HomeMy WebLinkAbout17160-z FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 217469 Date OCTOBER 28, 1988
THIS CERTIFIES that the building ADDITION
Location of Property 840 OLD SHIPYARD LANE SOUTHOLD
House No. Street Hamlet
County Tax Map No. 1000 Section 64 Block 04 Lot 21
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated J(JNE 24, 1988 pursuant to which
Building Permit No. 171602 dated NNE 24, 1988
was issued, and conforms to all of the requirements of the applicable
provisions o£ the law. The occupancy for which this certificate is
issued is DECK ADDITION TO REAR OF DWELLING.
The certificate is issued to HELENA MEREDITH
(owner, )
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N/A
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
Fosnr xo. s
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)
N o 01716 0 Z DatC~oL~.....`f 19(lp
Permission is hereby granted to:
to ...................~.....lcx~.~.............l~~~i....~~............................
.............~~~~.~i.~~..v.........................../.~...../~~j ~~..y..~.....~............
ct premises fotated of .............Cl. ...~~........~l~.Jl..l~• /.y.~ .....G~~~`........'r.,_.........
County Tax Map No. 1000 Section ....l7.....y......... Block Lot No..........p4...`....
pursuant tv application dated L~/~~y~~'i.Q...........~ 19~. and approved by the
Building Inspector.
X
Fee $....,~...~J.... ~ysl.~f
Building Inspector
Rev. 6/30/80
r t ~ U FORM NO. 6 IJ
Q ~ TOWN OF SOUTHOLD OCT 2 ~ I~8~ ~
Building Department
Town Hall
Southold, N.Y. 11971 OLDG. DF.CT.
765 - 1802 TOWN OF SOilTFIOLD
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted ~ 9~~ to the Building Inspec-
torwith 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, acertificate 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 property 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: Additions $25.00 POOLS $25.00 ALTERATION $25.00
1. Certificate of occupancy New Dwelling, $25.00, Accessory 10.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50.00
3. Copy of certificate of occupancy $ 5.00 , over 5 years $ 10.00
4.Vacant Land C.O. $ 20.00
S.Uodated C.O. $ 50.00 Date
NewConstruction,,,,,,OldorPre-existing Building Vacant Land
U
Location of Property ....O.yU ................~~4r.-fh.P~,/~ `~`~/rr.~.ti.q!?.C.......-5'".'~?!~ ~~fl.
House No. l ~ StreSt Hamlet
Owner or Owners of Property {`".lF°. M P?p dr
Count Tax Ma No. 1000 Section ~Oy _ y., ~ Block Lot .
Y P ...!....z .
Subdivision .Filed Map No. ....../...Lot No. .
Permit No.Q 17.~G, Z Date of Permit 2, YJ,,,~rf ~~.Applicant . ~ ~ ,/,'7pJf~/;~~, , , , , , , ,
Health Dept. Approval ........................Labor Dept. Approval
Underwriters Approval ........................Planning Board Approval .
Request for Temporary Certificate .....................Final Certificate .
Fee Submitted $ .~.5~.° .
Construction on above described building and permit meets all applicable codes and regulations.
Applicant ~ vi.~...:.".'...C~.!~. ~ .~.y~~......... .
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~1c:LD "1.:5:'CiiUN (~llATE ~ i;OrINlENTS
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FOUNDATION (1st) ~'`'~`i5
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FOUNDATIOtJ (2nd)
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P,OUGH FRAME &
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PLUMBING
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IIJSULATIOM PER N. Y. '
STATE ENERGY
CODE
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ADDITIOPJAL COMMENTS: x .
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BUILDING DEPT.
