HomeMy WebLinkAbout14297-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Sou(hold, N.Y.
Certificate Of Occupancy
No....~.lfi. q ~9 ........ Date ........ ~u..n.e..5. .................. 19.8.6.
THIS CERTIFIES that the building .r~ .e.~..f..9 .up.d...,..2.n.d...s.~.qr. 7' .~.d.d., ,..7.. ~..s.~..f..~.pp.r.
Location of Property ...ztqJ5 ........... 7.a. r0p.lq.J_.n.e. 9.1.a' l~d ......... Iqa~;L±tuck
Hou.ee No. Street ........... ~l~l'e~
County Tax Map No. 1000 Section .... 1. 2. ~ ..... Block ....... ~ ....... Lot .... 2.2. ...........
Subdivision ............ ~ .................. Filed Map No....X. .... Lot No .... .X .........
conforms substantially to the Application for Building Permit heretofore fried in this office dated
·..$ e p.~r~l~.e,r.. $ ..... ,19. ~35pursuant to which Building Permit No .... 1. .4.2.9.7. Z. ...........
dated .... $ e p.~.e ra ~.e.~.. ~ 3 .......... 19 ~ 5., was issued, and conforms to all of the requirement s
of the applicable provisions of the law. The occupancy for which this certificate is issued is .........
.... [~.e.~. f~.~c~.~j..~r~;. ~.nc~. ~ t. qr.¥..a.d.d. ~_.~.~q~., .~.nd r.e.m.o.d.p.~..!~..~..f.Z..o.o.r. .......
The certificate is issued to ................
(owner, ~q~q~'~,~ ......................
of the aforesaid building.
Suffolk County Department of Health Approval ................ i~/. ~. .......................
UNDERWRITERS CERTIFICATE NO .................... [17.6.9. 7. ~ ¢ ......................
Building Inspector
Rev. 1/81
ffO]B~ NO. lB
TO~N OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N~- 14297 Z
Permission is hereby granted to:
.......................
,o ~....~.~ ................... .;...~.~.4 ~...
et premises located at ...,~...~./....~.,~......~.~.~......~ .... .~... ..............
County Tax Map No. 1000 Section ....... /....~...~. ...... Block ....... ..O....~.. ..... Lot No......~...~ ..........
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
Instructions
A. This application must be filled in typewriter OR ink, and'submitted in duplicate 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.
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,,I and unus or
topographic features.
2, Sworn statement of owner or previous owner as to use, occupancy a
3. Date of any housing code or safety inspection of buildin ra-
tion required to prepare a certificate.
C. Fees:
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 . .~.a.~.c.b..:[.7. ,., .19,8.6. ........
New Building .... .~. ....... Old or Pre-existing Building ., ~ ...... Vacant Land .............
4415 p Mi ' Mattituck N.Y.
Location of Property . .C.a.m. .... n..e.o.l.a..R..d.. ...............................................,
House No. Street Ham/et
Owner or Owners of Property . .~.~.:..A.~,qo..~.d..S..t; .e.~.q .......................................
County Tax Map No. 1000 Section ., .~.2.3. ......... Block ...,5 ........... Lot...:~ ...........
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No. 1.4, .2.9.7..Z... Date of Permit .9./..2.3/.8.5..Applicant ...~.aD.~.g.e. ?.],~,~ .................
N/A N/A
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval Filed For, ~'~q(~i-~.~Planning Board Approval N/A
Request for Temporary Certificate ................. Final Certificate X
Fee Su bm itted $. :~..(~.'~. ~.~.'~.~..~. ~L--~I
Construction on above described building and permit meets all applicable codes and regulations.
'~l~,"~&b , ~C~I le .~> Applicant .........................
Rev, 10-10-78
THE NEW YORK BOARD OF FIRE UNDERWRITERS
10(}0663 BUREAU OF ELECTRICITY
~ 85 JOHN STREET, NEW YORK, NEW YORK 10038
on ,,e S"S/SS N 749782
THIS CERTIFIES THAT
only the electoral equipment as described bel~ and int~duced by the applicant named on the able application number in the premises of
Start Flis~tvnold ~ Dora Stern) Calnp }4ineo].a Rd,, ~attituck, N,Y,
was examined on May 1 2,19 8 6 ..d /o.,d to be ia compliaace with the requirements of this Board.
FIXTURE
OUTLETS
21
IECEPTACLES SWITCHES
35 28
DRYERS FURNACE MOTORS
FIXTURES RANGES COOKING DECKS OVENS
FUTURE APPLIANCE FEEDERS
TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
NO. OF FEET
SERVICE DISCONNECT
OTHER APPARATUS:
S E R V I C
NO OF CC, COND A W G / A W. G,
p~R ,ff OF CC. COND NO OF HI-LEG J OF HI-LEG
NO. OF NEUTRALS
OF NEUTRAL
Motors-l-1 HOP.,
Track Lighting4-0"- 2 lites, Slaoke Detectors-2, Elec, Water
Glenn Bradley
Box 383
Laurel,
must not
11 g 48 GENEiAL MAN.~GER
Per
any manner; return to the office of the Board if incorrect. Inspectors may be identified ~y ' ~"
their ~credentials.
'ARTMENT. ) IN ANY MANNER.
'iELD INS[:ECTION
'OUNDATION (1st)
COMMENTS
OUNDATION (2nd)
~UGH FRAME &
FLUMBING
,ULATION PER N. Y.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IS~,~ [, ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING ~,~FINAL
REMARKS: :~~ /
DATE
INSPECTOR
'FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
', TEL.: 765-1803
Examined .. ... i9 .d
Disapp~oved a/c .....................................
