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Home My WebLink About9251-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No ..... Z105.1.6 ...... Date ......... Jmae THIS CERTIFIES that the building ................................................ Location of Property ....... 7.100..N. ~¥..~.u.t..t'9.l.k...A .v.e.n.u. 9..a.n.d...D.e.e.p...H.o.Z.e...D?.~.v.e. ? .H.a.g. t; t. l:uc k House No. Street Hamlet County Tax Map No. 1000 Section . .l 15 ....... Block ...1.6 .......... Lot ...0.2..8 ........... Subdivision..Deep..Flole. gv. eelc .E~ga.t, es..Filed Map No..4.~56...Lot No. 4.7 ........... conforms substantially to the Application for Building Permit heretofore Filed in this office dated ...... Play..16 ........ , 19.7.7. pursuant to which Building Permit No ..... .9.2.5. 1...g .......... dated .. Ma-~ · 18 ................... 19 .7.7., 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 ......... .......... B~£vate · Or~a-,Femt:ly D.~/elling. i A.dd$~.o.~ ) ........................ The certificate ~s issued to .,Ier~'~,..and. ~lachi .Toi;.o.l(;~ ............................... [owner, le~e~ of the aforesaid building Suffolk County Department of Health Approval ...... .N./.R. ................................ UNDERWRITERS CERTIFICATE NO ............ N.4~01 515 ............................. Building Inspector Rev 4/79 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT. ,, ~HIS PEI~AIT MUST BE KEPT ON THE PT~EMISES UNTIL FULL ~,'~' ~OMPLETION OF THE WORK AUTHORIZED) ~ -" ~ '" ¢~ ..................................... . ............................... {' .... ~' '9'"';:* ......................................... d~t~ and approved by the ...... z~t~ ......................... ~--'-: ............... ] -'~ Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CER,'rl FICATE 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 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. 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 prewous 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. Co Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-ex~sting dwelhng or land use 3. Copy of certihcate of occupancy $1.00 $5.00 Date ...Ma..y., 6. ;. 3:.9.8,.1 ............. New Building .... x. ........ Old or Pre-existing Building ............ Vacant Land ............. Location of Property ...7.3:.0.0. ............... N.e.w, .~..u~.~.o.[.~..A. ye.: ........... .~.t.~. $~.gq]¢. ......... House No, Street Ham/et Owner or Owners of P ropertyGe.~.a.s.s.i.m.°,s. .a.n.d..M.a.c.h.i..~.o.~o.l.o.s. ................................. County Tax Map No. 1000 Section . .1.1.5.:0.0. ....... Block . .1.6.:0.0. ........ Lot..0.2.8. :0.0.0. ....... Subdivision .~.~.P..o.~..D.e.e.~..~.o.]:.e..~.s.t;.~.t:.e.s. ........ Map No..4.2.5.6. ......... Lot No..4.7. ........... Permit No..cj251~. .... Date of Permit ...~,9.77. ...Applicant .G.e.r.a.s.s.~.m.o.s..m.o.t.c~l.o.s. ............... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..... ~ ................. Fee Submitted $..~.-.qq ................... ../. ! Construction on above described build,rig and pe~_ez~/el~p~a/l~ c~s and regular,ohs. ? Z5 Applicant ...... // { ~ ~ ~ ~ ~ ~ ................ 7: ~ ..... R~. 10-10-78 O~ / / ~ ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY I ~L~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 Oat~ ~cp~mbe~ 24, 1979 THI~ ~TI~I~ THaT only the el~trical equipment ~ ~sc~bed bel~ and intr~uced by t~ applicant named on the above application number in the premises of ~erry Totclos.New Suffolk Ave.,~attituck~.Y. in the following location; ~ Bmsement ~ 1st FI. ~ 2nd FI. Sectton Block Lot wasexam,nedon Saptember 20, 1979 andfoundtobe,ncomphanceu',ththerequtre .... tsofth~Board 8 zO 14 --%.YERS I FURNACE MOTORSI EUTURE A,'P.^.CE EEE,)ERS SERVICE DISCONNECT NO. OF I S E :TAMT A~p TYPE ~M~i~pR,.ff2W 1~'3W 3,~3W 3~'4W NO O~ CC CONDpER ~ OTHER APPARATUS. I- Sr:~oke de~eccor RANGES SPECIAL RECPT, R TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET SYSTEMS A,~T AMPS TRANS A.'4T H P NO. OF FEET V I C E A W G NO OF HI LEG OF CC COND AWG OF HI LEG EXHAUST FANS DIMMERS AMT WATTSq, WG NO OF NEUTRALS OFAiNEUTRAL Jerry ~oCoios New Suffolk Ave. ~,ia~cim~ck,N,Y. 119)2 GENERAL MANAGER Pe~ certificate must not ~e oltered m ony manner, return to t~e office of the Board i~ incorrect Inspectors may be ~denhfled ~y their credentials COPY FOR 5UILDIFIG DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ~ t tl FOIr, M NO, ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWH CLERK'S OFFICE SOUTHOLD, N. Y, Examined Approved ................. ...~.....~.....L....~.., 19~... Permit No ..... ~.....~....~..J......-~.. ...... Disapproved a/c ...........~'"z:"?'~" ................. ............................................................... ......... ........ ............. ....................... (l~uilding Inspector) APPLICATION FOR BUILDING PERMIT Date ..................... ................... , .... INSTRUCTIONS a. This application must be completely filled in by typewriter o~' in ink and submitted 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 buddings on premises, relahonsh~p 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 Building Permit to the apphcant. 