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Home My WebLink About9875-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Occupancy No. $9fi.(~'/ ........... Date .............. July..~0 ........... 19..7.9 THIS CERTIFIES that the building ................................................ Location of Property ...q.675 ............ 0'xa¢lcu:~r..CL~OeR .I~. .............. Sou.~olcL. House No. Street Hamlet County Tax Map No. 1000 Section .. O.~.O ...... Block .. 2 ............ Lot. 194J4 ........... Subdivision .... XX ........................ Filed Map No..X3~ .... Lot No. XX .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... 0'~..26 .......... 19'/8. pursuant to which Building Permit No...9/3~5. Z ............. dated .. ............ ~'LI.3.y. 3.~. ......19 .'~8, 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 ......... ................ AdcLL'~iorr .on'co..a. one .f~m~ ~ y. chaelling ...................... The certificate is issued to ... I-Ie.v..bev.~ .S.. t-~'m,. M,D~. ............................. (owner~l~~) of the aforesaid building. Suffolk County Department of Health Approval ...~o.'11 .l:'eclL~l.recL ........................ UNDERWRITERS CERTIFICATE NO ..... ./4~9.5..20 ...................................... Building Inspector Rev 4/79 FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ~ ....:~.~..~:.~ ..... ..... ~.~.~...?,~..!,~...o. ............ .... ~ ........ .~..~.~..~~. ........ ~ ..... .0..~..~/ at premises located at .... ; ............ i..~.~.~? ................................................................................ ~.~.~..~.~.~.~: ..... :..-. .pursuont to opplication dated ....................... ,.,?., ...... ~..~ ..... ..~..~: ,~;~;,..~ ? opprov~d 'by ~he Buildin~ Inspoctor. Fee $ ..... ~ ................. ~¢~.:' , ~' ..:, : ' p ~1~:' ~ U TO~'~-~E~VE EXCESS~RL L . FROM ABOVE,PREMISES 'BY . REGRADING LOT. . DRIVEWAY CONSTRU~ION ' " CESSPOOL CONSTRUCTION ',-- , - '-. CELLAR CONSTRUCTI°N FORM NO. 6 TOWN OF SOUTHOLD Bu ilding 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 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 features. 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 dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date...~...~....~.~. z. [.~. ~. ~. .... New Building ~... Old or Pre-existing Building_ . .' .......... Vacant Land ............. Location of Property /~.-~.~. :~..~....~... ~. ~,..~*~.~~ ............... House No. Street Hamlet Owner or Owners of Property ............................................................ County Tax Map No. 1000 Section . .~.?.O. ......... Block .. ¢:~ .......... Lot. ~.?.~. .......... Subdivision ........................... ~1 .... Map No ............... Lot No ............... Permit No.~...~?.~.' .~"~.. Date of Perm~/~..~.Applicant .... V?.¢.~....~. ~.~. :~..O. ....... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval .~..~..~. ~ ............ Planning Board Approval ...................... Request for Temporary Certificate ..................... F anal Certificate ... ~ ............... Fee Submitted $. ~..~ ................... Construction on above described building and,ll~ J 0~~-~.'ermit me~,a,~icable.~odes and regulations. Applicant ...!*~.~.~..~ .... .~. ........... Rev, 10-10-78 TOWN C) F S 0 UTH 0 LD OFFICE nF BUILDING INSPECTOR TOWN [~LERK'S OFFICE SOUTHOLD, N. Y. 1'1~71 TEL. 765-2660 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF' ELECTRICITY June 2~, 1979 ES .JOHN STREET, NEW YORK, NEW YORK 1OO38 THIS CERTIF'IES THAT onl~ the electrical equipment as described below and i~rodueed by the applicant named on ~]ze above ~pplication number in t~e premises of in the followlng location; [] Basement ~ Ist Fl. ~ 2nd Fl. Section Block Lot wasexarninedon JU~ 2~ ~'~79 andfoundtobelncornpllancewiththerequlrernent#ofthisBoard. FIXTURE [EPTA I I FIXTURES O~JTLETS IEC CLESl SWITCHES I,NO, N*SCENTI FLUORESCENT I ~( DRYERS I 'FURNACE MOTORS FUTURE AP~UANCE FEEDERS AMT, K, W. OIL H.P. GAS H.P. AMT. NO, A.W. G, RANGES SPECIAL REC'PT ! 20 COO~g~! Ni KBS. CwKS UNIT HEATERS MULTI-OUTLET iNS.~ SYSTEMS NO. OF FEET E EXHAUST FANS DIMMERS SERVICE DISCONNECT I NO. OF I S E R ML~TER NO. OF CC. COND. A, W, G, OTHER APPARATUS: IMulti-Outlet Systems ~;o. of Feet:6'-O" Track 4 ~;lec .Room Hea~ems: 2-1.5,2-1. O, 2-. 5KW V lites C E OF HI-LEG Joseph J, Frohnhoefer Route 25 Southold,N.Y. 11971 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. I~)~,,M; ~0. 1 TOWN *OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, ............... Approved .............. .~,r.~...'~q ..... 2.!.*., 19.'Z~Permit No ~'7,~' ~ .... ................ ......... :::::::::::::::::::::::::::::: ......... Application No. APPLICATION FOR BUILDING PERMIT Date ......................... .~.///.~ ~.. ............ 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 is 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 a~terations, or for removal or demolition, as herein described. 7'he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and ir~ buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ............................. ,~ ..~,~,. ~. '..¢ ........... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............... .............................................................................................................................................................. Name of owner of premises .... ,~.~M~,~Z....~ .... ~',(~/~.~..../~.~.~.~,.)..~. .................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......... /..~..~.. ................................ ! · Plumber's License No ....... ~.~./.....~.. .......................... Electrician's License No. ~ ~ Other Trade's License No ............................................... /~.- ~m ~,.~_- / ~./) ,~ Location of land on which proposecJ work will be done, Map No.: ............................. Lot No ....... Street and .................... ~. ................................................ : .............................. Municipali~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .... ~.Ag.....&...Z~.~..j ...... ~]~.~.~.~ .......... 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 /$ .......................................................................................... (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 ......... ~,- ............................................................................................................................... 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 ......... .~..~..~ ................ Depth ...~ .............. Height ......... ~,~.~ ......Number of Stories .......... ~'. .......................................... 7 ....................................... "' ............... Dimensions of same structure with alterations or additions: Front .......... ~...-~.. ................... Rear ....,~...~...~ ................. Depth .......... ~..~.. .............. Height ........ ~,/__2 .............. Number of Stories ....... ./. ....................... ! 8. Dimensions of entire new construction: Front ........... ~'..47 ................... Rear ...... i.~. ................. Depth ...~...~..! Height Number of Stories .......... /... ................ 9. Size of lot: Front ........... /..~.~".! ................................... Rear ....... /...~.~.r.~. .................... Depth 10. Date of Purchase .............. ./..~..~...~. .............................. Name of Former Owner ...................... :/---~..~./~ ,~..~... .............. 11. Zone or use district in which premises are situated ....... /~. ..... ~.G-.~./..~.,~---~J.~./,Z~'..~.. ..... ~ ......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ......... /~'..~.. ....................................... 13. Will lot be regraded. .......... .~..(f2. ........... Will excess fill be removed, from~ premises: .( Z/Y/Yes ( ) No 14. Name of Owner of prem.ses .~..~¢,/S...~B,'$. ......:/fl/~.~/,..~,D. ...... Address ..~.~/_Z:/Tk/~'/~./2.. ........... Phone No.~.~..~..~Z..~.~?...-~... Name of Architect ..f~.~.&~--,~.Z. ....~.41//Z.~-~.. .................... Address ..,~.~.~:'P~'.A.~..~. ....... Phone No. 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. r-,,/ _ STATE OF NEW ~(~BI.'.'~,.,/. .... .~...[;~~..'. ....... 6~.r.~</.~..~. ........... be ng duly sworn, deposes and says that he is the opplicam (Name of individual signing contracf) above named. ~e is the .............................................................................................................................................. (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 that the work will be performed in the manner set foah in the application filed therewith. Sworn to before this ......... .... ..... ...... ......... .......................... ~ I/ ~, ~ · (SignaTure or applicant) Commission Ex~ires Mnrch 30, L~ ATT. J 1'TZ.. O" / ! / APPROVED AS NOTED -'.-' DATE: ~ -"5 ~ ' -7 ~ ,/5' , NOTIFY BUILDING DEPARTMENT AT ,/ fo~'~'' '~-..~ 765-2660 9AM ,o 4PM FOR REQUIR- ' ~ _ , ~D ~NSPECTIONS: - ' ~' ~.. BEFORE BACKFiLLiNG FOUNDA- TION OR START FRAMING ~:J ~ ~ ~ BEFORE COVERING PiPeS OF ANY FINAL WHEN JOB COMPLETED ~ ' Ii ~ .- ~ 2 -- ~ 4. .~ '"" /'~~~'~/~'-/ / /ZJ ,14~--I ~ ~ NOT RESPONSIBLE FOR DESIGN- Att CONST. U~laN f [ I ! / /: !