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HomeMy WebLinkAbout13182-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificnte Of Occupnncy No.. g.14 ~ .(3.1 ......... Date ...... M..ay..! 4. .................... 19..8 .6 THIS CERTIFIES that the building ...H.Q .r.s.e..B..a.r.n. ................................. Location of Property .... 2.5.9. 5. $.O. UI~0. AV.$, ......... M..-5.T.T.%TU.C.K. ..................... House No. Street Ham/et County Tax Map No. 1000 Section .1.2 0 ........ Block .... ~ .......... Lot .... ~...1. ......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated · .~Iety..2 ............. , 19 ~3.4 pursuant to which Building Permit No .... .1.3.1. ~ g.Z ........... dated ....~.u.n.e...4 .................. 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 ......... ...... Cq~,t.r.~.t..~g .r.~.c.~4$ .t.u.~a..~. b.q~..s.e..b.a..~.n., .................................. The certificate is issued to ...... ~Rqbe~:.t..]~.t,e.~gt~tIn~ ................................. of the aforesaid building. Suffolk County Department of Health Approval .... ~//k .................................. UNDERWRITERS CERTIFICATE NO ............ I273.5579 .............................. Rev. 1/81 Building Inspector FOB. M NO. S 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) N? 13182 Z Permission is hereby granted to: ................. o ,ses located at .J...~..~....~....J~l......~: ........ .,~....~..~.....~.~..~ County Tox Map No. 1000 Section .... ./...~.....O.. ........ Block ........ ~ .........Lot No ...... ..~..:..I .......... ,o application dated ......... .~lr~...'~... ..................... , , 9.~.....~., and approved by the pursuant Building Inspector. Building Insl~ector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- ].802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. Th~s application must be fi~led in typewriter OR ink, and submitted ~j JJ~Jam~ 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 tile 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 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, Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. updated C.O. $15.00 Date ......... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property .................................. Harnler Hous~ No. ..~treet .... County Tax Map No. 1000 Section ............../~ B~ock ............... Lot.. ............. Subdivision ................................. Filed MapNo ........... Lot~/..N°' ,.~ ......... · I~ ~ e Pemit Permit No ........... Dat of r .......... ~,,~.-. , .~; ......................... ~.. / Health Dept. Approval ........................ Labor Dept. Approval ........................ Request for Tempora~ Certificate ..................... Final Certificate ....................... Fee Submitted $ ,~ .......................... · ou~o~e THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY, ~,~ ,,5 Jo.. S~'.EET, "E~' ~O"", "~W ~O.. ,OO~ THIS CERTIFIES THAT only the electrical equip~nent as described below and ~nt~duced by t~ applicant ~med on the able application number in the premises of ~'~, ~:~t;~m(~ig "~"}~/~t/C ~e~en Ave, a ~/o ~o~ ~v~e, ~,~ ~ in the followi~g location; ~ Baseme~ ~ 1st FI. ~ 2nd FI, Section Block Lot FIXTURE FIXTURES RANGES OUTLETS SWITCHES FLUORESCENT DRYERS S E R 'V I C OF HI.LEO OF CC. COND. NO. OF NEUTRALS OF NEUTRAL I~J.o#6341t GENEI~AL ~ANAGE~" , This certificate must not be ahered in any manner;, return to the office of the Board if incorrect. Inspectors may be identified by their credentials. co.~Y ~oa.Bu,~o.~e OEe~aZME.T. T~ S cOe¥~o~¢~a~c~.t~E ~US~T.OT a~ ^'~Ea~P ~" A"~ ~A~a. '~ FIELD INSPECTION FOUNDATION FOUNDATION 2. ROUGH FRAME & (1st) (2nd) FLUMBING INSULATION PER N. Y. STATE ENERGY qODE COMMENTS ADDITIONAL COMMENTS: RACIER & ASSOCIATES Structural Steel ...... _-A~_~:¢;AF~7/J ..... : Reinforcing Masonry Wood ............... Concrete ............ Soil Bearing INDEX RADER & AB~OCIA'rel CIVIL & STRUCTURAL ENGINEERS DATE, CHECKED BY F SHEET ~ OF .... CIVIL & STRUCTURAL ENGINEERS DATE CHECKED BY,, BY ,,SHEET., OF RADllI~ & A~IiOCIAI'IIB CIVIL & STRUCTURAL ENGINEERS CHECKEO BY SHEET ~ OF CIVIL & STRUCTURAL ENGINEERS __ SH;:ET ,, '~ Ot= CIVtL & ~FRUCTURAL ENGINEERS FtADEFi & ABBOCIA?I~B CIVIL & STRUCTURAL ENGINEERS DATE CHECKED BY SHEET CIVIL & STRUCTURAL ENGINEERS DATE CHECKED BY /~,' C- 4 -~?o o I:IAi:)EKi ~ ABBC3ClA'rEB CIVIL & STRUCTURAL ENGINEERS IDATE CHECKED BY /,~/-~ SHEET RADER & A~BOCIAI'~Ei ,, 0¥ CIVIL & STRUCTURAL ENGINEERS SHEET DATE CHECKED BY OF. 5950 3000 Tot~ C, H o.,2. ~> RADER & ASEIOCIATEB CIVIL & STRUCTURAL ENGINEERS .