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HomeMy WebLinkAbout13214-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building .~.n.g.v..o.u.n.d...s .w.l.m.m..~.n.g..p..o.o.1..~.. f?.n.c..e ............ Location of Property 3310 New Suffolk Avenue Mattituck, N.Y~ -' House No. Street Hamlet County Tax Map No. 1000Section .... 115........Block ..............9 .Lot .......... ;' ...... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ~..u .n.e.. ~..2 j .............I,9 .Off. pursuant to which Building Permit No. ~. 5..2.1fi. Z. .............. June 1 2 dated ............................ 19 .... 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 ......... ...... lCg~.quOg..&~¢¢m%Og..~qg~..&.~D.q~ ...................................... The certificate is issued to .... ~t g~ V. g 7..&.. O g.'t. $ 7 iq~. g g .0,S.I~ A W ........................ fowner,x/~(s~(~ ~q~t~ X X X of the aforesaid building. Suffolk County Department of Health Approval .............. I~/. g ......................... UNDERWRITERS CERTIFICATE NO ...... .............N.6........54853 .................... .. Building Inspector Rev. 1/81 1~O~ NO. ~ TOWN 0~ $0UTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CFHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13314 Z ~" ............................................................ ~,"'~"';~'r'"'~' ............ '\':'r'"~'"'-~' ......... ,,,,,rem,,es ,,~o,ed a, ...................... .~.....~j~.... ~U~., ........ .~'~ .............. Coun~ Tox ~ap No. ,ooo Sectio,~......~/..~ .......... B,o,:,~ ...... 3 ............ Lot No.....~... ............... pursuant to application dated ..... .~..~...~....-~... ....................... , 19.~...~.., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ~ la.....~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 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. 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 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- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5.Updated C.O. $15.00 Date .... "'-" './/~.//~',.O ............ New C on str, uc % i on ...... Old or Pre-ex isting BuiMing ............ ~ V~c~nt/ap~ ............. Location of Property ....... ~-~/~ ........ : . . ,~,. ,¢-~,., . .~,¢~,~,,.. ,~,~,~. · ............. Owner or Owners of Property ....' .~,~r~, . /_/~... ~,' .~.~ ............... County Tax Map No. 1000 Sectior( .... :..~.-~../... Block ...';7. .......... Lot ..... ' ........... Subdivision ........ ~ ........................ Filed Map No, ,, ~ ....... Lot I~o .............. Perm it No./.~ .~./. ,~. ~J)ate of Permit ~.I~,~..Applicant .. ~~¢~g~ ........... Health Dept. Approval ........................ Labor Deptc/Approval ...' ..................... Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate . ...~1'~.../.' ............. Fee Submitted $ ............................. Construction on above described building and per~m~/~,:ts~a,,~le ~_~nd regulations. Applicant , , , ,~/'~4',v,~. ~/~... ......................... Rev. 10-10-7B LO ~ )s~36 ~." THE NEW YORK BOARD OF FIRE UNDERWRITERS EIURE~A~J OF ELECTRICITY  - ~ 85 JOH~I STREETcNEW YORK, NEW YORK 10038 . ,~,~,o,,-,~ N 654853 THIS CERTIFIES THAT ~vet ~gs~w, s/s Now Suffo].k Ave. ~ 3~' itt the following location; ~ Basement ~ Ist FI. ,vas extmdnedon July 2,6, 1D$4 FIXTURE OUTLETS ~ECEPTACLES SWITCHES 2 ~ 2nd FlOtl-'~ld© Section Hlock FIXTURES OVENS Lot DRYERS FURNACE MOTORS AWG OF CC, COND. OF HILEG (;3¢tIi,'~ING POOL)~is certificate covers c~fli~mce aL the d;.~tc I~-~'5~1 cnv~'o~nts .i.t is advisable Lo t~zVC: frucluea't; m~h~ by ~ q~lifl~ per.n, Ruland El,ac. P.O. Box 143 Matt ituck, N.Y, · -eT .L195~ I,.Lc:.. 2/~,;; u: THIS IS YOUR BILL FOR SERVICE RENDERED AND IS NOT A CERTIFICATE OF COMPLIANCE. THIS BILL PAYABLE AT THE NEW YORK OFFICE, 85 JOHN STREET, NEW YORK, N. Y. 10038 FOUNDATION FOUNDATION 2. ROUGH FRAME & {1st) (2nd) PLUMBING 3. INSULATION FERN. STATE ENERGY ODE DATE COMMENTS FINAL ADDITIO COMME~ : .... , FORM NO. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~, $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined..~..~5"~.,..I..~e. .... 19~!{. Approved..~.~'~.../..'~.,., 19~ }/. Permit No./..~..~!.~ ..~.. Disapproved a/c ..................................... .