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HomeMy WebLinkAbout15385-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z15945 Date July 13, 1987 THIS CERTIFIES that the building ....... a..d.d.i.t.i..o.n..t.o...e.x.i.s..t .i.n.g...d.ch.e.1.1 ing. Location of Property 7.45. .............. .W.a.te.r.s.e.d. ge .W..a¥.. Southold House No. ' ' ' 'S'treet .................... County Tax Map No. 1000 Section .... Q .8 .8 ..... Block .. 9.5. .......... Lot 62 Subdivision .... B.~ylg.a.v.e.o .................. Filed Map No..2.9.1.0....Lot No..5..2 .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... .O.c.~Q~o.e.r.. $,..],986 .. pursuant to which Building Permit No .... 1..5.3.8.5. Z. ........... dated .O. ctob.a~. 1 O.,.. 1~ 98.6 .......... 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 .t.q..c.o.n.s. truct ...... an. ad.clitor~ .to. an .exi.s.~i~..o.~e..f.a..m.i.lx .d..w.e.l. 1. $.ng.,...a.s..a.p.p.l.i.e.d...fp.r. The certificate is issued to .......... K1 a/~s. t~or~ig .......... . .... , ...................... (owner, lessee or renanU of the aforesaid building. Suffolk County Department of Health Approval ........... ~ ./A ............................ UNDERWRITERS CERTIFICATE NO ....... N 81.6.411 ................................... PLUMBERS CERTIFICATION DATED: July 7, 1987 Building Inspector Rev. 1/81 FO]iU~ NO. O TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERJ~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15385 Z Permission is hereby gronted to: ..... .~..'~,...~.~ ............................................................ ,o ~'~'~'"~'"'~~"~ ............................ ~':x-~"~ ................... o~ ~,~ ,~ ~...~.~~~..~~ ....... '~ .................. ...ff.~....l~ ....................................................................................................................... co~w ro~ ~op uo. ~000 s~.o~ ..... o.~..~ ...... ~k ....... 0.~. ...... cot so....[.~ .......... pursuont to ~pplicotion d~t~ ...... ~.~....~ ................ , 19.~.~., ond opprov~ bv th~ Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y, 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 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: I. Accurate survey of pZ~operty showing a~l 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 1. Certificate of occupancy New Dwelling $25.00, Accessory,,$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.woant ,and O.O. 20.00 5.Updatecl C.O. $ 50.00 Date :.~... .~ ........ NewConstruction ., ,~/~... Old or Pre-existing Building ............ Vacant Land Location of Proper tY~oC~.is~.~,.. ~. ,d~. ,~ S~tr~t..~ ~, ~--).C'(.~,. Ham/et Owner or Owners of Property .......................................... County Tax Map No. 1000 Section ..... ,~. ..... Block ,.. 5.. ........ Lot ............... Subdivision .... ~ ..... .~ ~,~./~, .......... Filed Map No .... Lot No..~."--.c~ ....... Permit No../~-.~,7~..~ Date of Permit /.0//..~//..~..Applicant..~.,~.~. ,~'2~(,4.~.~. .............. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $..oK, .~ ..................... Construction on above described building and permit meets all applicable codes and regulations. ~,~(/bO, ~ ,~J, L6p l ,~ Applicant ..................... Rev. 10~10-78 THE 1001071 gun~ 24 THIS CERTIFIES THAT NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 88 JOHN STREET, NEW-YORK, NEW YORK 10038 only the electrical equipment as described below ao~l introduced by t~e appllca~t named on the above appilcation .umber in the premises ~Ionig~ 745 watersedge Road~ Southold~ N.Y. DRYERS FURNACE MOTOES ~2nd FI. Section Block Lot and found to be in compl ay ce u' th the requirentents ~f this Board. EXHAUST I:ANS TIME CLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET SERVIC~ DISCONNECT S E R V I C OT~' ~,~Jt..TU~ i9h ting 1 4 lites NO, OF CC COND PER ,e' AWG, OF CC. COND A. WG OF HI-LEG E OF NEUTRAL Box 215 $outhold, NoY. 11971 Lic#578~ Per _ ~his certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be ~d~t~[ed by their credentials. COPY FOR BUILDING DEPAETM~HT. THIS COPY OF CERTIFI~TE MU$T NOT BE ALTERED IN ANY ~NNER. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. /~J~ ~ owner //~l~ ~ '/-~"'../,. ~ /F-lease p~int) Plumber ~/~ ~7-- ~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. ? ~lu~ber s signature) Sworn to before me this Notary Public, Co.nt ~otary 'P~bl ~c BERHADE'F~E L TAPLIN ~...~.-~'~'q'J$gC5 PUBLIC. State o~ New Yor~ 765-1802 BUILDING DEPT. INSPECTION []FOUNDATION 1ST [ ] ROUGH PLBG. []FOUNDATION 2ND [/~]~SU~TION []FRAMING [ ]~INAL REMARKS: ~/jft/'q D/~ DATE 765-1802 BUILDING DEPT. INSPECTION'~ FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING FINAL REMARKS: ~~ ~_.,O · ,/ DATE* INSPECTOR 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [~ROUGH PLBG. i/ORAUNDATION 2ND[ ] INSULATION MING [ ] FINAL .