HomeMy WebLinkAbout13943-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No..Z.1.3.6..3.6 .......... Date ....... M..a.y..!6. ................... 198.5..
THIS CERTIFIES that the building .D.e.c.k. ...........................................
Location of Property ... 7.3.6.5. .S.0.[I.~D..V.~.E?...Ay.E... .......... 5. O.??.H.0. L..D .........
House No. Street Hamlet
County Tax Map No. 1000 Section .0.5..9 ........ Block .... .0 .6 .........Lot ... 5.: .2 ...........
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore fried in this office dated
·.. H.a,y....1.4 ............ 19 .8.5. pursuant to which Building Permit No.. 1. .3.93.3. Z. .............
dated .. ~..ay.. 1. 4. ................... 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 .........
... £.c~ns l:r.uc t. ~..large~. ~l.e.c k..t.o..~..e.x $ ~.~.~g. p. qe.. family, dwellin....,., .g...... .
The certificate is issued to JOHN KRAMER & WIFE.
(owner, I(t~ril~l ltXtrtl~y~{~ X
of the aforesaid building.
Suffolk County Department of Health Approval ...... .N./. A. ................................
UNDERWRITERS CERTIFICATE NO ............. ?1./. A. .......................
Rev. 1/81
l~OBl~ NO. ~
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
13943 Z
Permission is hereby granted to:
~......~.~...~...,~Zi .....
~--~.~~...~....¥......LL.t~..,~ ...........
~.-..--..~~.~~.~ ..... ~,.,~.~,~.....~ ....
......... · ~ ............. r"';~'~*""~'"'~'~~~ ........... :'; .......... ; ..........
~, ,,,~,, ~,~ed ,, ..~.~.~......~.~.Z~....~.,....~~ ........
County Tax Map No. 1000 Section ..... .~...~.?....o) ..... Block ...... (;~).J,a ....... Lot No ......,~.:...~.,..; .....
pursuant to application dated ........... ~..(~.!..~................, 19.~.~.'.., and approved by the
Building Inspector.
Fee $..~....! .............
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
~%outhold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
~nstructions
in duplicate ~-
A. This application must be filled in typewriter OR ink, and submitted, , ',V, ?o'zhe 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 p~an 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, buildings and unusual natural or
topographic featu res.
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 preoare a certificate.
C. Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling $ :[5.0 0
3. Copy of certificate of occupancy $1,00
c.o.
Date
New Building ............. Old or Pre-existing Building ............ Vacant Land .............
Location of Property .......... 7.4. ×¥ .... .................
House No. Street Hamlet
Owner or Owners of Property ..........................................
County Tax Map No. 1000 Section ...... .d.~..~ .... Block ....(Q..~ ......... Lot .... .~:; ''~
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No ..... ~ Date of Permit ... Applicant . .. · .....
Health Dept. Approval ............ .~' ........... Labor Dept. Approval ...~. ....................
Underwriters Approval Planning Board Approval
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ .............................
Construction on above described building and perm~.~:;~eets all applic~b~e cj;~ies and re~l~l~ions.
Applicant . . ~~ ........
%' 1 E L'D INSFECTION COMMENTS
FOUNDATION (1st)
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
QODE
FINAL
ADDITIONAL COMMENTS:
)rr~erly
i~orie
vere,
HEAL'TH DEPARTI TO cONSTRUCT
~ NEAREST WATER MAIN~T M .+ ~-$OURSE OF WATER~ PRIVATE~PUBLtC
~su~.~co.T~a~om~ ' s~c~loN -, BLOCK- , LOT '
~THE~E,ARg NO DWE~WITHIN I00 FEET OF THIS ~RO~TY
OTHER THAN THOSE 8~OWN HEREON.