~C.-,,6, L£ I'~ = 30o0 CIVIL & STRUCTURAL ENGINEERS CHECKED BY ,~ = /~'.6-o/zo -- . 935' RAILER ~ ASgOCIATI=B CIVIL & STRUCTURAL ENGINEERS p,-- .~ ~.~1~..-.-/.~' '~- 5-- OATE CHECKED BY.. BY, SHEET ~ OF.__ p=/zxz/zx z. ... /oo;' ~'' h,4-- /& -F~< CiVil & ~I'RUCTURAL. ENGINEERS lily RADER &' CIVIL & STRUCTUR'AL ENGINEERS DATE , 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined . Approved . . ..~..., 19 ~}t. Permit No..}.~../.~.0-..>%. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .~..ctS.. ~ .... INSTRUCTIONS a. Tiffs 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 tiffs 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 regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) OS cu'o. fq d... ~. F. 0.,.. ~.o .o..%~J.d. ~..~. I,.~.~.~... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .. ....... ............................ If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... ] ~ '~. 1. Location of land on which proposed work will be done. C"~.e,O.. ~..~..~.. ~, ,e~-~~ c ~ ~~.'.ox,& .0..~..-.~ ~:. ............ ~ ~.'~., SO?& ................ House Number ~Street Hamlet County Tax Map No. 1000 Section ..... I..~..O. ........ Block ...... ~.. ........ Lot .... .t.~.,. { .......... Subdivision ..................................... Filed Map No ............... Lot ............... (N am e) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy IQ0.: e_~v,-i~.~. 1})0. ©.c..%o.~a.cx~c.~. 7...LJD O.~e.~...°t~C.l'c~k). ~vr.~.l... b. Intended use and occupancy '~O.C.~q.e~..~. ~.o. ,. I.d.'.6.~ :..GO .C~ .e..~. ,r-&r7 r~ ......................... 3. Nature of work (check which applicable): New Building .... ,~..,,, 'Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work 4. Estimated Cost ..... ~...-~ .~.,~ ............... ,... Fee ...................................... (to be paid on filing this application) 5 If lwelli tuber of dwelli g units *'-' N tuber of dwelling units on each floor · c ng, nu n .............. u ................ If garage number of cars 77'.. 6. If business, commercial or mixed ,Occupancy, specify 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 structure with alterations or additions: Front ................. Rear ................. Depth · ..... i Height Number of Stories .8. Dinaensions of entire new construotion: Front ............... Rear ............... Depth .............. Height ............... Numbler of Stories ........................................................ 9 Size of lot: Front ' Rear Depth 10. Date of Purchase ............ i ................. Name. of Former Owner ............................. 11. Zone or use district in which premises are situated../~. ~.r?t C. OJ.dc.,.~c~, ~. ................................ 12. Does proposed construction viola!e any zoning law, ord~nanc~ or regulation'..., t') .0. ......................... 13. Will lot be regraded 9~5~ d-te,..~e.~e~r_q. ~?~a~.dCq~.45.Sv~l~'xcess fill be removed from premises: Yes ~ No 14. Name of Owner o£ premises ~q [6~r7t:..¢~rl{q~.~.~.~oAddress l U J £,uq od D.¢% ~¢~. Phone No .~L.q ~:~-9. ~ . .. Name of ~trchitect ......... ,_, ................. Address .... [ .............. Phone No ....... L ........ Name of Contractor R_ o.g¢c. ....... Address 0,&. gc 4olrJ. Phone No. q..O. .... i° e cv ~ ,'c .; t2o n+c-~ ~q ,% 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/YORK, ~ .~ ~ COI~TY OF-~ .... ..~:-/.Lf~....~. ?..~.t..~.~., .,: .................... being duly sworn, deposes and says that he is the applicant 0 (Name of individual sign}rig contract) above named. ~~ ~ He is the ...................................................... of said owner or ownem, ~d is duly autho~zed to perform or have perfo~ed the said work and to m~e ~d ~e this application; that all statements conthined ~ this application are true to the best of his knowledge and belief; and that the work w~l be perfomed in the m~ndr set forth ~ the application filed therewith. Sworn to before me this ............... ......... ~ ,,, ?~ · ,~,,~ ;~,~ ...................... fi~{~l~, [,¢f~ ~,f,h 1o, ~ (Si~ature of applicant) 12'6" 12'6~ ,,, J