HomeMy WebLinkAbout14502-zFORM NO, 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Z14840
Certificate Of Occupancy
August 28, 86
Date ................................. 19...
THIS CERTIFIES that the building ........................................... add..ition. . . :
· .Isabella Roa.~ Fishers Island, N.Y.
Location of Property/:/3t~sb No ................... ' ....................................
· . Street Hamle~
011 1 6.2
County Tax Map No. 1000 Section ............ Block ............... Lot .................
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
Decemb. e..r' 10, 19 .8.Spursuant to which Building Permit No 14502 Z
dated ... 3. .a.n.u.a.v. ¥..1.3. ,. ............ 19..8 .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 .........
addStio, n to ex.i.s.t, in.g dwelling -'.
Paul Var rani. an
The certificate is issued to ..........................................................
(owner, ~k, rx~e~o~r Xo~ltqt&
of the aforesaid building.
Suffolk County Department of Health Approval ........ ~/A ..............................
UNDERWRITERS CERTIFICATE NO ............... ~ 75.4.3. 9.8 ...........................
Plumbers Certification dated:August 23t,1~,~,,6 .......
Rev. 1/81
FOBM 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)
14502 Z
Perm,ssion is herebt granted to: ,~/~ ?~,~ ~
~.~~.~ .................................... ~o ,~,~ ~
.~..~,.~..~.....~e~ ....................................... ~'- ~ 2, ~ -
~.~...~...,...~..~..~..~.~ ~ , ~ ~,, ~,
............................................... .~..,....~ ...... .~..~..~.,~.~ ............................................................
cou.~ ~ox Map No. ,ooo Se¢,,on .aLl ............ B~o~k ..... /. .............. Lot No ..... ~..,.........-~
pursuant to application dated ../~...,~. ................. /..~.., ........... , 19.~.¢.~,~nd approved by the
Building Inspector.
Rev. 6/30/60
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
$outhold, N.Y. 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
LD~, ~,,
TOWN OF SOUl' ~,
Instructions
A. This application must be filled in tyl~ewriter 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 Enqineer responsible for the building.
5.Submit Planning Board approval of completed site plan requiremer~ts 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 $15.00
3. Copy of certificate of occupancy $1.00
4.Vacant Land C.O. $5. O0'~'/'"~' /¢~-'
5.Updated C.O. $15.00 Date .............
NewC°ns%ructi°n ...... Old or Pre-existing Building ............ Vacant Land ..
Location of Property
House No, ' ....... ~ ..../ ........... I(,
·
.
Owner or Owners of Property ... u.... ~/z~,~--~..~l.~. W ....................................
CountyTax Map No. 1000Section (~'// Block ..... ./. Lot
Subdivision
................................. Filed Map No ........... Lot No ..............
Date of Perm,t ...........
Permit ~0 ...
Health Dept. Approval ........................ Labor Dept. Approval ........................
Approval ~.~. ,'7~ ¢~. ...... Planning Board Approval ......................
Underwriters
Request for Temporary Certificate ..................... Final Certificate
.........
Fee Submitted $...
Construction on above described buildi~li~¢ts//all appllnahl~. ¢~des and regulations.
Applicad.L~, ~. ~ ................
Rev. 10-10-78
3 IW
THE NEW YORK BOARD OF FIRE UNDERWRITERS
1000913 BUREAU OF ELECTRICITY
[~ 85 JOHN STREET, NEW YORK, NEW YORK 10038
..~ Ju~, ~, 1986 .~..,,cat,o.~.o.~,~ 3~/~ N 754398
only the e[ectrlca[ equipment as described beJow and introduc~ by the applicant natned on the above application number in the premlses of
i~ thefolm~i~g ~oc~t~on; ~ B=sement ~ Ist FI. ~ ~nd FL Section Block Lot
was examined on and.found to be in cotnpliance ~tth the requ~re~nents of this Board.
June %0~ 1986
FIXTURE FIXTURES RANGES OVENS DISHWASHERS EXHAUST FANS
13 26 14 13
DRYERS MOTORS iAPPLIANCE FEEDERS TIMECLOCKS UNIT HEATERS MULTI.OUTLET DIMMERS
SYSTEMS
NO. OF FEET
SERVICE DISCONNECT S E R V I C
OTHER APPARATUS:
P arielbot~£~ls ~ 1-13ci~,, 125amps,,
1-15.0kw., hemt pum~
l-~tna A/C
NO OF HI-LEG
NO. OF NEUTRALS
~bobe:t g. Wall
06390 L~2455
:, '~ENEI~AL MANAGER
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 FOR BUILDING DEPARTMENT, THIS COPY OF CERTIFICATE MUsT,NOT BEALTERED IN ANY MANNER.
