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HomeMy WebLinkAbout13052-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Sou(hold, N,Y. Certificnte Of Occupnncy No. Z13672 Date May 24 1985 THIS CERTIFIES that the building ............. N.. E..~..D.~. E..L .L.~.N.O. ..................... Location of Property ..... 6865..BR ID.GE. L~LN~ ................... ~.U.~C ~9.C~L!$ ......... House No. Street Idem~et County Tax Map No. 1000 Section . 9.8.4 ........ Block ....~ ........... Lot .~, 7 ............. Subdivision .... SYLORET ACRES .................... ; ...... Filed Map No ......... Lot No. 7 ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ~ ?.~.i,1.. ! .8 ......... 198.6.. pursuant to which Building Permit No...~.3.0.5..~.Z ............. dated .. ~Lpr. ;L1..1.8 ................ 19a4., 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 ......... ..... Ne.w..on~..f. ami.Ly, d~.e. 1 lin~ ............................................... The certificate is issued to ....... $ .A.S.~.. E. }I.D..Ii. 9 .H.E.5...Z .N .C ............................... (owner, y(~qiX~tt~) of the aforesaid building. Suffolk County Department of Health Approval 14- SO - 9 0 UNDERWRITERS CERTIFICATE NO ..... .#.N.6. 9. .2.6.6.7. ................................... FLUMBERS CERTIFICATE 5/13/85 Rev, 1/81 Building Inspector FOJIM NO. ii 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? 13052 Z Permission is hereby granted to: at premises Iocoted at ............... ~ ............. County Tax Map No. 1000 Section ..... .(~....~....~. ..... Block ......... .1 ........... Lot No ......~...~..¢ ~ pursuant ,o application dated .... ...~...~.~-.~......!...~. ..................... , 19.~..~.., and' L approved by the Building Inspector. Fee $... I.~...,?, ;...~,..?.. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ~r ~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions in duplicate A. This application must be filled in wpewriter OR ink, and submitted ~V,, ,.?co~zhe 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 ~esponsible 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 survev 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 preoare 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 4.Vacant Land C.O. $5.00 ....... Date :-.. ........... New Building ,,,,,~,~,,,,,,,OIdorPre-existingBuilding ,,,.,,, ..... Vacant Land .,,,,,,. ..... Location of Property .~.$.~.,~,q .... ~,./~'~),~.'~. '/-"dr ,~.,~/~'%~,~,~.).~,', ~,~. ...... ......... Ham/et Street Owner or Owners of Property .................................. County Tax Map No. 1000 Section .............. Block ... ~ ........... Lot ....... Subdivision ............ Filed Map No ........... Lot No ........... Permit No./. '.~.Q r.~, Z Date of Permit ~././.~./~/~,Applicant. ,~, .~,~, ~..~.~, i.~,. ,~../,~2~,~,'., .~./,1~.~., Health Dept. Approval ........................ Labor Dept, Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. q Rev. 10-10-78 only the electrical equipment as described below and introduced by the applicant named on the abpve application number in the premises of F,a~t E.u~ ~,~o~ms~ ~'r:I,cl~e Lane, Ore,on ~as exami~d on ~,[I~ ~ C]X ? 0 ~ ~ 9 8 6 dndJound to be in compliance witb the requirements of this Board. RXTURt I fiXTURES RANGES OVENS DISH WASHERS EXHAUST FANS 26 DRYERS SYSTEMS NO. OF FEET E R V C NO, OF CC COND A W, G. A. W, G. NO OF NEUTRALS PER ,e' OF CC COND OF HI-LEG Smoke Detect' This certificate must not be altered in any manner return to the office of the Board if incorrect Inspecto/s may be dent f ~.d by';f~e r crodentia s ~[~ COPY FO~ BUILDING DEP~TMENT. THIS CO~Y OF CER~IFICAYE: MUST NOT B~ AL~ERE~ IN ANY MANNER. ~ FOUNDATION (1st) COMMENTS FOUNDATION 2, (2nd) ROUGH FRAME & PLUMBING 3. INSULATION ?ER N. Y. STATE ENERGY C,ODE FINAL ADDITI COMMENTS: 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. /30~ ~ Owner ~~A2~ ~ ,~ (please print) Plumber ~/g~ ~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber' s szgnature) Sworn to before me this /~ay of //~ , Public, Count No. 4702900 ©uahfled m Suffolk County Corn. mission Expires March 30, ID THE NEW yORK BOARD OF FIRE'UNDERWR!TERS: ,, , ~ ].001381 ~ , BUREAU OF ELECTRICITY ~ i ~ ' ~ 85 JO N SYREET,' NEW YORK N~W YORK 1003~' 'm r , ~ ,.~,~ .~, , ,, , , , , ,,.,~= ~ ~, ~. '~,,,,"~-",,,,~.