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HomeMy WebLinkAbout12908-zFORM NO. ~, TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin§ Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No., .Z.1.3.9.9.9 ......... Date ...... .N.o.v..e.m.b.e..r .... 7. ........... ,19 .8.5. THIS CERTIFIES that the buildh~g New Dwelling LoeatinnnfPrnn~rtv 480 Ackerly Pond Lane Southold House No. Street Ham/et County Tax Map No. I000 Section .... 0. 6. .9 ..... Block .. 9.5. .......... Lot..13/.O...1.3 ......... Subdivision X .Filed Map No. .Lot No. conforms substantially to the Application for Building Permit heretofore f'ded in this office dated .... .~.e.b.r.u..a.ry.. 2. .4 ..... 19.8. 4. pursuant to which Building Permit No...1.2. .9.0.8.g. ............ dated .... .lg.a.r. qh...6 ................ 19..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 ......... ..... New Private One Family Dwelli.ng ...... The certificate is issued to CARLSON, CLAUDE R. [owner, te~see-o'r' ter~e'n~ of the aforesaid building. Suffolk County Department of Health Approval ........ .1.4.'7 .S.O.-.2. J:. ........................ .P. ending UNDERWRITERS CERTIFICATE NO ................................................. Building Inspector Rev. 1/81 FO~' 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) 12908 Z Permission is hereby granted to:A .... ~....~...L.~......~.~ ............. ...~..~~......~.:.~..: ...................... County Tax Mop No. lO00 Section .... ..~.,...~-~ ........ Block ....... ..~. ......... Lot No....~.....L..~ ...... to application dated .~..~~....~...~. .................. , 19~..~,..,-'~ end approved by the pursuant Building Inspector. Fee $..~ .................... Building Inspector Rev. 6/30/80 TO %"O OLO -- FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted ia ~1~ 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 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 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 pZt)perty 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. Fees: 1, Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 Date New Building .. ~ ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ~:O )~C ~-~'f'/¥ ))O~t~~ /~.~/ Hou~ No. Street Ham/et Owner or Owners of Property ........ ~ f % ¢' 'L~o~ Oounty Tax Map No, 1000 Seotion ....... ~, .~ .... Blook ............... Lot .... 2 .~ Subdivision ................................. Filed Map No ........... Lot No .............. PermitNo..1,~,77,.~.. Date of Permit .,~/.~?(.~?.Applicant C_~/~. ~x/.~'~..~ . 1~'~©0 ' ,~\ Labor Dept Approval ~ Health Dept, Approval ................................................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..................... Fee Submitted $ ..... ~,.' ...................... Construction on above described building and I~')t meets all apj31ica~a'~"odes and regulations. (~LG~A'C~ r~, ~,~ Applicant.. ~~., . ~, .<~~~/~/I'/~- ....... ...... Rev. 10-10-78 FIELD INSPECTION COMMENTS FOUNDATION ( ls t ) FOUNDATION ( 2nd ) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY QODE FINAL ADDITIONAL COMMENTS: 78S-1802 BUILDING DEPT. INSPECTION FOUNDATION XST %',,~[/]/ ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION "~\ FRAMING [ ] FINAL REMARKS: THE NEW YORK BOARD OF FIRE UNDERWRITERS 'II~)O~ BUREAU OF ELECTRICITY ' ~[~ 85 JOHN STREET, NEW yORK,-NEW YORK ~OO~S only the electrical equipment ~ described below a~d introdu¢~ by the appBca~t named on the able application number in the premises of Cl~.u~ C~r~n, 37 Ac~e~y ?~md ~oad, ~uthold, was examined on ~()~ ~ ~ ~ ~ and found to be in compliance with th~ requirements of this Board. FIXTURE OUTLETS RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS FLUORESCENT VAPOR DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIMECLOCKS UNIT HEATERS MULTI*OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R V I C OTHER APPARATUS: l~-~ke De~ec.~tr OF CC, ~OND. 2 NO. OF NEUTRALS 1 C~ooda~ e A~[ectrtc Cant RR#I Box ~5A Main Road Ma.ttituck, N.v.J.'t9~ This certificate must not be altered in any manner; return to the office of the Board if ie~orrect, ..... _CO~Y~F?I~UIL_DI N G~ may be identified by their creder~fials. NANy MANNER FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined..~..a&.&..(q. .... ,19~.t!. Approved . .