The URL can be used to link to this page

Home My WebLink About10091-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. THIS CERTIFIES that the building ................................................ Location of Property .... .~.7...~...P~.t.v..8~.e...R.o?.d...~.'l.0. ..................... .S.o.u.~..h.o.3..~.... House No. $ffeer Hamlet County Tax Map No. 1000 Section 87 ..... Block I . .Lot .. .~:.~. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore tried in this office dated Noyember ~4 78 ~.009~Z ..................... 19... p~t to which BuUding Peri, it No ..................... dated ....December 29 19.7.8., was issued, and conforms to all of the requirements of the appUcable provisions of the law. The occupancy for which this certificate is issued is ......... One Family Dwellt.n.g.w.ith Additions The certi£amte is ~ued to . Kevin M..a~.d ..I.~9..r®n W. Boer~esson .................. i.'~.~,'~ ..................... of ~he afo~ea~d building. Suffolk County Department of Health Approval .......... N../~.. ............................ ERWmERS C RTIFICATE NO .............. ................... / Building InsI~CtOr FOEFI NO. 2 TOWbl OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS I~ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPL£T~ON OF THE WORK AUTHORIZED) Building Inspector. FORM NO. 6 TOWN OF SOUTHOLD 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 featu res. 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 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.O0 New Building ............. Old or Pre-existing Building .. -~-.~?.~ Vacant Land ............. ,~,~.~ ~,,,- ~, r~;~ :~o'O.t~l ~k~.z'boi~ ~Oad.~ Sot!t~,lo~L~ Location of Property .'~ ~ r-~V~. ~-~qe¥~ ...... ~ ..................... House No, Street HamNt Owner or Owners of Property .. ~ ~-~:~-J~. ~*.. ~J~'~:~.. ~-~'~ .[~f~. ~"¢P.~?~ ................... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. !u,~)! 2, Date of Permit . Health Dept. Approval -'"---- ..... Labor Dept. Approval Underwriters Approval . . .~./~..~.,/~.c~ .~..~./. ........Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...... ~. ............. Fee Submitted $ ~.,~0. ........................ Construction on above described building and permit meets all applicable codes and regulations. Applicant .... ~.../~. '.~...¢~. ~+¢¢~. ....................... Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS ob BUREAU OF ELECTRICITY [~ JOHN STREET, NEW YORK, NEW YORK .,,,,, ~e~i=e~b~.r ,?, ~.979 ..p,ic~,io.~o.o.~i,~ 003800 N 44922.1 THIS CERTIFIES THAT only the electrical equipment as descrlb~d b~low and introduced by the applicant named on the above application i~BmJwr in th~ lare~,~ses Of Xevln Boe~ge~aon. South Harbor Rd.~(Jaoobs La)~ ~oubholdE ~.£. in the following location; [] Basement [] 1st FI. was examined on September 13, 1979 RX?URE flXTUEES OUTLETS IECEPTAC~S SWITCHES I1 30 1~ DRYERS FLUORESCENT [] 2nd Fl. Section Block and found to be in compliance with the requirements of this Board. Lot RANGES OVENS DISH WASHERS EXHAUST FANS SYSTEMS NO. ~ I~ET S R I C NO. OF CC. COND. A. W.O. NO. OF HI-LEG OF CC. COND. OF HI-LEG NO, OF NEUTRA~ OTHER APPARATUS: 1- ,!lmok e Der. Kevtn Boergesson South Harbor Rd., Box 855 Southold, N.Y. 11971 MANAGER ~,is certificate must not be altered in any manner;, return to the office of the Board if incorrect. Inspectors may be identified by their credentials. q.q.,m'z~ fgR BUILSHIq~ DEPARTMENT. THIS ~OPl OF b[ttlm['lC. AlJ MU:I/ NOY BII AL'IIKI~ IH AHT 765-1802 BUILD,lNG DEPT. INSPECTION FOUNDATION 1ST []ROUGH PLBG. FOUNDATION 2N'D []INSULATION FRAMING []FINAL REMARKS: DATE INSPECTOR Exomined ..... , 19 ........ 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, 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 or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which Js part of this application. 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, Ordinances 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 lows, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildlng~ for necessary inspections.' .(Signature.of applicant, or name, if a corporation) {Address of opplica6t) State whether applicant is owner, les~e, agent, architect0 engineer, general contractor, electrician, plumber or builde Name of owner of premises ~~O~ ....................................................... .............. ................................................................ If app~ont is a co~orate, signqtgre of duly authorized officer. ...... ff (~me and titlo of co~orato officer) Electrician's License No. i' ~' . J, Other Trade's License No .......................................... 1. Location of land or~wh~:h proposed work will be done. Map No.: ....~ ..~.../.~..... ...................... , Lot No ......................... Street and .......................................................... :. ......................................................................... Muni¢ipallty 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy'"~ ~'~-'~//'~ ~ ~ ~ L~' ' b. Intended use and occupancy ..................................... ~. ................................................................. 3. Nature of work (check which applicable): New Building'. ................. Addition ..,~ ..........Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................ ,... (Description) 4. Estimated Cost .. ..~::~;~.. ........................... Fee ...... ./.,.--5.1..~.....~... ................................................................... (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 ........ ~ ...................................................................................... i ............................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front .........:~...~.. .............. Rear ..... ~,~.,~J' ..................... Depth ......'~...~. ........ Height ....... I.~.! ........... Number of Stories ..... .~. ......................................................................................................... Dimensions of same structure with alterations or additions: Front .......... ,~...~.. ................... Rear .....~....~:'.. ................. Depth ....... ~:~ .................. Height ....... ~..'t..~..~.~......Number of Stories ....~-~ ....................... 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front .................... .~..~.. ............................. Rear ................ .~..~....~. ................ Depth ....... ..'~.../...~...¢. ............. 10. Date of Purchase ..(.~,,6/.~,~O/_,~.~.~'. ........................... Name of Former Owner ZZ~..~...~...~.~.~.~,. ...... 11. Zone or use district in which premises are situated ..... ,~.~-'~..:. ................................................................................. 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ..... ~...~., ........................................... 13. Will lot be regraded ....j(-~ ................. Will excess fill be removed from premises: ( ) Yes (/?-) No 14. Name of Owner of premises .~:"~-l~l,~...~-~h~,~/~ ...... Address .~..'~.~M.~.~I.~. .......Phone No?.~.~.-..~...~.~. Name of Architect .............................................................. Address ................................ Phon~ No ....................... Nome of Contractor ~,~/'~'~.~t~...~.....~'A/~.~ ..... Address ~...~...~.~..~,/,) ....... Phone Ne...~..~.~.;...~;.?.?.?... PLOT DIAGRAM Locate clearly and distinctly oil 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 NEV~/~YORK, COUN FY OF~.~.,.~./;f: ......... ,.,~.~..~./~./~........~.. ...... (.~).~,~'.JcJ4.1.~t~. .............. being duly sworn, deposes and says that he is the applicam (Name of individual signing contrac0 above named. kle is the ... ~.~ ~. ~ ........................................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or o~ners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained Jn this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h Jn the application filed therewith. Sworn to before me this ~'~ ~X .......... day of Noto P,b ic,. ............................ Co,, ....... ........ APPROVED ~.S NOTIFY BUILDING 765.25~0 ~P.~ fo 4PM FOR REQUlR. ED INSPECTION~= 1. BEFORE BACKFILLING FOUNDA- -? :' ",,,., ,L.'. .;,. ./',,"b!: ,