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Home My WebLink About15546-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector, Town Hall Southold, N.Y, Certificate Of Occupancy Z16046 THIS CERTIFIES that the build~g dormer addition to dwelling. 120 King Street Orient Location of Property ............................................................... House No. Street Hamlet County Tax Map No. 1000 Section 26 .Block 2 .... Lot 3 Subdivision. X .Filed Map No ..... X....Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated December l, 1986 pursuant to which Building Permit No. 15546Z dated ...... .D?.c.? .m .b .% ~. . .5 !..1. 9. .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 ......... ...??.~y.. ¢.d.a.~..~.~.o.q, .~.o..~.~., ?.x.~.~..~.~., ?.~.~ .f.a.mA!7..$~O..%~.n.~': ................ The certificate is issued to ................. T.H..O.~...S...&...H~...R.~..5.....Kb.V?. Z. b.N.j.I..A.N ......... fowner,~r~O of the aforesaid building. Suffolk County Department of Health Approval ............... .N./.~. .......... . ............. UNDERWRITERS CERTIFICATE NO ...................... .N.8.2.]: 3. .8.1 .................... PLUMBERS CERTIFICATION DATED: 6/3/$7 Rev. 1/81 FOK~ NO. tB TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 15546, Z Permission is hereby granted to: .......... ~.~2~......~.,..,~L..~ .................. ~...~:.~. .,...ll.~..q..I.. at premises located at ..J..~.....~.~n~...~ ......... ..~,~..V ................................................. ...... ................................................................................ County Tax Map No. 1000 Section ....... ..v~.¢~,1~ ..... Block ...... ~ ............ t N ....................... pursuant to application dated~.~.....~. .................... , 19..~...~., and approved by the Building Inspector. Rev. 6/30/80 Bu ildingTownDepartment Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted ~ ~ to the Building In~ec- tot with the following; for new buildings or new use: 1. Final su~ey of property with accurate location of all buildings, prope~y lines, streets, and unu~al natural or topographic fea~res. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-g form or equal). 3. Approval of electrical installation from Board of Fire Unde~riters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and in~alla- 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-~xi~ing" land uses: 1. Accurate ~ey of p~perty showing all property lines, streets, buildings and unusual na~ral 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 pe~inent informa- tion required to prepare a ce~ificate. Fees: 1. Certificate of occupancy $25.00 -- BUSINESS $50.00 ACCESSORY $]0.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $I0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Data .......................... New C OhS tr uc t i on ...... Old or Pre-existing Building ............ Vacant Land ............. Locat,onofProperty..l .O..../¢2 .. ...Z ff...y 7 House No. Street Hamlet Owner or Owners of Property .~~. '~7' .~.t.~.¢~~/~ ...... County Tax Map No. 1000 Section .~ ......... Block ...& ......... Lot..~ ........... Subdivision ................................. Filed Map No .... ~..Lot No. ~ ~ Permit No ........... Date of Permit . ~. .... Applicant . Health Dept. Approval ........................ Labor Dept. Approval ........................ Unde~riters Approval ~ ...................... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...~ ................ s.. ....... Construction on above described building an_.q[j~mit meets all a~plicable codes and regulations. p ............. Rev. 10-10-78 ~ V THE NEW YORK BOARD OF FIRE UNDERWRITERS ~00070~ BUREAU 0~: ELECTRICITY '~. 85 JOHN STREET, NEW YORK, NEW YORK 10038 ,,at N 381 THIS CERTIFIES THAT only the electrical equipment ~ ~scribed be~w and intr~uced by t~ appl~ant ~med on the a~ve application number in the prorates of Th~S K~vaz~nji~n~ ~20 I~fng S~ Orient~ FIXTURE FIXTURES RANGES COOKING DECKS OVENS EXHAUST PANS DRYERS MOTORS TINGE CLOCKS UNI~ HEATERS MULII-OUTi. ET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT S E R V I C OTHER APPARATUS: .o. %~co.D.1 Sal Prato ~lectrician GENERALi, iMANAGER This certificate must not be altered in any manner; return to the office of the Boa~d if incorrect. Inspectm's may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST 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 TO Whom This May Concern, We are unable to complete your Certificate of Occupancy because .of the following reasons. /--~--~pplication for Certificate of Occupancy ~0 Un~dorwri.~ers Certificate on m_ez ~ /-/ No Health' Dept. Approval on file. /_--/ No final inspection has been made. Please contact our office on this matter° Thank you for your cooperation. .-Building Permit # -_~ ~__~ ~ ~ Z Building Dept. ***/Z/ No Plumber Solder Certificate on fileo all permits involving plumbing being issued after April 1,1984 ) TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL $OUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. f-~l~ Owner ?~./~/~/~.~ ~ ~/~N~/~J (please print) ' (~lease prin~) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this 3 day of ~._ , Notary Public, ,~ County Notary Public IfEt/'N IL DE VOE NOTARY PUBLIC, State of New Yolk No. 4707878, ~ CotlntY~c~ Te~m Expires Ms~'ch OUNDATION ( 1 s t) OUNDATION (2nd) OUGH FRAME & FLUMBING iNSULATION PER N. STATE ENERGY CODE FINAL . ADDITIONA'L COMMENTS 765-1802 BUILDING DEPT, INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG, FOUNDATION 2ND [ ] INSULATION FRAMING ~'~NAL ,INSP£CTOR~ 7~5-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION I$T [~"//ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: ~ 765-1~02 BUILDING DEPT. INSPECTION FOUNDATION 1ST [~ ROUGH PLBG. FOUNDATION 2ND [~ ]~INSULATION ~j/FRAMING [ ] FINAL . t FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N.Y. 11971 TEL.: 765-1802 Exami~..