HomeMy WebLinkAbout14509-zFORM NO, 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z 149.38 Date October 2, 1986.
THIS CERTIFIES that the building Addition & alteration to deck.& stairs
Location of Property .2.5.0...W.~.l.d...C.h.e.~.~.7' y.a.~ ......... Southold
House No. Street Hamlet
County Tax Map No. 1000 Section 05 2 ...Block 03 .Lot 031
Subdivision M/o. Sh.orecrest . . .Filed Map No. 5548 .LotNo. 19
conforms substantially to the Application for Building Permit heretofore flied in this office dated
~ o. y .e.m.b.e..v..2.9. ,. ........ 19 .8.5. pursuant to which Building Permit No.. 14 5.0 9 g
dated .. J a nfl. a. r y 1.5. ............ 19 8...6, was issued, and conforms to all o f the requirements
of the applicable provisions of the law. The occupancy for which tlfis certificate is issued is .........
Addition & alteration to deck & stairs t.o existing one family dwelling.
The certificate is issued to Yetvart K. Ohriker
..................... f id ii ....................
of the aforesaid building.
N/A
Suffolk County Department of Health Approval ..........................................
UNDERWRITERS CERTIFICATE NO. N 75 5 04 3
Rev. 1/81
1~0~3~ NO. ~
TOWN OF SOUTHOLD
BUILDING DEFARTM£I,4T
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Permission is hereb/granted to:
......... ~.~.'~z~. ~.~...~z.~ .......................
........... Q~.~./~..~..~.: ......................
........... _7o..~..7..~z..~. ?..~.,...~ ..................
,o ...... .co.~.=~.~.~5..~.~.,.~o~....~....~o.~..~.,.~.~....~.~/.../...~
.~ ........ ~..r.~.~....~0~~..~..~.......0~.~,.~.,~ ................... ..../
~t premises located at .....
....................................................................................................... .,~.~..~...~.?..-..~:.~ .........
County Tax Map No. lO00 Section ..... ~..~. Block ~'~ Lot No 03/
pursuar,t to application dated .... ~.......~....~.. ...................... , 19...~'"~,.i..~"'"~ and approved by the
Building Inspector.
Building Inspector
~e~'. 6/ao/8o
FORM NO. 6
TOWN OF $OUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765 - 1802
~ DLD[~. DEPT
~ ,TOWN OF $OUTHOfD
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
This application must be filled in typewriter OR ink, and submitted I~ 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.
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.
1es:
Certificate of occupancy $5.00
'2. Certificate of occupancy on pre-existing dwelling
3. Copy of certificate of occupancy $1.00
4.Vacant Land C.O. $5.00
5. Updated C.O. $15.00
$15.00
Date ....................
NewConstruction Old or Pre-existing Building Vacant Land
Location of Property....~..~.-..O....l~..l.~...~., .C. ~. .C.,.~.~. ¥.t/e; ~. ~ ~. ~_, .~. ~0.~. ~ .~..[,, ~
House No. t .........................
Hamlet
Owner or Owners of Property .~/:/./~-~¢/- ~?../'/I/~,:../. /(;
County Tax Map No. 1000 Section ~-~2 ~ -, -~Z2 Block Lot
Subdivision...~AOt'~.~..C. ('~.'1~. ................. Filed Map No. ~..J'/.~/ .... Lot No.../~. .........
Perm it N o./.Z/~'..~. ~.. Date o f Permit ~./~-. ~.~:~pp .icant ..................................
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $...~,.C~ .... .~-~c~ .~.
Construction on above described building and permit meets all applicable codes and regulations.
Applicant
Rev. lO-lO-7a
CO~
7GS.'~80~
BUILDING DEPT.
INSPECTION
[ ] FRAMING
, REMARKS:
FOUNDATION 1ST []ROUGH PLBG.
FOUNDATION 2ND []INSULATION
[]FINAL
DAT~
THE NEW YORK BOARD OF FIRE UNDERWRITERS
~000].~. BUREAU OF ELECTRICITY
~'~ 85 JOHN STREET, NEW YORK, NEW YORK 10038
~.t~ June 3~ 1986 392115/8~
N755043
THIS ~ERTIFIES THAT
o~y the electrical equipment ~ ~scribed be~w a~ introduced by the applicant ~med o~ the above application number in the premises of
Vetvart O~i~r, 250 ~ild ~er~
in the folJowlng location; ~. Basement ~ l~t FI. ~ 2nd FL Scot,an Bilk Lot
~s exa.llned on ~ ~ ~ ] ~ and found to be ln cotnpllance wlt h the requirements qf this Board
FIXTURE FIXTURES RANGES OVENS EXHAUST FANS
OUTLETS SWITCHES
FLUORESCENT
7
DRYERS
SYSTEMS
NO, OF FEET
OTHER APPARATUS:
S E R
OF CC, COND
C
NO OF HhLEG
AW.G
OF HI.LEG
NO. OF NEUTRALS
OF NEUTRAt
27,5 Town Harbor I~ue
~otr~hold~ N.Y. 11971 Lie.
