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HomeMy WebLinkAbout14513-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hal~ Southold, N.Y. Certificate Of Occupancy No. Z14593 Date July 3 1986 THIS CERTIFIES that the building a d d i b i o n. 465 ?vt. Rd. #3 Southold Location of Property .. .... : ......................... _ ......................... County Tax Map No. I000 Section .... 7.0. ......Block ........ .6 ......Lot ..... 1.6. .......... Subdivision.. X .Filed Map No. .X ..... Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated December 4 1985 pursuant to which Building Permit No. 1 .4513Z . dated .... ~..a !~.u.a.v..y..1.6. ............ 198.6.., 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 ......... Addition to one-family dwelling. The certificate is issued to CLARA FROUT ..................... ..................... of the aforesaid building. Iq/P, Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO ....................... N/A Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLb'TION OF THE WORK AUTHORIZED) N,o 1~513 Z Permission is hereb/granted to' ..... .~...7.~......I.~.~.Lb/.~.~. -.~ ...2~.c~..~.~.~.. r.. ~.~.....~.... ....... ~o ........ ~.~..T...cc.~.-Z... ...... ~.~..%~...~..~...~....~.~.~.......~n.,~.~...~..~..~ .~~:c~.~.~ ........ ~. ................ ~...a..~...~~..:... ................... ot premises located at .......!....~...ff_,Q...~.....~..~...-~.......-.~.. ~[:~.....-T~...~ ........................................... ................................................................................................... ~..~..~..~.~,,.~..~.~.~.. County Tax Map No. 1000 Section ..,..~.....~......~... Block ......~...,.~.. ........ Lot No.....~,.~..,.~,, ......... pursuant to application dated ~..~.........;.~... ....................... , 1 ..(~......~,~'~nd approved by the 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 This application must be filled in typewriter 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 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 disposel-(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 peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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. ~:ees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 New Building ............. Old or Pre-existing Building . .X ...... ,... Vacant Land ............. Location of Property .. ,~0. ~ ............ Pr t,t~.e,t;e. Rea~[. #.3~' ............ $o1~1;~olc~ ....... House NO. Street Hamlet Owner or Owners of Property o C~-~z'a l~z~°ut; County Tax Map No. 1000 Section .... .07.0. ....... Block .0.6 ............. Lot...Q[~ .......... Subdivision .... bT./..& .......................... Filed Map No ........... Lot No. ' Permit No...].~.3...~. ~ Date of Permit .3../.~.6././~. ~..Applicant ~..rz.'(~z,..o..r~.e..[?.1;..~.a..~ .1;,..~. ,Qg..~.o. 37..C... Health Dept. Approval ..... .~/.~.. ................ Labor Dept. Approval ........................ Underwriters Approval ......................... Planning Board Approval ....................... Request for Temporary Certificate ..................... Final Certificate ..... ~. ................. Fee Submitted $.. ~;.*.O.Q~ ...................... Construction on ahoy; described buil~e~7~ ~plicable codes and regulations. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION .uiiaing Permit Noo/~_%'-'~/~ (please print) Plumber ~\~'-~% ~N ~, UA ~,,~'/~ (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 before me this Notary Public, r~/~,~>/--, County ~~, Notary/Public~ UNDA J. t~OPER Notary Public, State of New No. 4822563, Surfak ~unty Term Expires December 31; 19 ~ u ~ v£ 1~< 40 "L, BUILDING DEPT. INSPECTION FOUNDATION xST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [~ FINAL REMARKS: FIELD ~NSPECTION COMMENTS FOUNDATION FOUNDATION 2 o ROUGH FRAME & PLUME INSULATION FER STATE E~ qODE FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-180:3 Approved ................. i .¢:.. ee it Disappr~veda/c .... :~'":"'~.~}/'' I . APPLICATION FOR BUILDING PERMIT Received ........... , INSTRUCTIONS a. This application must be completely filled in by typew/Ster 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 i~n part fo[ 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. .~.n.v. ~ .l'.o.ame. a.t. ~,~.~.,..Ibc.,..For..Clara .P. roa~ (Signature of applicant, or name, if a corporation) 39.7.5. %.riel i~xn..