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HomeMy WebLinkAbout14236-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z~ 389~ Date October ~ 85 THIS CERTIFIES that the building ........... i~g~OU~.~ .DQQ~ ...................... Location of Property ~ 0003 North Bayview Rd. Southold County Tax Map No. 1000 Section .... .7.9. ..... Block 5 .Lot q 7 Subdivision X X X ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated August 5 19.8.5. pursuant to which Building Permit No. ~1/4236Z dated . .S.e.p.t..e.m.b.e.r...5. .... 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 ......... ..Y~.~.r.o..u~..d. Rool and fence. The certificate is issued to ........... CAROL PLOCK .......... ...................... of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO. N708892 Building Inspector Rev. 1/81 FORM NO. Il 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) 14236 Z Permission is hemtm/granted to: ~. ' /./ , ©e i .... ~..~...~..~.~ ...... L.~.~....~.~..~. . ~/...~.....~.~.~ .......................... ~...~..~.. ~ ....... ~..,.. ~.~ ............. ~~...~ ~, ~.~. ~~. ~.~.'. ,r,~,,~ ,=,~ =, ~, ................. ~ ...................... .~ ...... ~......~~ ...... ..~..~.,..~ ................................................................................................................. C~n~ Tox ' ~ ~ ~ ~ L o I ~p No. 1000 Sectlo~ ........... ~ ....... Bilk ...................... ~ N ..........~ ............ pu~uont to application doted .... ~....,~ ................ , 19..~., and =pprov~ by the Building Inspector. ,J Fee $...~.~. ............. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold, N,Y. 11971 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: v/l~Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. // --'~..~Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). ~Approval of electrical installation from Board of Fire Underwriters. ~/Ir. 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~operty 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. lfl, J~Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.0 0 4.Vacant Land C.O. $5.00 Date ..... .'~, ~. ....... New Building ~..~, .~0. ~.~. , Old or Pre-existing Building ............ VacanILand ............. \,% Location of Property Owner or Owners of Property' . ..... ~,~.. f~\_~,...~..~ ~.. ~ ............................ County Tax Map No. 1000 Section .... (,,~ .-~ ...... Block ... ~ ......... Lot..\.~ .~;~.~,.. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ate of Permit Applicant ..... ~ ¢.%. Health Dept. Approval ........................ Labor Dept. Approval ........................ '~ ~:''~' Underwriters Approval. ~..~ .~..~ ~..~.~1~.~ .Planning Board ............ Approval .......... Request for Temporary Certifi,cate ................... Final Certificate ..... ~ ........ FeeS,,bmitted$.. ..... ......... Construction on above described building and permit-me~ all applicable cOd~ts and regulations. · %. ............ ................ Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS 10~50~:~ BUREAU OF ELECTRICITY ~'[ 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electricul equipment as described belo~v and introduced by the applicant named on the above application number in the premise# of t?lock, Private Ed~ e/o N. Bayview~ Southold, N.Y. in thefollowing location; [~ Basement [] 1st FI. [] 2nd Fl. Outside Section Block Lot was examined on 8e .l~t. ember 9 ~ ~ 9 ~ 5 and found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES COOKING DECKS OVENS EXHAUST 11 2 1 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: S E R C NO. OF HI-LEG NO, OF NEUTRALS OF NEUTRAL G.F.C.I~- 1 (Swtmminq Pool) This certificate covers c0mpliahce 'at the date of insp~otio~ only. Because of unusual environments it is advisable to have frequent test ~ · and/or repaY, rs ~sde by e oua.~if,~ed person. Henry Bohn 123. Sheep Pasture Rd. Setauket, N.Y~, 11733 Per 11 {i: /( must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by t~elr credentials. FIELD 'I~ECTION FOUNDATION (2nd) ROUGH FR&ME & FLUMBING COMMENTS ., .___~_~ INSULATION PER N. STATE ENERGY C,ODE FINAL _1 ADDITIONAL COMMENTS: 'l- '--'-i I-~-----.~1 !'-" ""' '--',i.-~ ~,.,-.,1''' " ..'~.d ' _ /- --' '',, ,,n,RGLA, E--T- ... '~"~ -I! II.''''E¢' '~'~ : i;.~ OPTIONAL STEP .": TYPE. 2.. OPTIONAL STEP "°,T,T~&~ ~o., s-oo~- .O..SH, O TYPE I. Aw.T,,o. PO,. ' WATER OISmSAL SHALL BE. LIMITEO TO ..... .PROPERTY TO. SuIT LOCAL SEE TYPICAL ' SECT~O# ~'.- 4'SANO 80~Oil SECTION--B-B CPO/~i~¢~ST u ~ cD8 v,Nyi~ L,NE TYPICAL POURED CONCRETE FOOTING WALL S ECT!