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HomeMy WebLinkAbout12984-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ..... .Z~.3. ?? ~ ...... Date ......... .4~. g.u.~.~.. 5 .............. 19~.~. THIS CERTIFIES that tbe building ..... .~.e.w...d.w.~.~..i.~g.. ........................... Location of Property .. 2.6.5 .............. .B.o.y.., ~.v.~.n.. ~.~.~. ~. ........... B. 9.u.~.h. 9 .l~ ...... House No. Street Hamlet County Tax Map No. 10O0 Section ....8.8. ...... Block ......... .q- ..... Lot ..... ~..5 .......... Subdivision ................ ~ ............. Filed Map No... ~ ..... Lot No ..... x. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ~arch 26 8~ f1298&Z ...................... 19... pursuant to which Building Permit No ...................... dated April 6 1987., 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 ......... l~riva~e one-family dwelling. JA~%ES ~. ~EO The certificate is issued to ..................... /o'~n~) '~ ..................... of the aforesaid building. Suffolk County Department of Health Approval .... UNDERWRITERS CERTIFICATE NO ................... .N.6609q........9 ..................... . Building Inspector Rev. 1/81 ~0~ NO. ~ TOWN OF SOUTHOLD 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? 1295~ Z Permission is hereby granted,t~: .....~_~....~:' ........ ~.~ ......................... ~~~...x~..:~: ......... ~..i.:~.~.....;. ,o ..c~,~.....~......~...~.~.....,.~.~~~ ...................................... at premises I~ated at ..~.~.....X.~.~:,,.~...~~.~~ ................ County Tax Map No. 1000 Section ..... ..¢~....~.~o ...... Block ...... ~ ......... Lot No......C)....)m....~ ......... pursuant to application dated .... ...~.~..~..~......~..~ ................... , 19.~.~., and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold, 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 featu res. 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 wh~re 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 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. 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 House No. Street ~ Hamlet Owner or Owners of Property . '.~..~.~.~.~. ........................................ County Tax Map No. 1000 Section .... ~,~:~ ....... Block .... .,~, ........ Lot...2.~. ......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. /.~..~.~..~. ?. Date of Permit ~//~/.~.~...Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval .... v~. ................... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $. ~: .~, .~..,t~, .fl~., .~' ......... Construction on above descr bed building and ~'~rmit..meet~ a)l applicable codes and ragu lation_~_~_:~--------, . FIEL~D INS?ECTION COMMENTS FOUNDATION { lst) FOUND~T~IO~,I __ _< 2_n_d? ~ 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS 100107! BUREAU OF ELECTRICITY ~ 1~5 JOHN STREET, NEW YORK. NEW YORK 1OO3~ THIS CERTIFIES THAT only the electrical equipment as described below and i~troduced by the appllcartt named on the above application nu tuber in the premises of ~ the followlng location; ~ B.sement ~ 1st ri. ~ 2nd FL Section Block Lot was examined on ~ ~ % · ~J~C ~7 ~ 1~ aapri found to ~e in co~npliance with the requirements oj~ ~hls Board. FIXTURE FIXTURES RANGES OVBNS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT DRYERS S E OI~HER AFPARATUS: ~t)tor~: 1-F. 1-G,~'.C.L 1.-,~{]oke Detector. *Fu'Lur~ Applian~ F~s: 1-2~14~ 1-2~12, 1-~3~ AW, G O~ CC COND 4 : C 4 G ~ S Ele~tric Box 215 ' SoutlDld, N.Y. 11971 Lic, 578 tl Pe~ This certificate must ~ot be altered il~ any mann,r; return to lhe office of the Board if incorrect. Inspectors may be identified by their ~OPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATEM U MANNEH. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ..... , Approved .~... ¢. ..... 19~.~.. ee~i~ ~o. ~. ~.~.~. ~. Disapproved a/c ..................................... (Building Inspector) 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 scaie. 