~i~LD I~ S, FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: LOT $?_ ' ~N 0,-" .%aUTH OL.D, OCCU?^NC¥ OR · USE IS UNLAWFUL WITHOUT CERTIFICATE '~r ~ 1902 9 .~M TO ~ ~ ~R THE ~: COM~E?E FOR ALL CO~T~L~TION ~L MEET THE ~EQU~RE~E~$ ~ COD~. NOT ~8~ ~OR ~iGN OR CC~I8~ON ER~RS, /' c\)4 3~- ~3 ,~p¢o',~vcC :? I"~',~S~o~)~ t ~w ~cce% ,Cf& ~-~.,I--~ I&''°~' Examined .(~.~.....~H~....~..., 19 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved..~...~7~ . .~.., 19~. ¢. Permit No. ] .~.~..~..~...~ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT BLDG~ DEPT. TOWN OF SOUTHOLD Received .......... ,19... INSTRUCTIONS a. 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 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 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 insvections -- traaiz±ng address of app]_±cant:)bUide--'l-'r. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or ............................................................................ Name of owner of premises . . . .~.O:..% .... O.R ........................................................ (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...¢. I.~...%.7.~. ......... Plumber's License No. {.(~)..~./..*~. .............. Electrician's License No...~..~.?.~. 7..~.~-. ........ Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. s ......................... ..... .................. House Number Street Hamlet County Tax Map No. 1000 Section . . . .~.~. ............ Block ...,~ .............. Lot...~ ~- ............. Subdivision..~.q.y...~J.Cs.~ggN. a144) ................ Filed Map No. ~,.~/.O ........ Lot..~..'~.'~.,} ........ State existing use and occupancy of premises and intended use and occupancy of proposed construction: - G '/,,,. a. Existing use and occupancy ... /./4.~[~... m t .. ~.~.~/. ¢~[ .~.-~ .......................... b. Intended use and occupancy .~ X .3C.~ d .~..~ [l~¢?t~5 ~/k~tC.~.e~ · 3.~ Nature of work (check which applicable): New Building .......... Addition.. i..~.... · Alteration ...... i... ' Repair .............. Removal .............. Demolition ........... ,... Other Work ............... ' (Description) --~ Fee (to be ~aid on filing this application) 4. Estimated Cost ..................................... . ............................ 5. If dwelling, number of dwelling units .............. Number of dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each ty~e of use ..................... 7. Dimensions of exis~ing structures if any Front .~.-/ ....... Rear . ~. (40 Depth ~/.. . . Dimensions of same structure with alterations or additions Front . 6~ .-/ . i . Rear ~ K0 ... Depth ...... ~.t/ ............. Height ...~.~/ ................ Number of~tories..5 ........ ; ......... 8. Dimensions of er~tire new construction: Front ... ~.~ ......... Rear ....'~:~ ..qO ..... Depth . .(,,.51. ......... Height .. ' ~ .tI ~.ulnber of Stories ~2- .... . ..... 9. Size of lot: Front ..../O.O~0 ............. Rear../.0..,~. .............. Depth .~9..O.~:0 ............... 10. Date of Purchase.. .... .6./~/~ f ................ ~ame, qf ForrOer Owner i/f.~.qtT.. J~.l.'e.~lth~ ............ I1. Zone or use district in which l~remises are situated .... ].~.eStc, i.e. np.l~C[ 12. Does proposed construction violate any zoning law, ordinance or regulation: ...,q.O .............. , ............. 13. Will lot be regraded ..... Z').LD. ................... Will excess fill be removed, [rom premises: Yes 14. Name of Owner ofpremmes . ./f.lg,.~..~ .~p~.,.~ .... Address . L~o~qtr £5¢0(~/.¢ .i~)q)~ Phone No. 7.6.~... ~'~( .... Name of Architect '-- . Address ~ - ~h~,~ 15. Is this property located withinl.0~eet of a tidal wetland? *iYes .)~,.. No ..... · If yes, Southold Town Trustees Perm~it may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate ail set-back dimensions from property lines. Give street and block number or description according to deed, and sho~ interior or corner lot. names and ind~cate whether STATE OF NEW YORK, COUNTY OF .... S.S · .~ .". t[,. [~t. gg .~. D.~[0.. ~. .............. .......... being duly sworn, depdses and says that he is the applicant (Name of individual signing contract) above named. He is the .... ~'~']~.~ .C~.Q../~.. ....................................... I ............................ (Contractor, agent, corporate officer, etc.! of said owner or owners, and is duly authorized to perform or have performed the shid work and to make and file this application; that all statements contained in this application are true to the best of hii knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ...... .cT~x'.'~.. c-~ ............ day of....~.0~-.~ ....... , 19~.'. Note Public, .... ~.. ~. 44~.... County , _ .