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HomeMy WebLinkAbout15130-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ..... Z.-~!.6.2.0.7. ..... Date September 25, 1987 THIS CERTIFIES that the building ALTERATION & 2nd FLOOR ADDITION L ..... 955 Soundview Avenue Extension Southold, N.Y. ocaIlon o! Froperty ............................................................... House No. E~treet Hamlet County Tax Map No.. 1000 Section ...0. 5. .0 ...... Block 02 .Lot I l Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated July 10, 1986 pnrsuant to which Building Permit No. 15130 Z dated .... .J.u.l.y...2.3.,.. ! .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 ......... ALTERATION TO FIRST FLOOR & CONSTRUCT 2nd FLOOR &~SECOND STORY DECK TO EXISTING · ' ' ONE' FAMILY ' DWELL ING ..................................... ~ .................... The certificate is issued to JOHN A. SCOURAKIS ..................... /o¥.'dr, ..................... of the aforesaid building· Suffolk County Department of Health Approval ...... .N./.~ ................................. UNDERWRITERS CERTIFICATE NO. N8164 I 0 N/A PLUMBERS CERTIFICATION DATED: Building Inspector Rev. 1/81 l~O~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15130 Z Permission is hereby granted to: ~:~.:...~ ......... u.~....~.~.......~....., .................. ............. ..................................................... ot premi,, ,=~,~ *t .~..~..~.~.~...~...~.%.....~.~ County Tox Map No. 1000 Section ....... ~.~ ..... Block ...... ..(~......~... ..... Lot No ........ )..~. ............. pursuant ,o application doted ........ ..~...,~4~...1...~.. ................... , 19.'~.k.,-- and approv~ by the /- Building Inspector. Building Inspector Rev. 6/30/80 ~oo~o7~ THE Jmxe 24, Dute THIS CERTIFIES THAT NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELIEOTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of P. SOoura3~is, 955 So%~n~view Avenue~ E~t. 1 ~s examined on attd found to be in conipllance with the requiretnents of this Board. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SERVICE DISCONNECT S E R OTHER APPARATUS: 1 G.~'.C o/. 1 Smoke De~ector I C E OF NEUTRAL 4 G & :3 glatt. ~~.~ ;~oc $out~j~old, N.~. 1197i Li~578E ~L Per '~ Z This certificate must not be altered in any manner; return to the oft[ce of the ~ord il incorrect, Inspectors may be identified by their credentials. COPY FO~ BUILDg~ DEPARTMENT. THIS COPY OF CEETIECATE ~ST NOTBE ALTERED N ANy ~NNER TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION (please print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this Notary Public,  e~'s signature) - ~ Notary- Public7 EI. JZABETH ANN NEVILLE Notary Publl~ StateM New YM'Ic 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND ~ i1 INSULATION FRAMING [/~FINAL ,,,~,,,,,,,,,s.. ~/cl//~~ ,, FIELD INSFECTION FOUNDATION (1st} FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION FER N. STATE ENERGY CODE ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [] FOUNDATION 2ND [] INSULATION 76S-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION XST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND[ ] INSULATION [/~RAMING [ ] FINAL 765-~.802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [~ INSULATION FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL £OUTHOLD, N.Y. 11971 TEL.: 765-1803 ExaminedI ~ '~'"~' '" 19~.~. Approved .~..~..., 19~.~. Permit No.). .ff./..-~....~.. Disapproved a/c ..................................... ................................ ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT TOWN OF SOUT~qOLD 'Received 19 Date .................. , 19.. INSTRUCTIONS a. Tiffs 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, Sqffolk 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 ~t)sp~ons~ ~ [Signature of applicant, or name, if a corRoration) .... State }~hetlier applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises··· .~J7~./1~. .... ~...~..O. ?. ?"...~ ..~.N .~,5 ....................................... (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 ....... ?.c4~ Cd. l~.k.) ...... .O_=. ..... ....... .............................................................. House Number Street Hamlet County Tax Map No. I000 Section ........ .~.' ?. ......Block ..... d ........... Lot ..... ././. ........... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of pTdses ~nd intended use and occupancy of proposed construction: a. Existing use and occupancy .... ,t~,~S.. ~_~ , b. Intended use and occupancy /a//'.{..e..~..~.e,-¢-F.~.~,., .......................................... 3. Nature of work (check which applicable): New Building .......... Addition.. Repair Removal Demolition Other Work i (Description) 4. Estimated Cost ................................. Fee ........... ,~ ........................... (to be ~aid on filing this application) 5. If dweiling, 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 type of use ..................... 7 D' nsio of isting truct it' Fr nt ,,~ .~t Rear . '/,~, Depth .~, Height f..~. Number of Stories ...... ]. .......... ~ ...... Dimensions of same structure with alterations or additions: Front . .~../1/ . . i ... Rear ,~.~. ..... ~ ....... Depth...~ ~ .............. i. Height.. ~.~. ~ .~ ............. ~quZmber of !tories. ~....x.. ..... : ....... 8. Dimensions of entire new construction: Front ...;~ ~ ........ Rear .. ~,t'/t.. 2 ...... Depth . ~.~, ....... 10. Date of Purchase ../..~.g. .................... rsNameof~FonnerO¥,,ner ..?~t~..~,,,,~X~.~.,~.. ............. 1 I. Zone or use district in which premises are situated ~ ~q. tc~.q .~..-~. t.~! ...... .: ........................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ] ............. 13.Will lot be regraded ..... .................. Will excess fill be removed from pre n'i;es: .... ' 14 Name 6f Owner of premises Address ' Phone No Name of Architect ............................ Address ........... ;, ......, Phone No ................ Name of Contractor )"~e.~..~.o[o.~t~l.. ....... Address ~./r~...-~.....l I ~b..~.~ <~r/ll~Phone.. 15. Is th:Ls property located w±th±nL00 feet of a t±dal wetland? e Yes ..... No ..... * If yes, Southold Town Trus~:ees ?erm±t may be requ±red. PLOT DIAGRAM Locate clearly and, distinctly all buildings, whether existing or proposed, an& indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and shov street names and indicate whether interior or corner ~ot. . ' STATE OF NEW YORK, COUNTY OF ............ S.S ................................................. being duly sworn, depo ;es and says that he is the applicant (Name of individual signing contract) above named. : He is the ' (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the s~id work and to make and file this application; that all statements contained in this application are true to the best of hisI knowledge and belief; an'd that the work will be performed in the manner set forth in the applicatioh filed therewith. Sworn to before me this Notary Public, .... . ,~,p.,.t~,..~ .~..~-.~.E~ .... Co,gnty ~ NOTARY PUBI. IC, State of New Y~k ~-'" ~k No. 4707878, Suffolk Ce~ntl~ ~ 'q Term Expires Nfsrch 30, 19 ~/ "