_O 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 ',xamined..~.N~.~.,~,..~......&~., 19 .~.&..'"~ tpp roved .% .~4~..~., 19 .$ E Permit No. !¢.&. .~../(.~... )isapproved a/c ..................................... Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERIVllT INSTRUCTIONS Builder's License No ...... .~...~-:~.....&. ?. ~. ...... Plumber's License No ......................... i Electrician's License No....?..~.. ~.'-'~.'~., .......... 1.! Slate whether applicant is Name of owner of premises ~, applicant is (Name and title of corporate officer) (Mailing address of applicant) ]7 ~t~//7 7o ~chlt'ec}, engineer, general contractor, electrician, plumber or builder. · i :. i',..: ............... ............ ..... ..... ~' (as on the tax roll or la}est ~ed) ~ V G, ~ ~ huthorized officer. ~ .~ Other Trade's License No. , ....... '~ .; Location of land on which proposed work will be done ...... .,~../.~.'.~.~...c)..,~.. ............... ................. . House Number Street Hamlet County Tax Map No. 1000 Section ..... ?..7..~. ....... Block . ..~. .............. Lot/..7.'.~ ............. Subdivision .... .~....~..W.~./..Z=..~. .................... 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 .../...~.d.~../~. ~.. 4~.~.{p..~M..c(~ b. Intended use and occupancy ...~. ??.~.,q..d.~ ..... ?/ .... .X.a..~..../....~.o?..~.D....O?.r~.<,¢/.~?. ( .~..&.../°.o?.~ ...... a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 s~ts 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 areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- c~ition. 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 st~all 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 s~all 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 B~ilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or aTR~mgUlations, 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_~ousing code, 9xu:L~egulations, and to it authorized inspectors on premises and in building for necessary inspections// /] ,~ ~ ) .) (Signature of applicant, or name, if a-C~Or~tion) '31 Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteration .......... .Re~ 2.: .~ ....... Rem:oval .............. Demolition ............ Other Work .~'~./.,p./~.x~...~.~.~.~ 4. ma ed Cost .................................. Fee .. 2 ...................... ~ (to be paid on filing this application) 5. If dwelling, number of dwelling! units .............. Number of dwelling units on each floor ................ If garage, number of cars .... ~ ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure With alterations or additions: Front ................. Rear .................. Depth ................... }.. Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front .../.¢..K,3..,~. ~.~¢.~ Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front .... ~.4~..rI ........... Rear ....... ~. .3./ :-. 77.' ....... Depth ....~,f'.g.~.~.'. 2 ........... 10. Date of Purchase .......... ! .................. Name of Former Owner ............................. 11. Zone dr use district in which prbmises are situated ..................................................... 12. Does proposed constrnction vioiate any zoning law, ordinance or regulation: ..~..o ........................... 13. Will 10t be regraded ........ [ ................... Will excess fill be removed from premises: Yes v' No 14. Name of Owner of premises .~.~.o.~. fl...p.z, qq~ ..... Address .~.0..x'/.~.q .~ .......... Phone No..~.~.-..Pq??.~. .... Name of Architect ......... ~ ................. Address ................... Phone No ................ Name of Contractor ~.~.C"q...'~W. ¢..~?F.~ ......... Address .z/.7./.~.7[..~. ?...~..oc.~'..~, Phone No. Z~.9'- .-~./~ o ' .......... ! ? 77~/ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from to deed, and show street names and indicate whether property lines. Give street and blocklnumber or description according interior or corner lot. O00op4m 'eou, o41vc l r STATE OF NEW YORK, COUNTY OF .... ~ .o.~..c.~z. ..... ·..~..~T.~. · ~..z-.° being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the .. .................. ...~...~9..7' ........................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file 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 perform'ed in the manne~ set forth in the application filed therewith. Sworn to before me this ........................ day of: ............... ,19 Notary Public, .........//'/~o~c¢_)~~~'^Pi~~ ............., County .. -Not~w~ubli¢, f~at~ o lowY~rk .......... No. 52-4!528433 OI a f ~l in Sufloik Cou, ptV ,, ~U~ of applicant) C, omm,lssion [:xpi!'e~ b~iarch aO, ~¢~ ,~,