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HomeMy WebLinkAbout13868-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N,Y. Certificate Of Occupancy Inground pool & fence THIS CERTIFIES that the building ................................................ 2675 Beebe Drive Cutchogue~ New York ~-- Location of Property House No. 103 S~et 026 Ham/et County Tax Map No. 1000 Section ............ Block ............... Lot .......... :'. ..... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated April 26 8..5 13868Z .... ,1.9. pnrsuant to which Building Permit No ...................... dated ../~.p.r. $ ~_..1.6, ............... 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 ......... Inground Swimming pool & fence as applied for. The certificate is issued to WESLEY J. SIMCHICK & MARYANN SIMCHICK ..................... × ................... of the aforesaid building. Suffolk County Department of Health Approval N / A UNDERWRITERS CERTIFICATE NO .................... N. 7. ] 3.4.3.~ ............... Rev. 1/81 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) N9 13868 Z County Tax Map No. 1000 Section ....... i...O...~ ...... Block ....... .1~..~. ....... lot No ..... .~...~....~. ....... pursuant ,o application dated ..... ..~.,~......~,..~. .................... , 19..~....~.'., and approved by the Building Inspector. Fee $ ....................... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Bu ilding Department Town Hall $outbold, N.Y. 11971 765- t802 APPUCATION FOR CERTIFICATE OF OCCUPANCY anstructions A. This application must be filled in typewriter OR ink, and submitted ~ ~ to the Building Inspec- tor with the following; for new buildings or new use: 1. Final ~rvey 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 ~werage 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 $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 5 · Updated C.O. $15.00 $15.00 Date ........ NewtOns t. vuc t±on Old or Pre-existing Building Vacant Land Location of Property '--~ £ - '~' '~ - ...................... L/.'.q .......... ' ....... /-louse No. Street Ham/et Owner or Owners of Property ...., ;.-,,-. .............................................. County Tax Ma.,p No. 1000 Section ../... ,,~ .... Block . .O .[[. ..... Lot.. ,~),~o ~ .... /~lW~,';~~ (~C~/(z' .d?- .......... Subd,v,s,on/~- ~'~.,/.. ('./..(. '( ,~/./. (;¥;, .(--(../~r. ......... Filed Map No. ~.~.' .?o~ ,Lot No... ~..~. ....... Permit No./..,-~.,,~.~ ,?J. Date of Permit ....L/-:/.~.,, .~.'~.App' '~' cant ,~..~..~.//.//. ,~ ..... (~,? /?. ............ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval Request for Temporary Cert f cate Fina~ Certificate Fee Submitted $ ............................. Construction on above described building an rmitff~eets ~1 appJ~cable co~[&s anff regulations. Applicant ................... Rev. 10-10-78 FIELD INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS i0011~ ~ OC~¥)b~T ].©, ].[.)~7 85 JOHN STREET, NEW YORK, NEW3~jB?~/~YORK THIS G~RTIFIES THAT only the electrical equipment as described below and int~duced by t~ applicant named on the above applicat~n number in the premises of wesl~] J~ S~.chick, Bc~be DrJ. V~ ~2d.'l~ ~-~cho~ in the/allowing location; ~,,Busement ~ 1st ri. ~ 2nd ~7. ~SidO SectionlOt~3 Block ~t 026 was examined on and found to be in compliance with the requirements of this Board. FIXTURE OUTLETS IECEPTACLES I 1 DRYERS FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS SYSTEMS E OTHER APPARATUS: S E R V I C NO. O~E RCC~CON D. AWG, OF CC, COND NO OF NEUTRALS OF NEUTRAL ¢~] .]~u'~ Electric 169 Bay Av~mue tI~nptc~ I~).y~ N.Y. GENEI~AL MANAGER Per This certificate must not~be altered in any manner;, return to the office of the Board if incorrect.. Inspectors may be ,~dentified by the r credentials. COPYFORBUILDINGDEPARTMENT. THISCOg¥O~CE itl' E' , TNOT b.~T~E~D~ ANY MANNER. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ~..1.l,.., 19~..