Loading...
HomeMy WebLinkAbout14812-zFOR~ NO. ~, TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...g.l. 6..0 .1.6 ......... D at e ...fi-.u.~ q .s .t..6. ,...1.9.8. 7. .............. THIS CERTIFIES that the buildb~g ..... 6 .c.c.e.s.s. 97Y. ................................ Location of Property . 315 Maple Lane Southold House No. Street Hamlet Count)' Tax Map No. 1000 Section .... .6~ ......Block .... ! .......... Lot 24 Subdivision ............................... Fi]ed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated April 23, 1986 ,. pursuant to which Building Permit No. 1481.2z dated A. I? .r .i.1.. 2. .6 ~.. 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 ......... Accessory building as applied for. . EDSON, LEWIS L. & DEBORAH The certificate is issued ro ..................... [o~n'e'r,'/~&~i'~nvs)~fXX X .................. of the aforesaid building. Suffolk County Department of Health Approval ......... b]. [.A .............................. UNDERWRITERS CERTIFICATE NO.. N 817060 PLUMBERS CERTIFICATION DATED: N/A Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 14812 Z Permission is to: a hereby granted ..%~..~~....~.....~..-.... ....~.~.~....~~....~.~ ........................ · ..;~...~.~,....~.:..X. ...... !..~...~.~.~ ........ ............ i;T;'"'"~; ........... ~;'":'"'~ ............... ~ .............................................................. ~o,,~ ~ox ~o, ~o. ,o0o,.~,,~.....?,.~:o ........ ~,~ ..... ..o...~ ........... ,o,,o....~ ............. p.rsuant '0 application doted .... ~ ....... ...~.....~ ................ , 19.~...~..., and approved by the 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~ to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of prol~erty with accurate location of ail buildings, property lines, streets, and unusual natural or topogral~hic 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 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 pZOperty showing all property lines, streets, buildings and unusua~ 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 required to prepare e certificate. C. Fees: 1. Certificate of occupancy $25.00 -- BUSINESS $50.00 ACCES$0R¥ $10.00 2. Certificate of-occupancy on pre-existing dwelling $50.00 /~ /~7 3. Copy of certificate of occupancy $ 5.00, over 5 )rears $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O.% $ 50.00 Date ....... ~.~....~ ........... NewC°nsbpuction.. ~'~.~ Old or Pre-existing Building ............ Vacant Land ............. Location of Property ......... ~ ..... ~ ....... ~~.. p ty . . .'-TY...'~T..'. ;~. ..... .'Z.~.~ '~ ) ....~. v,~.~,,~r~..L-JLL~..~P- ' .......... ....' .................... :5 ;7 ..... CountyTaxMapNo. 1000Secton (.~ ./-~. Bock..' .l ..... Lot . ~ ..... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. '~ ?/(~ [~.. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Temporary Certificate ..................... Final Certificate .. ~. ................. Request for Fee Submitted $ /(~.,, ~ Applicant ..... . . · .......... FORM NO, 6 TOWN OF SOUTNOLD Building Department Town Hall Southold, N.Y. 11971 765 - I802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. 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: I. Final survey of property with accurate location of all buildings, property lines, streets, and unu~Jal natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal-iS-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. B. For existing buildings iprior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~perty 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 required to prepare a certificate, Fees: 1. Certificate of oc~cupancy $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 NewCons truction ...... Oki or Pre-existing Building $15.00 Date .......................... ............ Vacant Land ............. Location of Property ...................... House No. Owner or Owners of Property .............. - County Tax Map No. 1000 Section ,~,. ,~,. ~,.. Street Hamlet Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./.~ ~,/~,..~-Oate of Permit//~,~,..Applicant .J,~"'.~..~, ~,, .~:'.:~, ,~,,~.' ,-~.~/~, ........... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. regulations. Applicant ~. , , .~-~,,., ~¢~'?..~,, ........................... zoo~.ov:L THE ~T'£ JU~A~ g6 THIS CERTIFIES THAT NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~.,~t87 85 JOHN STREET, NEW YORK, Lewis EdsoA, Maple Lane~ Main Rd., Sout/lotd, N.Y. ,,.~ollo,.i,,. i,,~.t,~.~e ~ £,.,e~j 7 ~ i.