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HomeMy WebLinkAbout15280-zFORM NO 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z15242 Date February 3, 1987 THIS CERTIFIES that the braiding .A.dd ~. [.~.o n. ................ 8 5.. ~.I .a .t .e.r. s .e .d g e. Way Southold ............................... Location of Property H o ' Street Hamlet County Tax Map No 1000 Sechon 0 8 8 .. Block 0 5 .Lot 5 6 Subdzvlslon .T.e.rry...W.at.e.r.s .... Fried Map No. 290 I .Lot No 7 conforms substantmlly to the Application for BuildIng Permit heretofore filed ~n tlus office dated .A.u g.u s t. 5. ,..I .986.., pursuant to winch Building Permit No... 152.8. 0. Z .......... dated . . .s e p.t e.m.b.e r . I .9?.. ! .9 .86. ~, was msued, and conforms to all of the reqmrements of the apphcable prowmons of the law The occupancy for wtuch tlus certificate m msued ~s ..... · De.n a. ddzt.~pn..[o.esq~,~t.z~g.gBo~.f~ra.~.].y .clsqelli.r~g ........... Thecertzficatem~ssuedto ..A.nt.h. ony &.y~o. le..t .Tam.bur. r.z.rtp ........... (owner, ~,~ox ~ of the aforesaid building Suffolk County Department of Health Approval ..... N/.A. ............... UNDERWRITERS CERTIFICATE NO. N793811 Feb. 12, 1987 PLUMBERS CERTIFICATION DATED: N/A Rev 1181 TOWN OF SOUTHOt. D BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER,AlT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Perm,ss,on Is hereby gr~:Lt~) \ _ , __ ..... ~ ...... .~.~.~,..~.~ ........ · ~.~..~~ .......... ~~//Z~/~;~.,....~.~..~.~...~ ....... ,~,. ~.~....~ ~ .. ~~...~...~..~.....~ ......................... ........... ~.,~,~,~ ~,..~.~.....~.~ ..~.~ ....... ~~ ............... .... Y~...~.~..z:~......~. ~ ~ .............................................. co.~ To~ ~ ~o ~o0o s~ ~ ~ ~ .... .~..~. ...... Lo, ~...~ ...... Building inspector. Fee $ :~' / 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 Th~s apphcatlon must be filled in typewriter OR ~nk, and submitted m ~ to the Building Inspec- tor w~th the following; for new buddings or new use: 1. Final survey of property w~th accurate location of all buddings, property hnes, streets, and unusual natural or topographm features. 2. F~nal approval of Health Dept. of water supply and sewerage dmposal-(S-9 form or equal). 3 Approval of electrical installation from Board of F~re Underwmters. 4 Commercial buddings, Industrial buddings, Muluple Residences and mmdar buildings and mstalla- t~ons, a cert~fmate of Code comphance from the Architect or Engineer responmble for the budding. 5 Submit Planning Board approval of completed rote plan requirements where applicabie. B. For existing buddings (prior to April 1957), Non-conforming uses, or buildings and 'pre-existing" land uses' 1. Accurate survey of p~operty showing all property hnes, streets, buddings and unusual natural or topograph m features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buddings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent mforma- t~on required to prepare a certificate. C. Fees' 1. Certificate of occupancy SB.O0 2 Certificate of occupancy on pre-exist~ng dwelhng $15.0 0 3. Copy of certificate of occupancy $1 O0 4. Vacant Land C.O. $5.00 /o~,o~/(~4~ 5. Updatecl C.O. $15.00 Date ........................./..~./.~. New Budding ~ .... Old or Pre-exmtmg Budding ...... Vacant Land ........ Locat,on of Property...~.~. .... .~)...Or...~..~? .~..q?~....<~...O~..,. .... .~..0...CZ;...-~..~.(~ ..... House No. Street Hamlet Owner or Owners of Propertv . . .~...Y~=-..O ..... CountyTax Map No. lO00Sect,on . .~f~. ..... Block . 0..~. ........ Lot. :~....~. ......... Subd~wsion ...................... Filed Map No .... Lot No ........ Perm,t No./..~.. ~ ~'0. FDate of Permit ?//. ?/~.~. Apphcant../~.O ~').../~..~??./..~.?' .Q. ~~ Health Dept Approval ................... Labor Dept. Approval ....................... Underwriters Approval ................... Planning Board Approval ...................... Request for Temporary Certificate ................. Final Certificate ...~. .................. Fee Subm,tted ~ ~.- ~......~.../. ~.~.. .... Construction on above described bu dd~ng a~t Apphcant .~.~'~'" Rev 10-10-78 // ,a' INSFECTION DATE COMMENTS FOUNDATION ~ ~ FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ~///~/ ~~r ADDITIONAL COMMENTS: 765-~.802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND ~SU~TION [~MING [ ] FINAL RE:MA. RKSI~ DATE~ 7GS-'"802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION [ ] FRAMING [ ] FINAL RI'MARKS: O,~ DATE 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG, FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: FINAL DATE INSPECTOR IIl~llllltt IIIIIIIIIIII Hi(ll.~ II1 U t111 ~.11f~1 IltlllltlllllliflltlllU~lllt~lllilllh Examined _~"~.. ! 