HomeMy WebLinkAbout14663-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hail
Southold, N.Y.
Certificate Of Occupancy
No...,~J.~7.?,3 ........ Date ... August ?, 19.~.6.
THIS CERTIFIES that the building a d d i t i on
Location of Property ....9.7.5...B.a.~.h..a.v.e.n...L.a.n.e. ............ Southold, N. Y.
t~ouse No. Street Hamlet
County Tax Map No. 1000 Section .... 8.8. ......Block ....4 ........... Lot . 35
Subdivision M/o Bay Haven at SoutholdFiled Map No 2910 .LotNo. 46
conforms substantially to the Application for Building Permit heretofore f'ded in this office dated
Ma r c h 4 ~, 19 .8 .6. pursuant to which Building Permit No. 1 z~ 6 6 3 z
March 17, 86
dated ............................ 19..., 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 to existing one family dwelling
The certificate is issued to . Tom Fox
.................... ?oWn'dr, .....................
of the aforesaid building.
N/A
Suffolk County Department of Health Approval ..........................................
N760966
UNDERWRITERS CERTIFICATE NO ..................................................
Plumbers Certification dated gul~, ~r~ ~ 1,986 .......
Rev. 1/81
FO~M NO. ~
TOW~ OF $OUT~OL~
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N, Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
14663 Z
Permission is hereb/granted to:
...~...,...r..~....~.g..~,,~.....(.,~.... '
,o .~.~.......~.,~..~.....~~....~.....~~ .........
~ *'1 "* v.u.~.,,. , . ~...~,, '; _~ ~ .?"1~ .~,.~"~ - "
at p,emises 'ocoted ot ...~.....~.........'~..~.,.,.~...~.~ ....... .~.,,~..~....--.....-~
County Tax Map No. 1000 Section ....... .(~...~..~ ..... Block ..... ..~3..~ ......... Lot No ..... ..'~..~'~... .........
pursuant to application dated ..... ~.~.,..~,.,...U. ................. , 19.~,..~ and approved by the
Building Inspector.
Building Inspector
Rev. 6/30/80
TOWN OF SOUTHOLD
Building Department
Town Hall
southold. N.Y. 11971
765 - ~802
APPLICATION FOR cERTIFIcATE OF OccUPANcY
Instructions
A. This application must be filled in typewriter OR ink, and submitted ~ ~ to the Building Inspec-
tor with the fol~owing; 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 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 p~operty showing all property lines, streets, buildings and unusual natural or
topographic featu res.
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 $15.00
3. Copy of certificate of occupancy $1.00 ~,/ ?, '/'~
4.Vacant Land C.O. $5.00
C~
5. Upda%ed C.O. $15.00 Date .... ,.~, .......
New C one tpuc ti on ...... Old or Pre-existing Building ............ V~cant Land .............
L°cati°n °f Pr°perty'' 9' P'3'~'' ~ ~ ~
Houso No. Stroet Hamlot
Owner or Owners of Property . . .~. · ./~., ...................................................
County Tax Map No. 1000 Section ..... ~..¥ ....... Block ... ~. .......... Lot ................
Subdivision ................................. Filed Map No. ~.. ~/O .LotNo.
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval .......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ .............................
Construction on above described building an~l applicable codes and regulations.
Applicant ..... fi~.~ .........................
Rev. I0-10-78
Co~
FIELD INSF E f~T~ION
FOUNDATION
FOUNDATION
2.
COMMENTS
ROUGH FRAME &
FLUMBING
INSULATION FERN.
STATE ENERGY
CODE
FINAL
ADDITIO!
COMMENTS:
[ ] FOUNDATION 1ST
7C~-1802
BUILDING DEPT.
INSPECTION
[ ] ROUGH PLBG.
FOUNDATION ZND [ ] INSULATION
[ ] FRAMING
[ ] FINAL
REMARKS:
DATE
]'65-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
DATE INSPECTOR
76.5-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
'~FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING
REMARKS:
[ ] FINAL
DATE INSPECTOR
7GS-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST ROUGH PLBG.
[ ] FOUNDATION ZND [ ] INSULATION
~/~FRAMING [ ] FINAL
RI'MARKS: ~ ~
INSPECTOR ,,~
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
CERTIFICATION
Date July 24, 1986
Building Permit No.
Owner Tom Fox
z14773
(please print)
Plumber F~ ~'~ff~'
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
/ (plumbers' s~g~tur~J~
Sworn to before me this
Notary Public,
County
Notary Public
HAROLD COHEN
NOTARY PbBLIC $fate of New
lerm Expires OecemDe~ a~,
~.o~5o~3 THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
'"'~--~ July 39, 1986 ES JOHN STREET. NEW YORK, NEW~{~'$S
,.,, ~..,,~.,,o.~o.~.~,,~ N 760966
THIS CERTIFIES THAT
o~y the ~r~aJ equipment ~ ~scrlb~,~elo~ff~.~tt~d by t~ applicant ~med on the a~ve appllcat~n number in the premises of
in the fotJowing locatio~t;1 ~Bas~ ~J~ lst FI.
flXTURI~
OUTLETS
13
DRYERS
FIXTURES
~ 2nd FI. Section Block Lot
and four~d to be in cotnpllance with the require nents qf this Board.
