HomeMy WebLinkAbout16254-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z16136 Date Sept. 4, 1987
THIS CERTIFIES that the building .... .A.q c..e .s.s.o.r..y .................................
Location of P rt 4 115 Soundview Ave. Southold
_ _rope_wy ~/3~s~ ~/'o] ....................... 's'~/e~i ....................... h$~iei
County Tax Map No. 1000 Section 6 8 . .Block 0 1 .Lot P / o 15
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
...... ~a.y...2.8.,...1.9.8.7., pursuant to which Building Permit No...1.6..2,5.4.Z. ............
dated .a.u. 1. ¥..2.0. ,...! .9.8. 7. ............ 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 .........
..... Ac ce~.s. Qry..s.h e~t..o.n...a.c.c.e.s..s p.r,y., p.l.a.y. 7 .d.e.qk...a.d.d.~. ~. ~ ?.n..t. 9' .a.q .c .e.s.s.o..r .y ....
T~ .bgil. d ~ng. .
ne cerdncare is issued [o .... ~! ,C.H,A.E,L., .&..R. ! .T.A..H.A..G.E.R.I~.A. ~ ............................
fora,nor, ~ggeToX Folia~oXJX X
of the aforesaid building.
Suffolk County Department of Health Approval ....... .N./.A. ...............................
UNDERWRITERS CERTIFICATE NO ............... .N.8.1. 6. .8,7.5 ...........................
PLUMBERS CERTIFICATION DATED: N/A
........... -.
Rev. 1/81
FORM NO. S
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWH HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PEI~MIT MUST BI: KEPT ON THE PREMISES UNTIl_ FULl.
COMPl-ETION OF THE WORK AUTHOR, IZED)
No- 16254 Z
Permission is hereby granted to:
..............................
. .~../../~.-...~.~.~....~ ......
at premises located at ............ ./~ .~.../.~...~.~.~~~..~-/.. ...................................
County Tax Mop No. 1000 Section ......... ~,.~.. ..... Block ....... ..~.../.. ....... Lot No .............
pursuant to application dated ...~./..~.~... .................................. , 19.~..~7,, and approved by the
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 I~ to the Building Inspec-
tor with the following; for new buildings or new use:
1. Final survey of property with accurate Iocatlon 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-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 bbildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees: Addit ±ons $25.00
I. Certificate of occupancy New Dwell±rig $25.00, Accessor¥-~$]0.00 Bus±ness $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50-. 00
3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00
4.Vacant Land C.O. $ 20.00
5.updated C.O. $ 50.00 Date .,~...~'.,..L.¥-.~'.?.
NewConstruction ...... Old or Pre-existing Building ............ Vacant Land .............
Location of Property...Z~/././~.~. ................... .,~. ~../~.'t/4~_ ........
County Tax Map No. 1000 Section ... ~.~ ......... Block .... .Q ( ........ Lot ...~..~. .......
Subdivision ................................. Filed Map No ........... Lot No ..............
PermitNo..~.~.~..Z. Date of Permit .......... Applicant ...~..~,~
v
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 all applicable codes and regulations.
Applicant ..... . ................
e.v.
?
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
~ 85 JOHN STREET. NEW YORK. NEW YORK 10038
O.t~ June ~5, 1987 ~ppli..tlo. No.o.file 484170/87 N
THIS CERTIFIES THAT
only the electrical equipment as ~scribed below and interlaced by t~ applicant ~med on ~he a~e application number in the prem~es of
Hage~man, 4115 Sonnd View Avenue, Southold,
in the fotlowlng location; ~ B~sement ~ I~, r~. ~d rt, garage s~ti,,. ~ Lot
· ~ ~ ~ ~ r 19{~ 7 and found to be in compliance ,. th the requ re,nents of th s Board.
FIXTURE
OUTLETS
DRYERS
FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
SYSTEMS
NO. OF FEET
E
3THER APPARATUS:
E R V I C
AWG.
OF CC. COND
NO OF HhLEG
NO OF NEUTRALS
Michael P. ~agerman
4115 Sound View Ave.
Sou~-zold~ N.Y. 11971
GENEIKAL MANAGER
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FO? BUILDING DEPARTMENT. THIS COPY OF CERT F!CATE M. Us~ NPT B~E ALTERED N ANY MANNER.
UNDATION (1st)
UNDATIO~ {2nd)
UGH FRAME &
PLUMBING
SULATION PER N. Y.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS'.
TOWN OF SOUTttOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
:5~ ~ ~1'87
TEL. 765-1802
To Whom This May Concern,
We are unable to complete your Certificate
of Occupancy because .of the following reasons.
/_~/ An application for Certificate of Occupancy
is not on file.
/~F' No Underwriters Certificate on file.
/? The check is(outdated/not on file.)~.o~
/5/ No Health Dept. Approval on file.
/5/ No final inspection has been made.
Please contact our office on this matter.
Thank you for your cooperation.
Building Permit # _~ ~_ ~ _~ .~ Z
Building Dept.
***/5/ No Plumber Solder Certificate on file.
( all permits involving plumbing being
issued after April 1,1984 )
0~cupancy or use is unlawful'without a Certificate
of Occupancy. Clear up this matter-as soon as possible
so that le§al action does not have to be taken.
