HomeMy WebLinkAbout14072-z FORM MO. 4
TO~N OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
UPDATED
CERTIFICATE OF OCCUPANCY
No Z-22242 Date APRIL 5, 1993
THIS CERTIFIES that the buildin~ ADDITIONS & ACCESSORY
Location of Property 12585 SOUND AVE. & 4140 CTY RD. $48 MATTITUCK, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 141 Block 3 Lot 38.1
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 5~ 1993 pursuant to which
Building Permit No. SEE BELOW dated ........
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 ACCESSORY BUILDINGS & ADDITIONS TO EXISTING BUSINESS BLDGS
The certificate is issued to
of the aforesaid building.
G.L. PENNY, INC.
(owner)
*-** THIS CERTIFICATE OF OCCUPANCY UPDATES THE FOLLOWING :
BP #3333Z-C0 Z-2757 DATED 7/20/67 FOR ADDITION & ALTERATION ON
EXISTING BUSINESS BLDG. & OFFICE SHOWROOM.
BP #5921Z-C0 Z-6301 DATED 1/14/75-NEW BUSINESS BLDG. ,(OFFICE USE)
BOH APPROVAL DATED 1/14/74-UNDERWRITERS CERT. $N-57920 DATED 11/29/72.
BP #8938Z-C0 Z-14636 DATED 7/14/86 ADDITION TO EXISTING OFFICE LUMBER
YARD SHOWROOM - UNDERWRITERS CERT. $N734440 DATED 2/6/86.
BP $11202-Z-C0 Z-14637 DATED 7/14/86-STORAGE & SALES BUILDING
UNDERWRITERS CERT. #N-734438 DATED 2/6/86.
BP #14066Z-C0 Z-14634 DATED 7/14/86 - ADDITION TO EXISTING BUSINESS
BUILDING (CARPET STORE).
BP $14071Z-C0 Z-14645 DATED 7/15/86 - ACCESSORY STORAGE BUILDING
BP #14072Z-C0 Z-14646 DATED 7/15/86 ACCESSORY BUILDING - UNDERWRITERS
CERTIFICATE #N704533-DATED 8/13/85
BP ~17285Z-CO Z-17357 DATED 9/27/88 ALTERATION TO CARPET STORE,
UNDERWRITERS CERT. #N-038891 DATED 10/12/88.
B~'~ ng 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
COMPLETION OF THE WORK AUTHORIZED)
NO_ 14072 Z
Permission is hereby granted to:
County Tax Map No. 1000 Section ..... /....~L..! .......... Block ........ ~ .........Lot No. ~...O....~].~..,~.~..
purs.,on, to opp,,cot,on da,.~ ......... ~.~dL..~.~ ............ . I'~..C and op~rov,~ b, ,h,
Building Inspector.
F.e ,..1~.'...~..
Rev. 6/30/80
FORM NO. 4
TOWN OF 50UTHOLD
BUILDING DEPARTMENT
Office of the Buildiilg Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
$.1464.6 Date .J.u.l.~ .1.5 19 8.6
No ....................... ,. ................ , . .
THIS CERTIFIES that the building ...A..c.c.e.s.s. gF.Y..b..u.i.l.d.i..n~..a.s...a.p..p.l.~..e.d..f.g.r... ....
Location of Property . !..2.5.8..5..N.o.r..t.h..R.o..a.d..&...4.2.5.0. County Rd. #48, Mattituck,N. Y.
Noose No. ' ~;;e3; ....................... h3~b~
' 14]. 38 1
County Tax Map No. 1000 Section ............ Block .... .3 ...... ... .Lot .... ..' ........ .. .
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
March 12, 19 .8.Spursuant to which Building Permit No. 14072Z
dated June 20, 19 85
............................... , 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 .........
Accessory building
George L Penny, Inc
The certificate is issued to ' ' ·
(owner,
of the aforesaid building.
Suffolk County Department of Health Approval ............ .N./A.. ..........................
UNDERWRITERS CERTIFICATE NO ~./.b '
Building Inspector '
Rev. 1/al
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N,Y. 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
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·
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
topograph ic 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.
Fees:
1. 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....~,~.z~,~...~.../, ?. ~(p.
