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HomeMy WebLinkAbout15412-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Ol~ Occupancy No. z 16270 ................. Date October 8, ]987 THIS CERTIFIES that the building Ac ce s s. 9.ry' pool Location of Property .... !999.5. ?. :. ?.~.y.y.i.e?...~.o.~.d. .... .S o.~. r..h o ~ d .. House No. Street ..... County Tax Map No. I000 Section 0 79 .Block ....0.5. ......... Lot ., .2.0...5. .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated Oct. 10, 1986 pursuant to which Buildiug Permit No. dated . Oct 20~ 986 ...... · _ ................. was issued, and conforms to all of the requirements of the applicable provisions of the law. Tile occupancy for which this certificate is issued is ......... ....... ~c ces.aor y..£ngr~.und..p, qo J,..a.r~d. £.e.nc ~..a.s.. ~ pp. 1. ~, e.d..f.g .r.. .............. The certificate is issued to James & Patricia Boyle ..................... /o¥,,'o;, ~[¢S~,5 >b'f;giF( x ~c x ................. of the aforesaid building. Suffolk County Department of Health Approval N/^ UNDERWRITERS CERTIFICATE NO ................. tq 808708 PLUMBERS CERTIFICATION DATED: Building Inspector Rev. 1/81 FOBM NO, ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDIHG PERJ~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 15412 Z Permission is hereby gronted to: ..~......~.~.~.....c.~..~...~; ..... ..... ~......~~......,..:.?..~. ....... ,o ..~.m....~......~~..~~..~..~...~.~......~.... ot p~,~ ~oa ~t ..1 ....................... .~..~ ......... ~ ...... ~~- ........ . .................................................................................................................. co~ ro~ ~op ~o. ~000 s~t~o~ ...... ~..~.~ ....... ~k ...... ~..~ ...... Cot ~o....g~...~ ....... purauant to ~pplic~tion dot~ ...... ~..~....L~ .................. , 19.~.~.., ond opprov~ 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 tvpewriter OR ink, and submitted m ~,m,,mmm 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 compl'iance from the Architect or Engineer responsible ~o~ 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 buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $25.00 -- BUSINESS $50.00 ACCESSORY $10.00 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 ................... New C ohs truc t ion ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ..... ,. ~./. .. House No, Street Hard/et Owner or Owners of Property .~.q .~ .e.~..*..5 . .. f~q I' .ct .... ~. ........................ County Tax Map No. 1000 Section /7 ~ Block 9-- Lot Subdivision ................................. Filed Map No ........... Lot,No .............. Permit No.../~,~,/. ,~.. Date of Permit ..... Applicant ........... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approva~ ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ~ ................. Fee Submitted $. ~...fJ,"~. ,~..~ .................. Construction on above described building and permit m~ee~ts all applicable codes and regulations. Applicant,. . ...: ...................... , °/z/z ? z/¢2 THE NEW YORK BOARD OF FIRE UNDERWRITERS  BUREAU OF ELECTRICiTy ~J~,~r 1J~ .1.~7 BB JOHN STREET, NEW YORK. NEW YORK 10038 N 808708 THIS CERTIFIES THAT o~ly the electrJc~l~u~t ~?~be~ ~e~ a~d ,~tm~uc~ b~ ~he ~a~pli~t ~ed o. the a~ve application number i~ the premises of i~ ~hefol{owlng location; ~ Basement ~ Ist FI. ~ 2nd FL Section Bilk Lot u~s examined o~t ~J~y Ol$ ~ ~ ~ and found to be in compllanee with the require.tent,~ of tts Board FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS EWITCHES FLUORESCENT DRYERS FURNACE FUTURE APPLIANCE FEEDERS TIME CLOCKS MULTI-OUTLET DIMMERS, SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R V I C E OTHER APPARATUS: ~S,~,/i~I~ILN~ POOL; THiS C~t. TIFICATI/, CO~ERS COMPL~C~ AT TH~ DATE OF ~SPECTION O~LY. ~OS~ OF U~USU~ ~NV~ONa~NTS IT IS ~VIS~LE TO ~Vi F~QUE~T T~ST ~D/O[ ~PAI~S OF NEUTRAL Box 213 Souchold, NY 11971 This certificate must not be altered in any manner; return to the office of the Board COPY FOR BU LDING DEPAR' iT. THIS ! OF CERTIF correct, be by their IN ANY J. 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: DATE ~OUNDATION (1st) ~OUNDATION (2n~) ) ~OUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE ADDITIONAL COMMENTS: ~o~~, 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined . .~.~..~..?., 19~.~.. ~o . . . Permit No I&'-q'l/ Approved O.0~...~.. ....... , 19 ............ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... INSTRUCTIONS a. This 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 c, ode, and regulations, and to admit authorized inspectors on premises and in building for necessary ~o~ . (Signature of applicanlk or name, if a cgJ~oration) lessee,(~'e~architect, engineer, general contractor, electrician, plumber or builder. State whether applicant is owner, (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 ......... ..~.~.'-}..~.'..ff. '.~'-.. ·. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ...... I ..... /.~-c~ ......j ............ : ......................... ~/,.-. ............ House Nmnber Street Hamlet County Tax Map No. 1000 Section ........ 7..~. ...... Block .... .~.... ......... Lot ..... .~..O.,..-5' ' ...... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and ~ccupancy ~f premises and intended use and ~ccupancy ~f pr~p~sed c~nstructi~n: a. Existing use and occupancy .... /..Z.. c/fi... .~ ................... b. Intended use and occupancy . .-~-..~.q~.~..&W<~/.. ~. (t/.Z.~..~Z.z..-~..~. ?fi;}?!~?. ..................... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteration ..... z .... Repair .............. Removal .............. Demolition .............. Other Work~.~ .~.a..a~.. ?. ' .~/.~ : (Descripti~n~F 4. Estimated Cost ./(.~--~V(.(~ ....... ~.~0 .~.~. ............ Fee ...................................... ~" (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor...7 ............. 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 structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure With alterations or additions: Front ................. Rear .................. Depth ....................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9 Size of lot: Front ' ' Rear ...................... Depth ........ 10. Date of Purchase .......... i ................... Name of Former Owner ............................. 1 1. Zone or use district in w ich premises are situated ..................................................... 12. Does proposed construction wolate any zoning law, ordinance or regulation: .............................. ... 13. Will lot be regraded ........ ! .................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ~.T~ .~/..~'~.o.~/~ ....... Address~/j?.,~ .a,,~,~ .~. ...... Phone No.~.~..D~.' .~.~.' .~.... Name of Architect ..... ,.., ..~ ................. Address ................... Phone No. .. Name of Contractor fiff.~'~i ~ .~...~.. ........ Address~..~f~. ~f'~. ~ Phone No. ~'.' .~' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, .... c,g~A<-c~-~. ~. ~. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. i (Contract~rporate officer, etc.) He is the ..................... . ............... ~ ............................................ of said owner or owners, and is duly authorized to perf6Tm or have performed the said work and to make and file this application; that all statements co~tained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manher set forth in the application filed therewith. Sworn to before me this Notary Public, ........... County ~ 11011~t ~8~1~-~.~ (Signature of applicant) "IMMEDIATELY" 0 O' 0 nl < ~ 0-1 0 -.<o ~ r"- :~ ,oo 'o9 ~ r~ 'R ,,00,£1,,69 'g ©