HomeMy WebLinkAbout13456-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z13644
Date ............ .~.u, 1, y, .1,7. ............ 19 ¢.5.
THIS CERTIFIES that the building ...... qq .e .-.f.a.m..i.ly..d. ¥.e.l.!i..ng.. ...................
Location of Property . .9.8.5. ......... Sou t.h,v i ew D r. 0 r i e n t
House No. Street Ham/et
County Tax Map No. 1000 Section ..... ~..3 ..... Block ......... .3 ..... Lot ..... 5.: J .........
Subdivision ............. .x ................. Filed Map No....x ..... Lot No ...... .x .......
conforms substantially to the Application for Building Permit heretofore filed in this office dated
...... fi.u, g .u .s.~.. 3. .0 ..... 19 ~..4. pursuant to which Building Permit No .... 1.3. 4..5.6.g. ...........
dated ........... .S.e.p.~.e..m.b.e.q..2.6... 19[}. t)., 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 .........
.... 9.n.e.r .f.a.~A!y...dy.e. ~..~.~.n.g: ....................................................
The certificate is issued to ............... .E.D.W. ARD & DORIS LINKER
(owner, ~X~t~O~'
of the aforesaid building.
14-S0-159
Suffolk County Department of Health Approval ..........................................
N699485
UNDERWRITERS CERTIFICATE NO ..................................................
Building Inspector
Rev. 1/81
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
CTHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 13456 Z
Permission is hereby granted to:/ -- / ~
...... ~/~.~......&~..~.o......~, ....
.... ~.~.: ....... .~ ......... ~..~ ..................
,o ...... .~/~.~.~.~.......o.~.~ ...... .~..~~......,..~z.,.~...~.~...
........... z~~....~......,~%~......Z~.~~ .........................................................
at premises located at ......~/.~...~..'~... ........ ~..~.~...~//~'J~'~...../~.~.* .................................
............................................................................................................ ~.~.~.~.....~.. ............
County Tax Map No. 1000 Section ..(~.../,.~.. ......... Block ....(~....~. ........... Lot No. ~.~..'~'..'.(. ....
to application dated ..... ~.~;~Z.,,~,,..~..~, ............. ,19.~ and a~rov~ by the
pu~uant
/
Building Inspector.
Rev. 6/30/80
FORM NO. 6
TOWN OF $OUTHOLD
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:
1. Accurate survey o{ 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 / land use ~/ ['5.00
2. Certificate of occupancy on pre-existing dwelling
fr
3, Copy of certificate of occupancy $1.00
Date J~..~-,~...(.~..[ .~.~.~'. · ..,
New Building . ~ ........ Old or Pre-existing Building ............ Vacant Land .............
Location of Property .......... ~.~ o ~"~ .*~. ~ ~ ~,~,~ ~. {;~, . ~..~, ).~..~..-~; . .~. :y~.~..
................................
House No. Street Ham/et
Owner or Owners of Property ~ .~,~'~ ~'
County Tax Map No. 1000 Section .. ,(~.l,~, ....... Block .... ,~. ......... Lot ................
Subdivision..~.0,..o..,~...~...~... ~. (, .~. ........ Filed Map No ........... Lot No ..............
Permit No.l$. r Kb. 9ate of Permit ~.~.~.~/.J.~?A~pplicant .L.I. ~,.O...~..~. ,1~.%.~...~-. ?...~? ,,. ....
Health Dept. Approval ~OL..~t/ ~'.~ ~¢~. ~' ..... Labor Dept. Approval
Underwriters Approval ........................ Planning Board Approval ........ · ..............
Request for Temporary Certificate ..................... Final Certificate ......................
Submitted .......
Construction on above described building ~u3d peri, it meets all applic~able ~odes and regulations.
Rev, 10-10-78
FORM NO. 6
TOWN OF ~OUTHOLD
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-exi~ting<_
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/ land
3. Copy of certificate of occupancy $1.00
use--Pre-Existing C.O. $15.00
Vac~ land C.~0~$ 5.00
Date ././., ,C~, ,'~, ?, ~ ,~.. ,--~,...~. _~.
New Building ..... --,'..~, .... Old or Pre-existing BuildiQg ... ~ ..... Vacant Land
Location of Property ..~.. ..... ~ ...... /.~.~--.~,..~.~..~.~; .........................
Owner or Owners of Prope~.~ ~. ~~~C~ ........
County Tax MapNo, 1000 Section,.,.~ ........ , Block .... , Lot,,.,
Subdivision.... ....... .~.. le~ .]~/~T ..... Lot~No.
Permit No ........... ' ....... ~'.- pp' ~/.( .......................
~ Labor Dept Approval
Heakh Dept. Approva~ ..............................................
Unde~ritersApproval,,,, .............. .,.,.. Planning Board Approval
Request for Temporary Certificate ..................... Final Certificate ................
Fee Submitted $ .............................
Rev, 10-10-78
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
CERTIFICATION
TEL. 765-1802
Date
Building Permit No. I~S&
(please print)
(please 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
~ day of ~u[~[ ,
19 ~.
Notary Public,~%~/~ County
~[Jsozx THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
~ O~L 85 JOHN STREET, NEW YORK, NEW YORK 1OO38
.a~e ~ ~' ~ ~p,,~.,,~,,~.~n~,,~ ~0~4 N 699485
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the ub~e application number in the premis~ of
~d ~', ~. Vi~ D~ ~t ~ ~1, Ori~ ~ ~
inthefollowlnglocation; ~ "asement ~ lstFI. ~ 2nd FI. Section. Ol~loek Lot 51
J~ ~ ~ ~ ~85 and found to be in compliance wi~h the r~quirements of this Board.
