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HomeMy WebLinkAbout14291-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z14491 Date .J. qn.9 .9 . .., 198..6 THIS CERTIFIES that the building One fami.l~f dwelling. Location of Property .. ~.0.Q .A.l.v.a.h.: s Lane .. Cutchogue Hou~ No. $~aet Hamlet County Tax Map No. 1000 Section ........... Block 0 2 .Lot 2 Subdiv~on ............................... Fried Map No ......... Lot No .............. con£otm$ substantially to the Application £ot Bu~d~g Permit hetctofote t'fled in this office dated June 7 8..5p h Building P 14~9. i $ ...................... 19. utsuant to whi¢ ennit No .................. date4 $gRt. q .~. 9.r...2.0 .............. 19.8.5., was L~ued, and ~onforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is L~ued is ......... Q%%~ ~u~.i.12f dwel. l~.n~. The certificate is issued to .. BERNARD &..E.L. IZABETH J. ROUSSEAU ................. ..................... of the aforesaid building. Suffolk County Department of Health Approval ...... 8. 5. .-.~.O.-: 8..3 ..... .M.a~.. 2. .7.,..1. 986 .. UNDERWRITERS CERTIFICATE NO N7472~7 April 30, 1986. PLUMBERS CERTIFICATE MAY 30, 1986 Building Impector RW.I~I FOI~[ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NM 14291 Z Permission is hereby granted to: ..~...o...~.~ .............................................................. ~ ~o, . i~.~..~.~.. . __. __ ~': .~.~ ..... , .... ,o ....... et pr*m:'~es located et .....'.~... ......................... .~ .................... ~ ............ County Tax Map No. 1000 Section ...... ]....0...~. ....... Block ....... .(~....~.. ..... Lot No ....... ~ ............. pursuant to application dated .... ....~..~..~.. ........................... , 19.~.?..., and approved by the Building Inspector. Building Insl~ctor Rev. 6/30/80 z00077z THE NEW YORK BOARD OF FIRE UNDERWRITERS ~]' BUREAU OF ELECTRICITY THIS CERTIFIES THAT × X FIXTURE OUTLETS EECEPTAC[E$ SWITCHES FIXTURES 40 3~ × [] 2nd Fl. Section Block Lot and fouttd to be in compliance with the requirements of this Board. RANGES OVENS DISH WASHERS EXHAUST DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS DIMMERS SYSTEMS NO. OF SERVICE DISCONNECT OTHER APPARATUS: Smoke Detector-1 S E R V I C E I I 1 Ru!and ~lec. Co. ?. O. Box 143 Hattitack, 11.952 GENEI~AL h certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be COPY FOR B '. THI ,IELD INSi~ECTION COMMENTS OUNDATION (1st) OUNDATION (2nd) !. OUGH FRAME & FLUMBING iNSULATION PER N. STATE ENERGY CODE ADDITIONAL COMMENTS: FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N~Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCS' BLDG. DEPT. TOWN OF SOUTHOLD Instructions A. This application must be filled in Wpewriter OR ink, and submitted m ~ 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 sit, ilar 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: I. 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. 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 5.Updated C.O. $15.00 Date~'~'~- ' //;f"J/../~....(~./../.~..~..~.. New Building ............. Did or Pre-existing Building ............ Vacant Land ............. · ocationofProperty.... ... .... ....... House No. Street -- ~/_ Ham/et Owner or Owners of Property .~~. , ~....~.~ .~.: . .~.~ County Tax Map No. 1000 Section ... ,/.~.f ........ Block ,~,c~. _~. _~,. .... Lot .... ,~, ....... '... Subdivision .............................. PermitNo.,...-...---..)~('~/Z- Date of Permit . . Health Dept. Approval ..................... .Filed Map No ........... Lot No .............. · 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 applicable codes and regulations. Applicant...2~.~~. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y, 11971 TEL. 765-1802 CERTIFICATION Building Permit No. /~ Owner (pleas~e print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. / v /~lumber' s signature) Sworn to before me this 19 ~{~ · Notary Public Notary Public, County NOTARY PUBLIC, St~ o~ ~L No. 4707878, Suffolk Counqj~ lerm Ex,res March c~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~eOUTHOLD, N.Y. 11971 TEL.'. 765d802 Approved . ~.., 19~.~.. Permit No ............ )isapproved a/c ..................................... Received ........... ,19.. .> (B~dlding Inspector) APPLICATION FOR BUILDING PERMIT i INSTRUCTIONS Ia. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 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 public stret ,r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this aPF ation. c. The work covered by this application may not be commenced before issuance of Building Pernfit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such pern 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 Occupan 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 t uilding Zone Ordinance of the Town of Southotd, Suffolk County, New York, and other applicable Laws, Ordinances [egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe .'he applicant agrees t(~ comply with all applicable laws, ordinances, buildinj~ code, h~ing code, and regulations, and altair-authorized inspectors on premises and in building for necessary inspe o (Signature~of applicant, or name, if a corporation) (Mailing address of applicant) gtate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buildt i ...... ....................... ; ................................................... ~ame of owner of premise~ff,~?~?.~. ~ .~. ........... ' (as on the tax roi1 or latest deed) f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plmnber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... · Location of land on which proposed work will be done ................................................ .... , 22 Az..Y. ........................ ltouse Num bet Street Hamlet County Tax Map No. 1000 Section .../.~.2 ......... 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 .. ~-'~/~.~.C.~'7. .......................................... 10. 11. 12. 13. 14. Nature of work (check which alppticable): New Building .......... Addition .......... Alteration ....... '... Repair Ren~oval Demolition Other Work (Description) Estimated Cost . ~.O./..a. O O .................. Fe ............................ '" (to be paid on filing this application) if dwelling, number o f dwelling tinits ............... Number of dwelling units on each floor If garage,~ -number o~' cars .... ~ ................................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... Dimerisions of existing structu).es,. , if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimehsions of same structure ~ith alt~ations or additioi~s: Front ................. Rear .................. De ~tll ................... ;... Height ........ ~ ............ Numbe~f Stories ...................... . , Dmmnsmns ol enttre new constructton Front ..... ~ ....... Rear ........... Depth .......... lteight ............... Nu~nber of Stories .. ~-. .... ~. ............................................. S,ze of lot: Front . ~..; ............ Rear...~ ............. Devth ...~ ............ Date of Purchase . .~. * ~d.~: ~ ............. Name of Former Owner ~~. ~~.. Zone or use district in which premises are situated .................................................... Does proposed construction vmlate any zoning law, ordinance or regulation: . .~ ......................... Will 10t be regraded .~.. 'i .. Will excess fill be removed from premises: ~es Namd of Owner of premises ~ ~¢~ ~ Address~~... Phone No. Name of Architect ...... ~ .: . ~ ............. Address .................... Phone No ................ Nmne of Contractor~ ~'~ ...... Addres~ ...... 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 bloc nualber or descriptio,n 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 si 'ning contract) above named. He is the ......................................................................................... (Contractor~ age,it, corporate, officer, etc.) of said owner or owners, and is dply authorized to perform or have performed tho said work and to make and file this :~pplication; that all statements contained in this applicatioh are true to the best of his knowledge and belief; and that the work will be performed in the manrier set forth in the application fil~d therewith. Sworn to before me this : .... day,;f ...... ........................ 19..J>.¢~ 'Notary Public ..... /~_g~¢. ~.../~..t/..~...~w. ....... County Hfl.[~, K. b[ V(Ih ....... (Signature of applicant) AFPROVED AS NOTED 6, 3, INSULATION 4, FINAL CONSTRUCTION MUST ~E COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET rile REQUIREMENTS OF THE N.Y STATE CONSTRUCTION & ENERGY CODES NOT RESPONSIBLE FOR DESIGn; OR.CONSTRUcTIO~ PLUMBER CERTIRCA TION ON LEAD COIffENT ~FORE CERTIFICATE OF OCCUPANCY OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIRCATE OF OCCUPANCY SOLDER USED IN WATER SUPPLY SYSTEM CANNOT EXCEED 2/10 el I~ LEAD. Mille K or L only J: I t L ....