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HomeMy WebLinkAbout14123-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificnte Of Occupnncy No... Z].4115 ........ Date ............ D.~.e.m.~e..~..2.6. ........ 19.8..5 THIS CERTIFIES that the building .... 2. n..d..f.~o. 9~..~.c3.d.~.~.5:..o.n: ...................... Location of Property ...~4.2.5. ................. S.k..up.k..L. gp.e' .......... .C.u..t.c.h.o.~.u.e ..... House No. Street Hamlet County Tax Map No. 1000 Section ..... 1.0.4:...Block ...... .0.4 ...... Lot ..... .o.qs. ........ Subdivision X .Filed Map No. X. Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated ·...J.u.l.2(..1 ............ 19 .8.5. pursuant to which Building Permit No. 141.23Z dated ....... qu..~y..8. .............. 19 .8.5., 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 ......... 2~d floor addition to existing dwelling. The certificate is issued to RXCIq~RD E. & IVI~RY BOZSNYAK ..................... ..................... of the aforesaid building. Suffolk County Department of Health Approval ................. .bi .~. ..................... UNDERWRITERS CERTIFICATE NO. N7 2 7 315 Building Inspector Rev. 1/81 l~Olt~ NO. B TO~VN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE. WORK AUTHORIZED) No 14123 Z Date ...................................... , 19 Permission is hereby granted to~ ,~. .--, ..... . . . /. .2.. . . . ..... ................. · ...... Z~.~./Z~ ~.., . ~ ~ . ~o~ . ~z Tz~.. .Z.~.....~/~ ...... ~..ZZz~.q ..................................................................................................................... at premises I~ated .............. / · [~ ..~ .. County Tax Map No. 1000 Section ...../.~....~.. ....... Block ..~...~.. ........... .~L~ No. ~..~.~... .......... pursuant to application dated ...... .~..~...,~--.....~... ........... ./. .................. , 19..~..~.., and approved by the Building inspector. Fee $ ........................ Building Ins~ctor Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall $outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY BLDG. TOWN OF~SOUTH. Q~.D Instructions This application must be filled in typewriter OR ink, and submitted m IIIm~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 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, 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 New Building ............. Old or Pre-existing Building $15.00 Date .... ·..~. ....... Vacant Land ............. Location of Property. ~.~..$ .... ~'.-~/~'~.~...~/~. ~Z~- .~..~, .~.~'~. ............ .~ ~P.~ ,.~. · · House No. Street ~ Ham/et Owner or Owners of Property .IQ ~F. ~ ~ ~ ~.~..~ County Tax Map No. 1000 Section., ./~.~ ....... Block ..... ~ ........ Lot...~ .......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./~/J.~.~,, .E... , Date of Permit .¢¢.~.~,..Applicant.·..~.,.c~<). ~,~,, ~ ./~..~'.5],A,¢~ ,~..,~'. o . . Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ....... ~ ............. Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...... ~ .............. Fee Submitted $ ~., .'~....~, .~..~. 3.~ ....... .~.. Construction on above described building and perngiLmee, ts all applicable co_des and regulations. .... ............. ............... Rev. 10-10-7S THE NEW YORK BOARD OF FIRE UNDERWRITERS o~L BUREAU OF ELECTRICITY ~'-- 86 JOHN STREET, NEW YORK, NEW YORK 10038 .at~ ~,[~:~ ~, :t~ ~,~....~o...~.~ ~o~/~ N 727315 THIS CERTIFIES THAT o~y the electrical equipment ~ ~scribed bel~ and i~troduced by the appllva~t named on the above application number in t~ premises of ~ ~)z~r~ak~ 6425 Sk~ ~:*, ~ ~t~ ~ Y i, the followi,g location; ~ Basement ~ 1st FL ~ 2~d FI. Section Block Lot was examined on [~ ~ ~ ~ ~ and found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES .'OOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS EWITCHES FLUORESCENT 7 1,7 1.1 7 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERE TIMECLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R V I C OTHER APPARATUS: This certificate must not be ahered in any manner; return to the office of the Board if incorrect. Inspectors may be ide~%tif[ed by their credentials. ,. CO~Y FoR~U-ILO!NG DEPARTMENT. THIS COPY OF CERTIFICATE M~$_T NOT B~LT[ERED IN ANy MANNER; TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P,O. BOX 728 TOWN HALL $OUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit Owner R% 0. ~4~f% ~ (please print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. 