~ Ob:..;~aae.,..2e o.c~ni¢ ,..NY. 1L95~ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Oe ne ~al Con~;~ao t;o~ ................... Name of owner of premises Clara Prou ~ .......... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ~esiden~ (Name and title of corporate officer) Builder's License No. S.C..214...HI..~.~56 ....... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. · Pr. iva~;s..Rd ,..off. O. aklav~.a .Ave ........................... $ou.~ahold ....................... ._ House Number Street ...... Hamlet County Tax Map No. 1000 Section ....0.7..Q ........... Block . .(> ............... Lot..].6 ......... ...... Subdivision .... ~//./~ ............................. Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . .0.qe...~.a.m.t. 3 y..d74e..Z.i.~ tog ....... _; ~.. ~;~.~ ;~?~ ............................ b. Intended use and occupancy . .O. qo...f.a.m.~..~y, fi. ye..5.~.t. 9g, ...?~..~ ~ ....................... 3~ ~ Nature ~r W'6~k.(check which applicable): New Building ..... ' ..... Addition . .X..' ..... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. EstimatecfCos~/ ....... C~ .~...., ..................... Fee ......................... .,; .. ~' (to be paid on filing this application) 5. If~lingz~number of dwelling g'nits ............... Number of dwelling units on each fl .......... !. arage number of cars ..... ¢ ............................ 6. If business, commercial or mixedI occupancy, specify n~ture and extent of each type of use ....... . '. ....... 7. D/mensions of existing structureS, if any: Front...3..~ .......... Rear ...2.~.r ......... Dept'l~ ii .-31~.~ i. i ..... Height ...~.[[.~. ......... Number of Stories .... 1. ................................................... Dimensions of same structure wish alterations or additions: Front . NC>..~.har~;e~ ..... Rear .................. Depth.. I&B.~ ............... ;. Height . .2[4! ................. Number of Stories ...... 1 ............... Dimensions of entire new construction: Front .... 13 ! ........ Rear ... 2DJ~. ........ Depth .... 1.0 ! ........ Height .... .~.4! ........ Number o~' Stories .... ~ ........................... . .....,... ~ ............... Size of lot: Front .... .2.0.2.~,.. j ........... Rear ...2.0.14~. ............... Depth .. ~.07 ..... ............ Date of Purchase ' Name of Former Owner ........... i .................. Re side nt~:t al ............................. Zone or use district in which premises are situated .................................................... Does proposed construction violate any zoning law, ordinance or regulation: .... ~¢ .......................... Will lot be regraded .. ~P ..... : ................... Will ex~ fi~llC~t~vlq~ ~gTPhbne No ............ Name of Owner of premises 0.~..a?.~ Pl'oug ~ro~l~l~remises: Yes No .......... Address ~/~ge' 'Pta±rr~; .... Name of Architect ........... !... ' ' ' ' .. . Address ................... Phone No ................ N,meofContractorSnfi. r.5?.q.n.m.e.n.~..~:.a.a.~.~..~nO:Address 7~..In. al.f .an .~.k .Ll~aoneNo?3..~.-.7.~?.~ 10. 11. 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly all: property lines. Give street and block interior or corner lot. buildings, whether existing or proposed, and, indicate ail set-back dimensions from number or description according to deed, and show stieet names and indicate whether See AtSached. STATE OF NEW YORK, S.S COUNTY OF ................. ' ........................... i ..................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the .................... i ........ ~~ .................................................... ! ~~, agent, corporate officer, otc.) . . of said owner or owners, and is duly author~erform or have performed the said work and to make and fii~-this-- application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the man3er set forth in the application filed therewith. Sworn to before me this ~ day,of. 19 ..o~.'~ Notary Public, . ......... Cou - ' ...... ;f ,[ If copper tubing is used for Water distributing ,,~ e:n; piping shall be ~ ',,'~',~ K or,L only SUPPLY SYSTEM CANNOT EXCEE'D 2/10 of 1% LEAD. AP,,~R~/~D AS NOTED NOTIFY BUILDING DEPARTMEK/T ,AT 765-1502 9 A~ TO 4 P~ FO~ THE ~LLOWING [hISPE~IONS: 1. FOUNDATION -~O REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSU,LAT[ON 4. FINAL - CON'STRUCT~ON MUST DE ~OMPLETE FOR C. O. ALL CON.RUCTION SHALL MEET THE, REQUIREMENTS OF THE N.Y. ~ATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR'CON.RUCTION ERRORS.