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HomeMy WebLinkAbout14461-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No... ~.1.5.~.~ 6 ........ Date ....... p.e.q e..m.~.e.~.. ,~ .0., ............ 19..8.6 THIS CERTIFIES that the building .qram..cAy., family d.welling. Location of Property . 6.%%.. H~n s e slq.a~. D~c,.~.v ¢ ............. ~.u.~, ¢l~9.gtl~ ,. ~ ,Y ........ House No. Street Hamlet County Tax Map No. ]000 Section . 09~ ........ Bloc~ .... .0.4. ........ Lot....1.8...~ ........ Subdivisinn~/..o..0.~.? ~.o.~..V. $??..~.~..~.a.~e..~ .... Filed Map No. ~ .2.4.1 .... Lot No .... 2.8. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated November 72 8..5p .................. ,19. ursuant to which Building Permit No ................ dated . .D?.q e..m.b.e.c...9., .............. 19 .~. 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 ig ......... One car garage addition t,o existing one family dwelling. KENNETH & KATHLEEN SCHEUERMAN The certificate is issued to ........................................................... [owner,;t~:~X X X of the aforesaid building. Suffolk County Department of Health Approval ........~/~. ............................... .. UNDERWRITERS CERTIFICATE NO .............. H....8 0 1. ! 7..8 ............................ · ' Inspector FORM NO. ~ 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) NM ~4461 Z Permission is hereby granted to: ..... .... ,~.o..~....~...'?...t. ........................................... ....... ~ ~t ~.~ ~=.~.:.~....~ m ...... ~.~..~..~.~......~... ~.....~_~...~.~.~.~o~ ..................................................... ot premises I~ated ot ...... ~.~...~.....~.~~.-.~..~ .......................... ~ ........ ........................................................................................................... .~.~.u~~...~.:~ - ~. ~ ~ . ....~.~,~...~.~....~~ ........ ~....,~ .............. ~..Z . Co~,~ m,~ ~,~ No. ~ooo s,~uo, .~..~ ...... ~ ...~.~ ....... ~ N~L~.,.~.~.. Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD 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 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 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 $15.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5.Updated C.O. $15.00 Date .......................... New Cons t~'uc t ion ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property..............,.. House No, Street Ham/et County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./.~.~, l. ~i. Date of Permit /'1/~l .~.... . .Applicant [.~,~f~.~..~.'~.~.~ ~- ..~..~ (-(F~q ~_j~j'.~.~, ~.... .. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval Planning Board Approval Request for Temporary Certificate ..................... Final Certificate ....................... FeeSubmitted$. ~ ~. . ~. . Construction on above described building and p~e~r, mi~ meets all a_Q~licable codes and regulations. Applicant ............................ Rev, 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS 1000343 BUREAU OF ELECTRICITY [~,~ E5 JOHN STREET, NEW YORK, NEW YORK 10038 ,... ~ 3~, ~ ~,~,~.,~.~...~,~ ~s~/~? N 801178 ,THIS ~ERTIFIES THAT b~y the electrical ~.ipment ~ ~scribed be~v a~ (.trod.ced by the apphcaat ~med on the able apphcat~o~ rt~ber ~. the pre~tses of ~n ~u~, 675 Hor~ive~ ~ue~ bllow~ng h,catlon~ ~ Basement ~sexaminedot~ ~ 2~¢ 1987 attdfoundtobe~nco.~pliancewlththere~l,~irementsofthisBoard,~ EiXTURE OUTLETS tEC~!TACLES. SWITCHES DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIMECLOCKS iULTI.OUTLET FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS DIMMERS SERVICE DISCONNECT S E R V I C OTHER APPARATUS: 1 G,~'.C. 7355 Main M~ttitJ~k, N.Y, 11952 L~#783E This cert(ficote must not be altered in any manner; return to the office of the Board if incorrect Inspectors may be ident~F~ by their credenfia[s. COPY FOR IBU LD,ING DEPARTMENT THIS COPY OF CERTIFICATE MU$?' NO~ BE :ALTERED IN ANY J',~ANNER. ~ .~ ) BUILDING DE~. ~°~ INSPECTION ~/[ ~ ~OUNDA~ON ~ST [~ ROUG, PLBG.~~, FOUNDATION ZND [ ] INSU~TION F~M~G ~ ~ FINAL FIE~D I~SPEGTION DATE FOUNDATION (2nd) , ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY q9D~ ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FRAMING RF.,MARK$: FOUNDATION 15T []ROUGH PLBG. FOUNDATION 2ND []INSULATION []FINAL ! /.=39.271 ' ~ SUBDIVISIONMAP FI~D IN THE ~FICE / OF TH~ C~BKOFS~O~ COUNTY~N /~ ~ [OC~O~ O~ ~ ~ ~-0~ ~P~I~ 4,1976 ASFIL~ NO 6241 REW$~ON$ YOUNG & YOUNG NOV. 15,197~ 400 0STRANDER AVENUE, R~VERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: Pt~OSTRUCT CORPOHATION 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved~-~l~..,~. ...... , l~.'