FIXTURE
OUTLETS
64
DRYERS
SERVICE DISCONNECT
FIXTURES
RANGES
K,W
~PECIALREC'PT
R
COOKING DECKS OVENS DISH WASHER
.85 : 7.3 L .2
TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLE
· NO. OF FEET
V I C
EXHAUST FANS
DIMMERS
OTHER APPARATUS:
EQUIP.
1-3/4 Hi~
2-~az~ Detector
Lightn~j g'-0" - 4-iit~s
OF CC COND.
INO OF HI-LE(
AW, G,
OF HI-LEG
NO. OF NEUTRAL!
AW, O
OF NEUTRAL
4/0
3327
This certificate must not be altered in ony manner; return to the office of the Board Jf incorrect. Inspecto~rs
LDING
GENERAL
Per
may be identified
FIELD~INSI~CTION
FOUNDATION (1st)
FOUNDATION (2nd)
2.
ROUGH FRAME
PLUMBING
INSULATION PER N. Y.
STATE ENERGY
C?DE
FINAL
o~ ~E
COMMENTS
ADDITIONAL COMMENTS:
t=ORM NO. a
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N.Y.
NOTICE OF DISAPPROVAL
PLEASE TAKE NOTICE that your application d.~ated.., d~..~ ..... wtST~..~ ..... , 19~..~.
for pe~it to ~OO~*~. OO~. ~~ .(~~ .......... a~
County Tax Map No. 1000 Section . ~. ~ ....... Bloc~ ...~ ~ .' ......
~ Filed Map No ~ Lot No
Subdivision ...................................................
is returned herewith and disapproved on the followMg gro~ds~.~..
. . o . . . . %.ae
76S4802
BUILDING DEPT,
INSPECTION
[~/FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
DATE /o///~/~/
INSPECTOR
76S~X802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[~J/FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS: ,,
DATE
INSPECTOR
FORM NO~ 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N,Y. 11971
TEL.: 765-1802
]sapproved a/c ~
APPLICATION FOR BUILDING PERMIT
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 Bttilding 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 i~pect~ns.
(Signat.urq of applicant, qg,u_ame, j,f_a corpgration)
·/¢.o. ....
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.................... . . . . q. ?.. .o. .o.:. : ..........................................
Name of owner of premises ~ ~.O-t. ~%~a.¢~>. .~..~..o..~f.$...~..( .~t..~..~..~ ......................................
(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.. · .]'4(~fi..-...g.o?.~..~.a./-..~. ....
Plumber's License No....~..q..~...-..? ............
Electrician's Liceuse No.. ~..~..?.-. ~ ...........
Other Trade's License No...-m. ..................
1. Location of land on which proposed work will be done..'~/~. :..~77:. ?.~.~.4..tg.l.~. W-......~..Ig..l y.~.. ..............
........ . .......... .o.. ¢'.,.,?.'T.. .... ..........
House Number Street Hamlet
County Tax Map No. 1000 Section .... . .~....(~f.~.... Block . ..~. .............. Lot.. ~ ./. ............
Subdivision·..~..~..O..~..~. ~.... ~.d ~Z.~ .......... 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 ........................................ · .............................
b. Intended use and occupancy .O..)~..~-....~.~?.'-?./.~..~... ~..~f.~..b.~./(~..~. ' ;' "~'
3. t.ur~ o~k (check which applicable): New Building .... : Addition .......... Alteration ..........
"~?Repalr' .....~ ..... .-¢ ....Removal ........... Demolition Other Work ........
(Description)
~" ' ' i ............... . (to be paid on filing this application)
5. If dwelling, number of dwelling ~nits ...... ~7. ......
· Number of dwelilng units on each floor~....-. ?.. ~..~..O.,.
If garage, number of cars ..... i~. ..............................................................
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 I .............. Number of Stories ........ : ..............................................
i~h alterations or additions: Front Rear
Dimensions of same structure w ..................................
Depth .................... ,.. Height .......... ~. .......... Number of Stories ............ ,~ ........
8. Dimensions of entir~ new construction: Front.· .~'.O ......... Rear·..~. .......... Depth .~.~. ..........
Height . .. ~ ~. ........ N. uml)er of Stones .... .,f~ ........
_
10. Date of Purchase .... /~.~,.~ .................. Name of Former Owner .............................
11 Zone or use .... ' ' '
· d~stnct ~n which premises are s~tuated .....................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: .../~. ~. .........................
13. Will lot: be regraded ..... P/~. ................... Will excess fill be removed from premises: Y_es
PLOT DIAGRAM
Locate clearly and distinctly all ibuildings, 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,
COUNTY OF .................
~S.S
..... .~.~ ~.., ,~ ~. ~.-~..,~A$,~!. ~..,~. ............... being duly sworn, deposes and says that he is the applicant
(Name of individual sign'ing contract)
above named·
He is the ......... ~.~ ~.~. ~*~.o.I, .o. lq- ....................................................... .......
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
applicationl 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 manner set forth in the application filed therewith.
Sworn to before me this
........ ,-~,~..~q'. ..... dayo~ .~ ....... , 19 ~.
....
: I ~ot~?t~l(~ ~ ~ Ne~ Y0r~ ...............