~",~'~ ~ , ' '.. N .6'92667 THIS CE~IFIE~ ~HAT ~ ,' " , . ~ ~ , , ,; . ~ ~ast' End Homes, Inc., Bridge L~ne, (Rt~24 G, Oregon Road)Cutchog~'e, NY . DRYERS 1985 2-Smoke detectors Jody Pumillo Pat L~jl%e, Box 182A Mattituck, NY ].1952' Lion% 2300E ,, This certificate must not be altered in any manner; return to the ;office of the Board if incorrect. Jn~pectom's may be ,J'dentifmd by H~eir credentials. ]'65-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION [] FRAMING ~/] FINAL FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved ......... ~.'?.., 19~. ]. Permit No. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received .......... ,19... INSTRUCTIONS a. Tiffs 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 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 building for necessary inspections. ..... ~..S.¥.. ¢.~..~....t~...~ .~..~. .............. t (Signature_ qf 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. ......... .................................................. Name of owner of premises . J~i~ . . J-~tf~.~../brio. '~.x...,.¢.,.jLi,).~..(:4J..0.~. ..................................... (as on the tax roll or latest deed) If applicant is a corpclrati/gtn, signature of duly authorized 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....~~.. ~. County Tax Map No. 1000 Section .... ,') 5[q=.,.,. - Block .../. .............. Lot .............. Subdivision....-~.. [.-1 [l~f~c.']-...~ .(:~..~.. .............. 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 ..................................................................... b. Intended use and occupancy .................................................................... 3. Nature of work (check which applicable): New Building .~..'. ..... Addition .......... Alteration .......... Repair .............. Rem6val .............. Demolition ..............Other Work ............... oqO00 (Description) 4. Estimated Cost ...... ~' '~ ....I ......................... Fee ...................................... (to be paid on filing this application) 5. If dwelling, numbor of dwolling ~nits ............... Number of dwelling units on each floor ............ If garage, number of cars ..... ]~ .... 6. If business, commercial or mixe0 occupancy, specify nature and extent of each type of use ..................... 7. Dimansions of existing st~cmre~, if any: Front ............... Roar .............. Depth ............... Height ............... Num~ber. of Stories ......................................................... Dimensions of same st~etur~ with alterations or additions: Front ................. Rear .................. Depth .................... ,~.. Heigkt ................ Number of Stories ...................... 8. Dimensions of entire new const~cfion: Front. ;~ ~ ..... Rear ............. - Depth ~.~ ........... Height ............... Num~ber of Stories.. ~ .................................................... 9. Size of lot: Front .... ........... Rear ...................... De ...................... 10. Date of Purchase ~.I.I Y............... Name of Fomer Owner ............................. 11. Zone or use district in which pr~mises are situated .. 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ , 13. Will lot be regraded ......... i ................... Will excess fill be removed from premises: Yes 14 Nme of Owner of premises ~ Address Phone No Nme of Architect ' Address Phone No Nme of Contractor ' Address Phone No PLOT DIAGRAM Locate clearly and distinctly alli 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. J STATE OF NEW YORK, COUNTY OF .................. ~ b ing duly deposes and says that he is the applicant ............................ , .................... e sworn, (Name of individual sighing contract) above named. He is the ..................... ~ ................................................................... i (Contractor, agent, corporate o'fficer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements confained in this application are true to the best of his knowledge and belief; and that the work will b~ performed in the manngr set forth in the application filed therewith. Sworn to before me this ~OTARY PUB[if], State of New Yo~'t~ ........... ' N,,. 4707~77 r~olio,~ Col,n~ ~ Q~ (~ignat~ie of applicant) i ,- i~i ~ - ~' '-~:, m/ " /~ ; .... ,,-- ~ / / / ~m '~ , . ;.~,~ ~ ~ o ~ ~[ ~: ',,,'.,~ m~> ,, ~ g ~h .- ~t'~'' :' ,'~ ...... ~,- ,.."~"-, . - · 0 ..< o~