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HomeMy WebLinkAbout13183-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Plumbers Certificate No. Z14255 Date .. ?.e.b.v..u.a.~.y. 28 .......... 198..6. THIS CERTIFIES that the building ...Q n~, .~ ¢ ~- 33r. . ql V.e.~ i. $ .ng.. ...................... Location of Property ......... .3.7.8.0.. 9.v. qh..a?fl..S..~F.e.e..~ ........... Orient House No. Street Hamlet County Tax Map No. 1000 Section .. (~ .2.7 ....... Block ....3 ........... Lot .. ~..'* .0..3. ......... Subdivision .B?.a..u.g.o.~.o..~.s..~c..v?.s. ...........Filed Map No. 6373 .Lot No. 5 conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ~uzae..q ........... , 1 ¢3.6.. pursuant to which Building Permit No. 1. .3.q.8.3, Z. .............. dated .. d.u.ne. 6 ................... 19.8. q, 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 ......... 9.~.e.. r..a.m.~.~.y...d.w.e..Z .~.~.n.g. ~..K~.~.h...~9.qd...s.~.qv..e .. .................................... The certificate is issued to ...... 1~ 5. ~ [t J~.~ D...D.E.. ~ 9 .E ......... (owoer, X~Jg{~'~t~{ ~ .................... of the aforesaid building. Suffolk County Department of Health Approval .... .1.4.-: $ 9 :~.1.q 9. ~./. ~[ 6. [.8.6. ................. UNDERWRITERS CERTIFICATE NO ............ ]).iq. 7. .3 .5.4.2. 2....2./. 1 g/,8,~ ................. 2/28/86 Building Inspector Rev. 1/81 FOmM' NO. S 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) 13183 Z Permission is hereby gronted~t~ , ~ ~ ~ / .~.~.~ .... !.b~...Y....~ .................. .~ ~' ........ ~. ............. ~~.....~.~ .......... ©~..~ ,~, .,. ........ .......... ~~...~~ ~ , ...................................................................................................... , ......................... ~,,r,m,,,,,~,,,~,...~..~..'. ........ :.~.~.....~ ......... ~~ ............... · c) ;~q k -3 Lo No ....~..:~.'~. .......... Count,/ Tax Map No. 1000 SectionI .................... Bloc ......................t . pursuant Building Inspector. Fee $ ................... Building Insl~ector Rev. 6130/B0 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 ,, Tow,, OF SOUT~OLD APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions This application must be filled in typewriter OR ink, and submitted m ~ 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 electrica~ 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 Amhitect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site ptan 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 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 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5.Updated C.O. $15.00 New Building ..~ .......... Old or Pre-existing Building Location of Property ....... House No, Owner or Owners of Property $15.00 Date 2/°~.~.~f° ............ Vacant Land ............. . .......................................... PermitNo..1,~./..~.~..Z... Date of Permit .~/~z/O~.%..Applicant .,~. !.~,~.~.~. ,~. ,~, ,~.~. .............. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets ail ap~pl~icable codes and regulations, Applicant .~..G .~ ~.~ ................................ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY BS JOHN STREET, NEW YORK, NEW YORK 10038 only the electrical equipment ~ ~scrlbed below and introduced by the applicant named on the above appl~o~ ~tu m~r i~g the premises of ~icha~ ~V(~h, S/S Ox'cha~t St:cee,~ (~:leut, was examined on ~¥~ ~ ~ ~ ~ tutti found to be in comptlance with the requirements of this Board. EIXTURE OUTLETS 1] ~ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS EXHAUST FANS NCANDE$CENT FLUORESCENT ~o~ 1l DRYERS FUTURE APPLIANCE FEEDERS TIME CLOCKS ~NIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO, OF PEET SERVICE DISCONNECT S E R V I C E 1 ,.t0 I ~/0 OTHER APPARATUS: ~o~z~: 1-ibp 38~0 .' Ck~chard S~r¢~et Orient, N.Y~ 11967 This cerfffkole must nof be ~itered in ony monner; return to the office o~ the Boord )( iocoKrect. )nspecto~ moy be )dentified by ~hek cre~e.fi~ s ~) [ ~ CO~FQRBD~LD!N~D~PARTM~NT, TH)~COPYO~)~I~MU~T,NOT~E~L~E~EPlNANYMANNER. _ TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. Owner ~/~P(~ ~ (please print) Plumber /~'~/~.