HomeMy WebLinkAbout20737-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22038
Date DECEMBER 16~ 1992
THIS CERTIFIES that the building
Location of Property 530 BRAY AVENUE
House No.
County Tax Map No. 1000 Section 126
Subdivision
ADDITION
LAUREL, NEW YORK
Street Hamlet
Block 1 Lot 20.
Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 17, 1992 pursuant to which
Building Permit No. 20737-Z dated JUNE 19~ 1992
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which thiscert±ficate is
issued is ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO. N-244888 -
PLUMBERS CERTIFICATION DATED
~ARJORIE M. YOUNG
JULY 30~ 1992
Rev. 1/81
· /~Buil~ing Inspector
I~O~,M NO. 0
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)
No.N: 2073? Z
Permission is hereby granted to:
....... ..~../~/~.....~,:...f.~.~. ...........................
...... ~... Z~/....~...,:~. ..........................
.... ~.~..~:.d .......... ~ ......... /./..e.~,e.... ~. _
....C~.~:.r~.~.(,.~. ......... ~ .......... ~.:~./).~.~.~.~ ......... ~.. ........................................... ...~.v.~
.(.. ~,~o~;~ I~. ~.,~..~..~ .................
............................................ :~ .................. ~ ................... : ....... ~ ............................
County Tax Map No. 1000 Section ..... ../..?~...~. ........ Block ...... .(~..~'.. ........ Lot No. ~
pursuant to application dated ........................................................ , 19...?..~., and approved by the
Building Inspector,
Fee $ .......................
Building Inspector
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
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.
6. 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.
Fees
1. Certificate of Occupancy - New dwelling $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 - $i00.00
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
New Construction ........... 01d Or Pre-existing Building .................
Location of Property .....................................
House No. Street Hamlet
0nwer or Owners of Propgrty .... ~..~'~.~..~/,Z~...~.~.%. .................... . .
County Tax Map No 1000, Section. ~.~.~. /. .Block ................ Lot..l[?.~.~.~.~. ..........
Subdivision ................................. . .. Filed Map ............ Lot ......................
Permit No .... Date Of Permit ................ Applicant./~.~J69~/a ~..~/.~.
Health Dept. Approval ....... ... ................Underwriters Approval ....................... . .
Planning Board Approval ........................
Request for: Temporary Certificate ......... ~ Final Certicate...
Fee Submitted: $.~..~5. ................ ~,'
FOUNDATION (1st)
FOUNDATION
2.
ROUGH FRAME &
(2nd)
.PLUMBING
INSULATION PER N. Y.
STATE ENERGY
CODE
FINAL
ADDITIONA'L COMMENTS:
Fred Milner
Carpenter
870 Bray Ave,, Laurel, New York' 11948
(516) 298-8821
Licensed & Insured #HI 19597
".-"~ '~ > I
'-t) ,'> o
C
Z696[ IH# peJnsul ~ pesueo!q
91;;'6!. [ >IJOA ~eN 'le~nD'l "eAr ADJ,]
Je.J.u edJl::)O
JeUllJAJ PeJ:::l
Fred Milner
Carpent,
870 Bray Ave., Laurel, k
(5i6) 298-8~
Licensed & Insured
~r
awYork 11948
,21
#HI19597
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [}ROUGH PLBG.
FOUNDATION AND []INSULATION
[~'~MING []FINAL
765-1802
BUILDING DEPT.
INSPECTION
~/~'] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION ZND [ ] INSULATION
FRAMING [ ] FINAL
REMARKS
DATE ~ INSP~
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[~ION 2ND [ ] INSULATION
[]FRAMING []FINAL
REMARKS:
/
DATE INSP
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
FRAMING [~L
DATE
THE NEW YORK BOARD OF FIRE UNDERWRITERS
'L~.7.~0~,:~ BUREAU OF ELECTRICITY
J~ B5 JOHN STREET, NEW YORK, NEW yORK 10038
Date ~[~[,Y 3~,[~2 ApplicationNo. onfile ~36~9~/~ ~ 24~[88
THIS CERTIFIES THAT
in thefollowlng location; ~ Basement ~ Ist FI. ~ 2nd Fl, 0~ Section Bilk
wasexaminedon J~[~ ~9~ andfoundtobelncompliancewiththerequirements~fthisBoard.
Lot
FIXTURE
OUTLETS
3
DRYERS
FIXTURES
MOTORS
OTHER
RANGES =OOKING DECKE OVENS DISH WASHERS EXHAUST FANS
MULTI-OUTLEt
EYSTEMS
NO. OF FEET
E R V I C
OTHER APPARATUS:
GENERAL MANAGER
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 SOUFFHOLD
BUILDING D EPA"R TM ENT
TQWN HALL
BOARD OF H£ALTII
SURVEY
..... ;..
ClIECK , . ..
SCI'TIC F 0 R,'I ..............
HAIL TO:
· (Bu/ding Inspector)
APPLICATION FOR BUILDING PERMIT
Date . · ...... 19.
INSTRUCTIONS
'& Tlfis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
s of plans, accurafe plot plan ~o scale. Fee according to schedWe.
