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HomeMy WebLinkAbout14366-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22219 Date MARCH 26~ 1993 THIS CERTIFIES that the building ALTERATION Location of Property 10095 (IA) MAIN ROAD MATTITUCK~ N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 142 Block 1 Lot 26 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 9~ 1985 pursuant to which Building Permit No. 14366-Z dated OCTOBER 16~ 1985 was issued, and conforms to all of the requirements of the applicable previsions of the law. The occupancy for which this certificate is issued is ALTERATION TO STORE ~IA FOR O~'~'ICE SPACE The certificate is issued to ALAN A. CARDINAr.~ (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED S/A N-715914 - NOVEMBER 6~ 1985 N/A Building Inspector 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) No_ County Tax Mop No. 1000 Section .... ./...~....~. ...... Block .....~../. ........... Lot No. pursuant to application doted ...... ,~.~ ...........~ ....................... , 'O.~,,,.~.Fand approved by the Building Inspector. Fo, $.../...Q...q. ......... Building Insl~mctor Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY . A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant~ C. Fees 1. Certificate of Occupancy - New dw¢ll%ng $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date .... 7.~..~....~....C. L ?.~.? .............. New Construction ........... Old Or Pre-existing Building.. ...~. ......... Location of Property~¢~ ........... ~.~.~r..y .......... ~ .......... ~ ..... ;; ............. House No. Street Hamlet Onwer or Owners of Property .................................................................. County Tax Map No 1000, Section..~.~..~. ...... Block. / ..Lot. '~ Subdivision .................................... Filed Map ............ Lot ...................... Permit No.~.............~ .Date Of permit ................ Applicant ........ Health Dept. Approval .......................... Underwriters Approval .... .~.Z~..~.f.~.... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ~ Fee Submitted: $..~.~.'f.~. .................... s .., ............. C~ % ~2~ APPLICANT FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted 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. B. 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~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 $15.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 New Building ............. Old or Pre-existing Building , ,,.~. ....... Vacant Land ............. House No. Street Hamlet County Tax Map No. 1000 Section . ~.~..Z~. ........ Block .~.~. .......... Lot....~..Z.~ ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./~/J~'[ Z Date of Permit .~./.y.~!..Applicant .~?..~..~/...~.'..~..~../~../../~.~...g~.. ...... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval..../~...../~..~l~.~J..C/~...PlanningBoardApproval ...................... Request for Temporary Certificate ..................... Final Certificate / Fee Submitted $ ..-~.07.~. ..~. .................. ~.. Construction on above described building and permit meets all applicable codes and regulations. ~ ,b,~ ~ ~'7-/0'~ Applicant ~c::~~ ~~/~ Rev. t0~10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS [0~,-.'~ BUREAU OF ELECTRICITY ~ 85 JOHN STREET. NEW YORK. NEW YORK 10038 Date /?~O¥¢~,~b~r {'){~ ~ 19~5 Application No. onfile N 7 5 4 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of F' ' r A n~te. in the following location; [] Basement [] 1st FI. [] 2nd FI. Section Block Lot was examined on and found to be in compliance with the requirements of this Board. October 3~, 1985 FIXTURE OUTLETS RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS EXHAUST FANS INCANDESCENT FLUORESCENT VAPOR ~ ! 4 5 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: S E R V I C E A. W. G, NO, OFHI-LEG A.W.G. OF CC. COND. OF NEUTRAL A. W, G. NO. OF NEUTRALS OF HI-LEG 7355 -~in Road ~at~ituck ~ ~1' 11952 Lic~783£ GENF. I~AL MANAGER Per_ This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined. (~ .~..../.~. .... , 19 .~. ·- Approved ~. ¢.~-....t~. ...... 1 .5~.. Permit No. (.%/.?.(( ~ Disapproved a/c ............ -~' 'Z~' ......... '~ ....... APPLICATION FOR BUILDING PERMIT Received../.0. -.. it TOWN OF SOLIT~OLD Date ..../.q.-... ?. ....... 19ff.~.~ INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) .... (Mailing address of applicant) ? ~ e.r'2 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .......................................................................... (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 .... .~....~-~.. ~. -.-.ff.~.~.?~.~.. Electrician's License No. Other Trade's License No ...................... 1. Location of land on which proposed work will be done../~Y.~qW...~d.W.~..4'./(.... ~.. ~,...~....~..~../(.77.E.,q. .......... 4 .... .... .................................. House Number r/o r ,q.c~c, ~a coo Street Hamlet County Tax Map No. 1000 Section . ./. ~..,~.. .......... Block . . .Z .............. Lot....2..~. ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ..~..7.q.t~..~. ~..~....~<. ~-~....~'.~?... ,. ..................................... b. Intended use and occupancy 3. Nature of work (check which applicable): New Building ' Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ..... __ 2~g/OO ~ (Description) 4. Estimated Cost -~...'~../-~)~).~-- · Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... 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 typ, e of use ..................... 7. Dimensions of existing structures, if any: Front.....~.o..' ........ Rear ...5:0. ........ Depth...2, .~,. '. ....... Height .../.$'..: ........ Number of Stories ..../ ................. · Dimensi0nso, f same structure with alte. rations or add,itions: Front ..~..qiiiiiiiiiiii'l~r'ii..~'.'.~i!iiiiiii''i' Depth.. ~,4t .................. Height .... e'.~. ............... Number of Stories .... /. ....... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 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 ~,~ 14. Name of Owner of premises /.ff....C.,q.~.O.~ ?~.~..~... Address eqv: ~....z~.~.~. 22 .... Phone No. q2p.8.: Yz z :~ Name of Architect ~,~r~. ,~y~ /,,,-~- ......... ........................... Address .............. .... -.'Phone No ................ Name of Contractor .......................... Address ................... 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 block number or description accord)ng to deed, and show street names and indicate whether interior or corner lot. STATE OF NE~_¥0rJg/~ coum'¥ ..... S.S ............... .?./,.~..iSd...~... Q_.~ .~..b. ! .&d. i~. q_.~. .... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the .......... O CC' F1 ~5 ( (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 manner set forth in the application filed therewith. Sworn to before me this ........... Y · -'~- ........ day of.. C?C.z/..cD. ~.ff ~7. ......., 19 .~.~ Notary Public, .~: .F'.~..o? ~Q, ~,ff_~:,~ ' ,~(_i . (z?c_~ ~[ ~,~. ........ County SUSAN M. ~ ... N~ARY PUB~, Stye ~ ~ ~ No. 52~1~ ~ ~ ~ ~xmr~ Mar~ ~. 1~' (Signature of applicant) ?