~ /~ ~'/~--~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber's signature) Sworn to before me this 19 ~ Notary Public Notary Public, ,~ County FIELD INSFECTION FOUNDATION 1st) FOUNDATION 2nd) ROUGH FRAME & PLUMBING 3. INSULATION FER N. Y. STATE ENERGY C~ODE COMMENTS FINAL ADDITIONAL COMMENTS: I am requesting that my Building Permit extended for six months B.P.#13183Z 6/4/84 extend to 6/4/86 be 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~. $OUTHOLD, N.Y. 11971 TEL.: 765-180:3 Examined.~.~ .~. ...... , 19g. .~. . .......19;~'1 .~: .~-'~-.....~ i Permit No / Ta \ '~ ~ 9c- Approved 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 Ihspector, 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 buildh~g 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 in~ ~/~t~~ (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...~[C~.~.~.. N .~..O~. .................................................... (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 ..... ~.~..t2.?. ............... Plumber's License No ..... Electrician's License No. Other Trade's License No ...................... I. Location of land on which proposed work will be done .................................................. ..Sr. ...................................... ..................... House Number Street Hamlet County Tax Map No. 1000 Section .... 0..~'.~. ........ Block ....... .~. ......... Lot....~...~,..(~)...~. ..... Subdivision ...... .6~0.-?.Q .~!.5. f[.~[~ ......... 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..~..~'~.~(.d, [tO~...Q .~.~-. Et~.Pl..~.(-. ~. .......................... b. Intended use and occupancy .................................................................... 3. Nature of work (check which applicable): New Building . .' ..... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cos . ., ....................... Fee ...................................... *'- (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits...~..~l.E~. ........ Number of dwelling units on each floor ................ If garage, number of cars ..... i ................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... 7. Dimensions of existing stmcture~, 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. Dimensions of entire new construction: Front . .g~.~.e~r. ...... Rear . .~..~g~. ....... Depth . flY..P~.~F. ..... Heieht ~2~ .~t'r Number of Stories . .o9. ................. Date of Purchase ............ : .................. Name of Former Owner ..~.A~..~..0~. ~.o.~. .............. Zone or use district in which premises are situated. ,~..~c~.. ~. .............. ! .............................. Does proposed construction vioh te any zoning law, ordinance or regulation: /'9..0.. ......................... ._.~. · Will lot be regraded ....... t~' : · ' · '~' · 'r .........Will excess fill_ be removed from premises: Yes ' (~No~ Name of Owner of premises ./Mi/~,~g~.l~[JO[ ...... Address .~.6.~.o...~../{/~P~..~T... Phone No.. ~.2[¢7~ .... .'~.. Name of Architect ......................... Address ................... Phone No ................ Name of Contractor ...... , ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all i buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block humber or description according to deed, and show street names and indicate whether interior or corner lot. 10. 11. 12. 13. 14. STATE OF NEW/yOI~I~, . j, c S COiJN ¥ 9F ,.,/(~..//~..~...(,f..~cff..... [ .................... being duly sworn, deposes and says that he is the applicant (Name of individual s~glrting contract) above named. . , He is the ......................................................................... (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 contained in this application are true to the best of his knowledge and belief; and that the work will b~e performed in the manner set forth in the application filed therewith. Sworn to b~fore me this Notary Public, (Signature of applicant) Oz ,/ 0 0 :~ Z I-,- _J 0 b. D /