TOWN OF SOUTi~OLD
OFPlCE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
CERTIFICATION
Building Permit No.//~)? ¢ ~
Owner
(please print)
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
(plumber' s signature)
Sworn to beforAme this
~x-day of ~ ,
Notary Public, ~Count¥
Notary Public
EILEEN G. V
Notary Public, $1ale at New Yor~
No. 52'95091~.5
Qualified in S'utfolk Counfy.~
~rerm Exl~ir~ March .~0,
*
\%0
~ '~'~ %.?,,
.~ f '~, .
TH~ ~4~ YO~ ~T&TE
~LA~ OF F~OFE~,'F'( TO 1SE: COMV~f~-D
FIELD INS[~ECTION
FOUNDATION
(1st)
FOUNDATION
2.
(2nd)
ROUGH FRAME &
PLUMBING
COMMENTS
INSULATION PER N.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
~.- ~,~ ~-'...
~UA~K~TEED TO
TITLE MO, IZll
~q.O
'FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N.Y. 11971
TEL.: 765-1802
Examined .~ .... /~.. ~'..., 19~.~
Approved~./~..~....., 19.~. Permit No...~. ~..~..~..,~ ~
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date ................... 19...
INSTRUCTIONS
a. Tins 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 comm~ced before issuance of Building Permit.
d. Upon approval of this application, the Building InslJe~d{ ~ill issued a Building Permit to the applicant. Such permit
shall be kept on the premises available for.inspe~ti~)ni~hrough0~lt~the w~ork~, ~.~
e No building shall be occupied or used in whole Or in.part f~a~:y~l~r~ose whatever until ~ Certificate of Occupancy
shall have been granted by the Building Inspector. , ,~ ~ .. ~ ~ ~
APPLICATION IS HEREBY MADE to the BmldmE Oep~ment for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town ot South~old~:Suffolk~'~o~ty, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, add~ti0~pr~Mt~ations 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 ins~l~ctigns.~ ' ~,
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee~age~0 architect, engineer, general contractor, electrician, plumber or
builder.
Name of owner of premises .~. ~.~../..~.. ..........................................................
(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 ..........................
Plumber's License No..~..(~..~-..'7....~. .........
Electrician's License No..~..t/.~_.~.~. . . .~.. ......
Other Trade's License No ......................
Location of land on which proposed work will be done. ~...~../..'~.--~....~..~ ......................
House Number Street
County Tax Map No. 1000 Section ....~.//. ......... Block ...... /. .......... Lot..~.,. ~ ....
Subdivision ..................................... Filed Map No ............... Lot ............... (Name)
State existing use and occupancy of premises and intended use, and occupancy of propose~d construction:
a. Existing use and occupancy ..... ~...
b. Intended use and occupancy .,~J~.. ~~. ....... 1...
:3. Nature ~fwork (check which applicable): New Building ..... ' ..... Addition ... eration ..........
I' Repair .......... ~,~ Removal .............. Demolition ; .......... i.. Other Work ........ ' ....:...
4. E~timated Cost ............ ~. ............
~ [to be paid on fihng this application)
'5. If dwelling, number of dwelling units ............... Number of d~velling units' on each floor ............. ..
If garage, number of cars ..................................... ...... - ..............
6 Ifb cialo 'd ifyn f '' ...'.'...,' ...........
,' s ch typ~ of '
· nsiness, commer r mixe occupancy pec atnre and extent oea use ...... , .....
of ting if at ' pth
7. Dimensions exis structures, any: Fro .............. Rear ........ ~ ...... De ..............
Height ............... Nu.mber of Stories ............................. ! ..........................
Dimensions of same structure with alterations or additions: Front ', Rear
Depth ...................... Height ...................... ' Number of Stories. .....................
8. Dimensions of entire new construction: Front ............... Rear ..... ,...!' .'7. Depth ...............
Height Number of Stories :
Size of lot: Front ...................... Rear ...................... Depth ......................
Date of Purchase Name of Former Owner
Zone or use district in which premises are situated '
Does proposed construction violate any zoning law, ordinance or regulation: .....
Will lot be regraded ............................ Will excess fill be removedl from premises: Yes No
Name of Owner of premises Address ' Phone No
Name of Architect ........................... Address ................ i... Phone No ................
Name of Contractor Address Phone No
10.
11.
12.
13.
14.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate
property lines. Give street and block number or description according to deed, and show
interior or corner lot.
all set-back dimensions fi'om
,re whether
OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATE
OF OCCUPANCY
STATE OF NEW YORK,
COUNTY OF.. .......... ..... S.S
(Name of individual signing contract)
above named·
being duly sworn, depos?s and says that he is the applicant
He is the ........................................
(Contractor, agent, corporate officer, etc. ) ,
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 applicati,0n are true to the best of his knowledge and belief; and that the
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
............. ...... day of.
Notary Public, ....... ~..tS. ;..
~r~t*t ~ ~ ~ ~ ' ~ ,,~.,:,~ ,2$ign~ature of applicator)
-- ~, ~ of New ~'ork
mrm Expires March 30, &9 ,~_~/ .....