The URL can be used to link to this page

Home My WebLink About14457-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy PLUHBERS CERTIFICATION DATED: No. Z 16380 Date November 9~ 1987 THIS CERTIFIES that the building ...A.d.d..i .t.i.o.n. .................................... LO~O,;~.~I~ .... ,., R/W OFF Bell Hill Ave Fishers Island House No. Street Hamlet County Tax Map No. 1000 Section 9 ...Block 3 .Lot 2 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fred in this office dated D e c. 9, l 98 5 pursuant to which Building Permit No. 14 4 5 7 Z dated . D..e .c....9. ,...1.9.8.5. ............. 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 ......... ..... .A.d..d .i.t.i. qn....t.q..a..s.u.m..m.e.r...d .w.e.l. 1. i..rig ....................................... The certificate is issued to GEORGE FURSE ..................... ioYn' , x ................. of the aforesaid building. Suffolk County Department of Health Approval ........... N../.A ............................ UNDERWRITERS CERTIFICATE NO. N 7 7 0 8 1 8 N/A Building Inspector Re~. 1/81 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD,, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 14457 Z Permission is hereby granted to: ~~~.***~~ .............. ,o ...................................... 7T7":~-'; .......................................... -~'~ ......... " ' at premises located at ........................................ ;=-b~/"',"S~-~/ ............................................................... ..... ............................................ cou.~ Tax Mo, No. ,000 Sec,o. ......... ~ ......... ~lock ....... ~ .......... Lot Na...~. .......... pursuant to application dated ........... ...~...~ ........ ~ ......... , ig..~.~,~'~d 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 ,-~ 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, propertv lines, streets, and unusual natural or topographic featu res. 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 buiidings, Multiple Residences and similar buildings and installa- lions, 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 pZ'operty 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. C. Fees: Additions $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory!Si0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date ../t~..'~....~...~..-~..~.2... NewCons truc lion ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .................... J'~ ~/,-~. ............................. House No. Street Ham/et Owner or Owners of Property. ................................ ..... ...... .... ....... ... County Tax Map No. 1000 Section .... ~. ......... Block ....~. ......... Lot ..... ~. ........ Subdivision ................................. Filed Map No ........... Lot No .............. Perm it N o./. ~ .~...,~. ~.~.Date of Perm it q~.c.. ~ .~..~.~Applicant . .(.~/. J.L~./.../.]~..Y~)....~--....~-~.~,. ~ J~)~'. ~..~ Health Dept. Approval ........................ Labor Dept. Approval ....................... . Underwriters Approval .J~..' ' ~7... 7~./~. ....... Planning Board Approval .................... Request for Temporary Certificate ..................... Final Certificate ....J,~...... .......... Fee Submitted $ ............................. THE NEW YORK BOARD OF FIRE UNDERWRITERS [~ BUREAU OF ELECTRICITY ,a~ ~pp,i~a,o. ~o...~ii~ N 770818 THIS CERTIFIES THAT o~y the electric~ ~ipment ~ ~scribed belo~ and int~uced by the appl~ant ~med on the above application number in the premises of ~. ~al~ Furse, Private ~, Fi~ers I~, ~M ~s examined om bep ~N i~ ~ l ~b aad found to be in compliance u,lth the requirements qf this Board FIXTURE , FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS ~ECEPTACLE$ SWITCHES FlUOReSCENT weO~ FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS MULTI.OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: i~,Y.l. S E R V I C E NO OF CC COND, A, WG PER 4~' OF CC COND NO. OF HI-LEG 06390 GENERAL MANAGER Pet' This certificate must not be attered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. FIELD INS[~ECTION FOUNDATION (1st) COMMENTS FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS FORM NO. 1 TOWN OF SOUTHOLD - ' BUILDING DEPARTMENT TOWN HALL ~ SOUTHOLD, N.Y. 11971 , · TEL.: 765-1803 ^pproved ...... P ,,it No./. ¥. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19.. INSTRUCTIONS a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with sets of plans, accurat6 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 street 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 permi 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 Occupant; 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 th~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of build,as, 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 admit authorized inspectors on premises anti in building for necessary inspections. (Signatnre of/applicant, or name, if a corporation) (Mailing address of aplCl{cant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................... If applicant is a corporation, signature of duly authorized officer, ff_,~.~ /~F-cA-'~ ~/~f /5'~~ ........ ',;ti; ......... Builder's License No ........ ./5..~. ~ ............ Plumber's License No ...... ~'~.././. ~ .~ ./.~. ..... Electrician's License No....~. ~..~...~...~.. ...... Other Trade's Iicense No 1. Location of land on which proposed work will be done .......................... ;, .... s,. ..... // .......... · .......... House Number / ~ Street / Hamlet ~x O' / Subdivision ..................................... Filed Ivlap No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use ant] occupancy ..... /~:'-g~.qOg.<..~f/~...~~/...~. ............ ' .................... b. Intended use and occupancy ..................................... [..*fi~.. ~ .............. 3. Nature of work (check which applicable): New Building .......... Addition ..~........~ Alteration ., ........ Repair .............. Removal .............. Demolition ............ Other Work ............... (Description) 4. Estimated Cost ........................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ./. ....... Number of dwelling unRs on each floor ................ If garage number of cars .... : 6..If bU3in.ess, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7'.:'Dim~ns~onsofexistingstructures, ifany Front /~z~ Rear ~.~,;9~ Depth ~.~ ....... lteight /.,~ Number of Stories / ' Dimensions of same structure with alterations or a~lditions: Front ..... .~.~/ .... ! ..... Rear ....~z..2~. ........... Depth ...... 95..0. ............. Height .... /..~. ............... Number of Stories ................ 8. Dimensions of entire new construction: Front ....~.~. ........ Rear ...~..~&...! ....... Depth ./.~. ........... Height .... g. ~. ........ 'Number of Stories ..... ~. .................... i ............................ 9. Size of lot: Front~..~¢~/a~./d.~ .... Rear ...................... ~Depth .... ,, ................. 10. Date of Purchase .: ./.'7...~-.~.'r .~ 7 ............... Name of Form~er Owner~..~ ............ 11. Zone or use district in which'premises are situated .~4>~.~2~.aa~,,~(,~/ . .¢~.... ~ ..... 12. Does proposed construction vi01ate any zoning law, ordinance or regulation: .... ............................ 13. Will lot be regraded .... ~o~.~.' .................. Will excess fill be re~.ovdd fromm premises: Yes 14. Name of Owner of pren/t~e_s,~-..'~-F-444~..... Address .~.~ff~*.~,~'o. Phone No ................ Nd/ne of Architect ~.//~ ~ .f~.~7~/,~.: .......... Address ~..~.'~z~. :~...I .... PI;tore No ~./~.-?.~d:],-. ~..5//..,~,. Name of Contract6/r ~(~~.d~/'7 ~¢-Address .~ ~/~o,~e Noff~.P..~7..~. ...... ~ ~ PLOT DIAGRAM ~ Locate clearly and distinctly all buildings, whether existi.ng~ or-proposed, and. i~dicate all set-back dimensions from property lines] Give street and block number or description' ~i~eordifig' fo deed, and show street names and indicate whether interior or corner lot. ' ~.: :i' :~'' STATE OF NEW YORK, o o COUNTY OF ....... a.o ~o .... : '(Name c~ndividual signing contract) ' being duly sworn, depbses and says that he is the applicant ab6ve named. He is the .... ~ ........................................ ~ ........... (Contractor, at~a-~4, corporate officer, etc.') of said owner or owners, and is duly authorized tb p~rform or have performed the ;aid work and to make and file this application; that all statemenls contained in this application are true to the best of h s knowledge and belief; and that thc work will be performed in the manner sef forth in the application filed therewith. Sworn to before me this 1 .~'..~. .... day of..~. ° u. · .O7~. · .'~.. 197.~ // i (SignatUre Of applicant) jJ ,,z ,-;,: \,,, OCCUPANCY OR USE IS UNLAWFUL WITHOUT-CERTIFICATE OF. OCCUPANCY APPROVED A8 NOTED ~O~LOW~¢~ ~SP~c~r~ ~0~ TH~ ONCR~E ROUGH ;~AM NG & p IN~dLATiO~ LUMBING i ., / PLUMAER CERTIFICATION ON LEAD COIIITE~IT BEFORE CERTIFICATE OF OCCUPANcy SOLDER USED IN WATER SUPPLY SYS]'EM CANNOT EXCEED 2/10 o! I% LEAD. OCCUPJ~N~ OR USE tS tlNt~Ut WITHOUT CERTIRCk'i'E OF OCCU?~NC¥ J