HomeMy WebLinkAbout15152-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z15194 Date January 12, 1987
THIS CERTIFIES that the building ...... .A.c.c.e..s .s.o.r.y...b.u.i. 1..dj.n.g. ....................
915 GRITTEb!S LANE SOUTHOLD
Location of Property ...............................................................
House No. Street Hamlet
County Tax Map No. ]000 Section .0. 7. .0 ........ Block .... J .! .........Lot ..... .3 ...........
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore flied in this office dated
July 30, 1986 . pursuant to which Building Permit No. 15152z .
dated ....J.u. 1. y....3.0. ,...1.9.8.7. .......... , 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 .........
49cessory building.
The certiflcate is issued to C. AUSTIN & HELEN B. DAWSON
..................... /o¥.'e; .....................
of the aforesaid building.
N/A
Suffolk County Department of Health Approval ..........................................
UNDERWRITERS CERTIFICATE NO ................ ~..7 .8.6.8. !.7 ..........................
PLUMBERS CERTIFICATION DATED: N/A
B I ~ .....
' nspector '''
Rev, 1/81
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N. Y.
BUILDinG PER~IT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPL~'ION OF THE WORK AUTHORIZED)
N°. 15152
Z
Permission is hereby granted to:
..~.~..~=.....~....~ .................
..~...~ ......... l.L..~..~..l.....,. ..................
, ~ .~.~~
~t premises located at ...~../...~..~.. ...... ~ ................. · ................. ...
County Tax Map No, 1000 Section ...... ..~..~....~- ...... Block ....... .~.) ........... Lot No ..... ..~ ................
pursuon, to application dated .......... ...'~.~..w~,..CJ .................. , 19.~.~., end approved by the
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. This application must be filled in typewriter OR ink, and submitted m~aa=~a~ 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 features.
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 comp(eted site plan requirements where applicable.
B, For existing buildings iprior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of p~-~operty showing afl 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 bousing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees:
1. Certificate of occ_upancy $5.00
2. Certificate of occupancy on pre-existing dwelling $ 3. 5.00
3. Copy of certificate of occupancy $1.00
4.Vacan~ Land C.O. $5.00 /.~.~.~./~.~.
5. Updated C.O. $15.00 Date ..............
New C on s t r u c t i on Old or Pre-existing Building Vacant Land
Location of Property r -~
House No.
Owner or Owners of Property . .,. . -; . .t ...................
County Tax Map No. 1000 Section ............... Block ............... Lot ................
Subdivision ................................. Filed Map No ..... ^ ..... Lot No ..............
Permit No. /~./~..~..~.. Date of Permit .7/~.~/~..~.Applicant ...~'..,..~.~...
Health ,Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Doard Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Foe Submitted $ .............................
Construction on above described bu ild,ing and perm~)meets~all ~appli_cable codes and regulations.
Applicant ~./., ~.~ ....................
R~v. 10-10-78 ~ 3f/'O/
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
.7~.~.~ ~, ~7 ~ Jo.. STREET, .~ ~O.~,
THIS CERTIFIES THAT
FLUORESCENT
EXHAUST FANS
DRYERS FURNACE MOTORS
FUTURE APPLIANCE FEEDERS
TIME CLOCKS MULTI-OUTLET DIMMERS
SYSTEMS
NO. OF FEET
SERVICE DISCONNECT
OTHER APPARATUS:
S E R V I C
NO. OF CC. COND A W.G. NO OF HI.L~G
A W.G NO OFNEUTRA
OF HI.LEO
OF NEUIrRAL
Glenn Bradley
Box 60Z
Lann~l, N.Y. 11~8
Mc, 1227
GENEEAL MANAGER
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their crbdentials.
: COPY FOR BU LD HG DEPARTMENT THIS COPY~ OF CERTIFICATE,. MUST~OT: BE~ ALTERED hi ANY___MAhlNER.
?'iELD -.I~lE C. T i 0 N
FOUNDATION (1st)
FOUNDATION
2.
(2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
CODE
ADDITIONAL COMMENTS:
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
To Whom This May C ncern,
We are unable~to complete your Certificate
of Occupancy because ,of the following reasons.
i--~!!notapplicati°non file. for(~~Certificate~ of Occupancy
_ Underwriters Certificate on
file.
/Z/ The check is(~d/not on file.)~3
/Z/ No Health Dept. Approval on file.
/5/ No final inspection has been made.
Please contact our office on this matter.