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 Soutltold, 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 codec, housing code, and~regulations, and to admit authorized inspectors on premises and in building for necessary inspection. / _ x/~ (.~ . (Signatu~;edgf applicant, or name, if a corporation) ......... (Mailing address of applicant) //~ ~ ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · .~../:¢..x??..~..-.. _~.z~./~ .z? ~.~. ..................................................................... Name of owner of premises .~',-~....~'...../~../~.-?. .... ~......~./..x~'.~.. .............................. (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. ~,~)... (~.~.$t(-.~.~.... - EIectnczan s Lzcense No. .... . . .~. Other Trade's License No ...................... 1. Location of land on which proposed work will be done ................ . . .. . . r. . . . . J ................ House Number Street Hamlet co~,~ ~ ~o. ~000 Se~o, ..... ~ ~ ........ ~o~ ........... ~ .~ . ~o, ..... 9. ~ ....... 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 .... ~~ ......................... } ........................... b. Intended use and occupancy .. ~.. 3. Nature of work (check which applicable): New Building .......... Addition ........ Alteration Repair' . ............. Removal ............ Demolition ............ Other Work ............... (Description) 4 timat d Co F · Es e s ............. ........................ ee ................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...~../'(~.~. ....... Number of dwelling units on each floor...0..z~.~ .... If garage number of cars ~:?,~'..~'. 6. If business, commercial or mixed occupancy, specify nat, m and extent of each type of use 7. I)imensions of existing structures, if any: Front !( ..... Rear ..... Depth .~ ......... Heighf ......... Number of Stories.... Dimensions of same structure with alterations or additions: Front ................ Rear .......... Depth .................... !.. Height .......... i ' ' 2t ........Number of Stories ......... r .......... ,' · 8. Dimensions of entire new construction: Front .. ~...~..~ O. ..... Rear . .~",~ ~ .~. .... Depth~ P.~..~.~.o. Height .~ .-.~ ..... ~.. Nu ber of Stories .. ~../~ ................................................. 9. Size of lot: Front . ./.. O. ................ Rear .../.o.t~.~ .............. Depth . [l~..~ .............. 10. Date of Purchase /~ .-.]..-. ~.~,~. ................. Name of Former Owner ~.~..w<', ~'~Ate~.~..~'/~-. ~..~'..,~.~'..~(Y- 1 1. Zone Or use district in which prqmises are situated ..................................................... ' 12. Does proposed construction vio!ate any zoning law, ordinanceorregulation:...~/.~. ....................... 13. Will lot be regraded . .~.~'.~;...: ................... Will ~xcess fill be removed from premises: Yes , 14. Name of Owner of premfises ~.,/r(.~O. ~. fiff../~.~. .... Address ~2~,~ ~...~o~..~'.~.... Phone No. ~../..~.'~'~,5.. Name of Architect .~.,. ~..~..~ ................. Address .. '.'. ....... ". ....... Phone No.. i :'..' .... ~ ..... Name of Contractor~.,. A4.~..O 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 humber or description according to deed, and show street names and indicate whether interior or corner lot. _C~>/~ f/x~ ~ ~/4/~Y'~d A(..~.~.j~ STATE OF NE,~ YORK, COUNTY OF ~L ?L .c-.~ .......... (Name of individual sigr above named. - He is the ~ ..... (Contractor, agent,~eorporate officer, etc.) of said owner or owners, and is dui ~ authorized to perform or have performed the said work and to make and file this application; that all statements cont dned 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 th~ /~ i . ............. .2..4 .... ............. Notary Public,. · .~...~ ................ County /1 t i JOEL FEINSTEIN / / ~. /I / //1~ (.,,/ Notarvi Public, State of New York (  ~ No. so-4a4se21 . .,.~,,~y~?//~...//. ......... /..~..~ ...... Qualified In,Nassau County / /' / .... (/ ........ tmgnamre o[ applmant) Ce~. Filed in Kln~ls County ~,. / / .................... being duly sworn, deposes and says that he is the applicant lng contract)