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HomeMy WebLinkAbout13111-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate 0t: Occupancy No...Z.'q.3..4.t.~. 3. ........ Date ............. l~Io~..q/+ ............. 19.85 THIS CERTIFIES that theq~itd-i~tg . ,5-.n.~r. 9.u.~.d...s.w.5.m.m..~.~ .~79.o.1. ,&...~.e.~.g9 ........... Location of Property ...c).©. .q~..d.8.z'../?~y.o.. (.&..S..u¢, ¢.fi_.~., .139&d,). ........... ~. 9~g.~.t39~-.d- .... House No. Street Ham/et County Tax Map No. 1000 Section ...0.7~ ...... Block .... 0.9 ......... Lot .... Q29 .......... Subdivision ......... .X. .................... Filed Map No .... 2~ ....Lot No... ~ ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... .~.a.2;. 9 ........... 19 &/4. pursuant to which Building Permit No .... ~. 3~fi.q · 7, .......... dated ....... ~8;7..q.0 ............. 19. ~3.z!, 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 ......... ..... ~cr~. ir~ourxc~ .swirami~..1~ool. ............................................. The certificate is issued to ......... .E.D..h/.~.R.~..&..~.U.~..~..Y., g.I.~..~. ?.I, r4L.. .................... (owner, t*~e~ ~ of the aforesaid building. Suffolk County Department of Health Approval ...lXI~.R. .................................... UNDERWRITERS CERTIFICATE NO .......... .~..6. 593.6.Q .............................. Building Inspector Rev. 1/81 FOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEP-JV~IT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) 13111 Z Permission is hereby granted to: · -": ........................ '~"'~'"' .................. ~'t .............. ....(~.~iL~:~-~.. ~.:..~.: ....u...~..~..~.~. ........ ~o ............................ T' '- · r' ................................ 77 ........ ~L.~ ....................................................................................................... : ............ ~ .............................. C~, ~ ~ ~ ~ , ~ .. ~.~.~ at promises I~ated at ...~.(~ ............ ~L...%~..~...~..~ ........... ~...~,~J~......~.~ ........~ ............ t .............. .......... ....................................................... County Tax Map No. 1000 Section .... ..~..:]..:~ ......... Block ........ ..~'. .......... Lot No ...... .c~....~. ........... pursuant to application dated .................. ~ ....... ~...~ ....................... , 19.?.. , and approved by the Building inspector. Fee $...~ .................... ..~ ...~ ....... : ............. ~' .................... Building Insl:mctor 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 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~-'~operty showing all property lines, streets, buildings and unusual natura~ 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 New Building ............. Old or Pre-existing Building ............ Vacant Land ............. ...... ~House No. .~ -~ Street Owner or Owners of Property . County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept, Approval ........................ Underwriters Approval ........................ Planning Board Approval ............... Request for Temporary Certificate ..................... Final Certificate . . ~i i . i . . . i . . . Fee Submitted *.. ~¢~', .~, ~ ................. Construction on above described building and permit meets all applicable codes and regulations. ^pp,cant .... FIELD I iI,5 P E.C'£ I ON FOU,qDATION (1st) FOUND~TIOU 2. ROUGH FRAME & PLUMBING ( 2nd ) COHMENTS IUSULATION PER N. STATE ENERGY C.ODE ADDITIONAL COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS 1000783 BUREAU OF ELECTRICITY ~hg 85 JOHN STREET, NEW YORK, NEW YORK ~0038 ~ate July 0~ ~84 ~pplication ~o. o.~ile 276893/84 THIS CERTIFIES THAT N650360 only the electrical equip,nent as described below and introduced by the applicant named on the above application nuo~ber in the pre~nises of Cie,,latk~ ~i/W/C C~da~ Av~n~o~ & ~um~f~, ~o~hold~ in thefollowing location; [] Basemeut [] 1st FI. [] 2nd FI. O~Ji~ Section Block Lot ~Jl~ ~0~ ~L~ and f°und to be in cotnpliance with the requirements of this Board. FIXTURE FIXTURES RANGES COOKING DECKS OVENS OUTLETS EXHAUST FANS DRYERS FLUORESCENT E R V I C NO, O~ CC COND A.W G NO OF HI.LEG PER ~' OF CC, COND, OF HI-LEG OF NEUTRAL ~,,'~. :~. I~ ~~ ~L~ffZ_c by the,r cred~nt als. GO~ ~OR 8~I.LDING DEPARTMENT. TNI~ OOPY OF OERT F[OATE ~U~ NOT ~ ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTIViENT TOWN HALL SOUTHOLD, H.Y. 11971 TEL.: 765-1802 Approved .~.'.9...,19}~'PennitNo... ............ Disapproved a/c ....... '. ............................ APPLICATION INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in t~plicate to th~ Buildi 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 sire. or areas, and giving a detaded description of layout of property must be drawn on the diagam which is part of this apt cation. .. c. The work covered by this application may not be commenced before issuance of Building Pemdt. d. Upon approval of this application, the Building Inspector will issne a Building Permit to the applicant. Such pern 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 Occupan sb~l have been~ranted by the BuUdiog Inspector. APPLICATION IS IIEREBY MADE to the Building Department for the issuance of a Building Pe~it pursuant to t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demoIition, as herein desc~N The applicant agrees to comply with all applicable laws, ordinances, building cod% housing code, and regulations, ~d admit authohzed inspectors on premises and in buildings for necessa~ inspections. (Signature of applicant, or name, if a corporation) (Marling ad'ess of applicant) 1/ State whether applicant is owner, lessee, ~gent, architect, engiueer, general contractor, electrician, plumber or build / (as on the tax roll or la~.d, eed) ..... of corporate officer) .... .NoTI[y 80TL~F~ .... ~ D~PA~TM[NT AT flder's License No .... ~ ........... / 1.FOLLOWING INSPECTIONs:PM Bu' THE PlunbersLkens~No...~K/ T/ON _ TWo REQUIRED FOUNDA .................. FOR POURED CONCRETE ~ 2. ROUGH _ FRAMING a PLUMBING Electrician's License No. /~7Z~ ............... 3. INCULATi~N 4. FINAl... CON'STRUCTION Other Trade's License No ...................... ' ALBE~"~m-~FL o~ ~,-,~FOR C, O. MUST 1. Location of land on which 2reposed work will be done, .~ ........ JU~ Street -"- ~ ,N eRRORs Subdivision ..................................... Fi~e: M~ No ............... got .~.~ ....... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..../.. . ~ .......................................... b. Intended nsc and occupancy L Nature of work (check whict, applicable): New Building .......... Addition .......... Alter~,tiof ....... Repair .............. Removal ............ Demolition .............. Other Wo;V3IOZ,~J,~. fao l (De Estimated Cost ............................. Fee .................................. (to be paid on filing this application) ;. If dwelling, nuinber of dwelling units ............... Number of dwelling units on each floor ................ If garage, nurnber of cars ........................................................................ If business, commercial or mixed occupancy, specify hature and extent of each type of use ..................... Dimensions of existing structures, if any: Front ............... Rear.. ............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .......... ./ ...... Dept ....... Itc ~t ......... , ..... -.. blumb*r ~>f Stories ....... ~., /,. ...... Dimensions of entire new construction: Front ,/~.15~. ~.' ./'/~¢.,f~.q~r~//./.~.//.2~:/.,,~.//,~j~/~.... Depth ,--~/~: ?. 7.J... ...... Height ............... Number of Stories 1~'4,'~... ff.( ~2~.~../-4-~ff..~. i ~_~. ~...~,:9~ ................ Size oflot: Front... ~*~./.~ ............. Rear..,,~/F~ ........ -...fi-i'7 .-' ~epth ..-/.0.0 ............ Date df Purchase ............................. Name of Former Owner ............................ Zone or use district in which premises are situated .............. ' ..................... ' .................. Does proposed construction violate any zoning law, ordi~3ance or regulation: .. ~2 P... ~ .................... \\'ill lot be regraded ,, ........................... Will excess fill be r.emo,aed from premises: ~ N( Name of Ox, mr of pr~m,ses . ff.-}~/,z-~-4<. ......... Address 1~. C. te,,,t~l ~F;,~4'.,?~/. Phone No. ,. ~.~..~ ..... Name of Architect ../j.,~ .. ........... , .......... Address ................... Phone No. Name of Contractor ~//,~J~/.~././7.J~.'/g'~/~,zXJ ....... Addresscv??~./.,~/,~//~. ~/2,~/~. Phone No. ). 2. 1. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from roperty hnes. Give street and block number or description according to deed, and show street names and indicate whethe~ te~or or corner lot. (Name of indMdual sign ng contract) )ore named. duly sworn, deposes and says that he is tile applicant e is tbe .......... ~7,~~... .................................................................. (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed tile said work and to make and file tiffs )plication; that all statements contained in this application are true to the best of his knowledge and belief; and that thc ork will be performed in the manner set forth in the application filed therewith. worn to before me this. fi ........... ~...~.. , .day of ...... ~ ..... 19~ ora Pubic ~ ~'~' ~~~/~' - --~ N~ P of N .............................................. No BI ublic, State ew York ~ :~ ' ~ (Signatur~ a can l , '~963 Suffolk ~un~( of ppli