0- (~fumber's signature) Sworn to before me this /~ day of ~E~/~/~ , 19 ~ · Notary Public, ~~ County Notary Publ?ic Ut~DA 4. ~ NOTARy PUBLIC, 5ffl~e M N~w Yoj:k No. ~225~, S~lk Cout~ ~ Term E~ires March 30, 19~ ~ ELD ~NSPE~T10~$ COMMENYS FOUNDATION (~st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING iNSULATION PER N. STATE ENERGY FINAL ADDITIONAL COMMENTS: '[ Roo~l t To 0 0 ~co~ ?LooR P/4A/ 'FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ....... ,19 .. Approved / Disapproved a/c ......................... (~ .......... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BLDG. DEPT. TOWN OF SOUTHOLD 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 pumuant 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 inspecti~-s.~ / ~? ~/) / ....... ........ (Sigr3gture of applicant, or nan,, if4 corporation) (Mailing address of applicadt) ~ / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... R. ............................................................................. Name of owner of premises ...................... / ................. f' .............................. (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....~O),O..'.~.' O, [.t~l~2~' .... Electrician's License No...~0.~.~...f~...tt.~.~.~ ..... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. I000 Section .... /.'.~..~. ......... Block ..... ~'~.,. , ..........Lot...47 .............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed cdnstruction: a. Existing use and occupancy b. Intended use and occupancy ~$./.~g.l~.~.:~..~ 3. Nature of work (check ~/hich applicable): New Building ..... ' ..... ddition .. ~. ...... Alteration .......... '~EsRej~[ ~ .~ .~].ti~ate; st--~ . _._ oval..~'..~ .......... Demolition ............. ~~ Other Work ............... (Description) 4. Co I OCD, · ......................... Fee ~ .... ~ ......................... : O~iO~.~ltJ. (to be paid on filing this application) 5. If dwelling, number of dwellin~ units ............. Number of d yelling units on each floor.. Z ............ If garage, number of c~s ... } .................................................................... 6. If business, commercial or mix'ed occupancy, specify nature and extent of each type of use ..................... 7. D~ensions of existing structures, if any' Front ~$~ .. Rea .. ~ Depth .~(~ j'. ...... [*( ~ be fSt Height ............ Num r o ofies ................................................... :.. D~ensions of same structure With alterations or additions: Front ~/'. ...... Rear ~( .t.. ~ ( HeiSt ~ ~ ~umber of Stories Dep~ .............. ~ ............................................... ' . 8. Dlmens~ons of e~tlre new con~tmct~on: Front .. ~o t ~ .... ~o. { ....... Depth .~. t. H-i-h* ' ~] ~-mh~r oe e,~,o .. · .~ ....... em .......... - O t .t. ' ...................... ¢ ........... 9. Size of lot: Front ...... 7~. ~ ............ Rear ...... ~O ............ Depth ...~ ............ 10. Date of Purchase ......... 3 ................... Name of Fome r.~wyer ............................. 11. ' Zone or use district in which premises are situated ...................................... 12. Does proposed construction viblate any zoning law, ordinance or regula ~ion: ...... ~ .................... 13. Will lot be regraded ...... ,. ....~.. ~ ........... Will excess fil be removed from premises: Yes No 14. Nme of Owner of premises ~'~.. ~..~.. Address ................... Phone No. ~.'.~... Nme of Architect .......................... Address ................. Phone No ................ Nme of Contractor ......................... Address ................. Phone No ................ PLOT DIAGRAM Locate cle~ly ~d dis~cfly fll bufld~gs, whe~er existing or prop( ed, ~d, ~dicate fll set-back d~ensions from prope~y ~nes. Give street ~d bloc c number or description accord~g to dee ~d show street names and ~dicate whether ~tefior or corner lot. ~ ~, ~ ~ STATE OF NEW YORK, COUNTY OF. S.S ................................................. being duly s ~orn, deposes and says that he is the applicant (Name of individual sigging contract) above named. He is the ..................... ~ ............................................................ . ......... (Contractor, agent,'cbr~6rate o 'ricer, etc.) of said owner or owners, ~d is drily authored to perform or have perfo reed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the work will be perfo~ed in ghe m~er set forth in the application filed there' rith. Sworn to before me this ........ ....... ~.~ .... day ~f ...... ~ ........... 19 , Notaw Public, . . . ,~. ~.~,~: ...... County ...: .. ......