~t FIXTURE 2 FIXTURES ~ 2nd FL garage Section Block Lot and found to be in contpllance uq{h the reqtdremenis t~f this Board. RANGES DISH WASHERS EXHAUST FANS DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI.OUTLET SYSTEMS NO, OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: R V I C E AWG. OF CC. CQND, NO OF HI.LEG G & $ Elect. Box 215 $outhold, N.Y. 11971 LiC$ 578E GENERAL MANAGER This certificate must not be altered in any manner; return to the office of the Boa[d if /nco(feet Inspectors may be identified by their credentlais. COPY FOR ~UILDING DEPARTMENT. THIS COPY OF CERTIFI~, 80T BE ~LTERED IN ANY MANNER. FiEL~ INSFECTION COMMENTS FOUNDATION {1st) FOUNDATION (2nd) ROUGH FRAME & FLUMBING INSULATION FERN. Y. STATE ENERGY CODE ADDITIONAL COMMENTS: 7GS-1802 BUILDING DEPT, INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION ;ZND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARK : ~ 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined. ...~.[¢..., 19~° Approved ~...~..(o .... 19~.~.. Permit No.).9.~.~..~r.:~. · · Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PEP, B/lIT INSTRUCTIONS Received ........... ,19... Date ..... ¢/.2,-.:~ ....... 19 .~.~. 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 inspections. .... .......... (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ·.. .................................................................................. Name of owner of premises ../~/,O, S .Z ..... ~./~. J~ .O~d¢..-Z>,..,~"/D~o,~ ........................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ~'~ '(~e an~ 'title of corporat; ;~ Builder's License No .... f.~5./. ................. Plumber's License No ...... .~/~. ............... Electrician's License No .....'~/~. ............... Other Trade's License No .....Ar f?. .............. Location of land on which proposed work will he done ..... !.~j~ ........ ........ .... ............ ................. House Num'~er-- / Street Hamlet County Tax Map No. I000 Section ...... .O..~.~. ...... Block ..... /. ............ Lot....~.~. ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... 0,/~. ~'... t~T(<~.~.' .~--ff.... ~6.~/~. ..... ~. ~.~.,..~ .................... b. Intended use and occupancy .................................... z~. h-¢,~?*~..¢,,[~',: ................. Repair . ~. !...; Removal .............. Demolition .- ..... ~l~ther Work 4. Estimated Cost ... ,(~o. 0...i ........................... Fee ...................................... .... (to be paid on filing this application) 5. If dwelling, number'of dwelling units ............... Number of dwelling units on each floor ................ If garage, number, of cars ... i ..................................................................... 6. If business, COmmercial or mi~ed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structtlres, ffany: Front ............... Rear .............. Depth ............... Height ............... NUmber of Stories ........................................................ Dimensions of same structure iwith alterations or additions: Front ................. Rear .................. Depth ' Height Number of Stories 8. Dimensions of entire new construction: Front.............../'Z ' Rear .... ./?. ........' Depth .... /~. ' ......... Height /~' · Nrlmber of Stories · R 9. S~ze of lot Front . ear /,,e~' ,' D~nth ...... 10. Date of Purchase ..... '. · ~. .............. Name of Former Owner ............................. 11. Zone or use district in which prgmises are situated .................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ...... .~..o. ..... Will excess fill be removed from premises: Yes ~/No 14. Name of Owner of premises ~.~'!~.~.' ~.'~,~.~'~ ii'Address . ~Y/~72{-~... ~[~4~g... Phone No. Name of Arcintect ........................... Address . . .~-~.~ ...... Phone No ................ ' Name of Contractor . ~d~ ;~-/:i~/.. d:~x.t~-Aff. Address ~ 4~.. Phone No. 2'~.~.-.~J-P-~.. .... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and~indicate all set-back dimensions fron~ property 1/nes. Give street and block number or description according to deed, and show street names and indicate whethe~ interior or corner lot. STATE OF NEW YO. RK. COUNTY OF .... ...........(- i Fl d.c~,~. ~'~-C.'~,4-. O.L · · · .. · .... ·........ being duly sworn, deposes and says that he is the applicant (Name of individual si~ning contract) above named· , He is the .... .~.~~,..!~...Z...~.'~ ......................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dgly authorized to perform or have performed the said work and to make and file this application; that all statements cpatained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manher set forth in the application filed therewith. Sworu to before me this ................ Notary Public, . ....................... · .~..~ounty (Signature of applicant) ..YZ .................. ~P~ROV~D AS ~OTED