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HomeMy WebLinkAbout14214-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z. 1.6..0J.5 .......... Date November 20 19 85 THIS CERTIFIES that the building A d d i t i o n Location of Property .... 1945 Glen Road Southold Hous~ hid ................ 's't/e;i ...................... h~d4,1 County Tax Map No. 1000 Section . . 0. ? .8 ....... Block . .0. ~. ........... Lot .... .0 .2.7 .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated ..... ~.u.g....5. .......... 19... pursuant to which Building Permit No. 14214 Z dated .... .~.u.g:..2.2. ............... 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 ......... Add a 2nd floor dormer The certificate is issued to . L. 9y.d..S. $ .mp.n. ..... [ohJn'e)~r~O,;~'l~t~,,}i'~f'~ .................... of the aforesaid building. Suffolk County Department of Health Approval ................. ~/.~. ..................... UNDERWRITERS CERTIFICATE NO ......................... ~17 iff. 693 ................. Building Inspector Rev. 1/81 l~OB~[ NO. II TOWN OF $OUTHOt~D BUILDING DEPARTMENT TOWN HALL SOUTHOLD, H. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No Permission is ttere6y granted ~ ._ ~ ....... ./.~.....~.f%~. .................. ~ .... ./:m...~....~/~.~..._~....~:. ...... ....... ..~..z.~./~/~..~..~.~..'./..: ...... zz?o/ tO ~ ~' F~/2 ' ''~ - ........ ~:Z.~.~.. ........ .~...~........Z'/~,,,~. ...... ..~-~~ ................................. .............. ~ ................ Zo.~. ........ ~..,~.o:~ ...................... ~, ........................ .._.. .......... 0, p,em,s0s ,o=,e~ at .../....ff~.~........-~..~m'~v...Z(o..,m..z2..7 ....... ~..~z~z~ ................ County Tax Mop No. 1000 Section ...... ~.....~.,.?,... Block ....~../. ........... Lot No...~.~... ........ pursuant to application dated ..~/~......,.~... ........................... , 19~...~.~and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This application must be filled in typewriter OR ink, and submitted ,- ~ 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~Coperty 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 $15.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 /./..,/~,./,/.~..~/.f.~...  Date ........ , ................ New Building ............ Old or Pre-existing Building-~----~.. ....... Vacant Land ............. Location of Property .... /..~.~.~,, ........ . .~.-,,,~ .~..~,,..~. ,~,~,~.,, 2,d~, .¢~,. ,~,~,~..~. ,~,,,, House No. Street Ham/et Qwner or Owners of Property .....~..Of,~..' 2~.~'/.~/. ................................ County Tax Map No. 1000 Section ... ~. ,~.~. .... Block .... .O. ~, ....... Lot.. (~...~.."~. ...... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ~..~ ,~. ~..~. ~Date of Permit .... Applicant ............ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets all ~pp~icable codes and regulations. App cant Rev. 10f10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS 50~, BUREAU OF ELECTRICITY gr 8~i JOHN STREET, NEW YORK, NEW YORK 10038 ,ate O~~ ~, .~,.~ ,~pplicatlo,~ ~,a. onSi,e ~/a~ N 7 :[ 4 6 9 3 THIS CERTIFIES THAT only the electrical equipment as described belotv and introduced by the applicant named on the above application nutnber in the premises of Lloyd SJ~on, 1945 (;ler~n in the following location; [] Basement [] 1st FI. ~ 2nd Fl. Section Block Lot (~k~+-O~tg.'~ ~4 t ~985 and found to be in compliance with the requirements of this Board: FIXTURE OUTLETS 2 DRYERS EECEPTACLES SWITCHES 13 4 2 FURNACE MOTOES FIXTURES RANGES OVENS EXHAUST FANS FUTURE APPLIANCE FEEDERS TIME CLOCKS MULTI~OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: S E NO. O~ECR C,~CO N D R V I C AW, G, OF CC COND NO, OF HI-LEG OF HFLEG NO, OF NEUTRALS OF NEUTRAL ROUte 1, Riv.ex*h~d, NY 11901 certificate must not be altered in any manners, return to the office of the Board if incorrect, inspectors may be identified by their credentials. COPY FOR E '. THII NER. FIELD~"]NS~ECTION FOUNDATIO~ (1st) COMMENTS FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) o~ ~C INSULATION PER N. Y. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: BUILDING DEPT. INSPECTION [~FOuNDATION 1ST [] ROUGH PLBG, [ ] FOUNDATION 2ND'[ ] INSULATION [ ] FRAMING FINAL DATE i ,' INSPECTOR 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 h TEL.: 765-180:3 Approved/~.7..~..'~. '..., ] 9~.~."~e rmit No. ~. ~'. Z .~ .~.~ Disapproved 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 ets 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 publi9 streets )r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. i 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 hall 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 hall have been granted by the Building Inspector. ' idh APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the uilding Zone Ordinance of the Town of Southold, Suff, olk County, New York, and other applicable Laws, Ordinances or egtflations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. e applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to mit authorized inspectors on premises and in building for necess~y inspecti..q~s.. ,, .......