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HomeMy WebLinkAbout14278-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Zl39z[8 Date October 22 ]9 85 addition. THIS CERTIFIES that the building ................................................ Location of Property 10270 Sound Ave. Matt±tuck House No. Street Ham/et CotmtY Tax Map No. 1000 Section ~ 22 .Block ......... .2. .... Lot ~ 2 Subdivision... X .Filed Map No. X....Lot No. X conforms substantially to the Application for Building Permit heretofore fried in this office dated ..... .A.u.g.u..s.~..~.~. ...... 19.8.5. pursuant to which Building Permit No. ~1 #278Z dated .... .S.e??.e.m..~?.~.. ? .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 ......... Addition to existing one-family dwelling. The certificate is issued to STANLEY G. DAVIS . · ..................... io¥,,'*;, ~ ...................... of the aforesaid building. Suffolk County Department of Health Approval ............... .~/.A. ....................... UNDERWRITERS CERTIFICATE NO ......................................... Building Inspector Rev. 1/81 FOurn' NO. O TO~N 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) NB 14278 Z Permission is hereby granted to: ....~.;ZiZ.~.~.....~..~.: ......... ~~......~..:~::...!..~.~..:...~ ....... ~ ................ at' premises Iocated"dt ~..~.~..~..-~...~Q~...~...~.`~`~`~r.`~`~.~.~.~.;.~"~...~.. ................. County Tax Map No. ]000 Se~o~..... ................. Block ...... ............ ot ..... ................ pursuant to application dot~u:l .... ~ ................ , 19.~...., ~nd ~pprov~ b~ th~ Building Inspector. Fee $..,.~..~,...'. ~. .... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, 'and submitted ~ IIl~ll~l to the Building Inspec- tor with the following; for new buildings or new use: , 1. Final survey of propertv 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 pL~perty 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 o 00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 Date (~ · 'z"' ": :' .... New Building .,,/'. ....... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ~- ~ z,z~,~-/- ~ House No. Street Hamlet Owner or Owners of Property , : .. ~?~',~ ~(,~2~..~,:~, .~ ......................... County Tax Map No. 1000 Section . .Z'~-.~ ........ Block .. ~-), .~'--~ ...... Lot., ~ ~'. ,~.~. ..... Subdivision ................................. Filed Map No ........... Lot No .............. ,~,',~.. '? ~ ' .~Date ~. ~.. ~' ,~pplican '~-~ Permit No. Z. /. of Permit-,~/~...Z'/, : .~.~. ......... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval. . ~-~.~.~ ...... Planning Board Approval .................... Bequest for Temporarg Certificate... ~ ................ Final Certificate . ~..'.. ........... Fee Submitted $.r.~ ........................... Construction on above described building and pejr~it meets all applicab/te'~es and regulations. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 To Whom This May Concern, TEL. 765-1802 We are unable to complete your Certificate of Occupancy because ~of the following reasons. /5/ An application for Certificate of Occupancy is not on file. J No Underwriters Certificate on file. The check is(outdated~not on file,~ /5/ No Health Dept. Approval on file. /5/ No final inspection has been made. Please contact ()ur office on this mntter. Thank you for your cooperation. Building Permit ~ ~-/ _~ __~_ ~ Z Building Dept. ***/--_/ No Plumber solder Certificate on ~ile. ( all permits involving plumbing being3 issued after April 1,1984 ) THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 o, te lS~rch ~.~ ~ 1~6 /lpplicatlon ~o. o, flie 3~330/~ on~ectrical equipment ~ described be~w and introduced by t~ applicant ~med on tke able applicatio, ..tuber i. the premises of ~m.loy G. D~s, S~nd Avr~nue~ Ma~ti~tk~ N.Y i1~52 in tke followlng Iocation; ~ Basement ~ let FI. ~ 2nd FI. Section Block Lot was examined on ~ ~ ~ ]~9~ and found to be in compliance witk the require,re,rte of tkis Board. FIXTURE OUTLETS 3 SWITCHES FIXTURES RANGES OVENS EXHAUST FLUORESCENT VAFOR DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDER: TIME CLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: s E R V I C AW, G, OF HI-LEG NO OFpERCC~COND. A,W G, rNO, OF HI-LEG OF CC, COND. Sot,md Avenue ~attituck, tVoY. 11952 GENERAL MANAGER certificate must not be altered in any manner; return to the office of the Board ~f incorrect. I.spectors may be identified by their credentials. 