Thank you for your prompt attention.
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
To Whom This May Co''~- - ~ncern,
We are unable to complete your Certificate
of Occupancy because.of the following reasons.
/:/'-' No Underwriters Certificate on file.
/_~
/-/
/-/
An application for Certificate of Occupancy
The check is(outdated/not on file.)~--
No Health Dept. Approval on file.
No final inspection has been made.
Please contact our office on this matter.
Thank you for your cooperation.
Building Permit # _~ ~ ~_~ ~ .~ Z~
Building Dept.
***/Z/ No Plumber Solder Certificate on file.
( all permits involving plumbing being
issued after April 1,1984 )
O~cupancy or use is unlawful without a
of Occupancy. Clear up this matter as soon
so that legal action does not have to be taken.
Thank you for your prompt attention.
Certificate
as possible
FULTZ
I
:' ,/ t' 'FORM NO, 1
NJ~¥ 2 8 J98'[, : ~ .' TOWN OF SOUTHOLD
I BUILDING DEPARTMENT
~, ~ TOWN HALL
'~ TOt;'~Vt,' '": I. _ ~ SOUTHOLD, N.Y. 11971
.................... ~; !: TEL.: 765-1802
- 1997
Examined .. ~/ ............ , . ..
Approved ............ , 7eemit
Disapproved a/c .....................................
............................... .
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
BOARD OF HEALTH ......
3 SETS OF PLANS .......
SURVEY ..........
CHECK ..........
SEPTIC FORM ............. :
NOTIFY
CALL ................
MAIL TO:
a. Tttis application must be completely filled in by Wpewriter or in ink and submitted to the Buildhng 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 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 o~
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 tc
admit authorized inspectors on premises and in building for necessary inspections, t
....... .t.t. g. .........
(Mailing address of applicant)
State ~vhether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ...... } .~/~ .~.'. ,~-'..'.a~ · ~&41t~..~-'-~;'~. ~. -'. · · 4qO,~.~0-d~2~( ............
on the tax roll or latest deed) xa
If applicant is a corporation, signature of duly authorized officer.
(Name and title of co,orate officer) -
ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED
Builder's License No ..........................
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
1. Location of land on which proposed work will be done~ .................................................
.&? hv. . .. co .... .......
House Number Street Hamlet
County Tax Map No. 1000 Section ... O~..~.: ........ Block ... ~). ] ........... Lot..~./~). ~../.~.~' .....
' Subdivision ...... ?' .............................. Filed Map No ............... Lot ...............
(Name)
2. State ex/sting use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ..... · ...................
b. Intended use and occupancy ....................................... ! ............................
Nature of work (check which apphqable): New Building .......... Addition ..... Alteration ..........
Repair .............. Removali .............. Demolition .............. Other Work ...............
. .~../.O. OO o~ ([~escription,
Estimated Cost ' Fee
" (to be paid on filing this application)
If dwelling, number of dwelling units ............... Number of dwelling units on each floor., t .............
If garage number of cars
;. If business, commercial or mixed oclcupancy, specify nature and extent of each type of use ........... ' .....
' Dimensions of existing strUctures, if'any: Front ............... Rear .............. Depth ...............
Height ............... Numberiof Stor es ........................................................
Dimensions'of same stn~cture with 4Iterations or additions: Front ................. Rear ..................
Depth ...................... Height ...................... Number of Stories ......................
' ti pth
,. Dimensions of entire new construc on: Front ............... Rear ............... De ...............
Height ............... Number]of Stories ........................................................
~ Size of lot: Front Rear Depth
). Date of Purchase .............. i ............... Name of Former Owner .............................
Zone or use district in which premisles are situated .....................................................
!. Does proposed construction violate hny zoning law, ordinance or regulation: ................................
· Will lot be regraded ........... I ................ Will excess fill be removed from premises: .Yes No
£p
· Name of Owner o remises ...... i .............. Address ................... Phone No ................
Name of Architect ............. .............. Address ................... Phone No ................
Nmne of Contractor ............ .............. Address .... : .............. Phone No ................
,. Is this property located within 300 feet of a tidal wetland? *Yes ..... No .....
*If yes, Southold Town Trusteles Permit may be required.
~ PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from
operty lines. Give street and block number or description according to deed, and show street names and indicate whether
:erior or corner lot. ,
'ATE OF NEWYORKa
being duly sworn, deposes and says that he is the applicant
(Na~'vidual ~igning 9ont~act)
ove named, i
is the :
i (Contractor, agent, corfforate officer, etc.)
said. owner or owners, and is duly a4thorized to perform or have performed the said work and to make and file this
plication; that all statements containe~t in this application are true to the best of his knowledge and belief; and that the
~rk will be performed in the manner se~ forth in the application filed therewith.
,om to before me this
..... ~..~. · .......... day or..
t ary Public, . ....~g~¢'~'. ,Il.tN g.~V~ i ' ~"' ~ fl'&' '~/' '~' ' ..... County ....~. ~~~i~i~
. No. 47o,,7,.
lerm Expires MJrch