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Home My WebLink About8889-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. lt.l. O921~ ...... Date ....... gp~:l. 3,. 5 ................. 1982. THIS CERTIFIES that the building ................................................ Location of Property .. 2 3 5 ............. ~a ~ g..L e g l.e.n. 1~ ~/.e~u e ........... ~la.t.t, ~, t,u.e.k.. House No. Street Hamlet County Tax Map No 1000 Section .. l 8 2 ....... Block ...0 3 .......... Lot . .Q 1 z~ ............ Subdivision .... ;~ .......................... Filed Map No...X ..... Lot No.. X ........... conforms substantially to the Application for Building Permit heretofore fried ha this office dated ·.. ~.e.p..t ¢.'n,.hq C. 2.9...., 19 7.6. pursuant to whmh Building Permit No... $ [.$.51, g ............ dated ..... .Ac. p .~..,';nl ~ e I~..2~ ........ 19 7.6., was issued, and conforms to all of the requirements of the applicable prowstons of the law. The occupancy for which this certificate is issued is ......... ....a.n.. a..d.d.~.~. ~ 9p..~.9. :~..~O~.-.~.a m;[J~.Y...d.~.,,.L ~ ~.~: ................................ The certificate is ~ssued to ...... ~.ff~or..1~ ~. &..~ J. g~.ll~l;la..~*~t'.o3~u~- J- ................. (owner, lessee ~r. tana~t,l of the aforesaid building. Suffolk County Department of Health Approval ..... }J/'~ ................................. UNDERWRITERS CERTIFICATE NO ..... 1~. 5.4.9.7. 4. ? .................................... Building Inspector Rev. 1/81 FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PE,RMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CO~ETION- - OI~'TlriE WORK AUTHORIZED) 88.'8~i z' ~o,o ..... ~~...~.:'::.L...:.....:...., Permission is hereby granted to: ~ ., %', . ~, -' , . ,~ ~ z~ · '-t~?~~'; ................... - ~ ~ , ~.~,:~..,...~~~r~ ........ -, ................ , FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and subr~itted 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 topographm 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. Bo For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusua~ natural or topographic featu res. 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 dwelhng or land use $5.00 3. Copy of certificate of occupancy $1.00 NewBulidlng' .~,...v~... OldorPre-existingBulldlng(:~)._ _ = VacantLand ............ Location of Property . .~.."~-~,~. ~.C....~..~. ~ .~,~..., .~...~'~. ..... . ./~..~..T..T..~. ,/~. ,~, .~_~. ,,~~ .......... House No. Street Ham/et County Tax Map No. 1000Section .../¢~...~. ..... Block ..... O3 ...... Lot....~../..t~. ....... Subdivision /~ .Filed Map No. ~' .Lot No. .~. Permit No..~..~..~..~...~Date of Perm.t..~¢~?.~'/?.~.Applicant .... ~.../~.~.. .................... Health Dept. Approval ..... '/~l ~' ............... Labor Dept. Approval ~-- .,. :/.-. Underwriters Approval .. . lanning Board Approval .................. Request for Temporary Certificate ..................... Final Certificate .... .~..- ......... Fee Submitted $ .... .~..~...cW. ............... Rev. lo-1a.78 Construction on above described building and permit'meets all app~cabte~codes and regulations. Applicant . ......,,~.- ........................ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electrical equipment c~s described below and introduced by the applicartt named on the above applleat~on number in the premises of P. Petrowski, 235 E. Le~ion Avex~e, MactiCuck, N.Y. tn the followlng locat,on; [] Basement [~ Is! FI ~ 2nd FI Section Bto, k Lot was examined on and.found to be tn compliance w~th the requirements of th~s Board. Jmmar~ 28, 1.982 FIXTURE RECEPTACLES I ~D FIXTURES RANGES OUTLETS SWITCHES INCA ESCENT FLUORESCENT I MERCURYvApOR I AMT.. g W 7 20 9 SERVICE DISCONNECT NO OF ,' S E R OTHER APPAE'ATUS COOKING DECKS OVENS DISH WASHERS TIMECLOCKS BEll UNIT HEATERS MULTI-OUTLET EXHAUST FANS DIMMERS A~T ~ATTS A W G OF CC COND NO OF HI LEG AWG OF Ht LEG NO OF NEUTRALS AWG OF NEUTRAL 235 East Le~ion Avera4e ~tti~, N.Y. i1952 Th~s certificate must not be altered ~n any manner, return to the off~ce of the Board Jf Incorrect Inspectors may be ;denfl~ied by their ~redentiaJs ¢0P¥' FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST I~IOT I~E ALTERED IN ANY MANNER. \ fl .L A PPROVED_A&~ IOTED DATE: FEE: BY NOTIFY BUILDING DEPA~,TMENT AT 765-2660 9AM TO 4PM DP, P, EOUIP`- ~D ii~s~c uk~.~; ~~OR~ ~ BA~ LLiNG FOUN~- TION OR START FRAMING 2. BEFORE COVERING PIPELINE 3. FINAL WHEN JOB COMPLETED NOT RESPONSIBLE ~R gESlGN O~ CON- STRUCT~QN ERRORS & TOWN OF $OUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE~ ,~ ~ E889 Examined ..~.2~...~.~ ..................... , 19.~... Application No .............................. .... .................. , P rm t .... .......... ............. ....... (~uildJn~ Inspector) APPLICATION FOR BUILDING FERMIT INSTRUCTIONS o. This application must be completely filled ~n by typewriter o~ in ink and subm,tted in triplicate to the Buildi~ 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, areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this applicatio, 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 Build~ng Permit to the applicant. Such perm shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in port for any purpose whatever until a Certificate of Occupan, 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 tJ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances, Regulahons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe, The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and ~ admit authorized inspectors on premises and in buildings for necessary inspections. ....... ............... (Signature of applicant, or name, if a corporation) ~3.