HomeMy WebLinkAbout14631-zFORM NO, 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
' No....Z J .5.q. 5..0 ........ Date .... I7..e .c.e.m.b..e .v. fi. ~ ................ 19..86.
THIS CERTIFIES that the building Addition and deck addition to existing
one family dwelling -
Location of Property . 20~5. Ws.at. Cr.ae k. ~.. 1255..~id.w. Qod. f~Qad .... C~.t. qhog.~', .'~.. Y.
House No. Street ' Ham/et
County Tax Map No. 1000 Section .... 1.1.0. ..... Block ..... 0.2. ........ Lot ...... 0.7... ~-'.. '~
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore fried in this office dated
F~.b.p. u ar.y.. 2 6, ......., 108 6. pursuant to which Building Permit No .... 1.z~ 63.1 .~ ...........
dated . .M.a.p.c..h..8., .................. 19 .S..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 .........
Addition and deck addition to existin~ one family dwelling.
The certificate is issued to BARBARA CHRISTENSEN
..................... ek ....................
of the aforesaid building.
Suffolk County Department of Health Approval .. N / A
UNDERWRITERS CERTIFICATE NO. N 77 7786.
Rev. 1/81
l~OR~ NO. ~
TChVN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERJvtlT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
CQMPLETION OF THE WORK AUTHORIZED)
Permission is hereb/granted to: ,
...~......~.~....C~.~.~.:. .......
~~.....~..~...~~ ..........
~...~.~.....~..:~.,...;....L!.~..~..~... ........... ~ ~
~......~ ....... ~:....~.~.....~ ................ ~ ............ ~ ..................... : .......... ~.~...
at premises Iocated~at .~..?..?...~.....'.L~.....~?~...~....~...~....!...`~...~.~..%..~....~..~.~....~....:.....~ ~
County Tax Map No, 1000 Section ....... I..!...~. ......... Block ..... ,?....~/. ........ Eot No ..... ~.~.....~. ............
pursuant to application dated ...~~......-~...,~. ................ , 19...~....~, and 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
APPLICATION FOR CERTIFICATE OF OCCUPAI~CY
Instructions
A. This application must be filled in typewriter OR ink, and submitted in duplicate 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 disposai-(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 peoperty showing all property lines, streets, buildings and unusgal 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.
C,
Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use [/~1 C,~ <~t. ('~,,, ~ ~ C) ~ J;-.
3. Copy of certificate of occupancy $1.00
New Building ............. Old or Pre-existing Building ... ~ ....... Vacant Land .............
Location of Property .;~05~.... ~.e.:~ 1~..Cr.e.~ k./~v.(~/~5;. ~:L c~p.o, cl. ~.c1..... g.~ gbPgg,~ ........
House No. Street Ham/et
Owner or Owners of Property ...~.....C .h.r.~. 8..~.e.qs.e. g, .........................................
Caunty Tax Map No. 1000 Section ...~.l.q ......... Block . .2. ............ Lot .... .7. ..........
Subdivision..~]/. ~ ............................ Filed Map No ........... Lot No ..............
Permit No. ,1,~6~33, .[. Date of Permit3/.~/. ~6....ApplicantE.~¥.~'p, .mp.ep.t..~{~fl.t~,, ~.qq ,. ~.o.~..~..
Health Dept. Approval .... ~./..A ................. Labor Dept. Approval ..... ~/~.A. ...............
Un~Jen~riters Approval ........................ Planning Board Approval .... .~/.A.. ...... : .......
Christen.
Request for Temporary Certificate ..................... Final Certificate ....... ~. ...............
Fee Submitted $. ~.,,00 ....................
Con,ruction on above described building/e~d p~~ codes and ragu lat ions.
R(I~.