New Building .~ ,T'.o.~..~,.~..~... Old or Pre-existing Building ............ Vacant Land .............
Location of Property /~'~'~-- ~,1o~,13~ ~,~ ¥ ~t,~'"O ~. ~ ..~. ~'¥'~?~'"u..~..
Hou,~e No, Ham/et
Own OW fP operty G~'o.~/ ~ l. ~'>1:~"~.~ I~...
er or nors o r . · .................
County Tax Map No. 1000 Section .... J..~.~. ....... Block .... q~. ~ ....... Lot...~.c~.~. A'~, .~. ?., .
Subdivision ................................. Filed Map No ........... Lot No ..............
/ * ~ % .~J.~. I .~.~:. ~ ' ·
Permit No..t~ ....... Date of Permit .Applicant
· . .q...~...~..~..z.,..~ ~7./~ ·, ·
Health Dept. Approval ........................ Labor Dept. Approval ........................
~~ Pla ning Board Approval
Unde~riters Approval ........... n ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ , ~'~,~ ......................
Construction on above described building and permit meetsgll ~licable codes and regulations.
................
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
~pplic.tlon ~o. o.~il~ N 704533
in the fotlowing location; [] Basement ~ 1st FI.
wasexaminedon At~gt~t' 08, 198§
FIXTURE FIXTURES
OUTLETS RECEPTACLES SWITCHES
9 3 2 9
[] 2nd FI. Section Block
and found to be in compliance wlth the requirements of this Board.
Lot
FLUORESCENT VAPO~
RANGES OVENS EXHAUST FANS
DRYERS FURNACE
TIME CLOCKS
UNIT HEATERS MULTI-OUTLET
SYSTEMS
NO. OF FEET
DIMMERS
SERVICE DISCONNECT
OTHER APPARATUS:
S E R
OF CC. COND.
V I C B
NO. OF HI-LEG A W.G.
NO. OF NEUTRAl o~A NEUTRALF
OF
HI-LEG
P.O. BO~ 143
This certificate must not be altered in any manner; return to the office of the 8oard if incorrect, inspectors may be /dent f ed ~¥ their credenfia{s.
FIELD INS~ECTION
FOUNDATION
{1st)
FOUNDATION
2.
(2nd)
~)ROUGH FRAME &
FLUMBING
INSULATION PER N.
STATE ENERGY
CODE
4.
FINAL
COMMENTS
ADDITIONAL COMMENTS:
BUILDING DEPT. COPY OF APPLICATION FORM 46-EL, NEW YORK BOARD OF FIRE UNDERWRITERS.
FILE THIS COPY WITH BUILDING DEPT. WHEN REQUIRED,
VILLAGE
TOWNSHIP ~'"~ ~7~ ~,~
STREET AND NO. OR
ROAD AND pOLE NO, /~"~/,~} //L~'
BETWEEN WHAT TWO POLE NO,
CROSS STREETS. IS
?~REMISEB LOCATED? SECTION BLOCK LOT
NAME /~ ~ / ~ ,~
SUPPLIED ~ ~,
BY / ~ FRO~ THEIR ~ OFFICE
BUILDING I
IS NEW [] OLD {~' WORK DEFECTS
IS NEW [~ ADDITIONAL ~' REMOVED
LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
No. of Flxture~ &
NUMBER OF O~UTLETS Lamp R~epte~les MOTORS HEATERs BRANCH
CIRCUITS OFFICE USE
Leea~ ONLY
tion
Side A h't H.P. Watts A.W.G
Ceiling, Wall R~I~'Ii Switch Pendant Bracket No. Type Each No. Eaeh No. Gaege INSPECTION
oat-
Sub*
base
Base-
111 PI,
2nd FI
OONOTUSET.,S,ACE.
~MUST BE PILLED IN OS APPLI~rATION MAY BE RETURNED. SPACES ~ DATE OF ~..J ~/
PRINT NAME AND ADD, RES$ , ~ , ~pPLICATJ~ ~ ~ /
APPLICANT ' ~'' ~ '~ OF APPLICANT~/ / ~/
, ~EN APPL CABLE
~e ~ (.~.'¥ee) ~RATE APPLICAT ; FI ; BUILDING
BUILDING DEPT. COPY OF APPLICATION FORM 46-EL, NEW YORK BOARD OF FIRE UNDERWRITERS,
FILE THIS COPY WITH BUILDING DEPT. WHEN REQUIRED,
CITY OR
STREET A.O NO. OR :~
RETWBEN WH^T TWO
CROSS STREETS IS
RUILDING
POLE NO.
