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HomeMy WebLinkAbout15424-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy PLUMBERS CERTIFICATION DATED: THIS CERTIFIES that the building Ad d i t i o n Location of Property 125 BRIGANTINE DRIVE SOUTHOLD House No. Street Hamlet County Tax Map No. 1000 Section ....0 .7.1 ...... Bloc]< ... 0..2 .......... Lot .ltl. .............. Subdivision .H.A.R..B.O.R..,.~ .I.G.H.T. 8...8.E.C. :..I ....... Filed Map No. 4362 .Lot No. 3 I conforms substantially to the Application for Building Permit heretofore filed in this office dated Oct. 6, 1986 [5424Z. ....................... ' ... pursuant to which Building Permit No .................... dated........................° c t. 23, 1986 .... 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 ......... Garage addition to an existing one family dwelling. The certificate is issued to THEODORE R. AND LILLIAN SIMPSON ..................... ?o¥.'o;, X .................... of the aforesaid building. Suffolk County Department of Health Approval N /A N799900 UNDERWRITERS CERTIFICATE NO .................................................. N/A Building Inspector Rev. 1/81 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 15421 Z Permission is hereby granted to: · ~.~....~..:~..,;....u....~...~.J.... ,o .~....~....~.L.~......~....~....~.~.~. .~..~..~.~.,.~, ..:~~..~ .................. ~. ......... :. .................. at premises located at ../.~..~-~....~-~..~-.~.'....~..~~ ............... "?Y.'.~"~'Z~~"i"~'""~'~' ................................. i'"'i ................................ County Tax Map No. 1000 Section .....(~...~.../. ......... Block ..... ..~,....~/. ....... 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 BLDG, Southold, N.Y, 11971 TOWN 765 - [802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. 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: I. 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 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 New'Dwelling,$25'O0, Acca~sory;~$t0.00 Business $50.00 2. Certificate of-occupancy on pre-existing dwelling $ 50-. 00 3. Copy of certificate of occupancv $ 5.00, over 5 years $}0.00 4.Vacant Land C.O. $ 20.00 5. Updated C.O. $'50.00 Date .......................... NewCons%ruction ...... Old or Pre-existing Building .., .......... Vacant Land ............. Locat,onofPropertyo...... ......... /"/ou~ /VD. f~ ~ Street /,~ f ~"~amlet Owner or Owners of Property .~...~. ;~..~,?.~.. f..~.~ ~.~...~..~.....~...~...~..~ ~.~... County Tax ~ap No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filea Map No .......... .~et No ........... Permit No /'/ ~.~.'~ Date of Perm t ..~..../ ,~A ,cant //~ ' ~o i"..i 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 appljca~l/e codes and regulations. THE NEW YORK BOARD OF FIRE UNDERWRITERS ].0010'/]. BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 1003'8 ~ ~x~ ~4, 1987 463157/87 ..,~ A.p,,c.,,o. No.a.f,,e N 799900 THIS CERTIFIES THAT only the electrical equipment ~ ~scribed belo~ o~d ~tr~ed by t~ applicant ~l~ed on the u~e application number in the premlses of L~i~ S~n, ~i~ti~ ~ive, s/s 300' w/o ,~o,,o~,.~.~,~..~.~~ -~ ~ -,~,. ~ ~..~ ~',. ~ ~.o. .,~. ~,,, in ~'~s exa~nlned on a~d found to be ia co.tplia~ce with the requlre.~ents ~f this Board. FIXTURE OUTLETE FIXTURES RANGGS OVENS DISH WASHERS EXHAUST FANS DRYERS MULTi-OUTLET SYSTEMS NO. OF FEET DIMMERS E R V I C E NO O~ CC. COND A W.G. NO. OF HI-LEG A W G, NO OF NEUTRALS A, W O ~THER APPARATUS: G & $ Elect Box 215 Southold~ N.Y 11971 Lic~578E GENERAl, 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 FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATEMUST NOT BE ALTERED IN ANY ;vtANNER. 'OUNDATION (1st} 'OUNDATION (2nd) tOUGH FRAME & PLUMBING iNSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because,of the following reasons. /Z~ An application for~,~Certif~cate of Occupancy is not on file./~F~/os~/) / .No Underwriters Certificate on file. /~The check is(o~k~l~4~e~/not on file.)~O O /~/ No Health Dept. Approval on file. /Z/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. ~uilding Permit ~ / ~ ~ ~ Z ~~/~ Building Dept. ***/~/ No Plumber Solder Certificate on file. all permits involving plumbing being issued after April 1,1984 ) C cc ~"9 -! uO~ ~ BUILDING DEPT. INSPECTION ? ~;UNDATION 1ST [ ] ROUGH PLBG. OUNDATION :~ND [ ] INSULATION FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No ................................ . ,, .~..~..~..q,. PLEASE TAKE NOTICE tl~at your application dated . .(D .~.....~.... ~ .......... 19 ~ ~. for permit to construct...~. ~q .~... ~.~ ...................... at Location of Property ......... ).~.q .~ ~... }~ ~ · · .~~ ..... .... House No. } Sire** Ham/et County Tax Map No. 1000 Section .... .~ ..... Block ..... ~. ~ ..... Lot .. ). ~. ....... Subdivision ................. Filed Map No ................. Lot No .................. is returned herewith and disapproved 0I~ the following grounds..~..'..~....L~..~ .~.~./..d~.~..~ ~... ....... ...~._.:.~ .......... ..