHES FLUORESCENT [] 2nd FI. ~ Section Block Lot and found to be in compliance with the requirements of this Board. RANGES OVENS EXHAUST SYSTEMS NO. OF FEET E R V I C A.W.G NO. OF HI-LEO A W.O OF CC COND OF HI-LEG NO O~E~COND. OF NEUTRAL ~ox Laurel, M~ 11948 Per ~~z~~w~m~m~~Thiz cerfific~le mvsl nol be ohered in ~ny monner: re~orn to the office o~ Ihe 8o~rd FIELD '~ INS?ECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL COMMENTS ADDITIONAL COMMENTS: 765-1~02 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: DATE 7GS-Z802 BUILDING DEPT. INSPECTION []FOUNDATION 1ST []FOUNDATION 2ND []FRAMING [ 'REMARKS: [ ] ROUGH PLBG. ] INSULATION ] FINAL DATE ,- * ~' ,~"FOI~MNO. 1 , ' TOWN OF SOUTHOI. D ,' ,: .. BUILDING DEPARTMENT TOWN HALL ,. $OUTHOLD, N.Y. 11971 TEL.: 765-1803 }isapprovcd a/c ..................................... ............................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ,19... a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sts 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 this apphcation 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 aall 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 .~all have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Departme.nt for the issuance of a Building Permit pursuant to the ,uilding Zone Ordinance of the Town o.f Southold, Suffolk County, New York, and other applicable Laws, OrdCmnces or '.egulations, for the constraction of buildings, additions or alterations, or for removal or deznolition, as herein/described. 'h~ applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulatk~ns, and to dmit authorized inspectors on premises and irt building for necessary inspections. ~ ...... ............. (Signature of applicant, or naeme, if a corporation) (Mailing address of applicant) ;rate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . .......................... f 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 ...................... Location of land on which proposed work will be done ....... 5~,'i i i .".... '... y. ¢ii .... ':.. ]': .................. House Number Street Hamlet County Tax Map No. 1.000 Se~ction ..... /..~..'7 ........ Block ......... (P. ........ Lot. J '~' Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... i .~)....o-~k-....o:?~..'~.. ................................................ b. Intended use and ocCUpancy . ~.dCc.~):...'c~t7 . ...... ' ')"~;~' '~ddi 3. Nature of work (check which applicable): Ne~ Building .......... t/on .......... Alteration .......... Removal ..... Other Work Repair .............. .............. Demolition ............................. · ~ : ,'~, "' (Description) ' 44'?. ? , " Fee 4. E~timated Cost ..................................................................... '~- (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits ... ill ....... Number of dwelling units on each fioor If garage number of cars i ~ ' 6. If business, commercial or mixed occupancy, specify natu,re and extent of each type of use .................... 7 Dimensions of existing structure~, if any: Front ' Rear Delbth Height ............... Nun~ber of Stories ....................................................... Dimensions of same structure w~th alterations or additions: Front Rear Dept ' .ei t i Stories 8. Dimensions of entire new construction Front ..... ~ .(e ...... Rear ............... Depth ' /..~. Number of Stories Height 9. Sizeoflot: F~ont .......... .~.~ .......... Rear ..... 2 ................ Depth ...................... !0.' Date of Purchase ...... /.~ ................... ~,tt Name of Fenner Owner .... * ........................ ~ I Zone or I .... ~ ' , . ~se distnct in which pr~mises are situated .................................................... 12. Does proposed construction violate, any zoning law, ordinance or regulation: ........................... t 3. Will lot be regraded ........ ~..'/~Z.'...,, ,~ ....... Will excess fill he removed from premises Yes No 14. Name of Owner of premises..~-A.~.~.-~Adclress .~.~,~.~ ..... Phone No. ~ .~..% ~. ?~..~.. Name of Architect ...................... f ....Address ................... Phone No ................ Neane of Contractor ' Address Phone No · :' ' '"" ; PLOT DIAGRAM Locate clearly and distinctly all! buildings; whether existing or proposed, and, indicate all set-back dimensions from ~roperty lines. Give street and block humber or description according to deed, and show street names and indicate whether nterior or comer lot. ;TATE OF NEW YORK, 'OUNTY OF ............................ .................... being duly sworn, deposes and says that lie is the applicant (Name of individual signing contract) bore named. Ie is the ..................... (Contractor, agent, corporate officer, etc.) ,f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication; that all st0~ements contained in this application are true to the best of his knowledge and belief; and that the turk will be performed in the manner set forth in the application filed therewith. ;worn to before me this 1 lotary Public ...... ~ .~....~).~..' .~.tg~......-. " .. County ¢[I [Iq Kj, O~ V0[ ,~. ~ ~0lflRY ~[; lug, ~ate vi New ~mg ......... ~. , ., .... I',,~ ~f~,r~ ~,~arcl, 30. ls~5~ (Sig~turo of applkant) c~ 4, Il ~) 2O 8