Loading...
HomeMy WebLinkAbout13783-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hale Southold, N.Y. Certificate Of Occupancy No. Z13998 Date Novem. b. er 12 ,19 85 THIS CERTIFIES that the building ....a.d.d..i.t.i.o.n.: .................................. Location of Property .... $.6.5 ................. .B.a.y, .A.v.e.: ............... . .Mg~.t.j:.~..u.c.k..' House No. Street Hamlet County Tax Map No. 1000 Section ..... ~.4.3 .... Block ........ .4. .....Lot 25 X X X Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... .Ma...:..c.h..~.5. ...... , 19 .8.5. pursuant to which Building Permit No ........ ~.3..7.8.~.Z. ....... dated ..... .M:a..:.c..h...2.5. ............ 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 ......... ....... ~.OO~A~,9~...~9..~.x.~. ~ .~.~.n.g.p.n.~.r .~.am%%y...~.e..~.~.~.n.g.. ....................... The certificate is issued to Violett Pannone ..................... io¥.'~;,'~ ...................... of the aforesaid building. Suffolk County Department of Health Approval .............. .~./A. ........................ UNDERWRITERS CERTIFICATE NO .... ~T? 3.5348 Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEP, MIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 13783 Z Permission is hereby granted t.(~. ~ .... .Y.~:~ ............. /...~ ............. .~.~..~'.......~..~...: .............. ~ ...... .~~.....~..:.~.:....u.~.~..~ Coun~ Tax Map No. 1000 Section .... J..~..~. ........ E~lock ...... ~ ............ Lot No...~.~.~.. .......... ..~~ ~ ,~.~.~ ~umuont to a~lication ~t~ .......... ~ ..................... , and app~ by the Buildl~ In~or. ~~ulldlng Inq~ctor Rev. 6/30/80 )LD 11971 OF OCCUPANCY A, This appl tor with ' 1. Final na:mral 2. Final al~roval 3. Approval of Dept. tions, a certificate of Code compl 5. Submit Planning Board approval and submitted ~ ~ to the Building Inspec- 3n of all buildings, property lines, streets, and unusual form or equal). =ire Underwriters. Residences and similar buildings and installa- ineer responsible for the building. requirements where appl!cable. 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 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 4.Vacant Land C.O. $5.00 New Building ............. Old or Pre-existing Building $15.00 ........ ...... Date ............ Vacant Land ............. House No. / . ~reet ~mlet Owner or Owners of Property ...... ~.4~ ~: .~.~:.~.~ ............. County Taxi~p No. 1000Section..'.~..~..~. .... Block ...... ~. ....... Lot .... .?.~.~.. ...... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.. ~..~.;~.~/~TDate of Permit .~/~.~T./~':~pplicant...~'.~. ~./:~.~...~.~.~/..~7'A/v'./~; ........ Health Dept. Approval ............ -~JJA ....... Labor Dept. Approval ................... ' "- Underwriters Approval .... ~..."TJ.~.~i .~...~.. ~.~. .... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..... ~ .......... Fee Submitted $ ~..C~.....V/.~... [ .~.~..~. ........ Construction on above descr bed building and permit meets all aaglicable codes and regulations '-~,~' ~7~[~ Applicant...~.~':..~-'~.~4~. ~'. ~~ ..................... Rev. 10-10-78 FIELD INSPECTION FOUNDATION FOUNDATION 2. ROUGH FRAME & PLUMBING (1st) (2nd) INSULATION FERN. Y. STATE ENERGY qODE FINAL COMMENTS o/'c -lot e O. ~ ADDITIONAL COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS ].0003~3 BUREAU OF ELECTRICITY ~ BB JOHN STREET. NEW YORK. NEW YORK 10038 THIS CERTIFIES THAT only t~ e~t~ ~uipment ~ ~ ~ ~ i~t~u~ by t~ ~p~ant ~ on t~ a~ ~pl~ation ~um~r in t~ p~m~es o~ J~ P~ne, ~ ~y Av~ue, ~tti~, N.Y. w~ exami~d on ~ ~ ~ ~ and found to be in compliance with the requirements of this Board. FIXTURE ~ RXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS ECEPTACLES SWITCHES FLUC~ESCENT 4 ~ 0 5 DRYERS FURNACE MOTORS FUTURE AFI~JANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. Of FEET SERVICE DISCONNECT S E R OTHER APPARATUS: 1-Smoke Detector Panelboards: 1-11cir. OF CC. COND. 9. C NO. OF HI-LEG OF HI-LEG Good~e Electric Cont. Inc. 7355 uatn Street ~att:Ltuck, N.Y. 11~o2 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. --~ __ ~CO~PY_I:O_ R _BUILDING DEP~AART~M_EN~T.~T_HI-B C~OP~Y _OF CE~RTIFI~CAT~EE M_US~T N_OT BE ALTERED IN ANY MANNER. Approved . .~... ~ · .~.?.., FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 19 Sx.~'. Permit No. ).~.-'1..~.~..~. Disapproved a/c ..................................... ............................... ....... (Building Inspector) APPLICATION FOR BUILDING PERMIT wN OF SOUr~OtO ~ Application No .................. 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 areas, 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 purpose whatever until a 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, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. AMERICAN EXTERl0RSsignature of applicant, or name, ifa corporation) P. O. BOX 667 MATrlTUCK, NEW YORK 11'952 ........................................... (516) 298-4625 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .......... UJ~~ .... .~/~J'XZ}q.0r-}~ ............................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... ~'.~.~.COff.."7 ........... Plumber s License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ................................................... House Number Sh'eet Hamlet County Tax Map No. I000 Section ..... /..~. i.~. ....... Block ..... .~. ........... Lot .... .~..r~. ........... 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 ....................................................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair ....... ,,. ~. ..... Removal .............. Demolition .............. Other Work ............... · " ' ~ (Description) 4. Estimated Cost ..... ~] .~... · .'~. ...................... Fee..~--.O. :.....-'"'~. .......................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ 6. If business, commercial or mixed 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 ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ Size of lot: Front ...................... Rear ...................... Depth ...................... Date of Purchase ............................. Name of Former Owner Zone or use district in which premises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ................................ Will lot be regraded ............................ Will excess f'fll be removed from premises: Yes No Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ I0. 11. 12. 13. 14. 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, COUNTY OF.. S.S ................................................. being duly sworn, 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 fife 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 fried therewith. Sworn to before me this ............ /.~..'..E~.. ..... day of ...... ~.~ ..... , 19 .fi'..5- Notary Public ......... ~ ."?~.....~.'..~.. · .~/..~. ounty NOL'~R¥ ~ u~-t' , """ cl . ............. (Signature of applicant) OCCU HC¥ OR .B .U. NLA ¥DL GF OCCUaH,CV. FEE-~' BY: ~'~' NO~I~Y ~tI~HING 9EPART~ENT AT -:P-- :L, ,E. V ATJ O N ,, "' ~: ~' "