~"/..¢:.?..~. 2~.~<~~ .............. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) itate whether applicant is owner, lessee, agent,' architect, en~neer, general contractor, electrician, plumber or builder. 4ame of owner of premises . .x , ~. ,,.r,-. .................................................... (as on the tax roll or latest deed) f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No....~.. ~.~. ............... Plumber's License No ..... Electrician's License No ....................... Other Trade's License No ...................... Location of land 7 which proposed work will be done.. /. ?...~..5-7 . .~.' .~..ff..~....~. · .................... House Number Street Hamlet 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 proposed construction: a. Existing use and occupancy .......... ' '~' '~'~''' b. Intended use and occupancy ....... .~.~. ..~..t~. f.. , j 3. Nature of work (check which,apphcable): New Building .......... ddition .......... Alteration ...... Repair .............. Ren~oval .............. Demolition . .4 .......... Other Work ............... C : (Desc-iption) 4. Estimated Cost.. .o~..q ............................. Fee . ~ . ~ 5. If dwelling, number of dwelling units.. [ ............ Number of d~ If garage, number of cars i ............................ 6. If business, commercial or mixed occupancy, spe?~y~n,ature and extent 7. Dimensions of existing structur, es, ifany: Front .'.~'~ ........... Rea (to be paid on filing this applicatio:O ~elling units on each floor ................ )f each type of use ............... '-g~. ........... Depth ............. property lines. Give street and block number interior or corner lot. Height ............... Number of Stories ..~g~ ............................................ Dnuensmns' ' of same structure w~th' .... alterations or addmons: Front .~. 7.; Rear .~,. ?. t ....... . pth ~ '~ ~ 'ght ] De ................ I' · · Hel ...................... lumber of Stories ~ ................. 8. Dimensions of entire new cons[ruction:, Front ............... Rear ............... Depth ............... Height ............. .~. Nu~nber of Stories ...... 9. S~ze oflgt: Front ./.~.~ ..... ~ ......... Rear / ~..~ .............. Depth~...'TCr?.'~. ............. 10. Date of Purchase .......... ! ................... Name of Forme ~ Owner ..... ./.~'..~.~4.~.~.~ .......... 1 I. Zone.or use district in which p~emises are situated ........................ 12. Does proposed construction vi$1ate any zoning law, ordinance or regulal ion: ./~.0. ..... 13. Wflllotberegraded ../~.~...., ':.;~".r>., .......... ~/illexces.sfill ~e~r,e~m,~,d from premises: Yes _ No 14. Name of Owner of pre~ises A~,~.~, ~..l~'~P~/..Address [~.~.~.-.~.~.~..~.~.: PhoneNo'7~.~."~/~.'~.: Name of Contractbr .~?d~g,. ( ~ ,t(./$~.~/, ........ Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or propo~ t, and. indicate all set-back dimensions from or description according to dee . and show street names and indicate whether STATE OF NEW YORK, COUNTY OF ........... S,S ........ ' .................... ! .................... being duly s ' (Name of individual signing contract) above named. He is the. .................... ! ................................ ~ (Contractor, agent, corporate o of said owner or owners, and is drily authorized to perform or have perfo application; that all statements con,dined in this application are true to the work will be performed in the man,er set forth in the application filed there, Sworn to before me this ........................ day of ..... ~f~. .......... 19... Notary Public, .. ~-.~'. .......... County ....... '/ om, deposes and says that he is the applicant 'ficer, etc.) med the said work and to make and file this best of his knowledge and belief; and that the ?ith. (Signature' of applicant) EL~ w/~ -F, ON NOTI~ BUILO~NG ~EPA~T~ 765-1802 9 AM TO 4 PM~OR THE FOLLOW RS--~NFPECT~Qh(S: L]. FOUNDA~ON - ~/O REQUIRED FOR POU2~D CONCR~E 2. ROUG~H - FRAMING & PLUMBING 4. FINAL - Cg~3T~UCT~DN MU~ BE CC'~ cT5 FOR C, O. ALL CON~qUCT~ON SHALL THE REQU'r~EM~N~S OF THE N~ Y, ~ATE CON~RU~ION & ENERGY CODES. NOT RES~NSI~L] DESIGN OR CON~RU~ION L.I ii ; iL_ T I O L cw 'f II I ~Lvs~r ri2. ///d ?'z 'o '.- i / / OCCUPANCY OR UNLAWFUL WIT! T CERTIFICATE _OF OCCUPANCY -FI ON x. ~APE'ROYED AS NOTED FEE:,~ ~'"O ~ BY: NOTIFY BUILDING DEPARTMENT 765-1802 9 AM TO 4 PM FOR THE FOLLOWIN~ INSPECTIONS: 1. FOUNDATION - ~O REQUIRED FOR P~Uq~D CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULAT~qh.J 4. FINAL - ~N'STPUCT',ON MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL ~E REQUIREMENTS ~F THE N, Y. ~ATE CON.RUCTION & ENERGY CODES. NOT RES~NSIBLE FOR DBI~N OR CON.RUCTION ERRORS. IL KEY ' ;I 5 FLoo ~.