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HomeMy WebLinkAbout14261-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z14205 Date February 5 .................................................. 19.86.. THIS CERTIFIES that the building Addition Location of Property ~/~t~s~]'''4 ~'5'tvo Lake Dr ive Sou tho la ..................... 'S't;~i ............................ · Hamlet County Tax Map No. 1000 Section ...0.5. 9 ...... Block ...... .0 ~ .......Lot ..... 1. .0 .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore t'fled in this office dated ..... .A.u.g:. ~ ......... , 19.8.5. pursuant to which Building Permit No..1.4.~6.1.Z. ............. dated .... ~ ~ 9.~. ·..~ .1 ............... 19 ~. 2., 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 ......... .... .A.d.~.~..t.i.o.n...tp..e.x.~.s.t.2. n.g. one family dwelling. The certificate is issued to ......~l~.a.H~. ~... ~.C 1~ .a~LY. rowner, Ya~ ~,,~va~ .......... of the aforesaid building. Suffolk County Department of Health Approval ... ~/. g ................................... UNDERWRITERS CERTIFICATE NO.. N 7 3 3 3 0 6 Plumbers Certificate 2/~/86 Rev. 1/81 Building Inspector l~w~ NO. B TOVfN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERA~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 14261 Z Permission is hereby granted to:, ..~.~~....~.:..~: ...... L.L.~.~.~ ......... ,o ~.....~..~ ................... . ................................................................................................. ~,,,,~,s,,~,ed.,.....~.~ ......... ~.....~.~......~~ ....... .u.~ ....... .~ ..... County Tax Map No. 1000 Sectio~..~.~...~....'-~ ~... Block ...... ..C:A..~~. ........ Lot No ....... }...~. ............ to application dated .... ~..~.~........~ ................... , 19..~..,~..."~ and opproved by the pursuant Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1~802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions Bo 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. 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. 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 $15.00 Date .......................... New Building ./~/. .......... Old or Pre-existing Building ............ Vacant Land Location of Property ...... c .... : ........... ;, ~ ..................... House No, Street Hamlet Owner or Owners of Property ../~/~(¥4 ~4, .... . ./~.c; ,./~,,/~ .,~ .................................. County Tax Map No. 1000 Section ....P.~,? ........ Block .... ~..s~. ....... Lot.../.o. ........... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./, ~'.~.4'./. Z,. Date of Permit .~.~X~./. ./.~ .-~.~pplicant . . . .~.,. ~/'~..~.~v ~ .............. Health Dept, Approval . //"~,,~ . .Labor Dept. Approval ,Z//z~¢'.'~. Underwriters Approval .... ?~. ~..~..~. ......... Planning Board Approval ,. ~/-'~q .~. ............... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit.,~meets all, applicables.codes and reg flat. ions. Applicant ................................. Rev, I0-10-78 .1000708 THE NEW YORK BOARD OF?~FIRE' UNDERWI; BUREAU OF: ELECTRICITY ]~ 85 JOHN STREET, NEW YORK, iNEW YORK 10038~: ~ 0. t, January 29,1986 ,~prl;catlo. ~vo. on fie ,ii THIS CERTIFIE~ THAT only [~ el~tdc~ equipment ~ descried ~l~ and intr~ by t~ applicant ~med oJ ~ apphcot~t McNally, 1455 ~ke Drive, Southold,'~N H*,,,*, ?~ th~followlng location: L_J Basement ~ 1st FI. ~ 2nd Ft~ ~ ', ~:,Bl(~k ~ u,~ exami~d on Jan. 23, 1986 ' ' und found to be in complia~o u, ltI tl;o ~qt~iromo~ t~ of this TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. t 1971 TEL. 765-1802 CERTIFICATION Building Permit No. /~/ Owner ilVoF,~,.7~fl ~ ~ iV~ (please print) (p~ease .print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. ~ Sworn to before me this County Notary Public TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 Jan. 22, 1986 To Whom This May Concern, Final inspection was done 1/22 everything O.K. We are unable to complete your Certificate of Occupancy because,of the following reasons. /~ An application for Certificate of Occupancy is not on file. A~lication enclosed ~/ NO Underwriters Certificate on file. ~/ The check is(~~not on file.) /~/ No Health Dept. Approval on file. /Z/ No final inspection has been made. Please Thank you for your cooperation. Building Permit #~ _~261 Mc Nally Building Dept. contact our office on this matter° Z No Plumber solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) Application en~_!_Q~ INSPECTION DATE COMMENTS ~DA__TION ('lst) ~DATION ( 2nd ) ........ -- ~^ME ~ ~o/7/~ 0~:~ ¢/r ...... PLUMBING CODE -' FINAL · i ADDITIONAL COMMENTS: ~0[ Ot OU f' 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined .~.~ .~... [I..., 19 .~.~7 Approved .~...~..Tr~. · .~?. · [.I .... 19 .~ .'5.~ Permit No. I.q .