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HomeMy WebLinkAbout15022-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate O[ Occupancy No. Z16401 Date November 13, 1987 ..... Alteration THIS CERTIFIES that the building ................................................ I 10 Beverly Road Southolfl Location of Property ............................................................... House No. Street Ham/et County Tax Map No. 1000 Section 052 .Block ...0.2. .......... Lot 16 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ....j.u.q e...2.3. ,...1.9.8.6. .... pursuant to which Building Permit No. 15022z dated June 2 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 ......... Remodel picture window as applied for, 2 skylights in upstairs bedroom. The certificate is issued to BARBARA & FRED BRUCH ..................... ?o¥,,'o;, 'ri~a'~c~'a~ f~ " '. ................. of the aforesaid building. Suffolk County Department of Health Approval ......... N../.A .............................. UNDERWRITERS CERTIFICATE NO .... N/A PLUMBERS CERTIFICATION DATED: N/A Building Inspector Rev. 1/81 ~O]B3d[ NO. ~' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERJ~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Z Permission is hereby granted to: ..~~.~.....~.:..~..:.....!..:.~...~.~. ........ .... % ,~ ~.. ~o~.~....~..-~..~ ...................................................................... . County Tax /~op t4o. 1000 Section ..... ..~..,~....~m..... Block .........(~......'~:.. ..... Lot No ....... )....~. ........... pursuant to application dated ..... ....~..~....~.~ ................. , 19.~..~., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 THE NEW YORK BOARD OF' FIRE UNDERWRITERS 1000121 BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 ,.,, .ov.,e. 15, ,. 87 N 43901 THI~ CERTIFIES THAT thefollowlng location; ~ Basemen~ ~ Ist Fl. ~ 2nd ~. Section Bilk Lot ~s examined on ~' ~ * ~ ~ and~ound to be in compliance u'ith the requirements ~f this Board FIXTURE OUTLETS FIXTURES EECEPTACLE$ SWITCHEE ~cu~ 19 13 14 FURNACE MOT(~RS H..P FU TA~U?~E ~PPL~Ao~CE FE~D: R: RANGES ~PECIAL REC'PT R NO. OF HI-LEG A, W. G NO OF NEUTRAl OF HI-LEG EXHAUST FANS DIMMERS OF NEUTRAL 275 Town Harbor Lane Sou~hol~, N,Y, 11971 Lie., 282E GENER~. MANAGER . -- /~~ 's c~rti~icate~,~must not be altered ..... in any manner; return~to .... the office~e~of the Board if incorrect. ..... Inspectors may. be~identif ed by their credentials.' COPY FO BUILDING DEPARTMENT.. TH S COPY ~OF CERTIF ...... CATE *UST NOT..~BE ALTERED ..... IN ANY ~NN~'. BARBARA E. BRUCH FRED R. BRUCH 110 BEVERLY ROAD BOUTHOLD, NY 11971 ~oy to the $outh~d.~,N.Y. 119?l I ,,omo Dollars ;Y ~ to the Building Inspec- :y lines, streets, and unusual 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 [esponsible 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 property 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 requ ired to prepare a certificate. C. Fees: Additions ~$25)O0- 1. Certificate of occupancy New Dwelling $25.00, Accessory ,$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years 4.Vacant hand C.O. $ 20.00 /~/6_/....7,//~' 5.Updated C.O. $ 50.00 Date ...... ,,~.~' ................ NewConstruction ...... Old or Pre-existing Building ............ Vacant Land ............. ........ :~ o ~/. i[V; Location of PropertYHoum..//?'NO. ..... ~..V'~.~.~. ~... ~'~'2 ' ~;r;gt ................ ) 1' .............. Ham/et Owner or Owners of Property ~~2.. ~.~..~,~ ............................ No. 000 ........ . ........... ............. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No .......... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $~.~., ,..Z~. ....................... Construction on above described building and permit meets all applicable codes and regulations. App,,can, ............................. Rev. 10-10-78 FIELD IN $ F ECQ~ION FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING C OM~4 E,'~ TS INSULATION PER N. Y. STATE ENERGY CODE ADDITIONAL COMMENTS: 76~-U02 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. '[ ] FOUNDATION 2ND [ ] I/NSULATION [ ] FRAMING [wi FINAL REMARKS: INSPECTOR 765-180:) BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION ;ZND [ ] I~ULATION / [ ]FRAMING [/] FINAL REMARKS: DATE INSPECT'OR ..