~ ~E WATER 8UPPLY ~ ~EW~ ~DDI8 POBAL S YBTEM FOR TH~ RESIDSNCE
· = SPIKE ' . -
'~THE ~T~N ~ WELL (~)[SE~IC T~K(ST)~ ~SP~LS (CP)SH~ HEREON
SURVEY FOR
RICHA/?D C. /?'ECf(MEYE£
TEST HOLE
top SO/'/
heavy
loam
lraces
of clay
AT SOUTHOI D DATE
TOWN OF SOUT:HOID SCALE:
SUFFOLK COUNTY, NEW YORK .NO.
~UNAUTHORIZED ALTERATION OR ADDITION TO THIS
~SURVE~ IS A VfOLATIQN~OF SECTION 7209 OFTHE
NEW YdRK STATE EDOCA~iON LAW,
~ COPIES OF TH B SURVEY NOT BEARING THE LAND
BUR~E~OR'S"INKED SEAL OR EMBOSSED SEAL SHALL
NOT BE CONSIDERED td EE,~ VA[~ID TRUE COPY
~GUARANTEES~INOICATED HEREON SHALL BUN ONLY TO
THE pERSON~EON wHOM THE B'URVEY IS PREPARED.
AND ON HIS'B~'H~LF TO THE TITLE COMPANY, GOVERN-
MENTAL 'AG.~CYAND ~END~NG INSTITU¥1DN LISTED
HEREON,AND TO. THE A~ESIGNEE$ OF THE LENDING
!NSTIT~T!ON. GUARANT~ES ARE NOT TRANSFERABLE.
TO ADDITIONAL INSTI/~UT~ONS OR SUBSEQUENT
OWNERS
~DI~TANCE$ sHOWN HEREON FROM PROPERTY LINES
'.TO E'XJSTING. S~TRUCTURES ARE FO~ A SPECIFIC
P~JRPO~E AR[i ARE Not TO, BE USED TO ESTABLISH
PROJBERTY LINES 'OR FO~ THE ERECTION OF FENCES.
APR.,29~ 1985
I' : 40~
: 85- ~zo
SOVTHOLO~ ~
,:',_ii[~:C,~:[.:,~,/UIN~.~ OI,TUUI~O * RIVERHEAD,NEw YORK.
-,- . ,
',~E. w. YOUNe,PROFESSlONAL ENgiNEER-
LAND sUrVeYOR N,~s;uccNs~ NOh~4~
' owARD
W. ~OUNG, LAND SURVEYOR':
.N.~8. ~ICEN~E NO. 45e93
FORM NO. 1
TOWN OF SOUTH
BUILDING D
Examined...~ .... !~.., 19~-~.''~
Approved · ..~.].~ I .t/..., 19.~.~.Permit No. .'
Disapproved a/c
(Building Inspector)
APPLICATION FOR BUILDING PERNIIT
.......... ,19...
Date .................. , 19...
~ 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
or a~eas, and giving a detailed description of layont of property must be drown 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 purpose whatever until g Certificate of Occupancy
shall 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
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, housi~d regulations, and to
admit authorized inspectors on premises and in building for necessary insp~~
......~~ /.~_z~-~...~.~ ............
~ap~h'cahB',7or nlYg~, ifa corpop:a,tion) //
(Mailingjdddress of applicant)
(Name and title of corporate officer)
Builder's License No ..........................
Plumber's License No .........................
Electrician's License No .......................
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
....... ~..6Q..~. F.~.. ............................................ ~ ....... ~I. ,I. >- .. ~ .....v~tl~.~..
~. .. _
N~e of owner of premises .~ ~.~
(as on the tax roll or lat~ ~, HI.qlNG ~E~MENT AT
if applicant is a corporation, signature of duly authorized officer. 765-.1 ¢e9 9 AM TO ~ PM FOR THE
FeLl ~ ~NG INSPECTIONS:
1. FOUNDATION - ~O REQUIRED
FOR POURED CONCRETE
2. 20[JGtq ~ FRAMING & PLUMBING
3. l¢lc[
4. F~'~ . COk,:STRUCT~ON MUST
BE C~MP~ rite FOR C. O.
