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HomeMy WebLinkAbout13028-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y, Certificate Of Occupancy No,81362.9. .......... Date ............ fl.u.l.y..~.2,~ ...... - .., 19.85. THIS CERTIFIES that the building ... ~ .ri.g?. 9 .u.n.d.. ~..~.5_.m.m. 5:..n.g..p. ? .o .2L.. .................. Location of Property., .... ] ~35..~..H.~?.~...~.~.~.V.~. ............ ,S.O~.T.H..0.L.~. ................. .ouse No. Street Ham/et County Tax Map No. 1000 Section ...0.7.9. ...... Block 03 .Lot 0 7 9 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..h p ~ j..2, . 6 ........... 19 ~3 .4. pursuant to which Building Permit No ..... ]. 3. .0 .2.3. Z. .......... dated .. ~. p r ±/1.. l 2 ................ 1986., 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 ......... .. ,~..ng?.qq .n.d..s.~$.rLm.~n. g' p.q q.1.. .................................................. The certificate is issued to JANET & WILLIAM MARIN (owner, ~' of the aforesaid building. Suffolk County Department of Health Approval N / A ~1667890 UNDERWRITERS CERTIFICATE NO .................................................. Rev. 1/81 Building Inspector FOB~ 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? 13028 Z Permission is hereby granted to: ..~ ~b~ ~ , .......................... ........ ........ ~..~.....~..,...~..~....~.J.~.~...~. ......... ...O..~.~..~L. ~~...~. ~~...~. ,om..~.: , :~.. ~ ~ ........................... at prem,ses located at ...-/.......~...~. ...... ~ ...... J..~.......~.~ ............. County Tax Map No. 1000 Section ...... ~..O....~....cJ ....... Block ....... ...~ ......... Lot No ....... ..,]...Oj ........... pursuant to application dated ...................................... , 1 .. Building Inspector. Fee $.?...~....~..~.. and approved by the Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Bu ildlng Department Town Hall Southold, N.Y. 11971 BLDG. DEPT, TOWN OF SOUTHOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted ia ~ to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of aH buildings, property lines, streets, and unusua~ 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 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 · 00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 Date ...... New Building .~'..L~).O~. !> .... Old or Pre-existing Building ............ Vacant Land ............. Location of Property \~ ,~ O-- ~-~'~"~(~. ~'~3..~.~..~..~.~.~. , .... ~.~.' .~. House No. Street Hamlet Owner or Owners of Property ............................ County Tax Map No. 1000 Section (~ .~ Block ©"~ Lot Subdivision ......................... ' .Filed Map No ........... Lot No .............. Permit No.[..~..~..~.~-... Date of Permit ~!~.~. t~'.~....Applicant .~x.'y.~.~..d~....~-~.. Health Dept. Approval ................ . ........ Labor Dept. Approval ........................ N q.q gq G Underwritera Approval ....................... P~anning Board Approvet ~equest for Temporary Certificate ..................... Final Certificate ....~. .................. Fee Submitted $ .'.'~..~ ...................... Construction on above described building and permit meets all applicable codes and regulations. Applicant .~.. ,'.. ~K~ ........ / J THE NEW YORK BOARD OF FIRE UNDERWRITERS 1000121 BUREAU OF ELECTRICITY ~ jllllO 1~} i~[ 85 JOHN STREET, NEW YORK, NEW YORK 1OO38 ~74485/84 , Date Application No. on file N T..S CE.T,.,ES T.AT 647S90 only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of Wtlliom M~rin, 1635 Ship Drive, Southold, NoY. in the followlng location; [] Basement was examined on Juno 198~ FIXTURE OUTLETS ~ECEPTACLES DRYERS [] 1st FI. [] 2nd Fl. (~A~Si~ Section Block and found to be in compliance with the requirements of this Board. Lot FIXTURES RANGES OVENS EXHAUST F SYSTEMS FLUORESCENT S E R V I C NO O~ECRC~COND, A W, G, NO OF HI-LEG A W, G. NO, OF NEUTRALS A. W G, OF CC COND OF HI-LEG OF NEUTRAL OTI~R APR~R~,TUS/ ~yi,,~_G i~OL: '~his cer~i£icat~ covers cc~pli~uce at the da~e of iuspec~ior~ ~ily. B~Jcau~ of ~k~u~l environ~,~nts it is advi~le to have frequen~ tes~ and/or repairs m~de by a qualified person. FIELD INSRECTION 1. FOUNDATION { 1st) FOUNDATIOn! 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C~ODE FINAL COMMENTS ADDITIONAL COMMENTS: FORIVI NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GL£RK'S OFF~C,E SOUTHOLD, N. Y. Disapproved a/c ............................................................................................ Application No ................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter or.' in ink and submitted in triplicate 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 ofproperty must be drawn on the diagram which is part of this application. 