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HomeMy WebLinkAbout13036-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z15932 Date July 8j 1987 THIS CERTIFIES that the building addition to dwelling 1225 West Lane Road Southold Location of Property t~[~d's'e'~d ....................... County Tax Map No. 1000 Section 8 8 .Block 6 .Lot 9 Subdivision ......... .X. .................... Filed Map No. X .Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .Ap.r.~l...1.3.~. 1984 .. pursuant to which Building Permit No. 13036z dated ...~. p.r.i.~...i .3.,.. 1. 9. .8.4 ......... 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 ......... ..... a4d..i.~.i.o.n...t.o..a..n..e.x.i..s.%n3..o.n.e. 7 .f.a.m.i. ~. ¥..d.w.e..~.~.i.~3.: ...................... The certificate is issued to MARILYN MENACK ..................... [d~,n'e;', ~k~ ...................... of the aforesaid building. Suffolk County Department of Health Approval ....... N/A UNDERWRITERS CERTIFICATE NO. N673833 PLUMBERS CERTIFICATION DATED: N/A Building Inspector Rev. 1/81 FO~M' NO, 0 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? 13036 Z <0~ ..... .~ ............. Lot No ....... ..~ ............... County Tax Map No. 1000 Section .... .~..~. ........... Block ' pursuant to application dated ..... ~.....J.~ ...................... , 19b...~, Building Inspector. and approved by the Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD l~u;IdJng Department Town Hall $outhold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in Wpewriter OR ink, and submitted ~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 unu~al 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 Coda 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 ~Jrvey of p~operty showing all property lines, streets, buiidlngs 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 (nfo:ma- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancv Nov DwellJ. n.S.$25.00, Acce.~sory '~[0.00 Bu~lnea;; $50.00 2. Certificate of occupancy on pre-existing dwelling ~ 5 0.0 0 3. Copy of certificate of occupancy $ 5.'00, over 5 years ~10.00 5.U~dated C.O. $ 50.00 Date .................. ~ 6. Alteration $25.00 NewCons t~uc'tonL ' , Property /-* ...... ~--.~M or Pre-exIsti¢~~ ng Building ....... ~ : .... Vaca~~.nt L nd ....... ...... OCatlON O . .~. · ,~ ..... * ........................ House NO. $treot Ham/et Owner or Owners of Property '- co..~v T~ ~0. ~o. ~000 s.o~o....~ ........moc~ ..... Lo~.2R~.2~O.. ' ' ' Flied Map No .... Lot No Subdw~s~on ...................................................... Permit No. {' ~ ~'' ' ' ) / ' ' ¢ d ~ ........... ate of Permit . Apphcant ...... ; ................ Health Dept. Approval ........................ Labor Dept. Approval ........................ ./Y~ ................ ...................... ~equest ~or Tempora~ Certific~to ..................... Final Certificate ................ ~.. ets all applicable co'es and ragulations.~:O..~...~ I~q Construction on above described building and~permlt m! THE 1985 NEW YORK BOARD OF' FIRE, UNDERWRITERS BUREAU OF, ELECTRI TY,~ 85 JOHN STREET NEW YORK NI"(~ YC~RK 10038 ~pp,,c.t,o/.No. on~.,,e ~8~-ie~~3/e'~ ' N 673833 in the following location; [] Basement THIS CERTIFIES THAT / ~ ; only the electrical equipment as described belotv and ~ntrod~ced by the applicant name~l on the abo~e application number in the premises of Douglas~ Lane~ ?~ft Side P~conid by n~w 2nd Fio ~ Southold~ Sunset NY [~ 1st Fl ~ 2nd El. \1 Section Block Lot · andfoundtobeln,,c~mpllancew~h, therequirementsofthlsBoard. FIXTURE FIXTURES RANGES 0OOKING DECI~ OVENS EXHAUST FANS OUTLETS SWITCHES 21 21 ].3 FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNEC OTHER APPARATUS: Eleo. Room Heaters l~Smoke Detector S E R V NO. OFECCCOND,pR,E A W, G, OF CC COND 4~lamt 2.0-1.25kw B.J. Electric Stillwater Avenue Cutchogue, ~,yo 11955 Lico This certificate must ~n an' manner; return to the office of tl~e Board if 267~E w?