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HomeMy WebLinkAbout13666-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Zf13530 Date June 28 .., 19 8.5. THIS CERTIFIES that the buildflag bedroom addition to dwellin~ Location of Property 340 Glenwood Road Cutchogue House Ho. Street Hamlet County Tax Map No. 1000 Section fl fl 0 ...Block 6 .Lot 5 Subdivision...~.a..v.a.~.??.e..l~.e.a..l~.y. .......... Filed Map No .... ?.~.9..Lot No............z~5 .. conforms substantially to the Application for Building Permit heretofore filed in this office dated .. ~.a.~.u.a.~.y. ?. ........, 19 .~?. pursuant to which Building Permit No. ~ 36GGZ dated ......... .J.a.n.u.a..~.7..9. ........ 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 ......... .... ~.~..~.o.o.m...~.~.%~.~.o~ .~.?..~.~.? .o¢~ .~..~?.?, .o.~..?~..~??.:[..~. ~?~l.~.~.~.. ........... The certificate is issued to AI~'Pd~D SS>IRO (o~ne~ of the aforesaid building. Suffolk County Department of Health Approval ............. .Nf.g.. ......................... N6980O5 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 FOII~ NO. B TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL, SOUTHOLD, N. ¥, BUILDING PERNIIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions Co This application must be filled in typewriter OR ink, and submitted in duplicate 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 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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 prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 / New Building ....... ~..... Old or Pre-existing Building ... i~ ....... Vacant Land ............. Cutchogue Location of Property ............ .~I~L0..G..],~TLw.qc~ d. ~Q~C~ ................................... House No. Street Ham/et Owner or Owners of Property . ~L~.f.~.¢? d, .Spi ro ............................................. County Tax Map No. 1000 Section ... ~ ,~.0 ........ Block ...0(~ .......... Lot...(~©~. ......... Subdw~s~on ,R, aya.b.o,~. ~-.e. al~b~. .............. Filed Map No .... p~9. · .Lot No..~. & ..~ ....... Permit No, ,3-,~(~,~, ,~, Date of Permit ~[,,/c)/~...Applicant . ~3~v[r.o~ p,t .~a~.t;~..~ ...... as ~gent foz~ Alfred S~iro Health Dept. Approval . .~o.~, ................... Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .. 3; ................... Fee Submitted $. ~...0.(! ............... - · · · .~,-~. ,~ C~n~tr;ction on above described building d~per~' mej~js~des and~ ) /// regulations, R~. 10.10-78 ( ~oo~os~ THE NEW YORK BOARD OF FIRE UNDERWRITERS D.~e J%~e 26, 1985 ~ppllcationNo. onfile 320521/85 N 698005 Dr. b'pizo, Gl~mood Rcl,, Cnti',ogue, N ¥ i,, tkeJollowlng location; ~ Basement [] Ist Ft. [] 2nd FI. Section Block Lot was exu,nined on ~'l. klrle 20 ~ 1 ~}85 and found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES DRYERS DISH WASHERS EXHAUST FANS OTHER APPARATUS: 1~ 1-~ Det~c~ S E R 'V I C E AWG. OF CC COND NO OF HI-LEG OF HI-LEO OF NEUTRAL Gary Dozoski 425 ~mnsell Lane C~tchogue, N ¥ 11935 Lic 2941 E This certificate must no1 be altered in any manner; return to the office of the Board if incorrect. Inspector~. may be by their credentials, 76S.'t 802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [~/ROUGH PLBG. Ci ] FO~NDATION~ .REMARKS.: 2ND [ ] INSULATION [ ~ FINAL FIELD INgFECT~ON COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL Yo ADDITIONAL COMMENTS: FORM NO. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN ~HALL SOUTHOLD, N.Y. '11971W TEL.: 765~1803 Examined~.... ~. ..... , 19 '~..~ ~ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No .................. ~ a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. Yb. 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 issue 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 buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If ap~ature of duly authorized officer. Plumber's License No ...... .~'. {? ............... Electrician's License No .... .A~. '.~. ............... Other Trade's License No .... ./~..~. .............. 1. Location of land on which proposed work will be done .............. .~'.~./.~.,?.~?.~.C>..C~....~..~( ................ House Number Street Hamlet County Tax Map No. 1000 Section ........ /].O ...... Block ...... ~ ........... Lot.....',~'. ............. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................. ' ................ .C.' .C~. ............................... b. Intended use and occupancy ...................... .?'. ....... ] .................................... 10. 11. 12. 13. 14. property lines. Give street and block interior or corner lot. Nature of work (check whi",d~ p~plicable): New Building .......... Addition ...... Alteration .......... : Repair .~.,.~..~1~, 6val ............ Demolition .............. O~erWork ............... (Description) Estim~lt~2~tOO8 t0~ ' (to be p~d on filing this application) If dwelling, number of dwelling Units ....... ~. ...... Number o f dwelling units on each floor ................ If garage, number of cars ..... I ................................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... D~ensions of existing structures, if any: Front .... ~.T.~ ....... Rear .... ~ ~ ( ..... Depth .... ~f ...... . ~t , . Height ............... Number of Stones .................... . ..... : .................. ..... =: ..... D~ensions of same structure with alterations or. additions: Front . ~O...~ Rear .... ~q. Depth ... ~e..~.q~...~.. Height .. ~ .~ ~ ..... Number of Stories .. ~. ~.~.~ .... D~en~ions of entire new const~ction: Front .... ~./ .... ~Z Rear .............. ~epth .... .... ~ ..... Height . .............. m~mber of Stories... ~ ~.. ~~ Z. ~..~. ~~... Size oflot: Front .... ........... Rear ..... ............ Depth .... ~ ................ Date of Purchase ............................. Name ~ Foyer Owner . .Z. g~.,. ~ ~ ....... Zone or use district in which pr~mises are situated ....... ~~ ............................ Does proposed construction vip!ate any zoning law, ordinance or regulation: .... ~ ........................ Will lot be regraded ....... ~ .;~0 ..... , .......... Will excess2ill be removed ffo~ premises: - Yes Name 0f Owner of premises [/~¢.d. ~(~ ...... Aaaress ~q S~.~d.~¢~one No.t/~ Name of Architect .......... ~ ................. Address .......... , ......'.~. Phone No ................ N~e of Contractor ~¢¢~P~m. Rq~. ~. ~. .... Aaa~ss %gC ~('. ~q~ ~, Phone No..ZOO.; 7 ~ PLOT DIAG~M Locate cle~ly ~d distinctly bulldogs, whether existing or proposed, ~d. indicate all set-back dimensions from number or description according to deed, and show street nines and indicate whether STATE OF NEW YORK, COUNTY OF ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. : He is the ...................... : ........ ~ .................................................. ~ntractor,~gent, corporate officer, etc.) of said owner or owners, and is duly at~orm or have performed the said work and to make and file this application; that all statements conthine0,&w4q~s 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 No 4/07878, S~ffo]lk Cotnlt~ C-.L£NVVO00 ROAD MAP OF LOTS 5UR VE YEti FOR --~. ~:Y~,~-~' ~. .. ~ ., .,,,~ ........... V, J,