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HomeMy WebLinkAbout12942-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING D£PARTMENT Office of the Building Inspector Town Hall 5outhold, N.Y. Certificate Of Occupancy No..ZA399.9. ......... Date Np.v.~m!P~..3 .~ .................... 195.4. THIS CERTIFIES that the building ... [~ $ y.i.rl g. ¥.o. q r0. ~cl. ~1 .e.c.!~. o.d.d& ~ :L.oy, .......... Location of Property 2500 R.O.W. off Westphalia Rd. Mattituck h~'~ ~o~ ....................... s'tle~i ....................... County Tax Map No. 1000 Section ... J .1.4. ..... Block . .0..7 ........... Lot1.0.: .2.-,6. .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated March 1 t+ 98.4. ...................... 1 . pursuant to which Building Permit No. 329 ~ 2 Z dated .... .~.a..~ 9.h..2. 7 .............. 19.8.6., 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 ......... .... L,i. v..i.n~. P, 9.o.m..a., .d.qq .k. ,a.d.d..i.t.i. qn., .t.o..e..x.i.s.t. ~ .ng..d.w. 9.1.1. i. ~g.. .................. The certificate is issued to .... .E.D.Z.~..~ p..V.A..N..H.O.L..T.H.E.. (owner,~Y~j( of the aforesaid building. Suffolk County Department of Health Approval ....... Iq./. ~. ................................ UNDERWRITERS CERTIFICATE NO ............ JI.N. 6..4.98.5. Building Inspector Rev, 1181 FORM[ NO. f~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPL~T'ION OF THE WORK AUTHORIZED) N.o 12942 z Permission is hereby granted to: ..... ~Q.:......~..~....../..g.~ ........................... .... ~z/..~.a~.....=~..,.../... ....... ..~ ~.~.~.~....~/.../~....' .~ .~.~ ....... ~...~~- ' ......... ~ ~.....~....' -z- · z~. /~,?0~ C~ ~,~: .... ..~~/~ ~', at premises ,~/ated at ............ .~.~. ......................................................................................... County Tax Map No. 1000 Section ...... ../~'./i.~.~.~.'. ...... Block "~'"Z' .......... Lot No..(~..~....~.....Z...:¢~.-' E pursuont tO appJication dated ......... ..~..Z./.~...~.. ................................ , 19....~,.,~.~ and approved by the Building Inspector. Pee $. ~.~,.~-~. ........ :,. Rev. 6/30/80 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 in duplicate 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 peoperty showing alt 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- t/on required to prepare a certificate. Fees: 1, Certificate of occupancy $5,00 2, Certificate of occupancy on pre-existing dwelling or land use 3, Copy of certificate of occupancy $1,00 $5,00 Date., ,$.e,p.,t, ,, ,t~/~,~, ........... New Building .,~.f.t.i.o.~. .... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ...2~,~(Z0.. -~.D...~....0J'-~..~e~t.p.h~.~.f~ ~& .................... ~t.~.t~u,c~. ..... House No. Street Ham/et Owner or Owners of Property . .~.~.~z~.&, .¥.~o~.~ ......................................... County Tax Map No. 1000 Section Z3J~. ........... Block ...... 92 ....... Lot.. D[g,-2,-~ ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No..~.2.97.2...~.. Date of Permit .3J~.?J..8~...Applicant ...O. ep.~.e..S..~A~.e;c....~.~:[.~¢.e~' ........ Health Dept. Approval ........................ Labor Dept. Approval ........................ U nderwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ...... ,5. O0 ................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ..... . G//~ ,~;¢. $. :~e~. _ (/~t .~,~ e,) ................... 1000771 THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ BUREAU OF ELECTRICITY THIS CERTIFIES THAT Edzard Van Ho].tb.e, e/s Westphalia Rd. 200 n/o Youngs Ave.Metri~uck,N.~ FIXTURE FIXTURES RANGES ~ OVENS EXHAUST FANS OUTLETS SWITCHES ~tUORE$CENT OTHER APPARATUS: S E R I C E AW, G, NO. OF HI-LEG A.W,G A. W G. OF CC COND. OF HI-LEG OF NEUTRAL .... 1 GFC~[--- JNO OF NEUTRALS~ Rul,and Elec, Co. P.O. Box 143 ' Ma~i~uek,N.Y. I195~ lic. 242 E ~ GENERAL MANAGE~ ,/ / ~1 ~ ., COP~FORB~LD NGDEPARTMEN' THISCO~O~C~R~IE~S~T~,,~TNSr~EiLTEREO~ANY~ FIELD INSPECT:]ON ~ 1. ~'0~t) FOUNDATION ( 2nd ) 2 o ROUGH FRAME & PLUMBING COMMENTS INSULATION PER N. STATE ENERGY lODE FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OI= SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765'1803 Examined ............... , ...5..:7. . .. Disapproved a/c ......... ;;-:.-x~ .~ .......... ~ ....... (Building Inspector) A~Pk[CAT[O~ FOR 8O[kD[~G ReCeived...;~..~Z . ,1 Date g.a.r.e.h..~.~,./.8.~ ....... ,19.8¢. 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 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 reg~ations, and to admit authorized inspectors on premises and in building for necessary inspections. . '-~' '~ · - "':~' ~ ............. r ..................... (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. Name of owner of premises . $.d.~ .ar.cl...V.a.n..Hgl .tl~.e ....................................................... (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.~P. 5~ ...................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed wo}k will be done .... :Priy~;e.~fe, Off. ~e~l;phgl[~. Rg ................. House Number Street Hamlet County Tax Map No. 1000 Section . !~ .............. Block ..... ? ............ Lot... 9~-9~ .2.--~ ......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and ~ccupancy ~f premises and intended use and ~ccupancy ~f pr~p~sed c~nstructi~n: a. Existing use and occupancy .. 91x~. family., privage, home ........................................... b. Intended use and occupancy .. P~g}gg. rp9¢. 9r. ~lg~ng. room.. ~¢gi~oa, ..... aa~. ~t~ing. deck ....... over carport. 3. Nature of work (check which applicable): New Building ..... ' .....'Addition .......... Alteration .......... Repair .............. Remo~ai ............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost... ,. .. ~ ...................... Fee .......................... *" (to be paid on filing this application) 5. If dwelling, number of dwelling t~nits ............... Number of dwelling units on each floor ................ If garage, number of cars ..... i ................................................................... 6. If business, commercial or mixe4 occupancy, speclfy nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same strncture wiih alterations or additions: Front ................. Rear .................. Depth .................... !.. Height ...................... Number of Stories ....................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of'lot: Front ........... i ........... Rear ...................... Depth ...................... 10. Date of Purchase ........... ~ .................. Name of Former Owner ............................. 11. Zone or use district in which premises 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 No 14. Name of Owner of premises ...i ................. Address ................... Phone No ................ Name of Architect .......... : ................. Address ................... Phone No ................ Name of Contractor ......... 1 ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block ~umber or description according to deed, and show street names and indicate whether interior or corner lot. See Map Burve¥ an~ at~ache~ plans. STATE OF NEW YORK, i S.S COUNTY OF ................. ' being duly sworn deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ~ .............. i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duiy 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 mannor set forth in the application filed therewith. Sworn to before me this ........ / .~...~ ......... day 03...~'tT.~ ........ ,19~. ~. Notanj Public, ......... Count , F~£LEKr K, DE vOr. n"' i-,, ........... [~rl~¥ Pill]IlO,. grate a[ N~,w York (Signature of applicant).