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Home My WebLink About9543-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ................................................ Location of Property 1000 Minnehaha Blvd. Street Southold~ .N.,.Y,, ..... h~,~ ~io: ............................................. Hamlet County Tax Map No. 1000 Section .... ~.7. .....Block .... ~ .......... Lot ...... .7. ......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... i~0¥,e~t~17, ,7. .... ,19,7.7. pursuant to which Building Permit No ..... .9.5./~..~.~ ........... dated ...... N.. o. ¥.e.m.b..e .r..7. .......... 19 .7.7., was issued, and conforms to al/of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .................... ?.r.~.v..a.t.e..0. ~.e..~a..m.~.y...~..e.~.~..~.ng. (.a¢.d.~.~..~p.n.). .............. The certificate is issued to ............... 6r.~.h.~.r..t~o.s................................ (owner, ~~ of the aforesaid building. Suffolk County Department of Health Approval ......... N./..R .............................. UNDERWRITERS CERTIFICATE NO ................ .N.../4.~.1./f.~..~ ........................ Building Inspector Rev 4/79 N? 9543 Z Permission is hereby granted to: at premises located at ............ ~, DOO ~?/.b../~, ,~ ~/~. /4/=t -~, ,~, V" f~. ................. ~ ....... ..,~...~.u.. T.../:~. r., z-. ~, ~ .~d~ .......................... ,.: ..... Building Ins etor. 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 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. Approva~ 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 Enginee~ responsible for the building. 5. 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 peoperty showing all property lines, streets, buildings and unusual 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 New Building ............. Old or Pre-existing Building ~ ....... Vacant Lend ............. Location of Property . .,Z~, ¢.0..~ ..............,~. ,/~..~,~'. .~. ,~.~j~J,~......-~.~, ~. J~ ~, .............. House No. Street Hamlet Owner or Owners of Property . .,¢~'. ~'..1~../~..~..d~.-~.'~'~/~Cj¢~', .~ ........ ~../,~..: ........... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ~...L//..~... Date of Permit ///.~.~7.'.~'~2~.Applicant. ,z~. ~. .~../; .~7~. ~.. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval. ' ................. Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ~ .................... Fee Submitted $ ............................. Rev. 10-10-78 Construction on above described building and permi~ee~a_!,l applic~codes and regulations. Applicant .............................. og, o. Z_l¢l ;z THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ BUREAU OF ELECTRICITY ~- 85 JOHN STREET, NEW YORK, NEW YORK THIS CERTIFIES THAT only the elect~al equipment as described below and introduced ~ the applicant name~ on the above appllcatlo~ number in the premlses o~ ~. A. Rio3, 1~00 Mtnniehaha Blitd., Sou~hold in the follotving location; [] B~sement ~ 1st Fl. [] 2nd Fl. Section Block Lot ,~...,;.,.,i,,~;o. September" ~. ].~}"~) andfoundtobeincompliancewiththerequirementsofthlsBoard. FIXTURE RXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWlTCHRS 1 7 3 DRYERS FUTURE APPUANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS DIMMERS SERVICE DISCONNECT OTHER APPARATUS: S E R V I C E NO. OF CC. CC)ND, A.W. G, A. W.G. IqO, OF HI-LEG OF CC. COND. Alese! Eleot~ie Corp. ~7 Island St. Flainview, N.Y. 11803 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. TOWN OF SOUTHOLD ,, //_ ~'~'.. "..~/ . _/ E--,ned ................... -' ' ,K/,- ........ Applicat an -No ................................. ........................................ , 19 ........ Permit No ..................................... Disapproved a/c .......... ~.....~ ............... ..................................................................... ....... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ~ INSTRUCTIONS o. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building~ Inspector, with 3 sets of plans, accurate plat plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationsh p to edjo n ng premises or public streets or areas, and giving o detailed description of layout ofproperty must be drown on the diagram which is port of this application. c. The work covered by this application may nat 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 app cable Laws Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demo ition, 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 buildings for necessary inspections. ,'". / / ..../~ .................. ....... ............................ (Signati~re of applicant, or name, if a corporation) ..... ~. .................. -~L.~..: ......... .~.~(. ....... ,..,. ......... ..;:.....;:..:...,:......~. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....... ; ........ ........, .............. .~...z.......~ ..................................... If applicont is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. Plumber's License No ............. i.~/..~...../. .................... Electrician's License No. ./ Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number ..... ~:. ........ : ...... ;j..//,~..~.,..~.; ....... /...:......:;;~..~:..,J ............................ :,..j. ....................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ............. ~,..:.~...~')..~LL..~.:. ....... LI.,..[~,/..L ..................................................................... b. Intended use and occupancy ............ ~.~.:.;..J.~.,',..:,..,...~...i ...... ~/..,.;U..~. .................................................................. 3. Nature of work (check which applicable): New Building'. ................. Addition / Alteration Repair .................. Removal .................. Demolition .................... Other Work .......................... · .......................... y~ O 0 0 Fee / (Description) 4. Estimated Cost ...................................................................................................................................................... (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 ............................................................................................................................................. If business, commercial or mixed occupancy, .~,~,e ify nature and exter~f~o each type of use ......................... 6. 7. Dimensions of existing structures, it any: front .....r~ .................... Kear ................................ u p n .................... Number of Stories /..~.....z~.. Height .............................. -- ' .................................. .................................... .................. Dimensions o~,same structure with alterations or additions: Front ................. )-,~ ............... Rear ............................ Depth .....~.. ......................... Height ......................... rvNumber of Stories ..../..Z...~, .................. /7' 8. Dimensions of entire new construction: Front .................................... Rear ........ ./. .................. Depth ........................ / Height .................... Nu~pe~) of Stories ..................................... ;,1~ '~) .............................................. ,')' z~' ................... ,. /7' 9. Size of lot: Front ....j.~....?....] .............. ~ .......... ~.,~ ..... Rear ............................... :....: ..... D~ej)t~ ........... r~ ........ ; ........ .... /1'/ 4 ~ 6 H t 17b$ .... /~h~ /~'~, ~' I~'1 ]0. uote at vurcnose ................... : .................................... p~ame or cormer L~'ner ~r ...................................................... ] 1. Zone or use district in which premises are situated ................................................... ~,[~ ...................................... ]2. Does proposed construction violate any zoning Iow, ordinance or regulation: ........................................................ 13. Will lot be regraded . ......................... ~. Will excess fill be removp~ ~rqEq,,l~, ~J~e~; (.~) Yes ( )_ ,No. , , , 14. Nome of Owner of premise~.::i: ................................................ /~aclre~s ,; .............................. mane ~1o Name of Architect .............................................................. Address ................................ Phone No ....................... f' H/4/'~" ( Address ................................ Phone No. Name of Contractor 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 according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ................................ .......... /~i.li...~..!.:.....'...~. ............. i:~ii..L...~.. .................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ............... .~;~.....:.(..{...t...~ ............................................................................................................................................ (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 thru the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this A' V' / , ......... 7doy of ........................................ Notary P~blic,2~_~......~,~ ....................................... County (Signature of applicant) No. 52-4643721, Suffolk Cou~ip.j .[ezm Expires March 30, \ \