.~ermit No../..~, .~". · I Disapproved a/c ..... .......... 17 .......... ~ ......... /'(Building Inspector) APPLICATION FOR BUILDING PERMI'I' Received ........... ,19... INSTRUCTIONS a. Th/s 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 ava/lable 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) · . * , ,- ., x . .(.I. :I4,A.... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bu/4,der. ................................ O.V4. ~.a. ...................................................... Name of owner of premises . I.(I---~l .N.e T.14 · .~. ~'{/~.T 14. k..~ './:. ~[ .... ~ C. tj..~,Cl.~. Px.~.tgd ...................... - (as on the tax roi1 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. ~.':. ~.~.~.*.~.~' I. Location of land on which proposed work will be done .................................................. C'-I '~ .[J.o.a.$ ~. ,~. ~.o. t=, ..... O.a.t~ ~ ............. .c:,. ~.r.c ~4 o.~. u ~,- ................... House Number Street Hamlet County Tax Map No. 1000 Section ............... Block ................ Lot ...... *. ............ Subdivision .0 I}~ 6O.d..V .Ekd ~, 5.]7.t%.T. I~ ~. ....... Filed Map No..(o .~- .% l ....... 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 .~...o~...,.'~ x3 '(~'" 'C~kx~'' Q~'~'k~' '~ .... ~...~QI~:,) ................ 3. Natureofwork(checkwhichapplicable): New Building Addition.......... Alteration Repair .............. Removal .............. Demolition ..... ' ......... Other Work ............... (Description) 4. Estimated Cost ...- ..o ............... :.: ........... Fe " (to be paid on filing this application) 5. If dwelling; number of dwelling units ............ '... Number of dwelling unitslon each floor ................ Ifg be fcars t arage, num r o ........................................................................ 6. If business, commercial or mixed occupancy, specify ha)ute and extent of each typ~ of use ........ t~.) .g.~ q['.~.~ pth .~'~2-.~ ....... 7. Dimensions of existing structures, if any: Fron ' ........ Rear . .. i .... De . '. . ....... Height .. .............. Number of Stories : ............... ) ................. :; ............. Dimensions of same structure with alterations or additions: Front .'~.fl ....... ...:....'J" ' ' Rear . .~. ............. Depth.. ~'~ ................. Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front,, ~' . Rear .. ~o.' ..... Depth '.~.%..' Height Number of Stories 9. Size of lot: Front ...................... Rear ...................... Depth ...................... I0 Date of Purchase Name of Former Owner ' 11 Zon distri ti hihp mi it at d · eoruse c nw c re sesares u e ..................................................... 12. Does proposed construction viotate any zoning law, ordinance or regulation: ..... . ........................ l:t.q 13. Will lot be regraded ............................ Will excess fill be removed i'from premises: Yes No 14. Name of Owner of premises {(~ ~'eH~.~4~.~t~q. .. Address~.O'/~l ........................ i' '. Phone No. 7.g¢.': 5'7./~ ;u.~ .... Name of Architect ........................... Address ................. Phone No... Name of Contractor Address ' Phone No 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 showlstreet names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................ ................................................. being duly sworn, depo.Ses (Name of individual signing contract) above named. and says that he is the applicant He is the ............................................................. i ........................... (Contractor, agent, corporate officer, etc.)i of said 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 applica$ion are true to the best of hisiknowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ./~ ] ~ (Signature of'arii~l~ J t OR AS 'NOTED DATE: ,FEE,,"~L~ ,NOTIFY BU 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: k). FOUNDATION ~ TWO REQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING & PLUMBING 9. INSULAT~©N 4. FINAL - CON'STRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N, Y, STATE CONSTRUCTION & ENEP. GY CODES. NOT RESPONSIBLE FO~ DESIGN OR CONSTRUCTION ERROr. S, SOUTHAMPT©N tUMId6([ I~AIt ¢ kOAD 298 - 4711 AS NOTED BY: NOTIFY BUILDING DE~RTMENT AT 765 1802 9 AM TO 4'PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNPATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4, FINAL - CON'$TRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL THE REOUIREMENTS OF THE STATE CONSTRUCTION & ENERGY CODES. NOT RESPONS,IBLE FOI~ DESIGN OR CONSTRUCTION SOUTHAMPTON tUM6~R 298 - 471