ALL CONSTR~>C'TION SHALL MEET
THE RE~I'~R?MENTS OF THE N.Y.
STATUE CONSTRUCTION & ENERGY
Other T~ade's License No ............ ~,/~ CODES. NOT RESPONSIBLE FOR
.......... ~ ~, ~ D~IGN OR CONSJRUCTION ERRORS.
Location of land on which proposed work will be done...O~¢. 5~ ( ~(~. ~(q... ~ ..............
co,~ty ~a~ Uap ~o. ~000 S~io, ...... :~ ....... ~ock ...: ............. ro~..&. ~,= ...........
Subdivision ..................................... Filed Map No ............... Lot ............... (Name)
State existing use and occupancy of premises and intended use and occupancy of proposed const~ction:
a. Existing use and occupancy .~4../~....~?Sq~k~...~, .~.c,/..~.~4,,./¢~.~....~,Td.,~.._...~_.~. C~.~,~9 ....................
b. in,ended use and occ.pancy./. ...........
3. Nature of work (check which applicable): New Building ..... ' ..... Addition.. ~ Alteration
Repair Remo, 'al Demolition Other Work
(Description)
4, Estimated Cost ........... ~ ......................... Fee ......................................
'~' (to be paid on filing this application)
5. If dwelling, number of dwelling u nits ..... ./ ......... Number of dwelling units on each floor ................
If garage, number of cars ..... ~ ........... .......................................................
6. If,business, commercial or m~xedl occupancy, specify nature and extent of each type of use .....................
7. Dimensions of existing stmcture~, if any: Front .... .-x.~.q. ....... Rear . .' .~. ? ......... Depth :'.2< ,~72. ........
Height .... t~, ........ Number of Stories ..... ~ ..................................................
DimenSions of same stm,cture wi~h alterations or additions: Front ,..~..~ ........... Rear ...~(.~. .............
Ddpth .... ./~j~. '.~./.. ~ ....... !.. Height ... ~..~. ............... Number of Stories., ~ ..................
8. Dimen{ions of entire new construction: Front . .-fi', ,~, ......... Rear . ,_.._I~.... ~ .... Depth . ~ J ...........
Height .. ~ ....... Num~ber of Stories ~-. ~ .......................
9. Size of lot: Front . ../F~. O ..... ! ........... Rear .. ~.~..4; ............... Depth /.~2. f..~. r~.~ .~?..~ .........
10. Date of Purchase .../.~.X/~,. i ................. Name of Former Owner .'~'~lt~8~.n...-F.~.°.qT.~.~.lA .........
1 1 Z use district i which pm'mis ituated ~_/j~4'. ~.7 ~
· one or n es are fi , ~ ) .........................................
t2. Does proposed construction wolate any zomng law, ordinance or regulatmn: . ~ .......................... ~
13. Will lot be regrade~d . .4q ? ....................... Will excess fill be removed from premises: Yes (.__~t~
14. Name Of Owner 6f premises .~, c~ ~.l.q..gS.~..m..~. .... Address B4'P..~.~. ~.~c ./x. ,r~..'b.~... Phone No.)..~..-~, .].~.q~. .....
Name of Architect .,., ........... Address . Phone No ....... ~
Name of Contractor .-q..'Tr~'~, ~ .;C~.o.~. T,'r..zq~.~. ..... Afldress . ,~-Y~.TJC. t.~-H..~(.~... . 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 block~!number or description according to deed, and show street names and indicate whether
interior or
~orner lot.
(Signature of applicant~
STATE OF NEW YORK,
COUNTY OF ................
...... .'~-'y~..~..tx...~tC .~°VL~...'4'~7' · ................... being duly sworn, deposes and says that he is the applicant
(Name of individual ' ' '
s~gmng contract)
above named.
He is the
(Contractor, agen~,corporat~,~fficer, 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 ~11 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
Notary Public,~ ....