THE
1001093
THIS CERTIFIES THAT
NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
85 JOHN ~'~,~T, NEW YORK, NEW YORK 10038
November 6, .... 420545/86
~ppllcutlon NO. on fite
N 777786
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
Robert Christensen, Car. West Creek 2nd Wood, Cutchogue, N.Y.
inthefollowinglocation~ [] Basement ~ IstF1. ~ 2nd FI. Section Block Lot
t~s examined on October 30,198 ~ and found to be in co.ipllonce u'ith the re~t,~irements qf this Board
FIXTURE
OUTLETS
2 12
f FIXTURES J
j FUTURE APPLIANCE FEEDERS
FU
RNACE
MOTORS
SERVICE DISCONNECT
OTHER APPARATUS:
I~.F.I,
Track Lighting-16~O' 4
RANGES
~FECIAL REC'PT
TIME CLOCKS BELLIUNITHEATERSUNIT HEATERS MULTI.OUTLET
AM, T, AMPS. TRANS. ~ SYSTEMS
NO. OF FEET
~10. OF S V I C E
lites
EXHAUST FANS
DIMMERS
OF NEUTRAL
425 Honsell Lane
Cutcbugue, N.Y., 11935 .,~
Pe .
This certificate must not,be ollered in any manner; return fo the office of the Board if incorrect. Mspecfors ,may be identified by their credentials.
7GS-~.802
BUILDING DEPT.
INSPECTION
FOUNDATION XST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING
REMARKS:
[ ] FINAL
,, / /
]65-1802
BUILDING DEPT.
INSPECTION
[ ] FRAMING
REMARKS:
FOUNDATION 1ST []ROUGH PLBG.
FOUNDATION 2ND []INSULATION
[]FINAL
76S-:!.802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [~UGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[~MING [] FINAL
DATE: ~INSPECTOR ,,/~,,,~.~ ~
BUILDING DEPT.
INSPECTION
[ ] FRAMING
REMARKS:
[ ] FINAL
DATE ~/'~ ~ , INSPEG'q'OR
BUILDING DEPT.
INSPECTION
[~] F/~OUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
FRAMING [ ] FINAL
F1ELD %NSUECT~ON COMMENTS
FOUNDATION (1st)
FOUNDATION (2nd)
2.
ROUGH FRAME &
PLUMBING
3.
INSULATION PER N. Y.
STATE ENERGY
CODE
ADDITIONAL COMMENTS:
' FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
~OUTHOLD, N.Y. 11971
TEL.: 765-1802
Disapproved a/c .....................................
(Builatl~ Inspector)
APPLICATION FOR BUILDING PERMIT
BLDG. DEPT.
TOWN OF SOUTHOLD
Received ........... ,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 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 ail applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
.~ .nT.~?..~.mp.n)..~.%s). ~..~.n.q .....r.q~.. ?:4n.e. r ......
(Signature of applicant, or name, if a corporation)
.:~.~.~ 3.2o. 75..~.n.a. ~_.~n.,
(Mailing address of applicant) 119J8
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Contractor ........................................
Name of owner of premises ..~.. (%. t ~v. a~- w-- ~ ~Z~V' ~ ~-c~ ~,
(as on the tax roll or latest deed)
If~js a~co~/6~ture of duly
authorized
officer.
· ) ........ :., .......
(N~me and title o~rporate officer)
Builder's License No..~gff..~4~~. :[[~. 5~.!~6- .....
Plumber's License No ........ ~//L .............
Electrician's License No ...... [~/g. .............
Other Trade's License No ......................
1. Location of land on which proposed work will be done. ~I.e ;~.~...Crp.e.~..Ay~.. ~/.o. ).~i.dF. qgql. ~qaO ............
5-5- .
..... ~ ......................... W..a~. ~.ue.e.k. kv.a ................ g~.~.e.h~g~p ...............
House Number Street Hamlet --r -
County Tax Map No, 1000 Section ..... /. [...O. ........ Block ....... ~.. ........ Lot ..... .7 ............
Subdivision ~,' Filed Map No ............... Lot ...............
(Name) ,,
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .
b. Intended use and occupancy ~.~.qe.,l¢..~a~J.~y .~¢.s.~O~pee . ;~ ~'~ ~'r~~r ........
