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HomeMy WebLinkAbout14287-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.~.6.0. ....... Date .............. 4 .u.n.e. .2.9 ...........19.8.6. THIS CERTIFIES that the building ........ .o.n.e. ? .C.a.m.~. ~. y..d.~, e..~3.~.n.g ................. Location of Property .... .27.5. ............ C..h .v3.~' ~. 9 p.h.e.v...~ 3.. ............. ~. 9 .u 3.h.°..Z .d .... House No. Street Hamlet County Tax Map Ho. ] 000 Section ...7. 0. ....... Block ....... .1.2. ..... Lot ...... .2,~ ......... Subdivision ........... ~. ................... Filed Map No .... ~. ....Lot No .......... .~... conforms substantially to the Application for Building Permit heretofore filed in this office dated · ...Sg.p.~..e .m.b.e.r.. 3 ..... ,19 .8.5. pursuant to which Building Permit No .... .q .6.2.8.7..g ........... dated ..... .S.e.p..~ 9.m.b.e..r..1.6. ........ 19 .8.6., 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 ......... ·. ~r.~v.a..~.e..qn..e r.C.a.r?..~.3.y' .d..~.e.]_.3:. ~..rig.. ............................................. The certificate is issued to ............ E.O.~ $[LT..o.,..& .v. ............. (owner, i~.S~[ of the aforesaid building. Suffolk County Department of Health Approval ............. .8.5.-: S..0r.1.3' 8. .................. UNDERWRITERS CERTIFICATE NO ...................... .lq. 7. ~. 9.7.8.3. ................... Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWH HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby grante~d~to: ~ _ ..... ....... at premises located at ............................ ..~..-: ........... '.~ ........... County Tax Map No. 1000 Section ..... ..O....~..?. ........ Block .....J....'~T... ......... Lot No ......~..1~.. ............ pursuant to application dated ........ ..~.....~. ~.....~ ............ , 19.~.,~.~..., and approved by the Building Inspector. 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 BLDG. DEPT. , TOWN OF SOUTHOLD Instructions A, This application must be filled in typewriter OR ink, and submitted i~l/~ 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 comp{eted 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. Fees: 1, Certificate of occupancy $5,00 2, Certificate of occupancy on pre-existing dwelling 3, Copy of certificate of occupancy $1,00 4oVacant Land C.O. $5.00 $15.00 New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property .............. /. ...... House IVo, Street ' Hamlet .......... Owner or Owners of Property ...~.~.~./".~...~.~...'~,.f~.-~./.~(,[.~.. ' ' ~' County Tax Map No. 1000 Section 0 '?d Block ~.'~ Lot ~'~ Subdivision ........................... , ......Filed Map No ........... Lot No .............. Permit No. ~,. ~./.~. ?../~. ~ Date of Permit ,~.~<//.~.~?~.Applicant /~g;~. '.~.-~'...~ .~.~ ~/.~:~.,~'~2~//~,J(~ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... ..--~ Request for Temporary Certificate ..................... Final Certificate .....~.... ............. Fee S.bm,tted *. 7'? ......... Constrggtion on above described building and permit meets all applicable codes and regulations. J~ '--'V~:', .,~,,"h"2 ~' PP ' '~'~' ~":~~ ........ ' ............... %. THE NEW YORK BOARD OF FIRE UNDERWRITERS ~. 0 0~. ~ 7 5 BUREAU OF ELECTRICITY ~J~[ 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CE~IFIES THAT only the el~trical equipn~er~t ~ describ~ be~ and i~troduced by the applicant named on the above application ~ut~er i~ the preo~ises o~ Robert J, Haldas, Ch'ristoph~r St,~ P~.ne Neck ~ Oakwood, Southold~ i~ tho following ~gat/on; ~ Basen, ent X~ Ist FI. ~ 2nd FL See$~on Block Lot was examined on May 1 2 ~ ]. 9 8 6 and found to be Sn compli,nce w~t h the requiretnents of this Board. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES DRYERS FURNACE FUTURE APPLIANCE FEEDERS , TIME CLOCK! UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF .~EET SERVICE DISCONNECT S E C E OTHER APPARATUS: Motors - S~loke De'rector ~ ]. NO OF CC, COND, PER ~ R V I 2 Po O. Box 284 Laurel, N.¥,, 1,~..g45 GENERAL MANAGER 11 nG~ ~be aS~ere~ ~ an~ maaner; re*urn *e ?be off~ce o[ *~e ~r~ ~[ ~acarrect. ~nspec?ers ma~ be i~eafified~ bl *be~ TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-I 802 CERTIFICATION Building Permit No. Owner f'~O [gF-.ff.. /"' (please print) Plumber ~c.~/c~,~d //~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber' s signature) Sworn to before me this ~day of ~/ , 19~ . Notary Public, ~ N~'~ a~-y -pUblic ELIZABETH ANN NEVILLE ~NoOte~/Ptlbll~o State of New · 52-8126850, Suffolk Term EX~irea Octobm' 31, BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [] INSU~.LATION FRAMING ~]~-FINAL REMARKS: DATE 7(,S-~.#Z BUILDING DEPT. INSPECTION FOUNDATION "ST I: '] ROUGH PI. BG. [] FOUNDATION 2ND [~'~INSU~TION ,,-r~'~ [ ] FRAMING [ ] FINAL REMARKS: 7G5-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING REMARKS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. '~/]/FOUNDATION 2ND [ ] INSULATION [//~ FRAMING [ ] FINAL REMARKS: INSPECTOR 76S-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST ~ ROUGH PLBG; FOUNDATION ZND [ ] INSULATION FRAMING [ ] FINAL ,4, DATE ,/~ i~LD I~SFECTtON _DATE COMMENTS __ o u_~ D~_.T I_O_~ ._ / 1 s t > -,- ]' ___ ,, -- OUNDATION ( 2nd )~~ ~/~ /~ .~ ~o ,/ OUGII FRAME & ~' ' ' :NSULATION PER N.Y. ~~ STATE ENERGY _ cods FINAL ~,2 / ~ ~~~w~ ....... ' "' / / ADDITIONAL COMMENTS: -'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved .l.~.., 19~." Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT ~~'~PT~ T()Vdr~ ()F SOU i'HOLD Received ........... ,19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink ahd 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 or areasl and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. ' 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 shall 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 purpb'se whatever until ~ Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the i~suance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,..Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. / . (gignatufe'of applicant, or name, if a corporation) .Pr. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) cant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........ ~ .~ ~ ............ Plumber's License No ....... c\ O. ~..01 ........... Electrician's License No .... ~.'~...~ ,~..~. ........ Other Trade's License No ...................... Location of land on which proposed work will be done.. ~J ~..¢.,~)e'! .~ . .~.~., .~oP. '} .~. ~Y'~. , , '... House Number Street Hamlet County Tax Map No. 1000 Section .., .~.~ .l~. ........ Block ...... ~i'~[ ......... Lot ..... a~ ........... 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 .... X(Cx.%-o, xh.~...~..o,~xD~ ............................................. ..... ..... ~. ~.~ ~.~:. ,,, .......... 3. Nat re fifwork (check which ap icable): New Building ..... Addition .......... Alteration ......... RepaiF ... r,t~(~,l .~ ,, l}}~Removal .............. Demolition ............ Other Work ...... ' ....... · I (Desc qption) 4. Eat~at~d Cost... .~ ................... Fee ...................................... ,~ ~' (to be paid on filing this application) 5. If dwelling, number of dwelling units .... [. ......... Number of dwelling units on ea~ floor ................ If garage, number of cars ..... ~ 6. If business, commercial or mixe&l, occupancy specty nature and extent of each type of use .................. 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ................................. ....................... D~ensions of same structure wi~h alterations or additions: Front ................. Rear .................. Depth ~ HeiSt Number of Sto~es Dimensions of entire new construction Front . .~ .......... Rear ............... Depth ~ I ~l~ 9 Si fl I~ ' [~ .... ~ ........ pth ~'~ .................. . zeo ct:Front . .~ .... ~ ...... Re~ ............. e ................ 10. Date of Pureh~se ........... ~ .................. Na~eoEFo~erOwner .................... ... . ~.. .. 1 I. Zone or use district in which premises are ~tuated,, ~ ~ ~ ~ . 12. Does proposed construction violate any zo~ng law, ordinance or regulation: .............. , ............... ~ 13. Will lo~ be regraded .... ~,~, ..~, ,~,., ............ Will exceqs ill[bp re~ved ~,~re~es: Yes '~ 14. N~e of Owner of premises ~o~..~.~ 5... · Address ~ ~e~ .~ ~~o. ~%~,~5.g.~ .... ' N~e 0f Architect ..... , .... ] ................. Address .. ~ ..... , ..... ,',' ~ ... Phone No ................ N~e 6f Contractor , ~r~. ~.~.. Address .~3.~ .~)JJ... Phon, No. ~ GS. ~t .~ . P~T DIAGRAM Locate cle~ly ~d disfinctlg ~1.~ bu~d~gs, whe~er existing or proposed, ~d. indicate ~1 set-back d~ensions from property ~nes. ' ~ ' ' ' G~ve s~eet ~d block..number or description according to deed, ~d show street nines and ~dicate whether inte~or or Corner lot. ~ ~e~ /~g~[ ~ STATE OF NEW YORK, COUNTY OF ................. ' S.S ' being duly 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 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~performed in the manper set.forth in the application filed therewith. Sworn to ibefore me this . ............ ~.,0~... ...... day jof ............... 19 ~5~-... Notary PUblic, ..... ' (Signature of applicant) z u ~ · ~ Q Ox O < .~. The sewa~ ~iapo~a~and and found Engtneertn~ JU~ 11 198~ S'C I)E?T. OF Hk:AL1'H ~ z:.;~D~_!~~_ ~ODE~IC~, VAN RJY~:'~'(.~" ' , ~'~~ ..... , DESIGN #2505 © HOME PLANNERS, INC. TERRACE OCCUPANCY OR USE IS UNLAWflJL WITHOUT CERTIFICATE OF OCCUPANCY PLUMBER CERTIFICATION ON lEAD CONTENT BEFORE CERTIFICATE OF OCCUPANCY' SOLDER U.~ED IN WATER SUPPLy $I"~'TEM CAMVOT EXCEED 2/10 af 1~ IF. AD. APPROVED AS NOTED FEE:-'~- ~ ~ ' D't[ BYr ~ NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PE~ FOR THE FOLLOWING INSPECTIONS: 1 FOUNDATION ~WO REQUIRED FOR POUR~h CONCRETE 2 ROUGH FRAMING & PLUMBING 3. INSU~TION 4. RNAL CONSTRUC~ON MUST BE COMPL~E FOR C.O. ALL CONSTRUCTION SHALL ME~ THE REGUI~MENTS OF THE Y ~'ATE CONST~UC~¢~ON & ENEp~ ~ °f I1~ .K. or L only WALK-IN CLOSET MASTER BED RM, II°x 15© CL CL GATHERING 134 x 17© RAISED HEARTH ENTRY RM, <IT NOOK DINING 12© x 9© ON. DINING TERRACE CURB BED RM. ii© BED RM IO°x I PORCH 1366 SQ, FT, GARAGE HOME PLANNERS, INC. 23761 RESEARCH DRIVE, FARMINGTON HILLS, MICHIGAN 48024 I I U PRELIMINARY-- CHECKED APPROVED ~ VISIONS BY DATE NOTE~ j I -- d d ~A~,_~V,,_~ , ¢ ~ OL./L/D,&, ,CO,C/ II, RICHARD El. POLLMAN, DESIGNER · iRVING E. PALMQUIST, ARCHITECT HOME PLANNERS, INC. 2371~1 RES~AR(H DRIVE, FAKMJN(,TON HILLS, MI(HIGAN 48024 DESIGN NO. 2505 NO. OF ESECTIOt,.! //,./'TEE/0/~ /2 "I LP l tJ I I. J ~ --- 0 j, I /'-W.." C J 11' 4'" ~RELIMINARY CHECKED APPROVED S-~.C T / O /./ RICHARD B. POLLMAN, DESIGNER - IRVING E, PALMQUIST, ARCHITECT HOME PLANNERS, IN(;. 23761 RESEARCH DRIVE, FARMINGTON HILLS, MICHIGAN 48024 DESIGN NO 2505 .SHEET NO, OF 2 8 ]1 I I I I DATE RL~VI~ION~ BY NOTE: RICHARD B. POLLMAN, DESIGNER - IRVING E. PALMQUIST, ARCHITECT HOME PLANNERS, INC. 23761 RESEARCH DRIVE, FARMINGTON HILLS, MICHIGAN 48024 2505 ~HEET NO, OF