~..[0.1..~... 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 dets 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 r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ation. 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. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the luilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or [egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ?he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to ~dmit authorized inspectors on premises and in building for necessary inspections./ /~/ ~ ,4 ~ ......... ........... i ...... (Signature of applicant, or ~me, if a corporat'on) .. (Mailing address of applicant) gtate whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .... ,-,~. x~.~ .... Plumber's License No ......................... Electrician's License No ............... Other Trade's License No ...................... ....... '~- , .~../'.~..~/. Location of land on which proposed work will be done. .~. ~'~,/~ .... .~'?..~.~...~, ~'. ~;~..~ · ~.-,. . . . /. . .............. . . . ................. /. . .... .k ............. House Nmnber Street Hamlet County Tax Map No. 1000 Section ..... .~..~ .......... Block ..... ~ .......... Lot...I.~ .............. 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 ....~.,.~....~.47~ ...... ~. ?'._~.~ ................... ; ................... b. Intended use and occupancy . ..Z/. .'..~.~.~ .... -- O~-~.c .lt~'~*~,,.~ ':~t~.~a, ..... .,,~.....~...,/ ..... ~rl..~.~z,~','~r¥~,~,m ............. 3. Nature of work (check which applicable): New Building .... ' Addition ...... Alteration .......... Rep~tI~I~t'I) '~ ~ll~ ...... Removal .............. Demolition .............. Other Work ............... ~ v ,,~,-~ i' (Description) 4. Estimated Cost...~...............-5'-gT-d~I .................. Fee ...................................... , *-' (to be paid on filing this application) 5. [f dwelling, number of dwelli,~units ..... ~. ........ Number of dwelling units on each floor...~. ............ If garage, number of cars .,/7/~,'~~ ....... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front....Z*..~...?~... Rear ...,~..~'. ~. .... Depth.. ~-. ~.~'~ ...... Height ... x/.~'.. ~ ..... Number of Stories .... ./ ................................................... Dimensions of same structure with alterations or addit[olas: Front ...~. ~..'f.. ....... Rear .... ~..~.~.f. ....... Depth.. ,.~..'~..f. .......... i'" Height .... ,~.z~./~.. .......... Number of Stories .... .~..: ¢"/~.-f~. ........ 8. Dimensions of entjr, e new construction: Front ... ?...d..~..f- ..... Rear ... ~.~..~.r/ ...... Depth .. ~'. f.'.ff'.z~. ...... Height .../.~..J..'.~ ...... Nu~12er of Stories .... ./...,F.~.Cg' ........................................... Size of lot: Front .... ~.d..¢~. .......... Rear ..... /~.~?. f'~. ......... Depth ...o~.qT..~. f..~ .......... Date of Purchase ~ d ]~./(. ~f. . Name of Former Owner ~ . Zone or use district in which~.e~nises are situated ......................... ,~/ .......................... Does proposed construction viQlate any zoning law, ordinance or regulation: .../..~0 .......................... 10. 11. 12. 13. 14. Will lot be regraded .... ~ · ;,v. ~ ............... Will excess fill,be removed from premises: Yes (~ Name of Owner of premises . .~.~,. ~,. ~.~/. x/P.. ~('~'. Address ...~.~. ~..~.. ~. ..... Phone No. Name of Architect . .~a~.bt [,/~...~/~,/~, .Z~ ~ ~. ~.. Address .~.~. ~f~..o..x/~. ....... Phone No. i ~.' .~.~.' .'-.~.' ?.'3.' ~.~.' Name of Contractor . ~ ,~..... ~.e.C~. ~ ........ Address . ~.o~.~.. ~C~,,/~.. ~/~... Phone No.. PLOT DIAGRAM Locate clearly and distinctly property lines. Give street and blocl interior or corner lot. STATE OF NEW YORK, COUNTY OF ................ (Name of individual si above named. all buildings, whether existing or proposed, and~ indicate all set-back dimensions from :number or description according to deed, and show street names and indicate whether S.S ..................... being duly sworn, deposes and says that he is the applicant ding contract) He is the ......................................................................................... (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 coniained in this application are true to the best of his knowledge and belief; and that the work will be performed in the man~er set forth in the application filed therewith. Sworu to before me this .. ,., , q tt dayOif /% /tT£,' AZ/1A/ c / ?,q O /~0 Secuo~ 7209 of the New York 1 OCgUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANGY-o' APPROVED AS NOTED Y BUll L',!2q-~: r~Et~;'~TMErNT AT 102 O ~ '0 ~ ;~ ~R ~E COMPLETE ~OR C,O. ~N~TR~ION SHA~ ~ ,EQUIPMENTS OF ~E '~ CONSTRUCTION & ~ *ODES, NOT ~N~ ~ *~GN OR CON'RUCTION ~.