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HomeMy WebLinkAbout14009-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building .... .a.d..~$.t3.qn.: ................................. Location of Property ..3.QQ9 ............. .~.e.~..v.e. gr.?: ............ .~?..e.~.%e.u..c~ ........ House No. Street Hamlet County Tax Map No. ] 000 Section ..... 3. 00 .... Block ....... $ ....... Lot ..... ~ ........... Subdivision ....... X . .Filed Map No. X .Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated May 28 198..5 g p 14009Z , pursuant to which Buildin ermit No. dated ..... .~ i%o.. ~ ................ 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 ......... ...A. qtgty~Li~grL .'q. 9.9.x.i. 8. g.i.n.g. 9.n.o.-: .f .a.m.i.]:Y..cl.~..1 .i.i.n. cj: ............................ The certificate is issued to . . HER.BERT K. HARREN & WIFE .................. io~;.'o;, ~ ...................... of the aforesaid building. Suffolk County Department of Health Approval .................. i}1. z/.A ..................... PENDXNG UNDERWRITERS CERTIFICATE NO .................................................. Rev. 1/81 Building Inspector 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) N-° 14009 Z Permission is hereby granted to: ....~...*..~....9..~..9. ................................................. .......... ..~...,~,~'~ ~,, o~ :,~0.,,,~ . ...... .~.~..~.~.r ....~...~~ .~ ............ ~ .................................. ; ........................... ,~ ,,,~i,, ,~,~,d ,~ ...~.~.~.~.....t..~.~.~......~., ....... ~..~ .................... County Tax Map No. 1000 Section ..... /..~ ....... Block ...... .(~..~. ........ Lot No ........ ~. ............ Building Inspector. Building Inspector 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 DEC 2 0 1985 BLDG. DEPT. TOWN OF SOUTHOLD Instructions A. This application must be filled in typewriter OR ink, and submitted .- mamma to the Building Inspec- tor with the following; for new buildings or new use: I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic featu res. 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 p~foperty 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- don required to prepare a certificate. Fees: I, Cerdficate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 $%5.00 4.Vacant Land C.O. $5.00 /.~..//~./~.3/ Date .......... New Building ............. Old or Pre-existing Building ...~... ..... Vacant Land ............. Location of Property . ._~...~.O,~ ............. ~...~.../,~.~... ~.~.d~ .......... /~..<~Z. ~...~./..T~'.O' House No. Street Ham/et Owner or Owners of Property .... County Tax Map No, 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./~..~..~.~. ?. Date of Permit ~./.~./~'pplicant..~.*.~..~.~../~.~..~./~..~. ¢..~.. ,J~.. Health Dept. Approval . "'zW: '?': ............. Labor Dept. Approval ....................... Underwriters Approval , ,XZ~'./,~. ,~5''~ .Planning Board Approva~ Request for Temporary Certificate ..................... Final Certificate ................... Fee Submitted $ ....... ~ P..~.... ,~..c~, .~.~.' .7 Construction on above described building agd permit meets all applicable codes and regulations. PP '/'f" ...................... Rev. 1Q-lQ-78 Fi~LD fNSFECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL COMMENTS ADDITIONAL COMMENTS: TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y~ 11971 TEL. 765-1802 BLDG. DEPT. TOWN OF SOUTHOLO CERTIFICATION Date Bull. ding Permit No./~OO Own e r.~_'~A~/~/ ~ (~lease print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber' s signature) Swor~o befor~me thi~ /9 nay of ~, Notary Public,~County Notary VERONICA ~. C/DONE NOTARY F'UBLIC. STATE OF NEI/t,"FOR/¢ ItlO, /~2-4661405 Q',J.,~L;FIED IN SUFFOLIf COUNTY COMA',/$$/ON £XP/RES MARCH 30, 19~ ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ..~..~. ..... , 19~..~./ Approved. _,~.~,t~lJ~..[~ .... , 19 ~.~.~Permit No. J. ~.0.O. cJ..~ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BLDG DEP TOWN OF ~OUT'~OLr) l~ece ±red ........... ,19... Date .... ~.-~-~/Z_ ~> . 19 ,~,~.~'~ ! a. Tltis 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 tiffs 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. AI~PLICATION 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. ..... .fi): ...... (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. Name of owner of premises. ~..'