~, NO OF NEUTRALS A, W. G GENERAL MANA~'~R % , 11 .![ · P~ . may be identified by their~'~l F~[ ELD% INSPECTION Uun~-~ ...... FOUNDATION (lst) FOUNDATIO~I (2nd) ROUGH FRAME & PLUMBING INSULATION PER N, STATE ENERGY qOD FINAL ADDITIONAL COMMENTS: TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-I 802 To Whom This May Co cern, We are unable o complete your Certificate of Occupancy because ,of the following reasons. An application for Certificate of Occupancy is not on file. No Underwriters Certificate on file. The check is(outdated/not on file.) ($25.00) /~/ No Health Dept. Approval on file. /5/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. Building Permit # 1 3 0 3 6 Z Building Dept. ***/5/ No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) 765-1802 BUILDING DEPT. ~iNSPECTi,ON~ ~ [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION REMARKS: FINAL FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined..%'~,.,~ .I.3..., 19"~.c~ . .(~. ~ .~....I..~..., 19gtJ. Permit No.) .~ O g(o ~. Approved. ........ Disapproved a/c .......................... ' ........... .... (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No .................. INSTRUCTIONS a. 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 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 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 part for any purpose whatever until a Certificate of Occupahcy 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 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 necessa~ inspections. % ~'* i~gn~ture o?appX}icant, or name, i~' a p ' ) (Mailing address of applicant) State whether applicant is owner, lesse~[~, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .~..~.,k.~-~..kd~,,.~... i .~...~-..k..-~C-.-~. .................................... (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 ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ..../. ............... .%--ZU.. i ........ ........... House Number Street Hamlet ' Cghnty Tax Map No. I000 Section ...(5).~, .O...O. .... Block .... O..(,~:C~!Z) ...... Lot... '.(~.O~,(.~rS~... i 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 ........ ~-~k.~...~..-,.,,a~x.\.'YV.~.,,o,~ .......................... 3. Nature of work (check which applicable): New Building .......... Addition...~.. .... Alteration .......... Repair .............. ~emo?al ............ Demolition .............. Other Work ............... r~ .... (Description) 4 Estimated Cost Fee ................. .. ... .. ; (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars ..... ! .................................................................. 6. If business, commercial or mixe~ occupancy, specify nature and extent of each type of use .................... 7. Dimensions of existing structure~, if any: Front .... [~..~. .......Rear ...'~.. ~> ........ Depth .. ~i~ .'/,~ ....... Numiber of Stories ' ~ .~-~('CI~.....~ Height ................................................... Dimensions of same structure with alterations or additions: Front ....... ~ ...... Rear .~..~Q ......... Depth ~QI/~) ........ Height Number of Storiesc~ . - ........ 8. Dimensions of entire new construction: Front .............. i R. ear ............... Depth ............. Height Number of Stories of lot: Front i Rear Depth 9. Size ................................................................ ' Name of Former Owner 10. Date of Purchase ......... ~ ........................................... 11. Zone Or use district in which pr~mises are situated .................................................... · 'ate any zoning law ordinance or regulation: 12. Does proposed construction viol. , · .............................. 13. Will lot be regraded ......... i ................... Will excess fill,,b~e~r~emoved_from.~l~-'mise~: ~ Yes~ No 14. Name of Owner of premises . .~.O,~I.~.M~..~.0~.~. Address . .~9.~.c~ ~ ~o~e NoQC/(~). (~1~..St.~. ·~. Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .~IIlL¢~ )..~.~gl, .~.K. .... Adclress .c--~:..~ .~/.Z.~... 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 !number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, $.S COUNTY OF ................. ...~..~..~,_~(..~'l~{~J~.~ !.~~.~,..,being duly sworn, deposes and says that he is the applicant . (Name of individual'~igning contract) above named, j He is the ..................... i ........................................................ : (Contractor, agent, corporate officer, etc.) of said owner or owners, and is du'ly 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 manner set forth in the application filed therewith. Sworn to before me this ............. ......... Notary Public,~ .~: .~...i ................. Coupl.~--~, ..~__~ ~..