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Home My WebLink About13735-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.. Z~3597 Date July 5 85 addition. THIS CERTIFIES that the building ................................................ Ho~s970'e'dd Smith Dr±ye South Southold Location of Property Street Hamlet County Tax Map No. 1000 Section 76 .Block 3 .Lot q 6. Subdivision :c Filed Map No. ~c .Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated February 28 198..5 pursuant to which Building Permit No. '13755Z dated .... 1~. a..r.c.h..7. ................ 198.5.., 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 ......... ...~..~.d.~?.~. 9.~. ?...e.x3.~.~..~.n~. 9.~?.~. ~..~.~!:t ~ ¢?.~.! .~¢.~.. ............................ The certificate is issued to FIR. W.J. ]3USCItl~ (owner ,.,,~e-e~-t,~ee~) of the aforesaid building. Suffolk County Department of Health Approval ............. ~.../.~ .......................... N703582 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 1~O!1~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERA~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 13735' Z Permission is hereby granted tg:, . __ .............. ,o at premises located at .....~....?..~.....~.....~..~.....~ ..~.... County Tax Map No. 1000 Section .... ..C~.....-]....~. ...... Block ....... .~ .......... Lot No .....~...~...:.../. ...... ..~..'~. ~'"-~'~ , 197..~..'~, ond the pu~uant to application dat~ ....... ~ ........................ approv~ by Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted i~ ~ 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 featu res. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical instellation 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 $15.00 Date..~3~t~/, C./.. ~': · ! ....... New Building .. ~t,~.c~ .. ..... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ~u'?~ ~ Stmet HanTlet Owner or Owners of Property . ~. C:...~: .~.~.. f~'.~ ~ ...................... r i .1 County Tax ~ap No, 1000 Section ,.. ~ ,).~, ...... Block .... 5 ......... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit ,o. /..~.~),:~'.~.. Date of Permit . .Applicant .i~, .Oh .f).. Health Dept. Approval ........................ Labor Dept. Approval ........................ Unde~riters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .... Construction on above described building and pe, rmit meets all applica_,ble codes and regulations. .. , - ~ Applicant.~LfL~:L~), ~. '~"~--~'~' I 'f~' ' '~''' Rev. 10-10-78 100,t071 THE NEW YORK BOARD OF FIRE UNDERWRITERS ~1~ ~ ~' ~.CJ~85 BUREAU OF ELECTRICITY Date AU¢~Tt'/.:.~'~ JOHN STREET, NEW YORK, NEW ~ORK IOO.38 703582 THIS CERTIFIES THAT N only the electrical equipment as described belo~ and $~tt~duced by tho applicant ~med on the able application number in the premises of Rob~r~ Bu~chman~ Smith Dr. S., (Bertani Job)~ Sou~hold~ wasexamined°n~'~'~ ~-~ andfoundtobeincompliancewiththerequirementsofthisBoard. FIXTURE FIXTURES RANGES COOKING DECKS OVENS OUTLETS SWITCHES FLUORESCENT DRYERS FUTURE APPLIANCE FEEDERS UNIT HEATERS DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: S E R V I C NO. OF NEUTRALS A. WG OF NEUTRAL G & S Electric Box 215 . ,~ This ceriJficafe must nor be aJ*ered in any manner; return to the office o} the Boord if incorrect. Inspeeto$ mar be i~eniJ}Jed br fhelr cre~enfJaJs, TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because of the following reasons.<~d~O~ /~ An application for Certificate of Occupancy is not on file. /Z/ The check is outdated. /Z/ No final inspection has been made. No UnderwPiteps Ceptificate. Please contact our office on this matter. Thank you for your cooperation. Building Dept. TOWN OF SOUTHOLD OFFIC~ OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. / 3~3~ Owner ~)/~^. ~/~' '~' )/~(~e,f~C~ 9please print) (plgase print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Y ~plumber' s ' g Sworn to before me this Notary Public, county FIELD ~ NS~-~ECTION COMMENTS FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY FINAL ADDITIONAL COMMENTS: 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL,: 765-1802 Approved....~.~ . .o/t~.... 7.., 19 ~..~. Permit No.). ~U.~. ~ .~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 'tOWN OF SOUTHOLO 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 promises, 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, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. .... ~//,,/... ,~.~..~.z'~.. 2:g:,./_,-~.,~.e.. (Signature of applicant, or name, if a corporation) · ..... ........ (Mailing addre(s of applicant) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................. , .... t46 ' fihih'/ / ....................................... Name of owner of premises . . . Z'~.,~.. ~2.~ ~'7..~ ........................................... (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 No.. ,'(~.,~ ..... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. . .¢ ......... ........ ......... ............. House Number Street Hamlet County Tax Map No. 1000 Section ..... .~..'? .~ ....... Block ....... .~. ......... Lot ..... ]..67.: ./. ........ 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 .... t~)~...~.~.~... ~.'~/~.~. ................................ b. Intended use and occupancy.· .fff~..~(~ff;..~t ---- t~/~.,ff.~..~.. ~.~,.~ ~.. ::[.i,~ :'~;'i ":il ~ [')~;'~ .............. / 3. Nature of work (check which a~plicable): New Building ..... 'J ....'Addition . .V~'... .... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ~' ~ ~ "~ I (Description) 4. Estimated Cost ....-~.~),~ t~ ......................... Fee ...................................... ~' *'- (to be paid on filing this application) 5. If dwelling, number of dwelling [unit ........ 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 .................... '.. Height ........ r,7' ............ Number of Stories ........... .,...; 'r' 8. Dimensions of ent~re new construction: Front g'~' :~-* .. Rear ....~..'b:./ .7-.'4-..t.. Depth ...7... Height .... ~. ........ Number of Stories ........................................ 9. Size of lot: Front ~ pth .......... ~ ........... Rear ...................... De ...................... 10. Date of Purchase .......... , .................. Name of Former Owner ............................. 11. 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: Yes /~;No 14 Name of Owner of premises , Address Phone No Name of Architect . ....... q ................. Address ................... Phone No ............ ' .... Name Of Contractor ~.~./-~,. t~',...~..d..tg~.. Address ~/~..~ ...... Phone No..'"~tT'-:,d.~r~.~e~. ..... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimansions from property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW 3ZOl~ country OF.. .... S.S .................. ~ ............. being duly sworn, deposes ~d says that he is the applicant (Name of individual sig~ ~ng contract) above named. He is the..~f~. (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is du~y author~ed to perform or have perfo~ed the said work and to m~e and file this application;that ri statements centred ~ this application are true to the best of his ~owledge and belief; and that the work will be performed in the m~n~r set forth ~ the application filed therewith. Sworn to before.me this ................. day o ........... , (Signature of applicant)