HomeMy WebLinkAbout14856-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. .Z15026 Date October 22 86
THIS CERTIFIES that the building Insjround ]~ool
Location of Property 285 EMORY ROAD ~ CUTCHOGUE ,
HOU$8 No. Street Hamlet
County Tax Map No. 1000 Section . .1.Q 3. ....... Block . 0 4 .... Lot 0.3 8
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.... &~r il..Z3, ........ 19 .8.6. pursuant to which Building Permit No. 14 ~ 5 6 Z
dated .I~3y..8. ..................... 19 .8.6., 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 .........
.Ilog~cD.13.Ilqto poQ~ .a.n.d fence Lo code.
The certificate isissued to ROBERT & CARON DI MARTINO JR.
{owner, ~R~q~E4~X
of the aforesaid building.
Suffolk County Department of Health Approval .......... N.. [/~ ........................
UNDERWRITERS CERTIFICATE NO N7 7 5 0 2 0 ·
Rev. 1/81
/Building Inspector
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERA41T
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
14856 Z
Permission is hereby granted to: ~ ~
......... ~~ ...... ~ ...................
........... 2..<.<...~~o.~c.~ .......
.......... ,~..~Zl~....~.z~.*.~....z/... ..~o /
,o ...~~~. ~~ ~ .~~ ..............
............ ~...~ ~~....~..~...~.,.....~..~~.u~...
at premises I~ated at ...~:~...~ ........ ~~.~..~~ ..............................................
....................................................................................................... ~z~.~=.~,.~..
co~ ,~ ~ ~o. ~0o0 s~,~o~ .... /~.S ........ ~k ..0.~. ......... ~o, ~o.~.~ .........
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
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 featu res.
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.
Bo
For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of pZ'operty showing all property lines, streets, buildings and unusual natural or
topographic featu res.
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.
Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling
3. Copy of certificate of occupancy $1.00
4.Vacant Land C.O. $5.00
5. Updated C.O. $15.00
$15.00
Date ..........................
NewConstruction Old or Pre-existing Building Vacant Land
Location ofPro ert Z~'~) ~'Y~IO (J { LO IA~-
p y ................. ...... ............ ...........
House No, ~ ' Street , U Ham/et
Owner or Owners of Propertyfi .~.O.8~J~T..~..~..1~. ~J...~.; J~./~.t~.(..~3.~),..~'-.k:). ..........
County Tax Map No. 1000 Section .............../0~ Block....~. ......... Lot ................ 3g
Subdivision .................................Filed Map No ........... Lot No ..............
Permit No/~?~.~ E 5.%0'~ Applicant .~
.... Date of Permit .......................................
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate....J'. · I.._:¢~- ............ Final Certificate ....................... bunmitted $ .... ~___~.*.: .-~. ..... J..~..~. ....
Construction above described buildings ~ ·
lations.
/
THE NEW YORK BOARD OF FIRE UNDERWRITERS
1001381
BUREAU OF ELECTRICITY
~-~j~ BB .JOHN STREET, NEW YORK, NEW YORK 10038
THIS CERTIFIES THAT
O~y ~he electrical equipment ~ ~scrlbed belo~ a~d intr~c~ by t~ ~ppllcant ~ on the above app~i~atio~ number in the premises of
in the following location: ~ ~,~,t ~ ~.~t ~. ~ ~,,d r~. ~tside ,~t~o, ~t~ Lot
~sexa~ninedo~ ~:]~_ ~1, 19~ a~tdfoundtobelncootpilance~.i~hthere~ttt~ret~e~ts~fthi*Board.
FIXTURES RANGES C~KING DECKS OVENS fXHAUST ~ANS
4 4
DRYERS
SYSTEMS
NO. OF FEET
DIMMERS
3-G.F.C.I.
E R
C
panel~oards. 1-7cir. 'J25~mp
~Q_~m.,ij_n~,~l~O..l_)_ This certificate covers compliance at the date of inspection only.
Bc-cat~e o£ t~sual environn~nts it is advisable to have ~reqttent test/and or repairs
made by a qualified person.
jody P~illo
Pat Lm~e
Matti~uck, N.Y. 11952
Lic. 2300E
GENERAL MANAGER
This certificate must not be attered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. TftIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY t, AANNER.
eF I~ INSPECTION IIDATE COMMENTS
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N. Y.