~.. ..... . .... ~ ..... '0~ ';'"~5_~ ..... :"~"r~ ..... ; ...... Building Inspector RV 1/80 : FORM NO. 1 ' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL COUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ,19., Date .... F..y~ ...... , Name of owner of premises .~.~f'~..~....~..,.c..c. ( .~. ~ ............. .~. F..~.~.~ .~. ........................ : (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 ....................... Plu uber s License No ......................... Electrician's License No. ~. :~ .~.. Other Trade's License No .................... ... 1. Location of hind on which proposed work will be dbne ............. o/~.,q, p.O ........................ ........................... .a,4-...q.. ............ ...... ............ House Number Street Hamlet Cotmty 'Fax Map Nc,. 1000 Section .'.~'/'~/.'7.~...". [.~.. Block .................. Lot ..... ~'..~. · ........ Subdivision..~..~.~-. ~..~...Otr.~.f/.7..-'~..(~'5~,~.,q .O. Filed Map No...~. ~.&.. ,',',',',',',',',',~-, ..... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use ami occupancy ....... (~WT. ~ 40.. 4-~ .,,:<7~ ,~ '-- b. Intended use and occupancy ........ ~...51e~...~7.~. ! .~?/..'-rr:..... 7 .~.~. 9 ~ '* i-- ,, , ,~ · . :~...~.- sets of plans, accurate plot plan to scale· Fee acco~¥Jing'to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stree or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app cation. e. 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 pern 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 Occupam 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 ti Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regnlations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit anthorized inspectors on premises and in building for necessary insp~~,,~Z ~ (Signature of apptican~6r name, if a corporation) ........ gr. ..................... 7., ......... ........ ~iiiifi~ addre~ ~f~q~liclni) ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde 3. Natureofwork(checkwhichapplicable):NewBuilding .. ~.... Addition...'...., . Alteration .,....... Repair .............. Rem6val ............ Demolition .............. Other Work ............. . (Desc~ption) 4 Estimated Cost ' " Fee (to be paid on filing this application) 5. If dwelling, number of dwelling Bnits ...... '.'7 ........ Number of dwelling units on each floor ...... 7 ......... If garage, number of cars 6. If business, commercial or mixe~t occupancy, specify nature and extent of each type of use ..................... 7 ..... if any: Front Rear Depth · D~menmons of exm~ng structure, s, ....... 2 .................................... Height ............... Number of Stories ...................... . .................................. Dimensions of same structure Mth alterations or additions: Front Rear . Depth ' Height Number of Stories ~ 8.HeightDimensi°ns. · . [.~...~ of entire ....... new construction:Number of Stories . . .Fr°nt .... ,,9.C:~l 2_.. ...... Rear . ..... ..'~...°I ...... Depth "'i i '~' c~i ...... 9. Size of lot: Front ...... ~.'g'.~.i,..~.~V .......Rear ..... ,~. ~ ."3.., .o./2. ...... Depth .../.4'7.0 ............... 0 Date of Purchase ! Name of Forme~ Owner 1. Zone or use district in which prqmises are situated .......... :~. ~ 2. Does proposed construction violate~ any zoning law, ordinance or re,,ulation'~ . . ~..$........../~d.- ,~,~-~ez . ~,4..~.rg..,~...~... 3. Will ...... %'~ 'i' ' ~ ......~ ........ excess fill be remove~l, from premises: Yes No 4. NameofOwnerofpremises~'~'.,q.~..~..-~..-~.40..~.q?rAddress .<"~./.~.,V..v?/..,~..~,J~PhoneNo..7.,~.~.q..g~..~.~. Name of Architect ......... · , ................. Address ................... Phone No ................ Name of Contractor .~.x, ~3...~.,e..,(~..~. ,5. ...... Address '~2c .r~,..3..~. ...... Phone No.. ~ .~.~7: ..57-.6. ?.°. 5. Is this property located ~ithinl.00 feet of a tidal wetland? * Yes-. .... No .~.... · If yes, Southold Town Trulstees Permit may be required. PLOT DIAGRA~ Locate clearly and distinctly all lbuildings, whether existing or proposed, and. indicate all set-back dimensions from coperty lines. Give street and block number or description according to deed, and show street names and indicate whether ~terior or corne~' lot CATE OF NEW YORK, $.S )UNTY OF ................. ............................ ~ ................... being duly sworn, deposes and says that he is the applicant (Name of individual signihg contract) ,ove named, l : is the ...................... i .................. ' ................................................ , : (Contractor, age .nt, corporate officer, etc.) said owner or owners, and is dul~ authorized to perform or have performed the said work and to make and file this plication; that all statements cents!ned in this application are true to the best of his knowledge and belief; and that the ~rk will be performed in the mtmnerset forth in the application filed therewith. ~orn to before me this ............ :" .. .f.; · · · , .... dayof, ...... O. ........... 19 INSPECTION 765-1802 BUILDING DEPT. [ ] FOUNDATIONIST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ]FRAMI.G , [ ]FINAL REMARKS:_~ ~ * DATE ~/~ ) ~ .INSPECTOR.