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 issue 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 pa rt for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Departrnent for the issuance of e 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 and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general cantroctor, electrician, plumber or builder. .................... ........................ .......................................... , .................................................................................. Name of owner of premises ..... ~.~/..!..(..(....~..~ ....... .~,t~.....~....~..../..~q ........ ,..~.....~....: ....................................................... If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) Builder's License No ..................................................... Plumber's License No ........... .~....0~.. .............................. Electrician's License No. y~Ck~ Other Trade's License No ............................................... .-~ Location of land on which proposed work will be done. Map No.: ..... .~.~L~.~.. .................. Lot No ...... ~..0[. ~ ............. Street and Number .'~..]b.~).~....~..~)i~...~.Y'.~j....,~c.,~TT~/.(~ ...................................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ............. .O.~...~¢2~D~'LI-.(~ ~F-.~.i~ ................................................. b. Intended use and occupancy ............ ~....~.~....6~.).~°D~-.~< ....................................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ....:...:..:..:~,. Repair Removal, Demolition .................... Other Work x ' , . (Description') 4. Estimated Cost '"D'""~'Q~'i ....................................... Fee .......................................................................................... i (to be paid on filing this application) 5. If dwelling, number of dwel ,hg units ........ ~[~ ............ Number of dwelling units on each ,floor ..... [T~x~ .............. If g6rage, 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 Jf any: Front ... bl~( ............ Rear .......... ~.~. ............... Depth ...~. ~.! ......... Height ........ ~.-]...! ........ Number of Stories I .... Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Weight ............................ Number of Stories ................................ 8. Dimensions of entire new co6struction: Front ........... ~ ................... Rear .....-~.~. ................. Depth ...J~,. ............... Height Z~L~CF~.. Numbei of Stories ....Z~r~ ........................................................................................... 9. Size of lot: Front ............. t..-1..~.'~.,c) .................. Rear ........ ~.~.,.~.~ ................ Depth ..)..~..O.:..-J.~. .............. 10, Date of Purchase ............... ~F~, ................................. Name of Former Owner ........... ~ .................................... 11. Zone or use district in which premises are situated .................................................................................................... 12. Does proposed construction v(olate any zoning law, ordinance or regulation: ............ (~.O.. ................................... 13. ~ will iot be regraded, C~6Q~ ............. Will excess fill be removed from premises: ~:~) Yes ( ) No Name of Architect ......... ~C~?t~_<. .................................... Address ................................ Phone~ No ....................... PLOT DIAGRAM Locate clearly and distinctly alI buildings, 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. STATF OF NEW YORK, · I.~c COUNTY OF ..... ......... ~./../.fZZ'..~.~.....~.~..~/,.~.../.,~.~.~,,..~ ............................ being duly sworn, deposes and soys that he is the applicant (Name of individual signing contract) above named. He is the .., ........................................ ~..~O,~.~.~,.O..~...~L~.~ ...................................................... ' (Contractor, agent, corporate officer, etc.) ................................................ of said ownbr or owners, and is 'dul~ authorized to ~erform or have performed the said work o,nd to make and file this application; that all statementscont~=ined in this application are true to the best of his knowledge and belief; and thor the work will be performed in th~ manner set'forth in the application filed therewith. Sworn'to before me this ; ......... ,.....'7... ...... ..d,:.y ...................... , ,,,.. // Notary Public, ~ .................... .,Z'.~. County .~ ................. ~......./,..~.~..~.. ........ ~' , JO ANNE tiANSEN Notary Public, State qf New York No. 52-4667259 Suffolk County Camm ssiotl Expire~ March 30, ~~.; ..~;~ ..... .