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HomeMy WebLinkAbout13946-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.~.1~144 .......... Date ..... .J.a. n. .u .a .rX ..1.0 ............... , l~.6,. THIS CERTIFIES that the building -.., .n.e.~...Q'~..e.~J: ~.ng. ............................... Location of Property . 180 .................... ~.e.p.e.e..?.r.~.&]: ............. S.o.u.~.h..old House No. Street h~nie~ County Tax Map No. ] 000 Section .... 087 ..... Block .... 02 ......... Lot...0.~ 0 ........... Subdivision .... ~lunn~kom~..h/ate.rs ........ Filed Map No...5126..Lot No... 11 ...... ... conforms substantially to the Application for Building Permit heretofore f'ded in this office dated ..... · A~I;~LJ-..J,~ ...... , 19 8,5. pursuant to which Building Permit No...1,39.~..z ........... dated ......... ~¥..J.~ ............ 19~5., 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 ......... .... ~} .l~r iyia, t;e. one, ~lraiJ. y..Oaellinqj ......................................... The certificate is issued toDONALD & JEAN DEaN ..................... i o¥,,'o 'r.;,;,,'O ...................... of the aforesaid building. Suffolk County Department of Health Approval . 85.-~Q.-.5.2,1/2,/86~ .S. tephan..~o..C, os.t~ ~. P. E. UNDERWRITERS CERTIFICATE NO. N 714479 Plumber's Certification 10/23/85 Rev. 1/81 Building Inspector 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) 13946 Z Permission is hereby granted to: .~ ..... ~/~.~..~,Z~ ....... ..... ~.o.....&l~.~...Z~.: ....................... ...... ........ .......... ,o ..... E(o~..~ .~.~c..T......O~..~...~,~r~.....~=.~'Z..~.,.~.~....~.~... .................... ..................... ..~.~..~..~.,_. ....... .~,~... ........ .L...i .................................. et premises located at ...... ~..~...~.. ......... './.~.......~/'~.Z'.~,.., ............................................. z ,~,v.,s,~ ~o~.,~...~...~, .,d~....... ~o-.z ~.. .................... -~- ~ z.. ~....././. ................... County Tax Map No. 1000 Section ...~..~. ...... Block ....~.. .......>~Lot No.....0..~....~.. ........ pursuant to opplication dated ..... A~....~'~:~. ...... .~.'~. ............. , 1~...~,,.,, and approved b, the Building Inspector. Building In.q~ector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter 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 simitar 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 pz~perty showing all property lines, streets, buildings and unusua~ 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 3. Copy of certificate of occupancy $1.00 $15.00 4.Vacant Land C.O. $5.00 ~.~. Date /~¢-~z<. , .~../ ........ New Building ...~ ...... Old or Pre-existing BuiJding ............~Vacant Land ............. Location of Property ./~... ~;~. Ham/et House No. Street qwner or Owners of Property..~~.~ ................................... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Perm t No. .. Date of Permit , cant ................. Health Dept. Approval . ~ J o - ~ .Labor Dept. Approval Unde~riters Approval .. ~/,~.~ ........... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..... ~ ............... , su m 5, ...... Construction on above described building and per,c~il~ meets all applicable codes and regulations. Applicant . ; .~,~"-~,.. .~ .......... ' .............. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. (please print) Plumber <~ -r~/'~/ Q (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (p~ber s signature) Sworn to before me this ~ day of ~ , 19 Notary Public,~d~ County Notary Public NOTA~ PUGLIC, Stale of New Yerk Ne. 4707878, Suffolk CeuoW.~ Term Expires March 30, THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~'~9' 85 JOHN STREET, NEW YORK, NEW YORK 10038 · Date (]IC~.O~)C ~,~ ~ ~.985 2pplication No. on file 34222~/05 T..S C~.T,~.~S T.*T N 714 4 7 9 only the electrical equipment ~ described below ar~ Jntroduc~ by the applicant named on 'the above application number in the prem~es of was examined on 00~0~0:~ 2~ t ~,~8~ and found to be in compliance with the requirements of this Board. OUTLETS RECEPTACLES SWITCHES EXHAUST FANS FLUORESCENT VAPOR DRYERS FURNACE APPLIANCE FEEDERS TIME CLOCK.~ UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: S E R V I C E NO O COND OF CC, COND. OF HI-lEG 2/0 2-Smoke de~eo'Coz's AW, G, OF NEUTRAL P.Oo ~o~ 143 ~tti~uck~ ~Y 119~2 Lio~24~ GENERAL ~NAGER /' Per not b~ ol~r~d in ~ny m~nner; r~tarn to *h~ off}ce of ~h~ BOard i~ {ncorred. [nsp~c*ors moy be ~d~ntified by ~h~ir 'IELD INSPECTION COMMENTS 'OUNDATION (1st) ~OUNDATION ( 2nd ) OUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 ~____..