Thank you for your cooperation.
Building Permit # ~ J_~ ~'c~ Z
Building Dept.
***/Z/ No Plumber Solder Certificate on file.
( all permits involving plumbing being
issued after April 1,1984 )
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING
[ ] FINAL
DATE
INSPECTOR /~~
"' ' ' 'FORM NO, 1
:,;,,~'~,~' ~' ~ ~,,,;;~ TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
8OUTHOLD, N.Y. 11971
TEL.: 765-1803
^ppr;ved . 19 Ue it
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date ................... 19...
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 appl~z
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 inspe/,,)tio~,/' ~ /~,, ~,__' ~dd'>/t7
(Signature of applicant, or namer if a corporation)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ..........................................................................
(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. Locationoflandonwhichproposedworkwillbedone...~..,~...~.~~~.~..~..~ ..........
House Number Street Hamlet
County Tax Map No. I000 Section ......... lO. ..... Block ...... ].l .......... Lot . . .~. .............
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing useand occupancy. ~t4/...t~..~.-~..~.~..~. .....................................
b. Intended use. and occupancy../~. ..... ~. ~-7 .~./~...~ .~/..~. ~.. ........
3. Nature of work (check which applicable): New Building . .~..'. .... Addition ......... Alteration ..........
Repair .............. Removal .............. Demolition ............. Other Work ..... : .........
4. Estimated Cost ....................... Fee ....................................
' (to. b? paid on filing this application)
Nub f dwell'ng uti'ts ch floor
5. If dwelling, number of dwelling units ............... m er o ~ 1 on ea ................
If garage, number of cars .......................................... + .............................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .....................
....
7. Dimensions of existing structures if any: Front ............ Rear ....... Depth~-.~:~ t
Height ............... Number of Stories / .......................................................
Dimensio~ of same structure with alterations or additions: Front ...~i ...... Rear .~ .........
Depth ./~-~t.~h~. .............. Height .. ~f~ .............. Number Of Stories .J~f,,~40~-- ..............
.... 8. Dimensions of entire new construction: Front../~ ...... ~ ..... Rear../o~.. [ ....... Dept. .~f. ......
Height .~.' ............ Number of Stones' ./. ....................... i~ ........................... ..-
9. Size of lot: Front .,.,.. ~ ..... , ........... Rear ..................... D~pth ......................
10. Date of Purchase'~ /,,.~. P..7. .... Name of Former Owner ~fl~.s.
11. Zone or use district~fn 'dhmh premmes are mtuated ....................... [ ..............................
12. Does proposed constructign violate any zoning law, ordinance or regulation: Z~. rPFtF-~../~.~t~,L.~ .............. ._.
13. Will lot be regraded . .~.o. ....................... Will excess fill be removed from premises: Yes
14. Name of Owner of premises .~.~.~-~ .............. Address .............. Phone No...-r-/p.~?.t,.~?.~.?~...
Name of Architect ~ Address ~ Phone No
Name of Contractor ~ Address : ~ Phone No
15. Is this property located within 300 feet of a tidal wetland? *Yes ..... O .....
*If yes, Southold Town Trustees Permit maybe equ~red.
PLO*F DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. ~ndicate all set-back dimensions from
propsrty lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
l\
STATE OF NE~/YD~RK, 7 oo
being duly sworn, deposes and says
(Name of individual signing contract)
above named.
that he is the applicant
He is the
(Contractor, agent, corporate officer, e~c.)
of said owner or owners, and is duly authorized to perform or have performed tho said work and to make and file this
knowledge and belief; and that the
application; that all statements contained in this application are true to the best of his
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
.............. ........
N°tary Public'' ]';/~Z~~~''' C°unt
No. 4674306, Suffolk CountY,.-~
CommiSsion ElXplre~, July 31,
(Signature of applicant)
)E FRAMING
DE
f IlW¢
12'.8'S
FRONT FRAMING
.EFT SIDE FRAMING
REAR FRAMING
APPROVED AS NOTED
D~TE: ?JsoJe~ o., *
NOTIFY BUILDING DEPARTM~T AT
765-1802 9 AM TO 4 PM ~R THE
FOLLOWING INSPECTIONS:
FOUi~OA~ION ~0 REQUIRED
co~Es ~OT RES~NS~LE ~R
>R
\ ! J /
RIGHT SIDE FRAMING
CONC. SLAB
PLAN ~,~,',~"-,'-o"