~ /,. Le~io~ ,,ye, !att~tvc', ~ · . (Address of applicant) State whelher applicant is_o..~J1.9~ lessee, agent, architect, engineer, general contractor, electricmn, plumber or builde Name of owner of premises ...... ~...e...t..e...z*....~.~.:...:.:~..~.]:;?.~.~.s..]...i. ........................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's L~cense No ..... Jf~ ...................................... Plumber's License No .......... i..?..:9~...~..t....~.r..e...s..e..t..~.t.,.. Electrician's License No. ~' TM ~' ...,~.~.~.~ ................................ Other Trade's License No ............................................... 1. Locotion of land on which proposed work will be done. Map No ..................................... Lot No ...................... Street and Number .2_~....'~-%: ~- ........... Lc. ~ ,E.~.;-.L..: ~-,ve. ..................................................................... '.i,,~tb- tuck.~ ............. ~. .............. · Y. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exisiting use and occupancy ............ ~...~].~..~,...QD .... ~'.8,??.]k],~....~'~f~,],,'J,~.~ .................................................. '~ ~' '!.t.! ...... ':: ..... ~.?..:.~ ........ ~ ...... ~ .......... ~ ................................................ b Intended use and occupancy ...... .s.~.;..;~....~.~ 3 Nature of work (check which applicable). New Budding .................. Addition ...d:..?.I.~.~.e...~... Alteration ............ ~ Repmr .................. Removal ..................Demoht~or. ............... Other Work ......................................... (Description) 4 Estimated Cost ..... L~L~.~ .0..0...0..t .~..0. ................................ Fee .... ~: .1.. ,?. ~. .0. .0. . ................................................................. (to be pa~d on filing this apphcahon) 5 tt dwelhng, number of dwelhng units .......................... Number of dwelhng umts on each floor ...................... If garage, number of cars ............................................................................................................................... 6. If business, commercial or mixed occupancy, speofy nature and extent of each type of use ........................ · . . ~c~ _ ~ ............ 7 Dm~ensJons of ex,string structures, df any: Front ........................... Rear ................................ Depth .... ~bt- Height ....~..6..-. ............. Number of Stor,es ...... .9.~.~ ............................................................................................ Dimensions of same structure with alterations or addJtdons Front .... ~ ........................... Rear ..... ~.~ ...... Depth ....... ..~..br.. ............... He,ght ..J.?.:Z .......... Number of Stories .... .o.~...?..rL~...9.~.o... half 8 Dimensions of entire new construct,on· Front ................................... Rear ............................ Depth .......... Height ................... Number of Stones ......................................................................................... 9 S~ze of lot Front ..................................................... Rear ........................................ Depth ............................. 10 Date of Purchase ...~.~.;:....1.~.~..bf ......................... Name of Former Owner d' , ' ~ ...... ;-~.~ ...... ~ ..... ~.~,., ....................... 1 1. Zone or use district m which premises are situated ........... ~ ............................................................................ 12 Docs proposed construction wolate any zoning law, ordinance or regulation- . ....... LO ....................................... 13 W~II lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14 Narne of Owner of premises ~ eCaz' .:.~......~.~.~.z'...o.~?.~.~;$ ........ AH,-t,, ....... ~ zo .... voo Phone No..~.?.~.-..9...~..~.~ Name of Architect ..................................................... Address ................................ Phone No ..................... Name of Contractor ............................................ Address ................................ Phone No ..................... PLOT DIAGRAM Locale clearly and distinctly all buildings, whether existing or proposed, and mddcate all set-back d~mens~ons fro[ property Iines Gwe street and block number or description according to deed, and show street names and in&cat whether interior or corner lot sea Pl,~ n,~ t STATE OF NEW y'~R~,~ /~'_ iS S COUNTY OF ..'kg~.;~....~...f ' ....................................................................................... being duly sworn, deposes and says that he ~s the apphcar (Name of indwidual signing contract) above named He ~s the ................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and ds duly authorized to perform or have performed the sadd work and to make and f~ this application; that all statements contmned ~n this apphcat~on are true to the best of h~s knowledge and behef; ar that the work w~ll be performed in the manner set fo~h in the apphcation filed therewith· Sworn to befo~ me this __ ...... ;~.~..'~ day of ..x~.. 19~ ~~ ~ ~J ~ .... ...... ......... ...... ~ (Signature of applicant)