~f. Approved .l.le.., 19~. ?. Permit No. / .~.~. ...... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ~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, bufl~iag-~ode, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary~r~pey,~.~, ~;%.~ 4 .... ,:: ....... :..., .... (Signat~l~ of applicant, or name~i.f--~corporarion) M. (Mailing address of~pplicant) ,~C.~/,. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... ..................................................................... ofi. . ............................................ Name of owner of premises ..... I~.-. (as on the t latest d~d) If applicant is a corporation, signature of duly authorized °ffice~rz-3 ~ :-)~ ra~ D m_ ._ . .90 tz .................................. . ............ ¢,> .~ .. ~ LU -~J ~ ~ ~t' .] ~U (,Name and title of corporate~/.t~ officer) ~*' 4I:~ !"~' .:)~ ~i' (f t? ,~ ,1~ ~ ~ ~ Builder s License No....~:~,. ................ " . : :7 Z -~i~ : r~ - .~ u ,. Plumber's License No ......................... C! ca :>: -h'; ;f ~ '~ 'i:: ':7:~9 ~ ~ 1. Location of land on which proposed work will be done ..... ~ .~.Z.~.¢) ....... '. 7..-:t'.~. u.~ .~ ~ ............. House Number Street Hamlet County Tax Map No. 1000 Section ....~.O. ~ ......... Block .... .O..~ .......... Lot...O...o~..~. ........... Subdivision/~...~.d. [E. ?.~.I(.E.'. 4~.~...L~./q.S.X..d4(/~6./f~d;.'~.~.-... Filed Map No..O~7~. ~. ...... Lot..~..~. .......... (Name) 2. State existing use and occupancy o.~remises and intended use and occupancy of proposed construction: a. Existing use and occupancy .~'7~-~~"..~~ ....... ,/ .......................................... b. Intended use and occupancy ¢~t,J~.~...~7~(~.~. [~-t.l~. ~....~/~... .................. o 9. 10. 11. 12. 13. 14. Nature ofwork (check which ~pplicable): New Building ..... ' ..... Addition .......... Alteratt~on .......... Repair .............. Removal .............. Demolition .............. Other Work ~:i¢.3[~c}~,~... (D escrlplTo'n') Estimated Cost ..... . ./..~.~..(~..,..~.c? ...... Fee ...................................... If dwelling, number of dwelling units.. If garage number of cars If business, commercial or mi~ed Dimension~ of ~xisting structu'res, if any Height .. ~ (.O .......... Dimensions of same structure Depth : Height Dimensions of entire new construction: Front Height ............... Nhmber of Stories.. ' Size ,of lot: Front ... [ ~.q~. !~. ............ Rear . Date of purchase ' (to be paid on filing this application) f. dwelling units on each floor "°ruse ....... i i'.i ....... '. ..... Depth ....... .... Rear .................. of Stories ...................... ...... Depth ............... Depth ...................... Zone or use district in which ~remises are situated .................. DoesI proposed construction violate any zoning law, ordinance or regulation: Will lot be regraded ....... ~ .... 2 ............... Will excess fill be removed from premises.'.~_ Yes _ N.o Name of Owner of premises03ll~.LJ~.~ .'w~.~tt~r.~. Address ~[J~'cI'~I~J ~. ..... Phone No.'./.~..L/..'x~.c~ ~ '7' Name of Architect6;~ .... _.. l ........... Address .... Phone No -- _ Name of Contractor~¢. g..(,~,d~/?..IL ........ Address '~IkJ ~'42-14~Br[25 ..... 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 bloc c number or description according to deed, and show street names and indicate whether interior or corner lot. / STATE OF NEW YORK, i COUNTY OF .i S.S being duly sworn deposes and says that he is the applicant ~ (Name ...... of mdw~duai 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 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 mann'er set forth in the application filed therewith. Sworn to before me this ........ ....... ...... Notary Public ........................ County/'"~"-') /] NOI'ARY PIJBLIC, St,ate d No~ York ................... I No 4707878,'St~¢folJ~ O00i~hl_ (Signature of applicant) !