'3. Nature of work (check which a. plicable): New Building ..... ' ..... Addition..2; ....... Alteration ....... : ....
Repair .............. Removai .............. Demolition ............ Other Work ..... : .........
~<. '~ ,: ~Z~] (Description)
4, Estimated Cost,, ,~,~,,0, r,O,0,:~:i,0~ ....................... Fee .......
(to be paid on filing this application)
k~5: "If dwelling;'fiu'rnbe~ of dwelling units ...... o..n9 ...... Number of dwelling units on each floor ................
If garage, number of cars .... ~ ....................................................................
6. If business commercial or mixed occupancy spec/fy natu. m and extent of each type of use .....................
' .2,~
7. Dimensions of existing structures, if any: Front .... '. ..... '. Rear ... De ..........
Height ....2./4:. ~. ........ Number of Stories ...~. ...................................................
Dimensions of same structure With alterations or additions: Front .. } .2.'.6.. '~ ......... Rear . .. 3 ¢..6. ..........
Depth .~9 ' ...... Height . ?!47. i .. Number of Stories ...~'.
.... ~ 7'6" .... i' " ~6 ....... , ..........
Dimensions of entire new construction: Front ...... ......... Rear .... ~ .......... Depth .. 3.9. ..........
Height ..... I9'./.9 .......Nu~nber of Stories ....
9. Size of lot Front .......... :i ............ Rear ..... : .... ............ Depth ...............
10.. Date of Purchase .......... : ................... Name of Former Owner .............................
11. Zone or use district in which piemises are situated..R.e. ~..d.~ ¢.~;[.a~[ ......................................
12. Does proposed construction vi01ate any zoning law, ordinance o/e regulation: ...~q'. .........................
13. Will lot be regraded ... I~9...: .... :..,. ............ Will ex~ess fill be removed from premier: . Y~s _ . No
14. Name of Owner of premises ~. C ./XC'.s.~ .q-.~.%~. ¥.~, Address .Y .0. Q . .D .o y. qo.,..U.~ppl~;m~).gl.l;~. ?.~.~..-.5.~.~.1...
Name of Architect E ........ i .......~ ........... Address ~ ................. Phone No ...... - ..........
...... nv2~ro~ent ~ast, 'rnC.Addr~s~Q75 In~t,l~k. La..phrmaNo .~3~ 7474
marne o~ con~ractor ............................ ~>~'dfli~;' 'rTZ' ' 'XI95'23' ....................
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 accordin: to deed, and show street names and indicate whether
interior or coruer lot.
Atltached
STA'rE OF NEW YORK, I S.S
COUNTY OF ................
................................................. bein duly sworn, deposes and says that he is the applicant
(Name of individual sigping contract)
above named. ,
He is the ..................... i .......................... ' ..........................................
! (Cent;actor, agent, COlt orate officer, etc.)
of said owner or owners, and is dgly authorized to perform or hax'e performed the said work and to make and fii~'~this-
application; that all statements cofftained in this application are tru ~ to the best of his knowledge and belief; and that the
work will be performed in the man~er set forth in the application file d therewith.
Sworn to before me this ]
............ · ~.~ ..... . .... day ~f ....... .~....F~-.. ........19
....... co
.................
~1~. ~7 ~ x--4Signature of applicant)
OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATE
OF OCCUPANCY
APPROVED AS NOTED
NOTIFY 'BL~ LD NC, DEPARTMENT AT
765-1802 .9 ,AM 'ro 4 PM FOR THE
FOUNDATION ~0 REQUIRED
FOR ~OU~D CONCRETE
2 ROUGH F~AMiNG & PLUMBING
3 INSULA rlOr~
4. ;INA~. CO~JSTRUCT~ON MUST
8; COMmiE FOR C.O,
AL~ CONSTRUCTION SHALL MEET
FHE ~EQUIr~SMENTS OF ~E N.Y
S~ATE CONS rRUC~ION & ENERGY
CODES, NOT RES~NSIBLE FOR
~IGN OR cONSTRUCTION ERRORS,
J
.!