~. Plot plan show~g location of lot and of buildNgs on premises, relationship to adjoining premises or public streets
areas, and o' '
=~vm= a det~led description of layout of property must be drawn on the diagram which is pa~ of this appl-
e. The work covered by t~s application may not be C~mmenced before issuance of Btfildin~ Pe~' .
d. Upon approval of thzs application, the Building Inspector will issued a Bulldog Pemit t~the a~tplicant. Such pe~it
11 be kept on the premises ava~able for inspection throughout the work.
e. No building shall be occupied or used in whole or in p~t for any purpose whatever until a Certificate of Occup~cy
11 have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the BulldOg Dep~ment for the issuance of a Building Pe~it pursuant to the
lding Zone Ordinance of the Town of Southold, Suffolk County, New York, ~d ther apphcaole ~ws, Ord~ces or
:ulations. for the Construction of buqdMgs, additions or alterations, or for removal or demolition, as here~ described.
~ app~cant agree~, to comply with a~ apphcable laws, ordinances, building code, housing code, and regulations, and to
fit authorized ~specto~ on premises and ~ building for necess~w, inspections. ~
.... .........
(Signature of applicant, or name, if a corporation)
..... ....
(M~ling address of applicant) ......
:e whether applicant is owner, lessee, agcnI, architect, engineer, general contractor, electrician, plumber or builder.
...... . .. ~V ...... · .... APPROVED AS NOTED
~plicant is a corporation, signatur~fduly authorized officer. ,' 765-1802 9 AM TO,-4 PM FOR THE
~(~'ame .......... OCCUPANCY OR ~. FOUNDATION - ~O REQUIRED
and title of co,orate officer) FOR POURED CONCRETE
n ..... ~ ~/ ,, ~. n USE IS UNLAWFUL =. ROUGH- FRAMING & PLUMBING
PlumbcrsLicense No. · .T~k~% ...~t~h,~0CCUPANCY '
Electncmn's Liccnse No ~.~ . ~[~~ ~
' · ..................... THE REQUIREMENTS OF THE ",Y.
No '~ -- (C ~) STATE CONSTRUCTION & ENERGY
Otber Trade's License '~' ~ ~& ~ CODES. NOT RESPONSIBLE FOR
.......... ' .' .....O .... . ' .......
ouse Nwnber Street ....... Hamlet
°u"tY Tax Map No. 1000 Section .... /a~ ..... Block "'01
~bdivision Filed Map No.
(Name) Lot
ate existing use and OCCupancy of prcnlises and intended use and occupancy of proposed construction:
Intended use and occupancy . · · ',~h ..
3. ( beck which a 1' '
ature Ot work c · i
· . PP ]cable). New Build ng ,.
............ ucm°ml°n .............. Other Wor~ ' .
4. Estlm~ted Cost ...... -- '~ 4 (Description)
~ ....................... Fee ,
(to be paid on filing this application)
5. Ifdwelling, nu~berofdwelling~nits.. . .' . , Numbero
. Ifgarage, numberofcars ~ · ''~" & ~. fd?elh~gumtsoneachfloor..
6. If business, coma ....... ' '.' ' '.~ ............ ~...~ ...... ~&vow4W~ ..............
,u~ma~ o~ ~lXetll OCCt Dazey, specify ature ,i ex · ' '
7. Dm~ens~onsot existinvst~,.,.~J '- - ~ ~d , tent
, ~ .... It ..... . . ·
o, ulmenslo~s o[ entire new const~'-***-. ~ · · ........ INunlb~ o~
He-~t If ., ' ......... Rear /~ ~, .~ ;L'~ .....
9 .. o ... ............ l~UmberofStofies [ ~ · .............. ucpm .... t~.~/~.'.,.
0. Date of Purchase .... ~ ~ '~7 ~ ....... Rear ..... /~ .............. Depth ' ' ', ')~ ..........
1. Zone or use district n w~ ch ~re ~ises' 'r~ ~t~;25 .... Name ~For~5er O~nef ~:~ ~em~5 .......
-. Does proposed construction viob,~o --- . · ..... I~b~.O~.q~ .... ~ ..............
~ --.~. a.y zomng law ordinance or rel~u[ation. .. ~.~
o, W~llotberegraded . ~O ..... .. ., · · ~ . ....
........ ~ ', ' ~ ....... ~Yhl eXCeSS fill Oe rcmovc(I IrO~ prcmisc~: Yes
5. Is this property wiehfn 300 ieet of a ~id~1 wet' ' '~ '''
'". I PLOT DIAGR~
Locate clearly ~d distinctly ~1 b~ild~gs, whether existing or proposed, and, indicate ~1 set-back d~ensions from
ropegy lines. Give street ~d block number or descfiptioh according to deed, and show street n~es and indicate whether
;tefior or comer lot.
/oo
TE OF NEW YORK,, ,
JNTy OF .......... . S,S ~ '"~' ~
(Name of iff~Qidual ~ning cofitract ........ bmng duly sworn., deposes and says that he is the apPOint
e named. , q - -
the ......................... f.. .............................
I(Contractor agent corporate officer )
~ , , etc.
[d owner o~ owllers, and is duly authorized to perform or have performed the said work and to make and file this
:a/ion; that all statements contained in' this application are trne to the best ~]}j~knowledge and belief; ami that the
wdl be performed in th~ manner set fo th in the application filed therewith. ~
:~ to b~fo[~ m~/his
........ : .: · .d yof..
.............. , 19.
'. .................. t
~ puUl,, ~ ~ ~ .. --. ' ...............