INSPECTION
[ ]FOUNDATION i5T [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ] INSU TION
[ ]FRAMING [ FINAL
REMARKS: I"~
CQ~C.'j..~ C p
DATE ~ 4 INSPECTOR
_ _ _
THE NEW YORK BOARD OF FIRE UNDERWRITERS rh"r: '
7.1 '),~i665
BUREAU OF ELECTRICITY
83 JOHN STREET, NEW YORK, NEW YORK 10038
rr~y., ,s~. .ta^4~.'ea,IFli;Hk11ARY "O'i,7~8v~- F01Utt5ttylR9 N fi571A11
Uati• Application No. on file
TNIB CERTIFIES THAT
only the elactrlca/ equipment es described 6ekm and introduced by the opplicont nomad Ym the oboes opplicetion number in the premises of fo
Ht~t'%KK, 1.970 S'1'ROHSOM koAp; ~pOLh; ~t1, CI('1'CH(H;IIR, N.Y.
in thefolba;inq loca~ion• ? g~ t ~ let F(. ? Ynd Fl. .Sertiun Block Lot
reos examined rm mdJound to 6e in compliance with the reyuiremente of this Board.
NXTUB AOIET fYY1TOMl5 XTURlS RANOB COOKING D[CKS OVENS D19N WASHERS E7(NAUST FANS
OUTSETS INGNDESCEM PlUOK25CWT OTHER AMT. K. W. AMT. K. W. NAT. K.W. MIT. K. W. AMT. N. P.
7 1 14 1 R 1 7 't P'
DRYlRS RIRNACE MOTORS glTUp AMUANCE R~ERS fF[CIAL RECST 71ME CLOCKS YU UNIT WATERS MUlTIA11TUET DIMMERS
AMC K. W. Oll N. P. GAS N. P. AMT. NO. A. W. G. AMT. AMP. AMT. AMPS. TRANS. AMT. N. P. SYSTEMS AMT. WAin
NO.OF FtXi
) ~n
SERVICE DISCONNECT NO.OF 5 F R V 1 C E
AM1. AMP. TYPE ~ 1 / tW 1 / tW S / Tv 3 / ~W NO.O~Rr+COND. OF ZC. COND. NO. OF N4LFG Oi'IWX_IEGC. No. OF NEUTKAlS OF ~NlUTGIIAL
OTHER AMMATUS:
G.Y.C.I.-'t
Sp?oKR D6Pfh:CTOIt:-1
I,A,Kh: F,1,h:CTltfc.
'17 FC)BF;S'f' "LKA72,
ti l pt;h:, NY 1"t Yfiti l 0!lRAt'
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t~C('h:NSR Nt), "1x45 k Per
This csAificate mast not bs abered in any manner; return to }he office of 1M Board if iYlcorrect: Inspectors may bs identified by their tials.
4J _ COPY FOR 6UILDING DE AR ME I I i MUST B ALTER DIN ANY MANNER.
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' ~ BOARD OF HEALTH
3 SETS OF PLANS
FORM NO. t SURVEY .
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORM
' TOWN HALL
. SOUTHOLD, N.Y. 11971 NOTIFY
TEL.: 765-1802- CALL
ExamineCi~y~'~:~?~.e•f! Y, 1917/~7rr MAIL/T~0:
Approved . , 1~1~PermitNo..D~.7(.f7OZ ~ `2~
Disapproved a/c
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date ~ 6~.c1.~./R........, 15 d
INSTRUCTIONS
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 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
shallltave 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 ins ec tons-
- (Sign ure ot" applt, or name, if a corporanon)
...~~.!?.Q/e~Slr.-,~ .yCrr.o~~rn~F,..~ac!fna./s(
• (Mailing ~add'ress of applicant)
State wh/ether applicant/is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
/ / .
Name of owner of premises ..17.~`.lG'~~..~G?rCdj:~n
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer) CU
Builder's License No. !~t~ ~ ' a
Plumber's License No . R A
Electrician's License No .
Other Trade's License No .
1. Location of land on which proposed work will be done . .
House Number ~ Street Hamlet
County Tax Map No. 1000 Section G..`7....... Block . Lot ,
Subdivision Filed Map No. Lot...............
(Name)
2. State existing use and occupancy ofllpremises and intended use and occupancykof proposed construction:
a. Existing use and occupancy ...~a t'.Sie~rev.~ia
b. Intended use and occupancy . • ~<'Slte~r:~+'.~i u~. • • • • • • • • • • • • • • ,
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