~.., 19 '~'~'' A pl,~¢e~ .~'', 19~ .......£~ Disapproved a c ............ (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... IN STRUCTION S 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 schednle. b. Plot pl::.~ o~wing location of lot and of buildings on premises, relationship to adjoining premises or public streets ,)r areas, and giving a detailed description of layont of property mnst be drawn on the diagram which is pm~ of this appli- ..... red by this application may not be commenced before issuance of Building Permit. . . ': ~pplication, the Building Inspector will issued a Building Permit to ti~c av~ ....... %ch permit sh:dl be kept on {he premises available for inspection throughout the work. e. No bulldog 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 Dep~tment for the issuance of a Building Permit pursuant to the Buildh~g Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ord~ces or Regulations, for the construction of buildings, additions or alterations, or for removal or dcmelition, as herein described. The applicant agrees to comply with a~ applicable laws, ordinances, buildingcode, housing code, and regulations, and to ,thmt authorized inspectom on premises and ~ building for neccssaw i.7~t~/// ~ ../. ~:...~~'~ ..................... (Si ~ atme of apphcant, or name, if a corporation) . /.7...d~&~(~. . . ¥~'i/r~;. //~(' '.'~ .... /~ ,~/( -~ /~ //~/? I ..... -~mail~ng ad~ess of appllc:~nt) ...... Slate whether applicant is owner, lessee, agent, architect, engineer, geueral contractor, electrician, plumber or builder. ../~.. ~/~6.~. ~<~ ...~,~/~(~ ~./<':~ .................................. ~,,,~ o~ o~n~r o~ ~,,,~ .... ~?e~ ~ ..... ~ :~'"~/9:' ~'~ "V .............................. (as on th~ tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Plumber's License No .............. ' ........... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. llouse Number Street llamlet County Tax Map No. 1000 Section ... Subdivision ...................... (Name) ~. 3.'...'.'(~. Block .... 0, ............ Lot...9 ............... ............. Filed Map No ............... Lot ............... State existing use and occupancy of premises and intended use and occupancy of proposed construction: .... ................................................... a. Existing use and occupancy (.>~ t~/~ , b. Intended use and occupancy ...... ..:~....vt2-...v.~z~.~./.'-q :~..(.J~...c?~....~..... ........ 7.... ...................... 3. Nature of work (check which applicable): New Building ......... ~u~;tit,, ........ Alteration . ,~.<¢.4q'.~:' Repair .............. Removal .............. Demolition ........... Other Work ............. 4. Estimated Cost . .' .......................... Fee (to be paid on· filing this applica'tion) ' ./ Numbe of dwelling nits on each floor /. 5. If dwelling, number of dwelling units .............. r u ............ If garage number of cars ' /. 6~ If business, commercial or mixed occupancy, specify nature and extent of each type of use ................... · lnleflslolJs of existing structures, 1 any: r~ront .... ~, ......... ea ................... Height ............... Number of Stories ..... ;2~ .............................. : .... Di i of sam re With lte ' dditions: Front Rear mens ons e stmctu a rations or a ................................. Depth ~ Iteight Number of Stories 8. Dimensions of entire new construction: Front ..... 'da ........ Rear , .............. Depth . .,J? .......... tteight ,~/ ' ~ ' /. (. ............. Number. of Stones ............. ~ ................................. 9 Size of lot: Front i Rear Depth 10 Date of Purchase i Name of Former Owner 11 Zone or use district in which premises are situated 12 Does proposed construction v(olate any zoning law ordinance o~' regulation: 13. Will lot beregraded.......;...................: . Will excess fill be removed fi.om premises: Yes I, 14 Nam~ of Ownm' of premises " Address Phone No Name of Arcbitect ...... .~.; .................. Address ................... Phone No .... : ......... Name of Contractor ...,~.t~,,g.[ .Z"..5'.. X~/~..r--r. .... Address ,~/'~'3:-¢/.~.q~ ........ Phone No. ~.~.~T.drq~..Y... 15. Is this property located within 1,00 feet of a tidal wetland? * Yes ..... No .~z.., · If yes, Southold Town T9ustees Permit may bo required. PLOT DIAGRAM Locate clearly and distinctly ~1 buildings, whether existing or proposed, and. indicate all set-back dimensions fie property lines. Give street and block number or description according to deed, slid show street names and indicate wheth interior or corner lot. STATE OF NEW yORK. . S S ' COUNTy OF..-:qd*z~.:~L.Zr,AvC.., ' · . v?.. %A'.~.-[ .~ .'..~ .?/?/:t~ .................... being duly sworn, deposes ~d says that he is the applies (Name of individual signing contract) above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~fiy authorized to perform or have pertb~ed the said work and to m~e and file ti, application; that all statements coatained in this application are true to the best of his ~owledge and belief; and that work will be pertbrmed in the manner set forth in the application filed therewith. Sworn to before me this Notaw PubliC, SISIO Of ~ Y~ No, a8~2563 Suffolk ~u~ ~Signature of applican - ,' u~rures December31, OCCUPANCy OR USE IS UNLAWFUl. W~THOUT CERTIFICATE OF OCCUPANCY' ./ OCCUPANCY OR USE IS UNLAWRIL WITHOUT CERTIFICATE OF OCCUPANCY