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 part 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 t! 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 applicant 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 ~~~ ........ ...... (Address of applicant) State whether applican~is owner,)lessee, agent, architect, engineer, general contractor, electrician, plumber or bu~lde Name of owner of premises ~ ~.tS- ~ '/~..~.~t ~'~ 'FO ~.~ If applicant is a corparate, signature of duly authorized officer. (Name and htle of corporate officer) Builder's bcense No ..................................................... Plumber's License No ................................................. Electr,cian's License No ............................................. /,.~ ~/~ ~_~/~_ ~ Other Trade s License No ............................................... ~ ' 7/~_P ~. l ~ I Location of land on which propose, d work will be d, ont~. Map, No~.~:.r~..~ ......... Lot No ...../..../~.. ............ Street and N u~r~ber ...~.....s~.....~,...L~......O~.....~:...~...~..~...~:. ~..~.....~: ....... .../~..~.. rt.~. .~..~ ................................... Municipality 2. State ex~sting use and occupancy of premises and intended use and occupancy of proposed construction: o Exisiting use and occupancy ...................................................................................... b Intended use and occupancy ............................................................................................................................ 3 Nature of work (check which applicable) New Budding ...... ~n ............. Alteration ............. Repair ................Removal ............... Demoht~or. ................. Other Work ......................................... (Descnphon) ~ (to be pa~d on hhng this opphcahon) 5 If dwelling, number of dwelling un;ts ........................Number of dwelhng umts on each floor ........................ If garage, number of cars .......................... 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ........................ 7 D~mens~ons of ex~stmg structures, ~f any. Front ........................ Rear ................................ Depth .................... Height ....................... Number of Stones ............................................................................................................ D~mens~ons of same structure with olterat,ons or addmons Front .................................. Rear ......... Depth ............................. Height .......................... Number of Stories .............................. 8 Dimensions of enhre new construchon' Front ............................... Rear ........................... Depth ........... Height ............... Number of Stories ......................................................................................................... 9 S~ze of lot Front ........................................... Rear ............................. Depth ............................. 10 Dote of Purchase ................................................... Nome of Former Owner ....................................................... 11. Zone or use d~stnct ~n which premises are s~tuated ................................................................................. 12 Does proposed construction violate any zomng law, ordinance or regulahon' . ...................................................... 13 Will lot be regraded ............................ Wdl excess fill be removed from premises: ( ) Yes ( ) No Name of Architect ............. ~.~Z~ .... Address ............. ~ ................ Phone No ...... .~ ............. Nome of Contractor .......... ~, ............ Address ............. .~ ................ Phone No ...... ~..: ............ PLOT DIAGRAM Locate clearly and d~shnctly all buildings, whether ex~sting or proposed, and indicate all set-back dimensions fron property hnes G~ve street and block number or description according to deed, and show street names and indicat, whether interior or corner lot STATE OF NEW YORK, I S S COUNTY OF ............. ................................................................................... being duly sworn, deooses and says that he ~s the apphcar (Name of ind~wdual s~gn~ng contracf) above named. He ~s the ..................................................................................................................................................... (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and f,I th~s apphcahon, that afl statements contained ~n this apphcahon are true to the best of h~s knowledge and behef, an thor the work will be performed ~n the manner set forth in the apphcahon filed therewith. Sworn to before me this ............ '.4~ ..... day of ...... Nota ub,ic,. .................. ................... ..................... ~OTARY PUBLIC, State ,. ,'l~,~ ¥o[,~ . Comm,.,on Exp,res Niarch3J, t,? 0 ~,~3.,4J~ ~ ~.,~f~