HomeMy WebLinkAbout13717-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z14333 Date April 4
.................................................. 19 86
THIS CERTIFIES that the building ....... .~.e.W' .D.w.e.~. ~..i.n.c$. ..........................
Location of Property 600 Rosewood Dr. Mattituck
House No. Street Hamlet
County Tax Map No. 1000 Section 113 .Block 02 .Lot.. 018
Subdivision...R.o..s .e,qo..d..E.s.t.: ............. Filed Map No..5. 2. .4.0...Lot No .... 1. Q ........
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.... .F.e.b..r.u.a.r.¥...5 .... ,19 .8.5. pursuant to which Building Permit Nb .... .1.3.7.1. 7.z ...........
dated ...... .M.a..r.c.h....4 ............ 19 .8.5., was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which tiffs certificate is issued is .........
.... .--.'~77..~.e.¥. ?.r.~.¥.a.~.e...O.n.e..F. 9.m3,1.y' p.w. ql..1 $.n.~-. 7.~.i.r.s..t' .~.1. o. 9.r' .O..n.ly. ....
The certificate is issued to HORAK, ROBERT & PATRICIA
(owner,
of the aforesaid building.
Suft'o]k County Department of Health Approval ........ 1
UNDERWRITERS CERTIFICATE NO .... N 735656
Building Inspector
Rev· 1/81
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
13717 Z
Permission is hereby granted to:
ro ..... ~ ......... ~ ........,~ ~ ........................
ot ,rem,,~ Io~,,d ,.t ~~.....~.~ ...................
....................................... ...~..~....~,......~....~: ....... . ................................
¢oun~ To~ Map No. ZOO0 Se~,o, ..././...~. ....... :...,~,:~ ..~..,~,, ....... Ut No ..... ~Z'...~ .....
~.,~uo.~ to o,p,,~ot,o, do,d .~..,,~.......~ .......................... , ,~.,-;.d a~p,ove~ ~, t~,
Building Inspector.
Fee $....~
/Building Ir~pector
Rev. 6/30/80
FORM NO. 6
TOWN OF $OUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765- 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted .m I~==a~a~m 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 (pHo( [o April 1957), Non-conforming uses, or buildings and "pre-exist;ng"
land uses:
I. Accurate survey of pZoperty showing all property lines, streets, buildings and unusual natural or
topograph ic 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.
C. Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling $15 o 0 0
3. Copy of certificate of occupancy $1.00
4.woant and o.o. $ .oo
5 .Updated C.O. $15.00 Date ............
New Building ..... ~. ..... Old or Pre-existing Building ............ Vacant Land .............
Location of Property ................ .~-~.Z,~, .~?.~?, ,, ~¢ ................. .,~???. ,~',¢.,~,('
House No. Street Ham/et
Owner or Owners of Property .. ~.~.4~'..E../~../~.. ~...~../~./E../..¢'./'.~...,x.~..¢5~...~;~/..~' ..................
County Tax Map No. 1000 Section ....x/~..-~. ....... Block .... ~ ........ Lot ..... ./'..~. .......
Subdivision.. ~"~,~$~¢~...~*...~.z'~.~..~'.5. ..... Filed Map No..,~"?..~, .4~...Lot No....,~..C? .......
Permit No. ,,~'.,;?.~',/'Z~. Date of Permit .,~/: .,~/T.~.~'...Applicant .~/~., .~ .~....~z..~ .......
Health Dept. Approval ../~..~..~. ~?..'~2.~.-~. ~/. ....... Labor Dept. Approval ........................
Underwriters Approval .. ~'.../.'~7.. '.~/'. ~. ~, ....... .~.'.~l~'nning Board Approval ......................
Bequest for Temporary Certificate .....................Final Certificate ..... X ..............
Fee Submitted $ .... ~.'..~.. ................
Construction on above described building and permit meets all applicable cod~es and regulations,
CO~ ~/-~?, '~ ':'~ Applicant ..................
Rev. 10-10-7fl
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
8B JOHN STREET, NEW YORK, NEW YORK 10038
~..,,~..o.~o...~,,. N 735858
only the e~ctrical equipment as described belo~ and introduced 6~ the oppljcan~ ~ed on the able application number in the premises of
in the following location;,. ~ Basemer~t~,~ 1st FI.
FIXTURE
OUTLETS
DRYERS
~ECEPTACLES SWITCHES
FURNACE MOTORS
~ 2nd FI. Sectionl~'~ BIoc~~ Lot f318
FIXTURES RANGES ~ OVENS EXHAUST FANS
FUTURE APPLIANCE FEEDER!
TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
NO. OF FEET
SERVICE DISCONNECT
S E R
A W G NO OF HI-LEG
OF CC, CONO
3/0
AWG
OF Hi-LEG
OF NEUTRAL
Electric Roc~ fk~ter~ : 2-2.0kw~ ,=-l. Skw, 1-1,Okw, 1-~Skw~
~obart E1 Holm~k
P. O. Box.
Orec~port ~
This certificate must not be altered in any manner; return to the office of the Board if incor, rect. Inspector,s may be identified by their
GENEI~AL MANAGER
TOWN OF SOUI'HOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
CERTIFICATION
Building Permit No.
Owner /~z~~'~'~;~-
(please print)
Plumber /~/'
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
(plumber' s signature)
Sworn to before me this
Notary Public', ~ County
Notary Pub~ ic~
FIE .L~,
1.
INSPECTION
COMMENTS
FOUNDATION
1st)
FOUNDATION
2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
qODE
Yw
FINAL
ADDITIONAL COMMENTS:
BUILDING DElrr,
INSPECTION
FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING
[ ] FINAL
REMARKS:
INSPECTOR~, ~-, ,/-*- ~- :~
'FORM NO, 1
TOWN OF SOUTHOLD
· BUILDING DEPARTNIENT
, ' · TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-180:3
., I~...~'~;rmit No. [.
Received ........... ,19...
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
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 diagrain 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 kqspector will issued a Building Permit to the applicant. Such permit
shall be kept on the prernises 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.A .
(Signature of applicant, or name, if a corporation)
' ' (Mailing address of applicant)
State whether applidhnt is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
...~t,e.~..~.~. .....................................................................
Name of owner of';r~mises .~.~.,~.,~. ,~...~..~....~-..~.~,r.~. .~.~f'. .~. · .~..' · · .~.~..~, .~. · ............................
(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 ..........................
Plumber's License N'o ...... .~...~'.~.&...~-~.. .........
Electrician's License No.
Other Trade's License No ......................
I. Location of land on which proposed work will be done ...................... ~ ............................
.... / co ....... ...................
House Number Street Hamlet
County Tax Map No. 1000 Section //~'~ Block ~'~ Lot...t~../~..
Subdivision ....... ?.,~...~'..~-~..~..~......~.~..~.~..'~.'~..~. .... Filed Map No...~'..,~..~.t~. ..... Lot ... ~..~. ........
(Name)
2. State existing use and occupancy of premises and intended use and oc.cu~pancy of proposed construction:
a. Exis use and occupancy .................................................
b, Intended use and occupancy ...... -. ·:, ~..'~..~.,-,~. .......... .........
3, N,-~re of work (check which applicable): New Building ...... Addition .......... Alteration .........
? Repair .............. Remgval .............. Demolition .... ,,, ......... Other Work ....... ] ......
4. Estimated Cost ........ ~.~ ................. Fee.. ~...~...~. ...................
' q' (to bo p~d on filing this application)
5. If dwelliug, number of dwelling]units...~(~.. Number of dwelling units on each floor ................
If garage, number of cms .... [ ..................................................................
6. If business, commercial or mixed occupancy, specify nature and e~tent of each type of use ....................
7 I)~nensions of existing stmctures if any: Front '" ~Rear Depth
' tteight Number of Sto~es
Dimensions of same structure with alterations or additions: Front ................. Rear ..................
l)ep~ ................... ;.. Hei~xt ............ ~. · .~t ...... Number of Stories .................
l)~enslons of entire new construction. Eront .... ~ ......... Rear . .~Z ......... Depth . .~ ........
9. ~lze of lot. Front ..... ~. ~ ~., .......... Rear ....... ~. .......... Depth .... ~.~ .............
12 Does p oposed constructi 'olate a y zoning law ordinance or regular'
13. Will lot be regraded ....... ~ ................ Will excess fill be removed from premises: ~ Nc
14. Nme of Owner of premises ~..~. ~. Address ~..~ ~ Phone No. ~g.-~ ....
Nme of Architect ' Address Phone No
Nme of Contractor ........ ~ ................. Address ................... Phone[No ...............
Locate cle~ly ~d dist~ctly fll bufld~gs, whether existing or proposed, and, indicate fll set-0ack dfinensions from
property ~nes. Give street md block~ number or description according to deed, ~d show street nines ~d ~dicate whethe~
STA'II! OF NEW YORK, i S.S
COUNTY OF ................. :
............................ : ................... being duly sworn, deposes and says'that he is the applicanl
(Name of individual sighing 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 tlti.,
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 filed therewith.
Sworn to before me this
............ ~..~/II~ ..... day of .... .* ........... , 19 ..
N0ta, Public, ........ County
:.;~ X-. ......... '
NOTARY I'tJBLIC, State 01 New York
No. 470?8? Soflolk Cmmt~ ~
Im~ E~mres March 30, 19~ . .-[~lgnature Ri appnc~t)
REFERENCE,
I~ILED I-~4-69 ~IS MJI)~ IV0.$240
eUARANTEED TO,
VEYOR
?--., ., ,~RHE*(D, N.',', .....