~....a,~... k .... , 19t~.q.. Permit No./..~,.~ .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 work2 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 co, and regulations, and to admit authorized inspectors on premises and in building for necessary )j~pt~c~s~/; ~ ( ~ ~ .... q_~-k~.4~../~.~ · ~4 .~f, jV:w.~.~-. ...... (Signature of applicant, or name, if a corporation) .... £d.,.. ,. .......... t (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .. ~ld.l:l~. . ..................................................................................... Name of owner of premises .. ,,~..),~¢//.~.. ( .27U'. ) .................................................. (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. ~)U,;~Z~-' .../').CZJ .c4~i ...... Plumber's License No...O~ .~.~.: '.~. ............ Electrician's License No..7~'~3 ............... Other Trade's License No ...................... 1. Location of land on which proposed work will be done..~(3/(~' ~.&.-- ~d-- .~'¢,..).~.~/:( .~.~.~L~ ................... ..... ........................................................... House Number Street Hamlet County Tax Map No. 1000 Section .... ~.~..~.. ........ Block ..... ~ ......... Lot.. ~.~../._'~. ....... 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 ............................. .............................. use and occupancy ..... ~'.~ ~q .~.t</~i'~...--..DU.~,-...~ckv.~f./F..' ............................. b. Intended Nature of work (check which applicable): New Building ....... Addition .......... Alteration .......... Repair .............. Removal ............ Demolition .............. Other Work ............... Estimated Cost.· (Description) (to be paid on filing this application) If dwelling, number of dwelling ufiits ..... /. ....... Number of dwelling units on each floor ................ If garagel number of cars ·.. ~.. ~ ................................................................. If business, commercial or mixed 6ccupancy, specify nature and extent of each type of use ..................... Dimensions of existing structures,.lf any: Front ............... Rear .............. Depth ............... Height Number of Stories Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ..................... ~ Height ........ .,~ ............ Number of Stories ................ D~menslons ,o??ure new construgtton: Front·· .~/ .......... Rear ...~./.'. ~ ...... Depth .~.. ~.. ........ Height ...[.o..2 ......... Numbgr of Stories... O/.~.~ ........ , ....................................... · f F / / / $~ze o lot: rent . ~,[~1.~. .... ~ ......... Rear .... ]~D ............. Depth .. ~'.; ............. Zone or use district in which premises are situated..· ~"~ ....................... Does proposed construction violate any zoning law, ordinance or regulation J.q O ........ Will lot be regraded .... .)~..-t~'... [ .................. Will excess fill be removed from.premises: _Y('7~es% No Name of Owner of premises ..~. ~....~.. Address . ~t2di/g.g/~..~e~a~(l~one No. ~~...~.. Name of. Architect i Address Phone No Name of Contractor .......... i·. ·. · · · · · · · · · · .~t~ Address .......... ~.r. ....... Phone No. ..... z.~. ........ PLOT DIAGRAM Locate clearly and distinctly all bluildings, 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. ~)~'g-~ IO0~ Sec4 0(0~ dff:--~ ~ ~ ~' ~ ].~ STAVE OF ¥Oar,., cou, gsv O.F ..... '? .............................. i .................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named· He is the .......................... . .d3W.. .................................................... (Contractor, agent, corporate officer, 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 contai~ ed in this application are true to the best of his knowledge and belief; and that the work will be performed in the mm~ner ~ et forth in the application filed therewith. Sworn to before me this i day ~ ,19.~/. ' Notary Public, .fl. ay,~..~, ........ ...'' '~ '~~'' '~"'..~.~. Co..~.~ ~,~ t~,~,~ ~, ~ (Signature of applicant) 0 m < r ~ "n t r' > t0 0 8~ APPROVeD'AS', NeDItll ~. NOTIFY BU L'DING DEPARTMENT 7~5Z~802 9 AM TO 4 PM FOR TH~ ~-~ONnATION - TWO REQUIRED, MUST If copper tubing is for water distributing system; piping shall be al types K or L only !; '1