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HomeMy WebLinkAbout14478-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y, Certificate Of Occupancy No... z. L4 6 9 2 ........ Date .... July. 2 3., .................... 19 13.6. THIS CERTIFIES that the building... ~.d.c~$.Li.o.n.. ]z.o..e.~.i.s.t.i.n.g..d.w~.l.l.i.n.g .......... Location of Property ~-.7.5 ..... G~_~p.w. ooql. ,t%Q~[~t ............ .C.u.t.~12-p.g.~ ,. ~¥..Y.o.r.k...1.1.9 3 5 House No. Street Hamlet County Tax Map No. 1000 Section 11.0. ........ Block ...4 ............ Lot .. J_.0, ............ Subdivision Ra.v~ton~. ,Real,~.. Co~:,~ ....... Filed Map No.5 ~ 9 ...... Lot No...~. 0 .......... Section #1 conforms substantially to the Application for Building Permit heretofore filed in this office dated ·...D.e.c.e.m.b..~.r..1.7. ~ .... , 19 .8.5. pursuant to which Building Permit No. 14478g dated p.e.~ .mlo.e.r:..1.7.~ .............. 198. .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 ......... ............ AOOi.t. ion..t.q, e~c,i,s.t;i.n~I..d.V~.l.l.%~3~ ................................. The certificate is issued to ............. ~I..~,. OJ-.J,l~er.t. ............................... (owner,~~ of the aforesaid building. Suffolk County Department of Health Approval ....... .N/.A. ............................... UNDERWRITERS CERTIFICATE NO ............... .N/.A. ............................... Building Inspector Rev. 1/81 FORM NO. B TOWN O~ $OGT~OLD BUILDING DEPARTMENT TO%VH HALL SOUTHOLD, N. Y. BUILDING PERMIT FI'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ [4478 Z Permission is hereby granted to: ...~t~.~.~.~..o...:~.~z~...~.~T... ...~......7..,.~...,L~tT.v..-x. ~...~..e.'..c..L~. ...~,~. :. T. ,=::-~...~.c~.~..~..u..~..~ ...... u.~..~...~. ,o ...... .~ ~..~..E.~.~.~..T.......~(~.~.~..~..~i..~.~........7..c)....~.~.7.'.L..N..~j ............... ..~u.~:.u.ct ....... .~.& ............. .l~:...~.:...~.:...c..~.T. .......................................... 0t pre~,s0s ~¢oted ot ...... I.~..~.........~..L.E.~..X~.~O~....L~.O.~ .................................. ............................................................................................................ ...C.~.T.~u.~=.~:~ ......... C~unty Tax Mop No. lO00 Section .... ~..J...~.. ......... Block ...,.(~...~... ....... Lot No..,~.L~. ........... pur,.o.t to o~,cotio, dot~ ../:~.~....~... .......... .~...0... ................. , i...~...~.d o~.r~ by th. Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions TOW~-6F~J~oL~ A. This application must be filled in Wpewriter 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 accu;ate location of all buildings, property 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 egual). 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 ~o April 19574 Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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: Pr ~' ~7~ .~ /,S-04) 1, Certificate of occupancy $§,00 2. Certificate of occupancy on pre-existing dwelling or land use ~J~ 8,(~ ~ -~c~/, ¢~ ~ ©. - Z ~;-. 3, Copy of certificate of occupancy $1,00 Date ...~rt~t¢..2~,. 3.986 ........ New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ...]~7,~ ....... .G,],9 I~Fp.q~.. 1~.o.~ ................ (~t.t;~.ho~u~e ............ House IVo, Street Ham/et Owner or Owners of Property . .~. '., ,~.'..G. ~.l.b.e.z,..~ ........................................... County Tax Map No. 1000 Section . .~.0. .......... Block .... ,~. ......... Lot ..... ~.0 ......... 1 Subdivision,. ,RA~.~,~,°~.e,. ,iR,e,~,~ ,l;y, .8, o,[3p. ,S.e,c, .~.Filed Map No...53,c) ..... Lot No. -~2~. 7..~. 31.. Permit No. ~44.7~ .Z., Date of Permit .12/3.7./8J~,pplicantE a¥-~.o ame. r~t .E&st, .T.r~c, fo~..[~,. Gilbert Health Oept, Approval .... N/A ................ Labor Dept, Approval ... N/~. · ............... Underwriters Approval ........................ Planning Board Approval . ]~¢/A .................. ' Request for Temporary Certificate ..................... Final Certificate .... Z; ................. Fee Submitted $ ..... ~..~. OD. ................ ~nvlro~e~t E~s~, Inc, fo~H. Gilbel't RW. 10,10-78 7GS-:1,802 BUILDING DEPT, INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION :)ND [/] ~.ATION [ ] FRAMING [(3"FINAL REMARKS: FIELD IN$'PEC~ON )ATE COMMENTS 1. FOUNDATION 3. INSULATION ~ER N. Y. STATE ENERGY ADDITIONAL COMMENTS: 7-~,o' .5 57' 4.5' bJ ._? TD LI TEA//Z)/..//[-VS,~/ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ElECTRIcITY BS JOHN STREET, NEW YORK, NEW YORK i0038 THIS CERTIFIES THAT only the electrical ~ulpment ~ ~scribed below and introdaced by t~ applicant ~ed on the a~ee application number in the prem~es of ~d Gil~, 175 Gl~d in the following locatlon; ~ Basement ~ Ist ~. ~ 2nd ~. Section Bilk Lot ~s examined on ~ ~ ~ ~ and found to be in compliance u'ith the requirements ~f th~s Board. FIXTURE FIXTURES RANGES OVENS DISH WASHER OUTLETS SWITCHES NCANDE$CENT FLUORESCENT 8 ]2 8 DRYERS SYSTEMS NO. OF FEET E Detector E R V I C NO A, WG OF CC. COND AWG. OF HI-LEG NO. OF NEUTRAl A. WG OF NEUTRAL Gary Doroski 425 Nbnsell Iaue Cutcl~e, N.Y. 11935 Lie. 2941E This certificate must not .be altered in any manner; return to the office of the Board if incorrect. Inspectors may be COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MuSTNOT BE. ALTERED IH ANY MANNER. GENERA. L*'~NAGER / credentials. