HomeMy WebLinkAbout13820-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z15864 Date June 18~ 1987
THIS CERTIFIES that the building ....... i.n.g.rp.u.n.d.., p.o.q .1..&..f..e.n.c.e.: ...............
Location of Property ..... 7. ~ O .................. .L.e.q .ig.n' .A.v.e.. .......... ~.l.a.t.t..i.t.u. qk....
House No. Street Hamlet
County Tax Map No. 1000 Section ...... 1. z~ .2., .Block ........ .2 ......Lot ....... 1..3 ........
Subdivision ................ ~ ............. Filed Map No .... .x....Lot No ..... .X ........
conforms substantially to the Application for Building Permit heretofore filed in this office dated
March 29, 1985 13820Z
...................... pursuant to which Building Permit No ......................
April 1, 1985
dated ............................. 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 .........
Ingroun~ pool and fence.
The certificate is issued to JOHN K. & LORRAINE VAN RYSWYK
of the aforesaid building.
Suffolk County Department of Health Approval N/A
UNDERWRITERS CERTIFICATE NO ..... N 6 99 23 9
N/A
PLUMBERS CERTIFICATION DATED:
Building Inspector
Rev. 1/81
FOB.~ 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)
13820 Z Date ....
JO.. II 9..%'~--
,o
~": ....................... ~;';'~:;""'UP ........... :'"'"/~'"'_' ...... ~';f~'";F' ................................
ot premises located at ,.,I,..~.,.,~.,,.,~~.,,(~.,...,..~.~.1.~..f~.... ................................
-I .. . -- ~ ~
County Tax Map No. 1000 Section ..... ]....~. ............ Block ...................... Lot No .....i-.~ .............
pursuant to application dated ......~...O,~..,.~...~. .................. , 19..~...~..~., and approved by the
Building Inspector.
Fee $ .~..[..: ..............
Building Inspector
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765- 1802
:, ii/i: ~l l ~
~ TOWN O~~- 800 ~OLD
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted l~ to the Building Inspec-
tor with the following; for new buildings or new use:
I. Final survev of propertv 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, 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 $25.00 -- BUSINESS $50.00 ACCESSORY $I0.00
2. Certificate of occupancy on pre-existing dwei)ing $ 50.00
3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00
4.Vacant Land C.O. $ 20.00
5.Updated C.O. $ 50 .oo Date . .Z~a;y..2-~... 7.?..g.7
NewC°nstructi°n ...... Old or Pre-existing Building ............ Vacant Land .............
Location of Property .... ' .~.o?.O. ............ / ....................
House No. Street Ham/et
Owner or Owners of Property . '.~.~(~...//~,.¢. Lo.RiVAl. N('. .~.A.~'.~?.~,~.k
County Tax Map No. 1000 Section .. t.z'Z.~. Block ~'- Lot ...... [~..
Subdivision ................................. Filed Map No ........... Lot No ..............
Perm it N o,/~ ~°.2, ~. ~.. Date of Permit ~/t~,~ .3.. ,/q¢.~plicant ....... V,A.~.~.~./~..~..~.~6t4Z./[.~.~.~,
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Construction on above described building an~Yp~it/~l ,a~p{[c b~[e codes~d retaliations.
~ .... pp · · · ~, ~ .~../..t.. ,/>...~ ~ .%~. ~ ...............
,/ / /
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
This is to advise you that the job under building
permit no. 13820Z issued to John VanRyswym
on 4/I/85 for Accessory is completed
a final inspection has ( ) has not ( X ) been done.
and
In order to complete this file, it is necessary Chat
a Certificate of Occupancy be issued. Please fill out the
enclpsed form, return same to the above office with a check
for $I0.00 'payable to the Town of Southold. Please indicate
to Whom the Certificate of Occupancy is to be mailed, and
arrange with this office for an inspection date
Occupancy or use is unlawful without a Certificate of
Occupancy. Please help us to clear up this matter so that
legal action does not have to be taken.
Thank you for your prompt attention,
Victor Lessard
Executive Administrator
VL:gar
encl.
FIELD INSPECTION
FOUNDATION
(1st)
FOUNDATION
2.
(2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
~ODE
YJ
FINAL
COMMENTS
ADDITION^L COMMENTS · I'mm~
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION ZND [ ] INSULATION
FRAMING ~INAL
70S.380~Z
BUILDING DEPT.
INSPECTION
REMARKS:
FOUNDATION XST [ ] ROUGH PLBG.
FOUNDATION ZND [ ] I/NSULATION
/
FRAMING [~ FINAL
THE NEW YORK BOARD OF FIRE uNDERWRITERS
100'138[ BUREAU OF ELECTRICITY J ,~' ~,~ O '%L
~hg ES JOHH STREET, NEW YORK, NEW YO~K 1OO~B
~ ~ ~o, ~ ~,,~.,o.~o.~,,~ ~4o~s/~s N 699239
THIS CERTIFIES THAT
onty the electrical equlpmen~ as described below and introduced by t~ applicant named on the abo~e application number in the premises of
John ~ R~e~k, 780 La~o~ ~v~n~ ~a~u~k, ~
in the~following location; ~ Basement
wasexa,ninedon Jt3T~e 27~ [985
1 I ~ 1
DRYERS
~ 1st FI. ~ 2nd Fl. Section Block Lot
and found to be in compliance with the requirements of this Board.
FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS
FURNACE MOTORS FUTURE APPLIANCE FEEDERS
TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
NO. OF FEET
SERVICE DISCONNECT S E R V I C
NO OF CC, COND
PER ,l~
CC. COND,
NO OF HI LEG
NO. OF NEUTRALS
AWG
OF NEUTRAL
. (~W.I.J4MIN~G__~_OOL~) TH ~S
O~~ U~U~UAL ~[{VIRO~[qT~ I~ I$ ADV~A~L~ TO ~A~ F~Q~I~ ~'£ A~D/OR R~PAIP~ MAD~ BY A
QUALIFIED
Jody ~umtllo
~at Lane
~attttuck, NY 11952 Li~#2500
This certificate must not be altered in any manner; return to the office of the Board if incorrect.
i' be identified by their credentials.
C0,¥~OR ~J[LDING o~epA.tMENT. THI~ COPY OF~ ~I ANY MANNER,
'FORM NO. 1
TOWN OF SOUTHOLD ~r
BUILDING DEPARTMENT
TOWN HALL
~OUTHOLD, N.Y. 11971
TEL.: 765-1802
., 19 .s.
E×amlned ......
.~.~... J..., 19~. 5/. Pe~it No. / ~ ~ ~ ~
Approved
Disapproved a/c .....................................
(Build~g Inspector)
~P~klC~TIO~ FO~ BUIk~I~G P~MIT
INSTRUCTIONS
Received ........... ,19...
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 1S 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, bui/ld~,~ code, housing c. ode, and regulations, and to
admit authorized inspectors on premises and in building for necessary, in~'~°~'~'~' ff.~ //r---- -.~...~..~:.-...-'m,-~-.,,_- ~ .,-~-...~.~ ·
(Signature of applicant, or name,, itr~f corporation)
· &?~....q~...w//o~e....~.z~r~ .~
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.................. .U~.~r-~t .c..~.K ..............................................................
Name of owner o f premises ....... ~..ffd ..... ~/~ ./1~..gy~,q¢. ~./<' .........................................
(as on the tax roll or latest deed)
If ap/~i~ is a corpor~,~on,~duly authorized officer.
.... (Name and title ~ ~;~p--o~i~ ;~h~;r') .........
Builder's License No ........ ./.O. ...............
Plmnber's License No .........................
Electrician's License No...~.~.~..~..~.. fl~.n~...~. ~Z~C~IC,.. ~,O,
Other Trade's License No ......................
Location of land on which proposed work will be done ....... /~ J~-~..~. ].~.~. ...........................
........ 7. 2...o. ............ z. ~. o. o~. ..... ~.~.~ , ......... ./R. .r~.r. r:.z~t:¢'. . .~.,x. : . .~. : P.'. ./.,~, .c~..
House Number Street Hamlet
County Tax Map No. 1000 Section ...... [ .~. · .~. · ..... 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 .............. .~.~../~..Z..-~q F./.~(- .......................................
b. Intended rise and occupancy .............. ~'.TJffi,Z~SJ~/./-./..~. .....................................
3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteration ..........
Repair . 'c.' .......... Ren3°val .............. Demolition .............. Other Work
4. ]Estimated Cost.. 1~' ?. ~. . . · 'i' ......................... Fee ......... ' ...........................
i ~" (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 ................... i.. · Height ...................... Number of Stories ......................
8. Dimensions of entire new consVuction: Front ............... Rear ............... Depth ...............
Height ............... Number of Stories ........................................................
9. Size of lot: Front .......... i ............ Rear ...................... Depth ......................
10. Date of Purchase .......... ~ ................... Name of Former Owner .............................
1 1. 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 ...... ~ ................. Will excess fill be removed from premises: {~ No
14. Name of Owner of premises ~q~...U&/J.~)'.f.o.~[('... Address ~t~4~.. diff..'.//t~ff/g'./4~Phone No ................
Name of Architect .......... i .................. Address ................... 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 corner lot.
STATE OF NEW Yg~K,ff/' fl/d o o
...' .... ~t/~.~..'/1..../L~.-~..q(....~.., ............. being duly sworn, deposes and says that he is the applicant
(Name of individual siglning contract)
above named.
He is the ............. .~O~/-74L/q' ~ .............................................................
: : (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 file this
application; that all statements con;rained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manfier set forth in the application filed therewith.
Sworn to before me this
................. .~. · .~./~ .day ?f. ~. ~.. · .~.. ....... 19~.~"~-
Notary Public, .......
..... ..... : ....
Com~. ~,'~, ~,~h ~0, ~*-- ! ~ (~ature of apphcant)
,0
FOI_I O'A/~NG [~:
1. FOUFF~/~)N - nW9 RFQLJ~RED
FOq ~J[V~D CON('RET.~
2. R~Gtl - FRAM:N', ,~ P~ U/,.AqING
~ B~ C'''''~ E-'C F::R C. O,
ALL CQNq~'qUCTION S',-~A! l. M. FET
-l'HE R. FOIHREMF~Nq'S OF TIIE N Y.
'STATE CONSTRUCTION & ENERGY
CODES· NOT RESPONSibLE FOR
DESIGN OR CONSTRUCTION ERRORS.
bf.6\°~
( 0
AP: ..... :~D AS NOTED
2 F'nlJ,-'l FPAMINC ~ PLUMBING
YOUNG ~ YOU~IG
l~dr/~nus VanRyswy~