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Home My WebLink About9310-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the buriding ...... .s.e.q o..n .d..s. ~..o FY.. ~..d .ct.z.~. ~..o .n.. ................ Location of Property .. 3 5 5 .................. K. ~..n g..~. ~... ................. .O.v.z.e.n..~ ...... House No. Street Hamlet County Tax Map No. 1000 Section .... .2.6 ...... Block ......... 1. .....Lot ..... .2.7 .......... Subdivision ......... ~. ..................... Filed Map No .... .~ .... Lot No ....... .~ ...... conforms substantially to the Application for Building Permit heretofore Cried in this office dated ...... g..up.e., q..6 ....... , 19.7.7. pursuant to which Building Permit No .... .9.3.~. 0..Z ............ dated ......... d.u.n.e...q .6. .......... 19 .7.7., was issued, and conforms to all of the requirements of the apphcable provisions of the law. The occupancy for which this certfficate is issued is ......... .. ~.~.q 9.B.d..s .t;p?.y...~ .d.d.z.g..z 9.n' .g..o..o.n.o...s.~.qr?. y..s.e.c..~ .5. p.n..?.f..e.x..z.s?.z.n.g..cl.w.e..1.1.z.n.g:. The certificate is issued to ............. E.~. ~ .~B.~..E....&.. p .~.L.E.. K..I ~.~. ..................... (owner~l~]( ]~t~CZ of the aforesaid building. Suffolk County Department of Health Approval ............... 1j../.~ ........................ UNDERWRITERS CERTIFICATE NO ..................... ~ E..lq.I),~.H ~ ..................... Building Inspector Rev. 1/81 FOIEM[ NO, :~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDII~G PERMIT (THI~PERMIT MUST BE'.KEPT ON THE PREM~'SES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ...... at premises located ........................................................................ ........................... '~ ................. ,u,lding Inspector. Fee $....~...: ........... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY j~JT 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date June 20, 1986 406869/86 N755330 THIS CERTIFIES THAT L~#9310 only the electrical equipment ~ ~scr~b~ below and intr~uced by the applicant ~med on the above application number in the premises of Edward & Dale K~g, 355 K~g Strut, Orient, N.Y FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES OUTLETS . ~NC^~VESCENT FtUmESCENT ~,"~."~ [ ~T~_ K W 6 2 4 6 / ICOOKING~ECK$~ OVENS IDI~H W~f. IER~ EXHAUST FAN~ TIMECLOCKS I BEtL UNIT HEATERS ~ULTI-OUTLET DIMMERS R V I C E OF CC COND OF HI LEO AL F~wa rd Kinq 355 Ki-~3 Street Orient, N.Y. 118.~7 GENERAL MANAGER Per '; Th~s cerhhcate must not be altered m any manner, return to the office of the Board ~f incorrect Inspectors may be ~denhf~ed by'their credenhals COPY FOR BUILDING DEPARTMENT THIS COPY OF CERTIFICATE MUST NOT BE ALTERED iN FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A, This application must be filled in typewriter OR ink, and submitted I ~ to the Building I nspec- 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. Commermal buildings, industrial buildings, Multiple Residences and similar buddings 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 p~operty showing ail 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 safew 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-exist~ng dwelling $15.00 3. Copy of certificate of occupancy $1.00 4.Vacant .and C.O. $5.00 5.Updated C.O. $15.00 Date ...................... New Building . ./~, ~,~.~, '.~7.~..~.. Old or Pre-ex,sting Building ............ Vacant L, and ............. Location of Property ..a~'~T .... .... ........... i .......... House No, Street Hamlet Owner or Owners of Property . .~..~..t~..~...~:..~../~...~../.~ ..... ~ .~...~: .............. County Tax Map No. 1000 Section .... .(~..~.~ .... Block ...... O. J ...... Lot .... .4~.? ......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ~.~. !.O. ,~... Date of Permit .~J.~.~l?.~..Applicant .,...~...~.~......~'../.~..~. ........... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval. ~...~. ?.."~.~.?..~. ........ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ~ Fee Submitted $...~.~:. :... ~..~..L/..~.~ ....... Construction on above described budding and permit meets.all applicable codes and regulations. '~r-~-~, ~ , Applicant ..(-~. ' ................................ Rev 10-10-78 FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Examined 19.7...~. Approved 19..~.... Permit No... ,~....~,..../....~,.....¢~ ......... Disapproved a/c .................. i~..~ .......................... ~ ...................................... ................................................. ;....,...~...;~~~ ' ................................................. ................ (B~ding Inspecto~'~;' ....... 0 Application No ................... APPLICATION FOR BUILDING PERMIT Dar ...... /..