-.~ Disapproved a/c ..... ~ .... . ................. (Building Inspector) BLDG, OEP'r. TOWN OF SOUTHOLD Received ........... ,19... APPLICATION FOR BUILDING PERMIT Date .......... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ~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 streets ~r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. c. Thc work covered by this application may not be commenced before issuance of Bu//ding 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 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 ~dmit authorized inspectors on premises and in building for necessary irc~pe~tions, p ~ , /fl .... ....... " (Signature _of appkfcant, or name, if a cO~poration) (Mailing address of applicant) >tate whether apphcant ~s/~vner, lessee, agent, architect, en~neer, general contractor, elecmcmn, plumber or b flder. ................... ./O. .............................................................. Iame of owner of premises.. D.O~ {~. [~..~...~..~. I~...~..~'..~..~.. ........................................ (as on the tax roll or latest deed) f applicant is ~, signatU~ o,,l~lu~authorized of~,~er. ..... (Name and title of corporate officer) Builder's License No .......................... Plumber's License No. ~It~. · . ~/th~. Electrician's License No..~.~1,~.~ .~ Other Trade's License No .................... i.~ Location of land on which proposed work will be done...~..'~...~.~../.~l~..~.~. .............................. ...........................................................-- ................... House Number Street Hamlet ~) ...~. Lot ~O County Tax Maple. 1000 Section .................. Block ............................... 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 ...~,...~.~..¢ , ...... ~t..~'~t/.l~. ~ .............................. 3. Natureofw0rk(checkwhich pplicable): New Building ......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost ....... , .~. ~ ............... Fee .................................... i' '-' (to be paid on filing this application) , ! 5. If dwelling, number of dwellin~ units .............. Number of dwelling units on each floor ................ If garage, number of cars ... i .................................................................... 6. If business, commercial or mixted occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any Front ............... Rear .............. Depth ............... Height Number of Stories ~. Dimensions of same structure with alterations or additions: Front .... ~.O. ......... Rear ...~..~. ....... 8. Dimensions of entire new conitruction: Front ............... Rear ............... Depth.. .............. Height ............... Nulrnber of Stories ........................... 10. Date of Purchase .. '-"~ Name of Former Owner . ~ .......................... 11. Zone or use district in which premises are situated 12. oes!proposed construction viiolate any zoning law, ordinance or regulation: ............................. 13. Will lot be regraded ..... J~ ~ ,~ ........... ~ ...... Will excess fill be removed' from premises: Yes Name of Architect . .t., . . 'r ...... '~ .~ Address ........... ~tJ-, ~l~n~o . . Name of Contractor ~t. t~.t'~/.~..~.*itO~ .~.0-~. Address ~..~..[~',.~., ...... Phone 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 corner lot, STATE OF NEW YORK, S.S COUNTY OF ~ .............. . ........... ~.O.{} .~.~?. · .~.: · ~'~' ~.19 .~. [ [ being duly sworn, deposes and says that he is the applicant (Name of individual slgmng contract) above named. 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 application;that all statements cor~tained 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 ..................... YO ..~ ............ 19... IltJ([ Pb[/I.l(,, State et Now vet& .............................................. f¥o 4707878, ~t, fl0lk C0un / (Signature of applicant) 0 o · 54' u ~J, At~,~, ~g ..D..~.#~~ ~e se~a~e disposal and water supply facl'litiea for tb'~s loc~t' on have been in~e~ted by this d~pd.rtmsD% ~d fo~d .] SOLDER USEITIN WATER SUPPLY sYSTEM CANNOT EXCEED £/lO oJ' 1% L~AD. copper tubing is used [or water distributing s,/s~erni piping sha~i be oJ types~ ~p.~P,l?'V£.~. AS NOTED NOTIFY BUILDING D~pARTM~NT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: ]. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - F~MING & PLUMBING 3. INSU~TION 4. FINAL - CON'STRUCTION MUST BE COMPLETE FOR C. O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR D~IGN OR CONSTRUCTION ERRORS.