HomeMy WebLinkAbout12855-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No..Z.~.¢.~ ~5. ......... Date . .d.a.n.u..aF.z .~..8 .................... 1985.
THIS CERTIFIES that the building .... .A.d.d.( t. j. 9.r~ ..................................
Location of Property .. ¢.1.0.9. 5..M.a.i..n..R.q ~ ql ....................... ¢ N.t.c bog>ue .........
House No. Street Hamlet
County Tax Map No. 1000 Section .. ~ .02 ....... Block ... ~ ........... Lot .... 2.4. ..........
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore Fried in this office dated
·...F.e.b. :..1 ............ 198.4.. pursuant to which Building Permit No...~ ~.$.~ ~ ¢ .............
dated ..... F.e. 1~,..2. ................ 19.8.q, 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 .........
Construct 2nd story addition to existin business .............
The certificate is issued to SANFORD H. FR/EMANN &, HENRY F. RIENECKER
(owner, I~.X
of the aforesaid building.
Suffolk County Department of Health Approval ...... N / ^
UNDERWRITERS CERTIFICATE NO ................ #.N..6.7.0.9.8..8 .........................
Building Inspector
Rev. 1/81
FOR~ NO. ~
TOWN OF $OUTHOLD
BUILDING DI:'PARTMENT
TOWN HALL
$OUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
12855 Z
Permission is hereby granted to:
...8.1...o...q..~q......~.~....&,d .............................
..~~..~..,..~.:...q..~....~-~ ..................... ,,
,o ........
at premises located at ....~...?.! .c/..~ .......... ~... :. ....... ~ .............................
County Tax Map No. I000 Section .... /...O...,,L,. ........ Block......................& Lot No. .......~..~: .........
pursuant to application dated o.~..~....J .................. , 19..~...~.., and approved by the
Building Inspector.
Building Inspector
Rev. 6/30/80
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
SE JOHN STREET, NEW YORK, NEW YORK 10038
oa~e J~ly' 19, 1984 273437/84
on ,le N 652454
THIS CERTIFIES THAT
only the electrical equipment ~ described below and introduced by the applicant named on the able application number in the premises of
Pin~ ~en ~ ~
in ~he following location; ~ Basement ~ ~ FI. ~ 2nd FL Section Block Lot
was examined an ~'~y [[ ~ ~ 19~ and found to be in compliance witk the r~quirements of this Board.
FIXTURE
OUTLETS
RECEPTACLES
2
SWITCHES FIXTURES RANGES COOKING DECKS ' OVENS EXHAUST
fLUORESCENT
DRYERS
FURNACE MOTORS FUTURE APPLIANCE FEEDERS
TIME CLOCKS UNIT HEATER MULTI-OUTLET DIMMERS
SYSTEMS
NO. OF FEET
SERVICE DISCONNECT
OTHER APPARATUS:
P~zelboards; i-4ior.
lOOamps.
S E R V I C E
NO, OF CC COND A W G, A W.G. A W. G,
PER ,ff OF CC COND, OF HI-LEG OF NEUTRAL
NO OF HI-LEG NO OF NEUTRAl
Hank R& encl',ar
Main 1kind
Cutchogue, N,Y. 11935
This certificate must not be oJtered in any manner; return to the office of the Board if Jnco~'rect. inspectors may be identified by their als.
COPY FOR B[JILDING DEPARTMENT. THIS COPY ~J ANY MANNER.
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 1003~
THIS CERTIFIES THAT
only the elec trical equipment as described below and introduced by the applicant named on the above application number in the premises of
Har~k Rienecker (Pinewoo~ Garden Ceu~ Ltct.~ ~/S l~n Rd., Cutchogue, lq~Y.
in the following location; [] Basement [] 1st FI. '~ 2nd FI. Section Block Lot
was examined on Dec~!ttl;,~.~r O~ t 1984 and found to be iu compliance with the re~ quirements of this Board.
FIXTURE
OUTLETE
6
RECEPTACLES
15
SWITCHES
FIXTURES RANGES OVENS
FLUORESCENT
i 6
DRYERS
FURNACE MOTORS FUTURE APPLIANCE FEEDERS
TIME CLOCKS
DISH WASHERS EXHAUST FANS
MULTI-OUTLET DIMMERS
SYSTEMS
NO. OF FEET
SERVICE DISCONNECT
OTHER APPARATUS:
S E R V I C E
NO, OF CC COND. A. W, G, NO OF HI-LEG
PER ,~' OF CC COND
OF HI-LEG
NO, OF NEUTRALS A, W. G.
OF NEUTRAL
Hank Rieneeker
Main Road
Cutchogue~ N.Y. 11935
This certificate must not be altered in any manner; return to the office of the Board if incorrect.
COPYiFOR JILDING DEPARTMENT. THIS COP¥,OFCERT FICATE I
GENERAL MANAGER
inspectors may be identified by their credehtials.
FORM NO, 6
TOWN OF $OUTHOLD
Building Department
Town Hell
$]outhold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitte~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 where applicable.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of peoperty 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.
Co
Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling
3. Copy of certificate of occupancy $1.00
landuse--Pre-Existing C.O. $15.00
Vacant land C.O. $ 5.00
Date ..........................
New Building....../ ....... Old or Pre-existing Building .... ' .~.. .... Vacant Land .............
Location of Property .............. ~ ................................................