..~..~.~/~9.~..~ .A../'. .... .--.. ~...~.~...~..:. '..~...t~..'.' .'~.. ................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title ;f corporat~'~' ~ '~ ~i~ri ......... Builder's License No ..... ~..-~. ................. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done. ~./.~... ~?.-..~..~.~.... ~ .~.~. .... ./~..,.-~..7~-..7.~: ....... ...... . . ....... x'O .... House Number Street Hamlet County Tax Map No. 1000 Section ~.t~P. 0 ..--. ~.~.~.... Block .'.--'../ ............. Lot ..... .~. ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use ahd occupancy of premises and intended use and occupancy of proposed construction: / ................................. a. Existing use and occupancy . . ~. .......... r.. · b. Intended use and occupancy .... ,~)..~ ..... ~..~.~..~. 0.~..~ ,.~.';;/.~. '~., .~/~. ~ ~/.g . ..~ ~ © c: p....~2.~ · '~'~ ~ ~i~ ';;"~'; '/~ '~; ......... property lines. Give street and bloc interior or corner lot. 3. Nature of work (check which pplicable): New Building .... ' Addition Alteration Repair .............. Re'moral .............. Demolition .............. Other Work ............... ~ t~ (Description) 4. Estimated Cost ~.,,, ~, .~.o P. ~.. Fee ~'"~ .' ~ ' ~ (to be paid on filing this application) 5. It' dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mi~ed occupancy, specify nature and extent of each type of use ..................... 7 Dim~nsionsofexistingstruct~res if any: Front Rear Depth Height ............... Ndmber of Stories ........................................................ Dimensions of same structure lwith alterations or additions; Front ................. Rear .................. Depth ' Height Number of Stories 8. Dimensions of entire new construction: Front ......... : ..... Rear ............... Depth ............... Height ............... Nu~mber of Stories ...................................................... ;. 9. Size of lot: Front ....... ' Rear Depth ..... 10. Date of Purchase I Name of Former Owner ..... I 1. Zone or use district in which prem,ses' ' are situated. ................................................ ~. :. 12. Does proposed.construction violate any zoning law ordinance or regulation: f3. Will lot'be regraded .../~/.o. 1 ..................... Will excess fill be removed from premises: Yes 14. Name of Owner of premises ,~.z .,~z..,~::~.~,. g~.... Address ...,~..~. 7'-/T=: ...... Phone No ................ Name of Architect ........ : ............... Address ................... Phone No ................ Name of Contractor Z~.~.~'/.Z..~..~=J'.~.' i~:i ~i .,~: *~ddress.... ~ ~772:..-. ...... Phone No..i~..~. ~:-=~..~.2.~. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from ~ number or description according to deed, and show street names and indicate whether STATE OF NEW S S COUNTY OF ~ ..... ' ;~;hiv}~;Xl's};~i;;'cX;;;~;{ X'' ' being duly sworn, deposes and says that he is the applicant above named· He is the ~ ~ / ~. " (Contractor, agent, corporate officer, etc.) of said owner or ownem, ~d is d~ly authorized to perform or have perfomed the said work and to m~e ~d file this application; that ~1 statements contained ~ this application are true to the best of his knowledge and belief; and that the work w~l be perfomed in the m~n~r set forth in the application filed therewith. Sworn to ~efom me this ............ ~ ......... day qf ..... .~..~.... Notary Public, ...... ~. ~. ,~-~/A~.. ~ County ~7 /~ ~ ~ C.~ (Signature of/appheant) ................ .... ~ t 'OCCUPANCY OR '"~ USE: B ,~!~LAWFUL WJl'i-l~r (;[RI'iFICATE OF IICCUPANC¥ SOLDER ~,.: IN WATER SUPPLY $ i ~ z:M CANNOT .EXCEED 2/10 oj'1% LF~I.D. PL'UMBER CERTIF~CATIO~ ON LEAD CONTENT BEFORE CERTIFICATE OF OCCUPANCY I[ copper lubing is used for water distributing ~ system; piping shall be ,~:,:,:.!. -- 765-]802 9 AM TO 4 PM FOR FOLLOWING INSPECTIONS' 1. FOUNDATION - TWO REQUIRED FOR POUR'-D CONCRETE 2. ROUGH - FRAMING & PLUMBING 3, INSULATION 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. DESIGN OR CONSTRUCTION ERRORS. must be verihed On job site. .¸i %- T 'C ¥ ./- I The ~aftsman and/~r ~t~hit~c'~ s3all ~t~ I ..I //