STATE ENERGY
~ODE
ADDITIONAL COMMENTS:
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 'IST [ ] ROUGH PLBG.
/
[ ] FOUNDATION 2ND [ ] I~ULATION
[ ] FRAMING __~/J/FINAL
REMARKS: ~*~
DATE ,,,INSPECTOR ,,,
t
?),,CD),~/:;%01 ' ~
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
~OUTHOLD, N.Y. 11971
TEL.: 765-1803
Examined /~.~. ~..., 19~
Approved · ./~..~..q~.. .... 1 .9~.. Permit No../..~:(:
Disapproved a/c ........... ::- ........................
(Building Inspector)
APPLIOAIIO~q FOR BUILDING PERMIT
BLDG. DEPf.
TOWN OF SOUTHOLD
Received ........... ,19...
(7~ ~
Date .....
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 code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inrgmc4igms.
..... ~. '"~ ~- .~o~., .c:..~-... .....................
(Signature of applicant, or name, if a corporation)
...gzt ..... e_m~.o~*.~...,N/~.,. ...........
.. ~.<~.,~ .~......,~.. x~.: .....
~mailing addres~ of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
C.o.~oT~,ac-To~ .................................... ~, ..........................
........
(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 ..................................................
· .~..~..$-. ......... .4..m..o. ~ ~/...g?o~ ............ C.u.r~. w.o.~ 0~. ....................
House Number Street Hamlet
County Tax Map No. 1000 Section ..... ].O~ ....... Block ...... 7 .......... Lot..3~. ............
Subdivision ..................................... Filed Map No ............... Lot ................
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .... .~..~. [~ .~.~..~ .~.~ ..... ~ ......................................
b. Intended use and occupancy .~.~-~...~'..('r'~......~..Il [.~.... ]/~J~..~...O..C?..-~.~... ~_.~ ........
3. Nature of work (check which applicable): New Building .......... Addition..! ....... Alter~t4on .........
Repair .............. Removal .............. Demolition - , Other Work~2:OdlJ~!.
~ "~r~, ~ ' ,- ,. o, (Descriptio
4. Estimated Cost..[.q:a,'A,.d~.. ............... Fee . .~.
. .: ....................
(to be ~aid on filing this application)
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 e~tch typle of use .....................
7. Dimensions of existing structures, if any: Front ............... Rear ....... ~ ...... Depth ...............
Height Number of Stories '
i of re with alt ati tis dditions: F t Rea
Dimens ons same structu er o or a ron ........... ! r
Depth ...................... Height ...................... Number of Stories ......................
8. Dimensions of entire new construction: Front ............... Rear ........ i ...... Depth ....... ........
Height ............... Number of Stories.. ~ .... I. . .
9. Size of lot: FrontCp~j~...'..~. ..... R;~;::~:(~.'::::.::: ..... i);~it~"~'.':' ::". ....
10. DateofPurchase ..[.~'/ ............... Name of Former (~v~;; .[ ........... i.i.ii..i.
11. Zone or use district in which premises are situated ......................... ~ .....
12. Does proposed construction violate any zoning law, ordinance or regulation: ... AJ. iO. i iiiiii ii.
13. Will lot be regraded ...... ,.3.).0 ................ Will excess fill be re~aove.d from premises: ~ No
14. Name of Owner of premises ~qf.,~,~dO ........ Address ~4~1~..~0i... Phone No.
Name of Architect . .e'~-~.r~ ...... : :,n ........... Address ..... .~ ....... i... Phone No ........
Name of Contractor ..l~L?. ~..-..(-~t~ ...... Address Gl. ~:~' i · · · Phone No. ~.~.~.. ~..~ ~/~..
15. Is th±s property located w±th:[n 1.00 feet of a t±dal wetland? ~ Yes ..... No
~ If yes, 8outhold Town Trustees ?erm±5~13~DIAGRAM be requ±red.
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and block n.u~hber or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NEW YORK,
COUNTY OF ......... ........ S.S
................................................. being duly sworn, deposes and says that he is the applicant
(Name of individual signin~ contract)
above named, i
He is the .............................................................. : ...........................
(Contractor, agent, corporate officer, etc.) i
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application; that all statements contained in this application are true to the best of his 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
............... · ~ ....... day of ...... ~ ~ ....... ,19 ~. '1~
.. ?.'.
~.~"_~. ~i ~ 71 ~ ~iift~ 3' ~ .' (Signature Of applicant).