Owner or Owners of Property .~M~,'P. ~.~'~..,..~ ........ /~~.
County Tax Map No. 1000 Section .... ~ ~.~ ...... Block ..... ~ ....... Lot .... ~ .~ ........
Subdivision ................................. Filed Map No ........... Lot No ..............
. .......... ............ ....
H~th D~pt. Approv.~ ...... ~ ............ L.b~r ~.pt. Approw~ ....... W~. ...........
Unde~riters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ ............................. . --
Construction on above described building a~~ble
codes
and
regulations.
~-~L~-77 ~
Applicant ........... ~ ~ ...... ~ ......................
/lf / F
COMMENTS
FIELD INSPECTION~
1.
FOUNDATION (1st)
FOUNDATION (2n
2.
ROUGH FRAME &
PLUMBIN.G;
INSULATION PER N. Y.
STATE ENERGY
C,ODE
FINAL
ADDITIONAL COMMENTS:
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
Approved .~. ~..o~. ~ -, 19 ~..~. Permit NoJ .~X.~..~. r.'A~~'-
Disapproved a/c .....................................
Received .......... ,19...
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This application must be completely filled in by Wpewriter 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
shah 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 regvlati0?, and to
admit authorized inspectors on premises and in building for necessary inspections.
(Signature of 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.
(as on the tax roll or latest deed)
If appli~ntta corporation, signature of duly authorized officer.
v (Name and title of corporate officer)
Builder's License No ..........................
Plumber's License No .........................
Electrician's License No .......................
Other Trade's Lic?nse No ......................
Location of land on which proposed work will be done ..................................................
House Number Street Hamlet
County Tax Map No. I000 Section .... ./.~..~: ........ Block ...... ~ ......... Lot ..... ..........
Subdivision ..................................... 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 .... .~, .~. ?..~.(~....G'../77..~..~. · · .~. ~. ~ · .~... ..............................
b. Intended use and occupancy ... ,~..F~. { o~..r~¢ . t? F~F t¢~ (.tv o ~. o~z ~ ~ ./~..~...~..~.~
o
10.
11.
12.
13.
14.
Nature of work (check which applicable): New Building .......... Addition .......... Alteration ..........
Repair .............. Remgval ........... Demolition .............. Other Work ...............
(Description)
Fst'matedCost /..~..~ ].~..~. ~..~.'~.
~ 1 .............. Fee ., ......... '
(to be paid on filing this application)
If dwelling, number of dwelhng units ............... Number of dwelling units on each floor ................
If garage number of cars '
If business, commercial or mixe~ occupancy, specify nature and extent of each type of use .Z'..~l Y..~q~.-:...o..&?/?.¢...
Dimensions of existing structur6s, if any: Front .... ,~..q. / Rear ..... ~. ~/. ' Depth .-~-...~'. /
J. ~. ' Number of Stories Y
Height ........................................................... J ........
Dimensions of same structure with alterations or additionv Front .... ,~..~.. ~. .... Rear ..... ?.Y ......
Depth ....... ~. ~. ........ +.. Height ...... ~..~ .......... Number of Stories ....~. ..............
Dimensions of entire new construction: Front .... ~. y..t ...... Rear .... .z-.'-/. '. ...... Depth .... ,7.. ?. t. ......
/,,./, g t, Number of Stories ~.
Height -
Size of lot: F,rbnt ....... ,(z. ?,., .......... Rear ...... ?.$.~.' .......... Depth ....,.f Z 2- o /
Date of Purchase .... ~../t'? ............... Name of Former Owner . .~d.~.~.~.,tt~.--~... ~.'.r-.~t~:~ej ......
Zone or use dlstrict in which pr~mises are situated...e).' .~.,V. m .~dZ..~./.~. ?. ....................................
Does proposed construction violate any zoning law, ordinance or regulation: ....~..o. .........................
Will lot be regraded ....... /~.~..; .~ ~.,~.;;~_;,1,.~.... Will ex?ss fill be removed from premises: _ Yes ~o~
Name of Owner of premises .x~,.~..,-.~.~..~.,-.,..~..,vv..,ff.. Address ~'/'~.~.~ .~..:,~.°.5,~.~.".~.~Phone No..~¢¢~ .....
Name of Architect . .~.~.,op. ~.. ~y.~, ~ .......... Address .//.,~..~..~.~: .ff..nde. e A .°~F. Phone No..q. ? ?.-: .o.,/..o.~. ....
Name of Contractor ! 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! number or description according to deed, and show street names and indicate whether
interior or corner lot. ~
STATE OF NEW Y/2tRK
...... .?.O...r~..67.4 .... .~...... :~ .~..~.1.~..W~..~.~. V% ...... being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the
(Contractor , agent , corporate officer , etc . )
of said owner or owners, and is du!y 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
LINDA F.
NOTARY I}USLIC, St~le of New Yor[~ ........... '...~ .......
No. 52.4524771 ' (Signature of applicant)
Quahfied in Suffolk County
~,.ommission Expires March 30, 198,:. ~ ,'
Co.
C6J
¢'65-1802 9 AM TO 4 PM FOR, THE
FOLI ,'~dNG INS,aECTiON5: -
1. FooK~r~A~-ION _ TWO REQUIRED
FnR ~UR~D CONCR~E
, 2, RnU~H - F~MING & PLUMBING
, . ' , . 4. FINAL., CON'STp0m~i~N MUST
~ - & '"ENERGY
-j
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