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 ~.