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined .~-*..I.~ ...... , 19 .~..~'-- .~.~. 7.?.~ Approved l.~.~...i.'7 ....... 19~..~Permit NO.L ........ Disapproved a/c ............. ..--/'~..~ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ,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. . ,/t otcale .r.. ¢: ............. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, g__energl contractoL electrician, plumber or builder. · Name of owner of premises ...~.'../~,, ~.'././~.~.C~. ...................................................... (as on the tax roll or latest deed) If appl~o_r~i/or~, s[gi%at~re of duly authorized officer· · "~ (Narrfe ~nd title of corporate officer) Builder's License No. ~,~., .2. ].~ .... .~.~...4~..J~..4~..~ Plumber's License No ..... .N. (~ ................ Electrician's License No....~../'~ ................ Other Trade's License No ...................... · ' h work will be done .~../ (/;t~O[o'.~. ,~?d /~,C 1. Locahonoflandonwhic proposed · ~..¢ ........ ~, ............. , .... _ ...... -- .... House Number Street Hamlet County Tax Map No. 1000 Section .... '../.[.~. ....... Block ..... .4 ........... Lot ...... /...O .......... Subdivision [~.~.}/.~.~.~'f. /~.O/.~.F ~/~r27, ~.'~'/ Filed Map No. ~.~.~ ........ Lot -~ ~ .~'~F. ~J. .... ' ' ' (i, la~e)' r'r ............... 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 '.' .............. 3. Nature of work (check which a~plicable): New Building ..... ' .....'Addition . X ~ Alteration Repair .............. Re~noval .............. Demolition .............. Other Work ............... (Description) 4. Est~ated Cost. ~ O.O0:~ .......................... Fee ............................. ~ (to be paid on filing this application) 5.If dwelling, number of dwe~mg units .............. Number of dwelling units on each floor ................ If garag~ number of cars ' 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . ~ ............... 7. D~endons of existing stmctutes, if any: Front ...... ~f'. ..... Rear ....... ~' .... Depth ... ~.~ ......... Height ..... ~O~ ....... Number of St~fies ...~ .................................................... D~ensions of same structure with alterations or additions: Front ... ~...~ ~. fro. ~5~. ~ Dep~.. ~O..~q...~... HeiSt . ~O~..~t~q.. ~s .OO./~ .~ ~O/~..~q~. Dimensions of entire new construction: Front ............... ~ ~f~¢~g~¢./.. ~ . 10. Date of Purchase ............................. Name of Fomer Owner ............................. 11. Zone:or use district in which p~emises are situated ....... ~E~g~TtOL ................................. 12. Does proposed construction wolate any zomng law, ordinance or regulation: . ............................. 13. Will lot be regraded.........~O ..... ............... Will excess fill be removed from premises: Yes No 14. Nme of Owner of premises ~l~O ~ ~&O~T. Address ~.~.4 r.~.~ . Phone No ............... Nme of Architect ......... , .................. Address ................... Phone No ................ N~e ofContractor~t~o~me~ ~ Z~e Address e f~ot ~ ~eckL Ct~-7$~' ........................ ~. ~ ..... ~ ........ ~ Phone No .......... 7. r PLOT DIAG~M Locate cle~ly ~d dist~ctly ~1 bufldhgs, whether existing or proposed, ~d, indicato ~1 set-back d~ensions frpm prope~y Hnes. Give street ~d block number or descdption acoord~g to d~ed, ~d show stm~t n~s ~d indicate wh~ther ~t~rior or comer lot. STATE OF NEW YORK, S.S COU~Y OF ................ (Name of individual si~ning contract) being duly sworn, deposes and says that he is the appliqant above named. agent, corporate officer, etc.) of said owner or owners, ~d is d¢ly authon~to perform or have performed the said work and to m~e ~d fig~his application; that all statements cohtained ~ this application are true to the best of his knowledge and belief; and that ~'the work will be perfo~ed in the m~ner set forth in the application filed therewith. Sworn to before me this Nota, Public ...... ~ ...... County ._ . ......... · ~. '; . nt ~7~~ (Si~aturo ol app,ica SUPPLY' SYSTEM CANNOT EXCEED 2/iO o.F 1% ,LEAD, PLUMBER CERT[F[CATI05? ON LEAD CONTENT BErFOR~ C~RTIJ~ICA?'E O!;' OCCUPANCY I~ c~pper ~ubi~a is used ~¢a,r Water distributing I¥1tem; piping shall be of types K or L Only Ap.pROVED AS 'NOTED , .... IrEE" '~NOTIFY '~-'t4) BUILDING '5'- DY' :; DEPAR ~ TMENT AT, 765~1802 9 ~,M TO :,4 PM f~oR :THE FOLLLOWING iNsPECTIONS' , ' ' 1, IFOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING & pLUMBJN~ 3. iNSULA"(ION 4, FIN~.L - CO~'STRUCTION M~sT ~LL CO~~JCT~O~ SHALl '~HE ~E~LH~ME~ OFTHE N.Y. OES1GN O~ CON~UDION