'vlANNER. OCCUPANCY OR USE iS UNLAWFUL V~/~THOUT CERTIFICATE NO?~FY BUiLDiNG DEPARTMENT 7654802 9 AM TO 4 P~ FOR TH~ FOLLOWING INSPEC~ONS: t FOUNDATION FOR POURED CO[~ETE 2 ROUGH F~A~tNG ~ PLU~G ALL COr~TR~CTIO~ ~ALL ?ATE CONS i'~GC r~ON IELD INS~ECTION OUNDATION {1st) IUNDATION (2nd) COMMENTS UGH FRAME & ?LUMBING NsULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 xamined ,pproved .~.. ~ .w:~...~..~.'~., 19 ??. Permit No..].~..~.7.~. ~ )isapproved a/c ..................................... ............................... .... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ~ 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 lr 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 tail 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 g Certificate of Occupancy tall 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 uilding 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, hous~.,code, and regulations, and to tmit authorized iuspectors on premises and in buildinb for necessary ~s~_ection~s. . ./,.,?_ ¢ /. %,. . ................ (Stgnature,~6f applicant, or name, if a corporation) ltate whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) f applicant is a corporation, signature of duly authorized officer. (Name and title of cor0orate.4 officer) Builder's License No. // Plumber's License No ......................... Electrician's License No. Other Trade'sLicenseNo ...................... .~_,¢ .~.. i~.~.~ 2Z2.~~ /"?.~/ Location of land on which proposed work will be done ..... . .~x~.: :~. .... ~.. / / ?~-~__ ,/ ... [ 0 :&7© ............................................................................... House Number Street Hamlet County Tax Map No. 1000 Section .... ~ .7~...-~. ........Block ..... .O..-~.. ........ Lot. ~ [--x_.~- Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed constrtlction: a Ex~st]ng use'and occupancy O~I ~ .~..~./0./~ '*~"' ~.~' t/e/'&" 3. Nature of work (check which applicable): New Building ..... ' .....'Addition ...... Alteration Repair .............. Removal .............. Demolition .............. Other Work .............. .. /oi,o o o'o (Description) 4. Estimated Cost ........ ? "~ i ...... {. ~ ............. Fee ............................... ~ ~' (to be paid on filing this application) .~.. Number of dwelling units on each floor - 5 If dwelling number of dwelling units If garage, number of cars ... i ................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structuies, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. D.ept~ .. ....... : {....Height Number ?f Stories "8. Dzmens~ons of entire new cons.trucdon Front ............... Rear . ./.~./. ~ ./.~.. ~. Depth .............. Il'eight ....... ;_ Nu:mher of Stories ... / ............ ' . 1091 Date of Purchase Z'. ~.~.'. i ................. ...~jame of Former Owner ~2~~... 1 1. Zone or use district in which premises are situated..~.....~...~?..~.. ...................................... 12. Does propos, efi constru~io.~viblate any zoning law, ordinance or regulation: 13. Will lot be re'faded ....... "~-~ ; ·: .................. Will exc~ess fill be removed from premises: ~es No 14. Name of Owner o f premises(2~.~'~..~..~...?.. Addres~ .~¢v~q~.... ,~'~'~,~l~one $o.~-. ~.~.~... Name of Architect ........ : .................. Address ................... Phone No ................ Name of Contractor ....... i .................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blocir number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. ........................... ~! ..................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dOly authorized to perform or have performed the said work and to make and file this applicatiofl; that all statements cogtalned in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this (Signature of applicant)