.. (Building Inspector)
~PPklC~TIO~ FO~ BHIk~I~G
INSTRUCTIONS
BLD~, DEPT·
TOW,N OF SOUTHOLD
Received ........... ,19.. ·
Date ................... 19...
I be filled in in ink and submitted to the Building Inspector, with 3
a,
This
application
must
completely
by
typewriter
or
ets of plans, accurate plot plan to scale. Fee according to schedule.
tab. 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-
tion.
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
~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 ail applicable laws, ordinances, building code, housing code, and regulations, and to
mit authorized inspectors on premises and in building for necessary inst~ctions. ~~~.~_ ~
(Si~t, or name, if a corporation)
...~.~ ~. . . O l&. .b'Ja,'n . R4 .... ./¢.~ f~.~./~. .
(Mailing address of applicant)
:ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.... .(r.~.n~.-..! .... .C~.nT.~.~.~.*..~.. .........................................
lame of owner of premises ~ OK1. O}0[... 3'... DO ~.~. .... 57.~..If'J0 .........................................
(as on the tax roll or latest deed)
applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No.
Plumber's License No.
Electrician's License No .... ~ .~..2 .............
Other Trade's License No../~ .~.O...~..(25&~. ! ....
Location of land on which proposed work will be done ..................................................
· .'/'-//s- ·
..... ~- O ..... nlmeo.l .~. ...... ..Pm4..: .......... ' ....... ~.~;.-r~..~ .......................
House Number Street Hamlet
County Tax Map No. 1000 Section ..... ! ~ ~ ........ Block °Z- 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 ........ ~0.~ .~../. ~0, .~ .......... /~. ....j ..............................
b. Intended use and occupancy ....................... .c~. -' .~...~,'~..~[ ,~,~.~ .~.. ........ .~ ....
3. Nature of work (check~hich:!abplicable): New Building ..... ':.... 'Addition.. ~.. .... Alteration . .-'~.. ......
' Repair . '.".3'.ii ~ '" q~ ' R~m°val .............. Demolition .............. Other Work ...............
4.' Estimated Cost ........................ Fee ...................................
~.~ ...... " (to be paid on filing this application)
5.If dwelling, number of dwelligg units... ~. ~1.0.~-.... Number of dwelling units on each floor ..............
If garage, number of cars ...~ .....................................................................
6. If business commercial or miked occupancy, specify nature and extent of each type of use .................
7. Dimensions of eFisting structures, if any Front .9.~.' ....... Rear ~. 9' .... Depth '~ ~.' ' .'
Height /..~. Namber of Stories O rL~-. ..... ' .................
Dunens~ons of same structure w~th alterations or add,~hons' Front ~ ....... Rear ,~ ~. .~.. . .
Depth . .cJ .... ~a ........ , ....Height ... ~./,e .............. Number of Stories 'T~O~ .......
Dimensions of entire new construction: Front ... ~..~.' ........ Rear .. ~...'7. '..~. ~: ..... Depth . .¥~. '..~..~: .....
l-l~igh* ~ ~, ~ ~t!mber of Stories 7~.t,o o , ..............
10. Dat~ ur as ~ ................ am ormer ncr ..... ~r.~Jil]il ............
11. Zone or use district in which premises are situated .....................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: .....~. .........................
13. Will lot be regraded ... ~ 0. ..................... Will excess fill be removed from nremises: Yes )dNo
14. ~ame ~f ~wner ~f ~remises~:rt}~jdr..? ~r~ ~7.~r~ Address~`~.~.a.~a~.~.~: .~ne N~.~.~ ~ ~ ~? ....
Name of Architect 00ha/..d-, l. Oe~ t S ...... Address ~a~;a.~4,..O.~llbO~..... Phone No. 2~.'.$~F/I ....
PLOT DIAGRAM
Locate clearly arid distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
STA'rE OF NEW YORK,
COUNTY OF S.S
.............................i. .................. being duly sworn, deposes and says that he is the applicant
(Name of individual sighing contract)
above named.
He is the .' .................... i ...................................................................
i (Contractor, agent, corporate officer, etc.) , .'
of said owner or owners, and is drily 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 manner set forth in the application filed therewith.
Sworn to before me this
............ ~.' ~f_xe; ...... day ~f ............... , 19
I HEI.EN IL DE VOE .....................
. II0~l~'/~UBLIC, ~tat~'0l Nm ~ ~] (Signature of applicant)
I Ro, 4707878, SuffQIk Couldyg'";
~ Term Eafdres
l
.¢
SOLDER USED IN WATER
SUPPLY SYSTEM CANNOT
EXCEED 2/10 of 1% LEAD.
PL U21¢Z~ER CEBT! FICA TLYOLV
ON LEAD CONTENq_' BEFORE
CERTIFICATE OF OCCUPANCIe
,t
,E
OCCUPANCY OR
· OF OCCUPANCY.
~ IJ copper tubing is used
~ for water distributing
~ sys em piping shall be
~ of lypeS_K or L onJ.y
3
1
!
I IL.O''
t
APPROVED AS NOTED
rEE:/Z$~Y BY: ¢, ¢/.-.
NOTI~ B~ J[LD]NG DEPARTMENT A~
1. FOUN~A,]ON - TWO REQUIRED
%__.MCMATIG
WOcO
fz.:~-ce kd-"= I'-0"
, //
T'fl~ C_A L WALL.
~kTT II--¢2~.~L~TIC3-4 (l~-I I~
NOF~Tk-i ~1 ,,.EVAT iON
ILO'.
I~'~ FELT
' E.'x'?.