~. .............. , .......... INSTRUCTIONS a This application must be completely filled in by typewriter or' 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 buildings on premmes, 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 thru applicotio, 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 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} Bu,lding 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, os 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 ir~ buildings for necessary inspections. ..../... (Signature of applicant, or ng~, if a corporation) / (Address of applicant) / / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electricmn, plumber o~ builde Name of owner of premises ........................................................................................................... if apphcant is a corporate, signature of duly authorized officer. (Name and title of cozporate officer) Builder's, License No..~....~ Plumbers License No .... ~.~.~..~. ............. Electrician's License No ....... ..~..~ .... Other Trade's License No ............................................... Location of land on which propo~ will be.~/: .M/ap_.No ..................................... L~;.,.:..? ~ .... Street and Number ...~.,~...~........'~'z'~.~//~,~..~,,r,,c,cz.u.4 ....................................................... ~.~S~x..~y~,w~..r..: .......... -r / Municipality State existing use and occupancy of premis/~ and intended use ~d occupancy o~f proposed qonstruction' b. Intended use and occupancy ~//~/.~.~.../-.~Z~.~..-m~...~~-.~4'~*~-~-~.~4~`~.~-~/ 3. Nature of work (check which applicable) New Bu,ld,ng ............. Add,tion ...... ..~.../?...°..~'Alteration' ............. Repair ............. Removal .............. Demoht~or .............. Other Work ...................... ................. ~ (Description) 4 Estimated Cost .~./. ,~-.0.~. ~'~ .............................. Fee .. ~/,-5......-m. .................................................................... (to be pa~d on filing th~s application) 5 If dwelling, number of dwelhng umts .............. --=. ......... Number of dwelling 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 exmtmg structures, ~f any Front .................... Rear .............................. Depth ............... Hmght ........................ Number of Stories .. D~mens~ons of same structure with alterations or ad&nons Front ................................. Rear ................. Depth ............................... Height ............. Number of Storms ...................... 8 D~mens~ons of entire new construcbon Front ............................ Rear ...........................Depth .......... Hmght ................ Number of Stories ..................................................................................... 9 Dze of lot Front ......................................... Rear ................................ Depth .............................. 10. Date of Purchase ............. /'.~..~.~.. .............. Name of Former Owner . ../~.....~'~.4~..~_,..~......~ ............. I I Zone or use district in wNch premises are s~tuated ............. ,~(......~. .................................................... 12 Does proposed construction wolote any Tatung law, ordinance or regulation ........ ~...0'....' ................................ 13. Wdl lot be regraded ...................... Wdl excess fill be removed from premises. ( ) Yes ( ~'o 14 Name of Owner of premises ............................................ Address ................................Phone No ...................... Name of Architect .................................. Address ................................Phone No ...................... Nome of Contractor ............................ Address ................................Phone No ...................... PLOT DIAGRAM Locate ctearly and &st~nctly all buddings, whether ex~stmg or proposed, and red,cate all set-back dimensions fror propcrty hnes Gwe street and block number or descnphon according to deed, and show street names and in&cat whether interior or corner lot ALt. T ; : I I STATE OF NEV¢ YORK, COUNTY,,.~t ~ , ~ ,/QF .................... ...... ~.~?.?..,~..C~..,....N~.Z...K../..~,..~ ........................... be.ng duly (Name of individual signing contracf) above named He is the ............ ../.~..~.°c'.~. .~. ............................................................................................... (Contractor, agent, corporate officer, afc ) of sa~d owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and f~ this applicabon, that that the work wdl be performed Sworn to before me th~s ........ · /.~. ............ day of ..... Z°'.*O~ ........... , 19 ~7 '~..~/%7'/~ -ST(,/'' ~.~.~. Notary Public,./ ............ 7~ ............................ County ......................... .......................... ~,~ty £. D~WSON I~ $2-464~72t, Term ~res ~arc~ ~, 1 sworn, deposes and says that he ~s the apphca.