SECTION RLOCK LOT
OCCUPANCY
ITEL. ~
FROM THEIR ~/~/.~' ~ /~,~ ~ OFFICE
rWORK :
IS NEW [] ADDITIONA~[~ DEFECTS
REMOvED E~
LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
No. of Fixtures & BR~NCH
NUMBER OF OL!TLETS Lamp Receptactes MOTORS HEATERS CIRCUITS OFFICE USE
tion ONLY
Bide Att~ch't ! EH~cPi~ Watts A.W,G,
Ceiling Wall RedeP,la Switch Pendant Bracket NO. Type No. Each NO. Gauge INSPECTION
Sub-
SERVICE IOVERHEAD ~ I UNDERGROUND
AVOID DELAY BY GIVIN(~ FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED
PRINT NAME AND ADDRESS
BUILDING DEPT. COPY OF APPLICATION FORM 46-EL, NEW YORK BOARD OF FIRE UNDERWRITERS.
FILE THIS COPY WITH BUILDING DEPT. WHEN REQUIRED.
STREET AND NO. OR ~ /~ , ~,
~ETWEEN W~AT TWO
CRO~ STREETS IS SEC~ION, B~K LOT
FROM THEIR
BUILDING WORK
F~EMOVED []
LIST BELOW ALL EQUIPMENT WHICH'YOU INSTALLED
Ceiling Wall R~i~'Is Switch Pendant Bracket No, Type Each No. Each No. Gauge INSPECTION
2~d FL
.
~ISPECTiO REOUESTED
~V0~O DELAY I~¥ Gl'VINO SUL~ANO ACCURATE INFORMATION. ALL'SPACES 0ATE OF
PRINT NAME ~ND ADDR~S
740
~ ~ (,~v. ,/,,} A SepArATE APPLICATION MUST BE FILED FOR'EAqH~A~A~E eUI.gGI~G~ ~ '
BUILDING DEPT. COPY OF APPLICATION FORM 46-EL, NEW YORK BOARD OF FIRE UNDERWRITERS.
' FILE THIS COPY WITH BUILDING DEPT. WHEN REQUIRED.
STREET AND NO. OR
ROAD ^NO FOLE NO. ~'\ ~\ ~ ~O ~ ~,~ ~"~ ~,~ FOLE NO.
BETWEEN WHAT TWO
CROSS STREETS IS
PREMISES LOCATED?
SECTION BLOCK LOT
BYSUPPLIEO ~ '~ ~ C ~) FROM THEIR
IS NE~ ~ OLD ~ WORKis
ITEL.:~ ~,~l~,}.~ -~J~t ,J<)
NEW ~ AQOITIONAL ~ DEFECTS
REMOVED
· LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
NUMBER OF OUTLETS Lamp Receptacles MOTORS HEATERS CIRCUITS OFFICE USE
tion
Side At~eeh't H.P. Watts A.W.G
Ceiling Wall Re~ep'le Switch Pendent Bracket No. Type Each No. Each No. Gauge INSPECTION
WORK TO, BE {NUMBER) (CAPACITY)
,NS~ECT~O. R~OUESTED
ON OR AS NEAR AS ~ ~
NEW
OLD
· A~/OID OEL~Y BY GIVI ~O FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED IN CiA APPLICATION MAY BE RETURNED.
-'? PRINT NAME AND ADD~Ess
~e.c(.cv,/..)' , ASE~ARATE~ ~ APPLICATION MUSTBE F LEDFOREAC~EPARATEBU LDJNG
FORM NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N.Y. 11971
TEL.: 765-1802
Examined .~'x~N~..~..c) .... 19~..~/. .. ~
,'/~'' ,, , , , ,' ~,,, ' ~ ' , : , ' , ,.;, , ,,
Dis, approve~ a/c ....... ,..t ...... ' '. ...... ." ' ;' ', ....
