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HomeMy WebLinkAbout16519-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y, Certificate Of Occupancy No.. Z16792 .......... Date . . .April 13, 1988 THIS CERTIFIES that the building ...... .G .a .r .a g .e .................................... Location of Property 1425 Skunk . Lane Cutchogue House No. Street ' 'lfl~ar~/e;: County Tax Map No. ] 000 Section ... 92 ....... Block ...4 ............ Lot .. P/P..7 .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated October 6, 1987 pursuant to which Building Permit No ..... 1.6.5.1.9.Z. ........... dated October 11,' 1987 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 ......... ....................... aooosso~;7¢ .§anag, a ......................................... The certificate is issued to Stephen & Carol 0 'Conner (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .......... N/.A ............................. UNDERWRITERS CERTIFICATE NO, N848733 PLUMBERS CERTIFICATION DATED: N/A Building Inspector Rev. 1/81 FO~M NO. B 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) No- 16519 Z Permission is hereby granted to: ..~.~..~......%. .~...~....L.~ ........................ ,o ..... co..~ ~x ~ ~o. ~ooo s.~,,o. ..... ~.~ ........ ~,~ ..... ~.~ ........ ~o, ~...~..? ............. Building inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ToWN OF $Oui,u~-~ j~ Southold, N.Y. 11971 __ 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted aa~ 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 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 pZoperty 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: Additions $25.00 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory ,$]0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 5 0. O0 3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00_ 4.Vacant5.UpdatedLand C.O. $ 20.00 ........ / /~/ C.O. $ 50.00 Date ~. ,/,~.( New C OhS %puc t ion ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ./.?..~b.-....~.__~..O.¥.~.....~.~./~¥. .......................... .: ....... House No. Street J~am/er Owner or Owners of Property ~) County Tax Map No. 1000 Section .... .~..~. ~, ..... Block ..... ¢.¢ ....... Lot ..... .~/0., .7 ..... Subdivision ...... .~...~7.~..~. ................... Filed Map No ........... Lot No .............. Permit No ....... Date of Permit . . .Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ..... J~. ~.? ~ 3 ~ .Planning Board Approval Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ...... /.0.. ?~ .................. Construction on above described building and permit meets all applicable codes and regulations. - Applicant ................................... Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS 1000771 BUREAU OF ELECTRICITY BB JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT ~s exatnined on ~ 10 ~87 and found to be ,n compl,ance w, th the requiren,ents qf this ~ard fiXTURE S~/~/iTCHES FIXTURES RANGES COOKING DECKS OVENS EXHAUST FANS DRYERS FURNACE MOi%;~ FUTURE APPLIANCE F~RDERS TIME CI. OCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R V I C OTHER APPARATUS: pan~!s-l-3 cir 125 ~ NO OF CC COND A W.g. NO OF HI-LEG A.W G pER ~' OF CC COND OF HI.LEG NO OF NEUTRALS .~aland E!ec~ric ~ tD ~c~ 143 ~at~cLck Ne~ York 11952 L:~c~242-E GENERAL MANAGER Per 11 /' 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 FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER: , 765-1802 BUILDING DEPT. INSPECTION FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [] FRAMING ~/FINAL REMARKS: _~-- ~' ~.~30~ 'FORM NO. 1 ~ r ~ ~0~ O~ ~OU~O~O BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 76~1802 Examined. a.'~.~., 19~. Ap.roved Disapproved a/c ..................................... "- (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ? 3q- 7q 3 3 Received ........... ,19... fi. Tins 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 schedhle. 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 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) (M'ailing address ~t applicant) ' [' ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................. ..................................................... Name of owner of premises .... .~...7~.~..~..fl., .~. ~..~.~ .~. ,~..M.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 .......................... Plumber's License No .... ~..~..~. ~..~. ........... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ..................... House Number Street Hamlet 1 C~ounty Tax Map No. t000 Section .... ~).~.~. ......... Block .... .O..t4 ........... Lot... ~2./.O 7 Subdivision'.....~;.~.~. .......................... Filed Map No ..... T ......... Lot -- (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....~_~.~?..T~?...~.. ?~'.'.-~. !~.c..~. ......................................... b. Intended use and occupancy .., '...J~. · .~..C..~..~m~... ¢ ,~, , ~G 3. Nature of work (check which applicable): New Building .......... Addition.., ....... Alteration .......... Repair .............. Removal .............. Demolition ........... i.. Other Work ............... ~ .~ ~'OO ~' (Description) 4. Estimated Cost .... Fee .......... , ..................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling unit~ on each floor ................ If garage, number of cars ~-- ' 6. If business, commercial or mixed occupancy, specify nature,and extent of each typ~ of use ..... 7. Dimensions of existing structures, if any' Front .~.~ Rear . ~ De,-*h' ' ' ' '~-~' ~ ....... Height ...... (6. ....... Number of Stories /. ......... ; ...................... Dimensions of same structure with aiterations or additions: Front ~ Rear Depth ...................... Height ............ ;. ......... Number of ~tories ............ ~,~ ........ 8. Dimensions of entire new construction: Front ...... .~..~ ...... Rear ..... .;~.~. ~ ..... Depth ....~.?7 ......... Height ...... {~ ........ Number, of Stories . I Date of Purchase ....... ~z/2/; .................. Name of Former Owner . J.~.) Zone or use district in which premises are situated ................. : ....................... Does proposed construction violate any zonin~ law ordinance or regulation' ~.o .... Will lot be regraded ........ ~,o. ................. Will excess fill be remo~ve~t from premises: Yes Name of Owner of premises . .~. (9/q4q~-- ......... Address . .I.~-¢~.. ~.q~.~..b~... Phone No... 7.~..7.5t3.~~. .. Name of Architect ........................... Address ............ i Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM ' Locate clearly and distinctly all buildings, whether existing or proposed, and. ind:icate all set-back dimensions from property lines. Give street and block Rumbe~ or description according to deed, and show street interiororcornerlot. /~2.~- ~-b--,~k-~ Z.n~v~ Cor~,6. oe./dg/./ . ! names and indicate whether being duly sworn,, COUNTY OF, .,~-~44~.....~'.,~' ' ......... ~~;l's~~' ~' ~'9~--~-- ~'' '"'--~. mn, contract ......... ( .... g . g ) He is the .................................... (Contractor, agent, corporate officer gf said owner or owners, ~d is duly authorized to perfom or have application; that ail statements cont~ned ~ this application are true to the best o~ work will be performed in the m~ner set forth ~ the application filed therewith. S~om to beforeme~is~ ~ . .~.g.;~,.'. dayof . ~ ~. .... 19~7 ~1~ In 8~lk CounW ~ ~ .th~at he 4s4h~ applicant e~ahd file this and that the (Signature of applicant)