~.' (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS R~ceived ........... ,19... Date ..... .¢.~ / z 19..~¢/ a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets 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 ,r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of tiffs application, the Building Inspector will issued a Building Permit to the applicant. Such permit hall 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 hall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Departme_nt for the issuance of a Building Permit pursuant to tlxe 'uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or '~egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ~he applicant agrees to comply with all applicable laws, ordinances, bufldi~llg, code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for necessary ~15~~ (Signature of applicant, o ,~e, if a corporation) z . . . , . . (Mailing address of applicant) ;tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. , .~..~.. ~..~...~. ~.~. ~ ./~..~. ~ .................................................. lame of owner of premises ].W..t~..4.~..~.. '4'' '&t<~4· '~.'~'' '/~'' '~/~z~'/>/e~-~ ..................... fas offthe tax roll or latest deed) f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) -.... Builder's License No ..... ¢ ...... /~.~. Plumber's License No .......................... Electrician's License No ....................... Other Trade's License No ...................... · Location of land on which proposed w~r~ will be done... ...... ......... .................. House Number Street Hamlet County Tax Map No. 1000 Section ............ Block ........... Lot .............. Subdivision ..................................... Filed Map No ............... Lot ............... (Nmne) · ~tateexistingusean~ccupancy~f~e~isesandintend2usea~d~c~pancy~fpr~p~sedc~nstr~cti~n: b. Intended use and occupancy ,2~'~ (~d-L~''k'Q,~ (U-)f.~..~... '.'.~.c.~..I...ffJ~j.~..~., 'f.F~..~..~...~:~. ........ 3. Nature of work (check which apphcable): New Building .. v.' ...... Addition .......... Altera,t, ion ......,-...i Repair .............. Rem?si ..... 0 ...... Demolition .............. Other Work~i~Jl~4.~14,.~..~ Estimated Cost .'~.Z ~)~)~. ~ ' Fee }..~.:': '~' (Description) ~ (to be paid on filing this application) If dwelling, number of dwelling ~nits .............. Number o f dwelling units on each floor ............... 0, Date of Purchase ........... i .................. Name of Former Owner ............................. 1, Zone or use district in which pr~mises are situated. ......................... · ......................... 2. Does proposed construction violhte any zoning law, ordinance or regulation: .. ' ~.~)i ........................ 3. Will lot be regraded ..... J[~C~ ..... ~ ........... Will excess fill I~removed from premises. Yes No 4. Name of Owner of premises }.{~ .~ '~-~0. Address/~.Ct~,~L,~. ~Y~.. Phone No ................ Nme of Architect ~ ..... ~ ................. Address,[:.. t ~21XQ~,.~-.. Phone No ................ Name of Contracto~ J~v: ~~ .... Address67J. ~-~ .~,. Phone No. ~).~2 7~.~... ' ~ P~T DIAG~ Locate cle~ly and dist~ctlg ~1 bulldogs, whether exist~g or proposed, ~d, ~dicate ~1 set-back d~'ensions from ¢operty ~nes. Give street ~d block ,dumber or description accord~g to deed, ~d show street nines and ~d~cate whether ~terior or co,er lot. ' ~ , If garage number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ........... 7. Dimensions of existing structurei, 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 ............... Rear ............... Depth ..... Height ............... Number of Stories. .................................. ~. 9. Size oflot: Front . · .......... Rear.~ ............ De .. : . rATE OF NEW YORK, [S.S OUNTY OF ................. ............................ i ................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ~ove named. is the ...................... ................................................................... (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this ~plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ~rk will be performed in the mmmer set forth in the application filed therewith. yom to before me this No 4701878, Std~olk (~0un~y (Signature of applicavt) Ierm Expires Mmch 30. 19~