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HomeMy WebLinkAbout11710-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.Z.].4.1.5.7. .......... Date January 15 19 86 THIS CERTIFIES that the building One family dwelling Location of Property 1865 Maple Lane Greenport County Tax Map bio. 1000 Section ...0.~ ...... Block .... 0.8. ......... Lot...0.0.3. .. 9.q3. ...... Subdivision... Minor Sub #206 ...Filed Map bio. .Lot blo. 3 conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..M. ~ty..8~ ............ 19 .8.2. pursuant to which Building Permit No. 11710Z dated .... .d ;~;n.e.. ~ .................19 .8 .2., 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 ......... ·..On& .fam.Lly. d~.elling ...................................................... The certificate is issued to .......Fa.ed. a..denaY.. $~,k~q 8~.k¢ ~-8 ....................... of the aforesaid building. Suffolk County Department of Health Approval .... 1 2 - $ O- 5 2 UNDERWRITERS CERTIFICATE NO ................. ~7. 2. .6 ~.~ 7. ......................... Building Inspector Rw. 1/81 FOlr, M NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~0 z ~,.....~,,~....~. ...................... , ,,..~ Permission is hereby granted to: ..... ~....~~~.~7~.,.~... ..... ~..... z~.~,~...~',~ .... .... ~Z;....i/--~-:~-_~_~.....~....Z... ........ ~/ ,o ........ ~' ---- "----'' -- '..c.~..~.~z.~..~..z:.......~.~.......-z:..',o.~.,..~,_...o~..~.zz,.,-.,~.: ................. ........ ~ ............................................................................ ../... ............................... ~ ................... County Tox Map No. 1000 Section ...~-~!.~........ Block ..... ~..~... ..... Lot No. pursuant to application dated ..... ~..~..~.....4~..~.. .................. , 19..~...,~nd approved by the Building Inspector. Fee $..,ZZ ............. .... ' '-B/ulldlng Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF 8OUTHOLD 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 in duplicate 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. B. For existing buildings (prior to Al~ril 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peopert¥ showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner a~ to use, oocul)ancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premis~, or other pertinent informa- tion required to prepare a certificezle. C, Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling./ lam] use --P~'e-Bxis t,±ng C. 0. $15 · 00 3. Copy of certificate of occupancy $1.00 Vacant, Zend C.O. $ 5.00 .. ...... ........... New Building .... ~ ..... Old or Pre-exisl[ing ButJllrll~ . .w.= ,~ .... ., ¥lll~l~: Land ............. i · oca. on of Prope~ L/.~. ~,..~...~o~.~e....~.\..~~r~., ~...g~....q.~.~/... ?",..-~°use N°' ~ ~. . .'"'"-'E"-' I~I'O~'IO f~ I I ~B ~I(..I.,j.~O[~..,,.. ~ t,, , ~ ~,,. ,I/~: . . Hamlet Owner or Owners of Property ...~..(-/... ~. ~4~.t.O ,',',',',',',',',',~(. ,~,0/'¥--././~... County Tax Map No. 1000 Section .... .(~...-~... .... Block ............... Lot ..... °. .. Subdivision ...... ~ .......................... Filed Map No. '~ .Lot No. X Perm,t ,o. I.~..~ ~ ~. ~. Da,e of Perm,t ~ [ ~. [ ~ ~..App,,cant....F.C ~ .d... £.'.. ~~~..'.~ Health Dept. Approval /~?- ~,5 ?. - ,~-, .~., ~ i(//~,/~,.~.abor Dept. Approval .-)'~/..'-~ Underwriters Approval ............... ,'7 ...... Planning Board Approval ............. Request for Temporary Certificate , v Final Certificate ...... Fee Submitted $ .... ~,,; (_.)0 / ~ ~ Construction on above described building and permit meets all applicable codes and regulations. Applicant .................................................... Rev. 10-10-78 c.o. z fY/g7 THE NEW YORK BOARD OF FIRE UNDERWRITERS ~.000~2']. BUREAU OF ELECTRICITY ~1 85 JOHN STREET. NEW YORK, NEW YORK 1OO3S THI5 ~E~IFIE$ THAT ~ly t~ e~t~al ~uip~nt ~ ~cH~ ~ a~ inr~ by t~ ap~i~t ~ on t~ a~ ~pl~n numar in t~ p~m~s of Fre~ Schoenste~n, 1865 Maple L~e, East Marion, N~ York w~ examin~ on Deo~e~ 9,19 8 $ and found to be in compliance with the requirements of th~ B~rd. RXTURE FIXTURES RANGES OVENS DISH WASHERS O~JTI~TS SWITCHES 34 33 43 34 TIME CLOCKS UNIT HEATIrRS MULTI-O~JTLET DIMMERS SYSTEMS NO. OF F~ET SERVICE DISCONNECT S E R V I C OTHER APPARATUS: Special Rec'pt.- 1~20amp., 2- G.F.I. 1- Smoke Detector NO. O~ECRC~,COND.A, W, G. NO. OF HI-LEG A.W.G. NO. OF NEUTRALS A.W.G. OF CC. COND. OF HI.LEG OF NBUTRAL 2/0 1 2/0 1-30amp., 1-50amp. William Simmen 290 Woodlawn Ave. St. James, N.Y., 11780 lic. S1814 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 r)F CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FIELD I~SFE~TION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDIN~ DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION ZND [ ] INSULATION [ ] FRAMING [//~FINAL REMARKS: ~' DATE Approved .