GENERA[/~' [NAGER
Per / . _ --
This ce~ificate must not be altered in an manner return to th .... ~ . , , .
_ . y ; · ottice ot the moara ir incorrect, fnspectors may oe Mentified by their ~redentials
COPY FOR BUILDING DEPARTMENT. THiS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY ~NNER.
7GS-~80Z
BUILDING DEPT,
INSPECTION
[ ] FOUNDATION IST [~ ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
~)~ FRAMING
REMARKS-'
FINAL
~ION COMMENTS
FOUNDATION
FOUNDATION
2,
(2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST ~ ROUGH PLBG.
[ ] FOUNDATION ;ZND I- ] INSULATION
["q~FRAMING [ ]FINAL
REMARKS:
DATE ~//~////~
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N,Y. 11971
TEL.: 765~1803
Disapproved a/c .......................... "
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date ............. 1 .
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 issue 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 Occupahcy
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 buildings for . .~5~. ~?' nt.,~(~..~a c~a'tio'~) ....
necessary inspections.. /,~ ~ ~-7
(Siga{tture of applica , , '
P.At. g. t.. .A ...................
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
....................... roll or latest deed)
(as on the tax
If applicant is a corporation, signature of duly authorized officer.
t'Au t l R 5,
Electrician's License No .......................
Other Trade's License No ......................
Location of land on which proposed work will be done... /~ ~ Y ~¢' ~ R. ~. L- ,4..~. ~
............. . .
House Number -Street Hamlet
Cohnty Tax Map No. 1000 Section . · i..~.J~. .......... Block . · .~9~...: ..... .. Lot... ~,~,Z. ...........
Subdivision ..... Zor. e .~F.e+(..~. ................ Filed Map No.....~,~.5~. ...... Lot../.~. ...........
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ...... ':.v'd.-Z(e ~. .~..~. ~,~' ~'~ ~'~%~r'~ .......................
~F .. ~.. .~ .... 4' ......
b. Intended use and occupancy .......... .~.~J~.q.. ~.-~. e eC.~;.., ~'~,....,,~%.., ,... ,~ya~ ......................
3. Nature of work (check which applicable): Nev~ Building .......... Addition .... Alteration ..........
Repair ........... Removal .............. Demolition .......... .'... 'Other. Work ...............
, : ' - (Description)
Estimated Cost ~ Xt'J g')/9: Fee ~. ~--.~...'~.~.' ......
(to be paid on filing this application)
5. If dwelling, nu er of dwelhng umts ............... Number of dwelling units on each floor ................
If garage, ~Umber of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of uso .....................
7. D~ensions pf oxi{tjng stmcture~, ff ~y: Front ............... Rear .............. Depth ........ ~ ......
Height .; .... ; ;~ .... Number of Stones ..... ~ ......... ~ ~
D~ansions of same structure wl~h aiterahons or additions: Front ..... .~ .......... Rear } .~
' ' t Number of Stories.. ....... '. · ./ ........
.................... "' :" ZO""'"
8. D~mensions of entire new construction: Front ... Rear ............... Depth ...........
S~ght...g/ ......... S~m~ofSto~..Z...~,~ .................... )~p'~ .........
9. Size of lot: Front ...~.. ........... Rear .................. Depth ..............
10. Date of Purchase ........... [ ................. Name of Fomer Owner ............................
11. Zone or use district in which promises are situated...5. ~ ~.~. & ~.~ ...............................
12. Does proposed construction viol3te any zoning law, ordinance or regulation: .............. . ...............
wH11~ h~ reoradad ~ O . ~ ........... Will excess fill be removed from premises: Yes
........ i .. Address ~ y .... Phon~ No ................
Nme of Contractor ~.~ ~. ~' A.P.]~ H ........ Address ~.g ~.O.g M~.~ U. Phone No. ~ ~. ~ F.~ ~.
P~T DIAG~
Locate clearly ~d distinctlg ~1~ bufld~gs, whe~er existing or proposed, and, indicate ~1 set-back d~ensions from
prope~y Hnes. Give street and block number or description according to deed, ~d show street nines and mdwat whether
interior or Corner lot.
STATE OF NEW YORK, S.S
COUNTY OF ................
............................ . ..................... being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named. ~
He is the ...... . .................................. i ........................
i (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 ~e this
application;that all statements cohtained in this application am tree 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.
Swo:m to before me this
........... ~ .~. ......... day of ..... .~...~g?A'~.. ........,19 ?..'~ '
Notary Public, ..... ~..~.%.. ~...L: :?/..g~. County :
KQTAR'Y FU
Term Expires March
(Signature of applican0
765-1802 9 AbA TO 4 PM FOR THE
FOLLO~^'ING I~:FPECTIONS:
1. FOUNPA~ION - TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSULAT!ON
4. FINAL - CnN£TP, UCTtON MUST
BE C~FAP! rTE FOR C. O.
ALL CONSTRUCTION SHALL MEET
THE REQU~REMENTS OF THE N.Y.
STATE CONSTRUCTION & ENERGY
_../~_.._.~ ~ RE.~PONSlBLE FOR
9 'X ~- '