5. Approve~+~. ~. ]. ~ Disapproved a/c 'FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N Y. 11971 TEL,: 765-1802 ,19 9 0 , 19gl' PermltNo (Building Inspector) APPLICATION FOR BUILDING PERMIT Date AugusL .5.. ., 198{ INSTRUCTIONS a. Ttus apphcahon must be completely fiiled m by Wpewnter pr ~n ink and submitted to the Building Inspector, with sets of plans, accurate plot plan to scale. Fee according to schedule{ b. Plot plan showing location of lot and of bmldmgs on premises, relationship to adjoining premises or pubhc stree or areas, and giving a detaded descnphon of layout of property must be drawn on the diagram which ~s part of thru app cation. c The work covered by tlus application may not be commenced before issuance of Budding Permit d Upon approval of tlus apphcation, the Bml&ng Inspector will issued a Budding Permit to the applicant Such peru shall be kept on the prenuses available for mspectmn throughout the work e No budding shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan, shall have been granted by the Bufldmg Inspector APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Bmldmg Permit pursuant to tl Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of bmldmgs, addmons or alterations, or for removal or demohtlon, as herein describe The applicant agrees to comply with all apphcable laws, ordinances, budding code, housing code, and regulatmns, and admit authorized inspectors on premises and in building for necessary mspechons Ron. Mori.z.z9 B.q~i.d.e.r.,..In.c. (Szgnature of applicant, or name, if a corporation) P.O...B.ox. 7.89.,. S.o.utho.ld.,..N.:Y.. ·11.9.21. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bullde Genqral Cont r a. qt. 9.r .......... Nameofownerofpremlses hnth~)n3' E. &.V~olet Tarabu.r.ri.n.o. . (as on the tax roll or latest deed) If a/~nt Is,~37ah?n, .slgna/~ of duly authorized officer (Name and~ff~'o5 corporate officer) Builder's License No 2.6 7 ..... Plumber's License No 7 4 1. P Electrician's License No 2B2 E Other Trade's License No. Location of land on which proposed work will be done W.ab.er sed, e ~qa7 House Number Street County Tax Map No 1000 Section . Subdivision Te r.r y Waters (Nan~e) ' ' Block .Soubho. 1.d .... Hamlet .. Lot .. Filed Map No 21901 · Lot .7 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction a. Existing use and occupancy One b Intended use and occupancy One f am.i 1 y. dwel.linu. family dwelling with 3. Nature of work (check which applicable). New Budding ...... Addmon . .X ...... Alteration-. ,,. Repmr ....... Removal . . Demolition ....... Other Work ............ ~ 5 ' (Description) $20,000 4 Estimated Cost ............................... Fee .................................. (to be pald on filing this application) 5. If dwelling, number of dwelhng umts ........... Number of dwelhng umts on each floor ...... If garage, number of cars ........................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............. ?. Dimensions of existing structures, if any Front ....... Rear ............. Depth .......... Height ....... Number of Stones.. Dimensions of same structure with alterations or additions' Front ........... Rear .............. Depth ............... Height ....... ., ....... Number oftStories ........ 8. Dimensions of entire new construction Front ~/. ~. ...... Rear.../~ ........ Depth ~. i.~ TM i i He:g.ht /,~Z.~ .. . Number of Stones ... ~. ......................................... 9. Size of lot Front ...... Rear ................ Depth ................ 10. Date of Purchase ................... Name of Former Owner ....................... 11. Zone or use district in which premises are situated ........................................ 12. Does proposed construction violate any zoning law, ordinance or regulation' . ...................... 13 Will lot be regraded .................. Will excess ~l be removed from premises' Yes I' 14 NameofOwnerofpremlses A.n..'c.h.o.n¥ T.a.m.b. uF.ri, rA~dressWg~e.r.s?d.~e..Na.y...PhoneNo,7.6..Sr.5.~64 .... Name of Architect .............. Address Phone No ......... Name of Contractor Ron I,{or ± zzo Bui 1der, . Address ~>' 0': 'I~' "~ ~3' ' ' Phone No 765- 5772 PLOT DIAGRAM Locate clearly and dlstmctly all buddings, whether existing or proposed, and, indicate all set-back dtmensmns fro property hnes. Give street and block number or description according to deed, and show street names and indicate wheth intenor or corner lot STATE OF NEW YORK, COUNTY OF SS (Name of individual slgmng contract) above named · .. being duly sworn, deposes and says that he is the apphca He is the ....................................... (Contractor, agent, corporate officer, otc ) of smd owner or owners, and is duly authorized to perform or have performed the smd work and to make and file tt apphcat~on; that all statements contained m this apphcatmn are true to the best of his knowledge and belief; and that tl work will be performed m the manner set forth m the application filed therewith. Sworn to before me th~s .......... .... . . ...., ......