Loading...
HomeMy WebLinkAbout13105-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .... .z.1.3. ! .~ .0 ....... Date ...... .~An.... THIS CERTIFIES that the buildingS,d. d..~ .~.i.q n.. 5. ?. $ .g .c.h.e..n..a.~. g. e. ? .a.~. 5:..o p .............. Location of Property 2..55.q0...~.aAn. · F.°.~.d. .(.3.9r.3.0.0.) .... Oriept House No. ' ' ' Street Hamlet County Tax Map No. lO00 Section ...~.~. ....... Block ...~ ............ Lot ...... ~..0 ......... Subdivision ............................... Flied Map No ......... Lot NO .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated ...... .~.a.y.. 3. .......... 198.~.. pursuant to which Building Permit No. ) .3.1.0..5 .Z .............. dated ...... .H.ay..7. ................ 198.4. ., 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 ......... an addition & kitchen alteration. The certificate is issued to . . . .C.u.r.. g. ,i.s..A.: . .&..~ .a.n.c.y...E.,..N..o. ?.k.~.u.g...0.y..s..te.p.p.o. nd s..A.du.lt Home of the aforesaid building. Suffolk County Department of Health Approval N / A UNDERWRITERS CERTIFICATE NO ........................ j).~ 6. ?.2.6.6. 9 ................ PLUMBERS CERTIFICATION 12/11/84 Building Inspector Rev. 1/81 l~OR~ NO. 1~ TO~VN 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? 13105 Z Permission is hereby granted to: ..~ ...~] ...~.~:~..~.~... ........ a~....~.: ........ I..L.~.~.LS.~ ....... ~o ..2~:~~....~,.~.~,~...~.....~5~......~?~;~,~:~......~:j ....... ~~/~ ~ a~ ~Lz ~..., ....................................... ......... ...:~ ....... ~ .... ~ ..~.~ ............... ~ ............... ~t p~, ~oa ~t ..~:~.2 ........ ~.~ZL..~5 ................... ~.~,~2 .......................... County Tax Map No. 1000 Section ........... J...~. ...... Block ........... ~. ....... Lot No ....... .J...~. ........... pursuant ,o application doted ........... i.~..~/.~..~.~..(~..~.~. ..................... , , 9.~..(~.., and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy TEMPORARY C.O. No. Z13069 Date December 14 ...... ,1984 THIS CERTIFIES that the building..~.d..d.i.~.~.q .n..&..k..~.~.c.h.e..n..a. 1. ~..e.p.a.~.~ 9.n ............ Location of Property . .2 .5 .5.0, 0.. ~.a.~. n...~ .off. d...( 2.Q ~ ¢ ~3.0. ) .......... 0 r ± a n t House No. '" Street Ham/et County Tax Map No. 1000 Section .. ? .8 ........ Block ....6 ........... Lot .. ! .0 ............. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated .... lq~y. 2 ............ , 198.4.. pursuant to which Building Permit No .... 1.3. ] .0.5.Z. ........... dated ..... ~ .a y..7. ................. 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 ......... .... ~O..a.4~.tJ.q~. ~..~.t.c.h.e.n. alteration. The certificate is issued to ...C.u.r.t.i..s. fi.:..&. Nancy E. Norklun (Oysterponds Adult (owner, Xe~t.~ ~/t'X~VttFtJX X X of the aforesaid building. Suffolk County Department of Health Approval ....... N / A UNDERWRITERS CERTIFICATE NO ............... D ¢ ~.d.J, O g ........................... Home) Rev. 1/81 Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y, 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY InstractJons A. This application must be filled in typewriter OR ink, and submitted ml~am=~ 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-exist{rig" land uses: 1. Accurate survey 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 prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 ~,, ~$o2,~3. Certificate of occupancy on pre-existing dwelling Copy of certificate of occupancy $1.00 $15.00 4.Vacant Land C.O. $5.00 5.Updated C.O. $15.00 Date ....... '. ..... New Building ............. Old or Pre~existing Build, ing ............ Vacant Land ............. Location of Property 0("~'~ (~ ~. "' ......... ~~ ....... Owner or Owners of Property :~.~:~/~.V¢~' ' County Tax Map No 1000 Section . .