~ ~1 ~/f~ / ' ,', · , , .,~:,~> FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1803 Examined..~,~,6A~.... ~-C ,19g~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... INSTRUCTIONS a. This application must b~ Oo~fipl~.t~ly titled m by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans accurate plot.plan4~0¢sc~e -F.~e~aceordhiggtO.,s~hedule. b Plot plan shOwmg locat~b~,o~Jo~a~n~l,ofiJSu.il~m~s on premises, relationship to adjoining premises or public streets or areas, and giving a detailed des~rjpti0n of 19y0l~Lof property must be drawn on the diagram which is part of this appli- cation. '" ~ c. The work cove£ed by thi~ application ina'53 ~i6t 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 inspections· . .~..~..~.. c..r':.z...-~...%~,.td.~.r.T...c~....... ignature of applicant, o~ name, if a corporation) .... ,.©~. ~x..~.~71 ...................... '~ou,+b,o~d ~'-I, I~..q..u!. . (mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .. C~:,rx¢ ~o3,..Qo.~. +c. caq,.~, r. ............................................................ Name of owner of premises ...~"..1(..~>..~..'?...~...~.~.(~ ·. ?~.~.Q-, .~. ............................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly autho?ized officer. (Name and title of corporate officer) Builder's License No.....~v..Q?..~ ................ Plumber's LicenseNo ......................... Electrician's License No ....................... Other Trade's License No. ' Location of land on which proposed work will be done .................................................. House Number Hamlet County Tax Map No. 1000 Section ~O~ Block c>cO Lot / ~ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use anj~ccupancy of proposed construction: a. Existing use and occupancy .~..!~..~..~. ~..~..k~...~.~J~..k-3~. q .......................... - ' b. Intended use and occupancy .0..1~..~. ..... d.~O.Q~.~..~...~..q..~ ...... 3. Nature of work (check which applicable): New Building .......... Addition ........ Alteration .. :V:'. · .__ · · Repair .............. Removal .............. Demolition ............. Other Work ............... [to be ~aid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling unit! on each floor ................ If garage number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each typ:e of use ..................... 7. Dimensions of existing structures, if any: Front ............. Rear ...... i Depth Height Number of Stories,' It F ! Rear ............. Dimensions of same structure with a erations or additions: font ............ , .......... 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 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 fill be rel~oved.~om premises: Yes No Name of Architect ........................... Address ................... Phone No ............ .2... 15. Is this property located withinl.00 feet of a tidal wetland? * yes ..... No ..... · If yes, Southold Town Trustees Permit may be required. 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. OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY STATE OF NEW YORK, S.S COUNTY OF ................. ................................................. being duly sworn, deposes (Name of individual signing contract) above named. AppROVED AS NOTED !. .:_.__BY: FEE __ --- -- NOT~FY I:~UILDING OEPAflTMENT AT 766.18021 9 ,AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1 FOUNOA~qON TWO REQUIRED FOR ~UREO cONCRETE ~ ROUGH FRAMING iA PLUMBING 4k FINAL i coNSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHAA.L MEET THE I~EOUIR~.MENT$ OF THE N.Y ~E~3iGN OR CON$~IRU~; llum and says that he is the applicant He is the ......................................................................................... (Contractor, agent, corporate officer, etc.)! of said owner or owners, and is duly authorized to perform or have performed the /id 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 ........................ dayof .... ~ ........... ,19 .f-~/. ItOIM'~ rll~ ll' ~ ~I I~ ~ ...... 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