~0~.. FORM NO. 1 TOWN OF SOUTHOLD ~ BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEl..: 765-1803 APPLICATION FOR BUILDING PERMIT Date .......... ,19 .~.i INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, acoarate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, r~lationship to adjoining premises or public streels 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 issue 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,'Oldinances 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, hgqsing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessar~_il~ections. ( ) / __ . {Signature of applicant, or nan~ if a corporation) . ./. . . , ( (Mailing address of applicant) State w~h_ether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................................. Name of owner of premises ....... ~.~.4~"~.. }. ~-~'7 ........................................ (as on the tax roll or la;-- - ' If applicant is a corporation, signature of duly authorized officer, pERMIT INCLUDES AppROVAL TO REMOVE EXCESS FILL (Name and title of corporate officer) PROM ABOVE pREMISES ~Y REGRADING LoT DRIVEWAY coNSTRUCTION CESSPOOL coNSTRUCTION CELLAR cONSTRUCTION -- ig' - oTHER Builder's License No .......................... Electrician's License No. t, ~ t. Other Trade's License No ...................... Location of land on which proposed work will be done ........................... ........... ' ....... .......... House Number ' Sir'e~t Hamlet ............... County Tax Map No. 1000 Section ..... t. ;~ .~. ....... Block ..... ~,..r .......... Lot...~../~'..~. ........ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing uso and occupancy ..... ~t~Lo~..tg:~.. ......... :. ........................................... b. Intended use and occupancy ........ amt. . .~.~. . .. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost ........... ~?.'.,..~.©.O. ............ Fee ...................................... (to be paid on filing this applicaiion) / 5. If dwelling, number of dwelling units .... ';.-r /' ....... Number of dwelling units on each floor ................ If garage, number of cars ............ .~. ......................................................... 6. If business, commercial or mixed occupancy, specify nature and extant 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 ............ ~ .......... Number of,Stories ............... ,..~.... 8. Dimensions of entire new construction: Front ..... ~.~ ....... Rear....'~.~ .t'. ...... Depth .... .~/.. ' ' '//' ' Height ............... Number of Stories ........................................................ 9. S~zeoflot: Front ..... .,~ ............... Rear ...................... Dl~th ... ,_-~_.~.c~.. .......... I0. Date of Purchase ........ t~/~. ............... Nam¢ of Former Owner ..~r,~...~C~.2/gf~' ........... 11. Zone ar use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinanco or regulation: ................................ 13. Will lot be regraded ....... ~. ....... ~ ....... Will excess fill be. removt~d from premises: Yes No 14. Name of Owner of premises ,P~-~ ~.~,,d',~./... Address 7~..F~h~t~./~.. Phone No. Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposal, and. indicate all set-heok dim~miuns from property lines. Give street and block number or description according to deed, and show st/eot names and indicate whether intemor oo erlot, cc a STATE OF N~W~yJoP~,.../ .... COUNTY OF~ .... ~.e, ~ .......... (Name of individual ~i~ni~ contract) above named. sworn, deposes and says that he is the applicant He is the .......................... ~ .................................................. (Contractor, asent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have !~rformed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowl~18~ and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ? 7--, ............. of / 1741. (50' Pr i vc'le ~ocd) 1 ~.'' ~,T,~ il. D. REF. M.S. ~. ~.:_ ~he sewage dispoqe~ '' inspected by tn~S ~hief of General Znglneor~ Sea, Cea ..%ca I~ : [00 '=' [" (50' Private Hole % :! !I iL¸ L~l~hb~t~!) -:Y~TIC~ AP. EH OCCU?^NCI' USE OF OCCUPANCY 0 uVkC." kG"O,C( /4,'= rio" AS NOTED AT wING iNSPECTIONS: 1. ~OUNDATIOm ' FOR poURED CONCRETE 2, ROUGH - FRAMING & pLUMBiNG 3. INSULATIO~N,STRUCTiON MuST 4. FINAL - ' AL~ CONSTRUCTION SH~LL MEET CODES;- NOT RESPONSIBLE '[ ' PERMIT iNcEuoEs XP'~__i6~'~f" J TO REMOVE E'X'CESS FIL I FROM ABOVE PREMISES BY I REGRADING LOT -- ~' I DRIVEWAY CONSTRUCTION _~OL COnStrUCtiON ~ .P )qZ~o'~ ......... , il¸