~ ~... Bock . . ~ ...... Lot ................ Subdivision.. ~~.: ................... Filed M~No ........... Ldt No .............. '. t(~7'~d .Applicant ...... Health Dept. Approval ........................ Labor Dept, Approval ........................ Underwriters Approval ........................ Planning Board Approval ....................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ g .... ' ....................... ~ con ~ru cti~.~(.~ n~,~ '~ ~ab°ve describedApplicant . ~ ~:~.~building and permit meets all applicable codesaland regulaJions. ............. FORM NO. 6 TOI/VN OF 8OUTNOI. D Building Department Town Hall ~=uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY |nstructions A. This application must be filled in typewriter OR ink. and submitted-~mdupllc:t-" 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. Approva~ 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 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/ land 3. Copy of certificate of occupancy $1.00 use--Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date... J .~'./.~. / .~. ~/'. ............ New Building ............. Old or Pre-existing Building ....~..' ...... Vacant Land ............. Location of Property ...~..O. 73. o.?.....~.~ }.~....~...o~...~.....~.C!..~'~.. ,....~. ~. ..... ././?.0.-7. .... House No. Street Hamlet Owner or Owners of Property >.. .............. County Tax Map No. 1000 Section . J. 0~.-. .~..~./. 9... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. I.~./..~.<~'".~. Date of Permit .. ~?/&~.Applicant..~M/,-~¢;.../;-/.~....~.'.. ~/.~/.O.~-~ .{..~'.~ .... Health Dept. Approval ..... .~ / .~.~. ............. Labor Dept. Approval .... .~.]...~'T. .............. 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. / Rev. 10-10-78 d.o. 2 / 3//0 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY  E5 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT in the following location; [] Basement ~ 1st Fl. was examined on ~)~J~(~Vlb~,~ i~/ ][~")~ [~ 2nd FL Section Block Lot and found to be in compliance with the, requirements of this Board· ORYERS FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANE SYSTEMS OTHER APPARATU~ E R V I C O~.'ic&;t~ N.Y. 11057 Lic. ~ I~ This cerfifJcote must .or be oltered in ony monner; return fo the off[ce o~ the COPYFORB~ILDINGDEP~RTMENT. THISCOPYOFCER~IFICATE U-TNOTBE ~LTEflED IN ANY MANNER TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. /~/D~-~- Owner (please print) (please print) %} I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this //~- day of ~-~ , Notary Public, ~o/~ County re)(plu / N~tary Public COr4~qENTo 1. FOUIIDATION (1st) FOUNDATIOU 2. (2nd) ROUGH FRAME & PLUMBING II!SULATION FER N. STATE ENERGY C~ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined... I ~.. [.~.~...1~ . C) ~ Approved ., 19~. ~.. Permit No. )..~.~...~.. ~ Disapproved a/c ..................................... Application No .................. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date4- ~.//.~ , .................. 19..~. 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 issbance 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 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 co~nply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. .. ...................... (Signature of applicant, or name, if a corporation) (Mailing address qf applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. mameofownerofpremises~_~o_r~.~ g..,- l--~o~o~ /~. P,/olr/c/c~,-~ ~)/ro}tq ~xe_ .~.~s~e~f,~/~ (as on the tax roll or latest deed) V-o~- f~ ~'~ If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No...~O.~. .................. Plmnber's License No ...... .~..'~..tr'.C~...//. ........ Electrician's License No .... ~c~ .~-~..(~.. .......... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. · ..................................... ...................... House Number Street Hamlet County Tax Map No. 1000 Section . [~..~ .-..G..-../.o. ..... 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....(~. :t~...~.(~....~..~.r~..?: ............................................... b. Intended use and occupancy ..... ~...qq<o:...e~.... 72,,(.Z. ~../p/~..~/.~. ~2'.Z~..¥.. ~.~.~--.' .r~.~... ~./.~ .......... 3. Nature 'of work (check which applicable): New Building .......... Addition ~ Alteration Repair .............. Remoyal .............. Demolition .............. Other Work ............... .~ .(~. ~ ~. (Description) 4. Estimated Cost ........... Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling Units .... O..Q .~.. ...... Number of dwelling units on each floor ................ If garage, number of cars ..... ~ .............................................. .~ .;..; ~. ~ ~ ......... 6. If' business, commercial or mixed occupancy, specify nature and extent of each tvve of use !?~..~ · .~c~. · .e'r. ..... 7. Dimensions of existing structure~, if any' Front ..(e..ff. Rear o,v .3. .... Depth .. ~ .......... Height . ~.....-; ..... Number of Stories .... ~..~. ................................................. Dimensions of same structure wi~h alterations or additions: Front ., .(~ .3~ ........... Rear ,,. ~ ,3, ! .......... Depth ..... ~-7~? ............. , . Height .... ~.~..~, ~ ........... Number of Stories .... '.~. I/.'~ .......... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...-.,_.,......~ ........ Rear ...................... ,~Depth ....... ~....~. .......... 10. Date of Purchase' ' ' ~'/."~'l.~.~!' ................. Name of Former Owner ~o .~c~..~. ~ ! .~':~..~/.~ .' .~( .,D2~e.~.~...o~- 11. Zone or use district in which ' ' are ............. premises situated ........................................ 12. Does proposed construction violhte any zoning law, ordinance or regulation: ~, .~') ............................. 13. Will lot be regraded .....~.... i ................... Will excess fill be r_e~moved from premises: Yes 14. Name o f Owner of premises~O(~.0 .~..¢h~g.~../']0~c{ .~Address ~.: .3~9..fl~. ') .g .~.~.> .OF. :~-FP. hone No. ~.~. ~:-~q~-~ .... Name of Architect .......... ' ................. Address ................... Phone No ................ Name of Contractor .~...~. fi:.L ~.1.o.~.¢:...~.. ...... Address ,l~tr-~./.~.~.~ ~...o.~,~:.... Phone No. ~.:~...~.-..~.~..~..o... PLOT DIAGRAM Locate clearly and distinctly all ibuildirigs, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block Cumber or descriptio~ according to deed, and show street names and indicate whether interior or corner lot. of said owner or owners, and is dui application; that all statements cont~ work will be performed in the manne Sworn to before me this / STATE OF NEWYORK .... ... ................... being duly sworn, deposes and says that he is the applicant i(Name of individual signlng contract) above :named. He is the ~ (Contractor, agent, corporate officer, etc.) authorized to perform or have performed the said work and to make and file this .ined in this application are true to the best of his knowledge and belief; and that the r set forth in the application filed therewith. ,62. MAP OF PF2OPE~TY ~URYEYED FOP.,., JOHN M'.* MARION E. ODDEN EOBEi?T'~'GLADYS. , T'O'v,/~4 OF ~gUTH©LD ~ ~PA~D, AND ON HIS ~HAL~ TO ':~ CO.ANY, GOVE~NTAL ~ ' ' : ~"*,,: ~ , ' eo~n' ' ' :,,:' ---: ' '-' :" ::~ ':':::?:" ' ,': , , ~ ~ ~ -, -~- ~L,A rc , ~,'¢ ~ '~'~ ,, ,, ~ . , ,, , . ' ;1' % , , , ' ~, .... - , , .,] m , 765- 8~ e *,, ~0 4 PM FOR T-E :~ ~. ~ 4. FIN . MUST : , : , ' ,, ,, ,', '~ : , ~ , , . ,,, , ' If copper tubing is used for water dbtr but ng system; piping shall be SOL])E.~ USED IN WATER EXCEED 2/10 of 1% LEAD. .% \\ 7...