OVENS ~ WASHERS EXHAUST FANS
SYSTEMS
NO. OF FEET
Motors: 1-1hp
1-G. FoC.I. ]~t~:)]~e Detector
E R V I
A V~ G. NO. OF HI-LEG
CC. CONI),
C E
O~'~E% ~'"°' o~ NEm"^LS
A+W.G
OF NEUTRAL
tI~ry Bol~
1~1 Sheep Posture Road
East Setaul~t, N.Y. 11733
Lic. 2675E,
Per
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
coPY Fo~ ~Ui[DI~O ~P~T~L ~H~S C~P¥ O~ CE~F~C~ ~US~ ~o~ s~ ~L~T~E~ ~ ~Y ~E~.
.7GS-~,802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND ~/~ INSULATION
[ ] FRAMING [ ]FINAL
REMARKS.
',' ': -' ~,' ~'~'FORM NO. 1
~:~,, ' ,A,,,' TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N.Y. 11971
', TEL.: 765-1802
Examined..'~Y~ m'~.~ ./.'~.., 19 ~.~
Approved..~.~..(7.., 19~:gPe=it No.
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INS~UCTIONS
BLDG. DEPT.
TOWN OF $0UTHOL?,.,,,..~._~
Rece:J. ved ...........
Date ................... 19...
a. Tins application must be completely tilled 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 in~..o..~./CD'~ ~
(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~r>-;r> /~..~> ...........................
(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 .... .~..,.~..t~/./. ............
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
Location of Iand on which proposed work will be done ..................................................
............................. .?.q. .o. .O. ................
House Number Street Hamlet
County Tax Map No. 1000 Section ........ g.~. ...... Block ...¢ ............. Lot...~....~.. ...........
Subdivision ..................................... Filed Map No..?: .5/?° Lot...~.'~.
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
Existmg use and occupancy ................................ 7l ..... ./-.~... SA~?' ......................
b. Intended use and occupancy ................. ~.,./'~..~'f~'..) .Z¢7'7.. /... ~ .......................... !
, i
3. Nature of work (check which applicable): New Building ' Addition. i .. Alteration .. i ........
Repair .............. Removal ........... Demolition ........... ~.. Other Work ...............
~ (Description)
4. Estimated Cost ...... ~ * .~.0.0. .................... Fee .......... i ...........................
~ (to be Paid on filing this application)
5. If dwelling, number of dwelling units ............... Number o f 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. Dtmensmns of ex~st~ng structures, ~f any Front ~..~ Rear 6o ' Depth 2,~/r.
Height ............... Number of Stories / ....... .....
Dimensions of same structure with aiterations or additions: Front .../~e~ .~. .... 'i... i 'l~e~r'. i i i ~i; i/~ i ii i i ii ii
Depth ...... ~.~..t ........... Height ...................... Number of Stories... / .................
8. Dimensions of entire new construction: Front ... (~.~. ......... Rear .... .~ a. ~ ...... Depth ...~.~-: ........
Height ............... Number of Stories ........................ ; .......................
9. Size of lot Front ./.2~.~. Rear /.~., Danth / ~1~'' ....
10. Date of Purchase ............................. Name of Former Owner . ~///~z,~'T~....0.. r~..~/~,/g~z4~f
1 1. Zone or use district in which premises are situated ......................... ; ...........................
12. Does proposed construction violate any zoning law, ordinance or regulation: ...~'p ..........................
13. Will lot be regraded ....... ~Z..~ .................. Will excess fill be removed from premises: ~,~ No
14. NameofOwnerofpremises . .5,-~:~.. ,~'~<~ Address /~,O,,v/~l~.6'q~'A-'..Z~, PhoneNo ......
Name of Architect ........................... Address ............... i... Phone No ................
Name of Contractor . .~P. ?~x~T-./',//~..~/)A/ ....... Address .,fi'~.4'. ~J'T.jO~:-.~;~,~ Phone No . .~.~.~rF-..{//.~....
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 sho~ street names and indicate whether
interior or corner lot.
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 ........................................... i ........................... (Contractor, agent, corporate officer, etc.)
of sfiid owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application; that all statements contained in this application are true to the best of his iknowledge and belief; and that the
work will be performed in the manner set forth in the application filed therewith. '
Swgrn to before me this
.................. dayof
Notary Public, .....
................... .
........ .... .... ....