(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. Tho worl~ 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 p0rmit
shall be kept on the premises available for inspection throughout tho work.
e. No building shall be occupied or used in wliole 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
Regulationk, for the~¢onstruction 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 ~Ject0rs on premises an-t~ro~,.uilding for necessary inspections. ~
· ' "~(g~t~?e of applicant, or name, if a C~l[/[ffa['i;~} ~' ~
.. .... .q
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner o f premises .G.*."~...~..(,.). ~.....~..,....~...~...~'~. ,~ .~....~..A,.t .(~., i .....................
(as on the tax rol~ or latest deed)
If applicant is a corporat~"0, signature of duly authorize, j;1 officer.
Q__~Nam6 a~d title of corporate o~cer)
Builder's License No ..........................
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
Location of land on which proposed work will be done.../~,. ~. ~
. ..... ..................
....
House Number i .... /''/'' i~ .~....-~,
Hamlet
County Tax Map No. 1000 Section ................... Block .................. Lot ...................
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name) ~
2. State existing use and occupancy of premises and intended use and occupancy of proposed constructiop:
a. Existing use and occupancy ...~..../.~-.~..~/n..~.. fi .~.~...../~..(rS./..~ ..~, .t ~..(') . . ~ ~..77~5(~t..~j. io~'. .....
b. Intended use and occupancy ~. TT.~...~..~.~.o'."7, .... .~...1~. t..I~, .~.t ~'q.. ~'l~ ~..T..(~.. ~ ,?....~.
3, Na ute of work check which a cable): New Building .......... on ...... Alteration
Repair Rembval ' ' Demolition Other Work
4 Est~atedCost '
~ ' ' t~ ....... Fee
, ~' (to b~ paid on filing thi~
$, If dwelling, number of dwelling ,units Number of dwelling units on each floor
, If garage, number of cars ................. , '
6. If business, commorcml or m~xed occupancy sp ~c~ nature ~d exte~ of ~aeh *w~ nC.~ ~ ~ ~ G
7. D~0naxons ofex~stmgstmctur~s, ffany Front ~ ~' , ,.. Rear ',~:( ..... 'De~th. ~ '~ ~
9.. Size of lot: Front ..... ' ...... ' ........... Rog .... ;.'~ Denth .
10. Date of Purchase ' , .......... Name of Fn~r ~
11. Zone or use district in which ~rqmisea'aro situated ... ,:.... ............ ~ ..........................
12, Does proposed construction wolate any zomng law, ordmance or re lation . ........
13. Wflllotberegraded . ..~ ~ .. , ...... ' .....
.... · ~ ~ ...... ~; ....... ~nbexcess rill be removed from premises' Yes ( ~o~
a~n~ et ~rcmmct .................. , ...... Address . .' ............... . Phone No ................
, Nmne 6f Contractor ......... ~ ............ .,, .... Address ........... ........ Ph0neNo ........ 5, ......
.,,: ~ P~T DIAG~
~ Locate clearly ~d distinctly ~l~bufldMgs, whether existing or proposed, ~d. indicate MI set-back d~ensions from
proper~y ~nes. Give street and block ~ mmb~r et description aco0rdMg to deed, ~d show street names and Mdicate whether
Mte~or or comer Io~. , ' , , ,
STATE OF NEW_YORK.
COUNTY OF..~. ~.~ k.(~- ..... ~'~
,(Name of indwldual signing contract)
above named,
.... being duly sworn, deposes and says that he is the applicant
Hetsthe .... ~ ........... , ....... .., ........ ~.. .~.,~.~.k ................
i' (Contractor, agent, corporate officer, etc.)
of said owner or ewnem, ~d is duly authorized to perfo~ or have perfo~ed the said work and to m~e and file this
application; that all statements contained M this application are tru6 to the best of his ~owledge and belief; and that the
work will be p~rfo~ed in the m~nei set forth in the application filed therewith,
Sworn to before me this
...... ~ .............. dayof ....... ,19.
Nota* Public, · ~ .... County ~_
NOTARY pUBLIC, State of NeW Y a
,o .
. , ~x...~, ..... ~.)~ .~ .......... [.~ ............
Commissoa~ptres Ma c~o~.~/' I, . ' / x x tS{ atu o'~ " '