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Home My WebLink About11549-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin§ Inspector Town Hale Southold, N.Y. Certificate Of Occupancy No. Z~ ~ 608 Date April '13 19 83 THIS CERTIFIES that the building ...Acld£tioim ................................... Location of Property 525 [~own Creek Lane Southold House No. Street Hamlet County Tax Map No. t 000 Section 06/4 .Block 0'1 .Lot 0fl 3 ... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building permit heretofore filed in this office dated .... J..a.mRa. r. ~..~. ......,198. J. pursuant to which Building Permit No. q fl 5~9Z dated ...J.a.i~.~_.a.r.y...2.8 .............. 198.5.., 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 ......... E~elosed l~oreh The certificate is issued to ~lmet R. I,a'~son~'fT (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO .... ..................................... Building Inspector Rev. 1/81 BUILDING TOWN HALL ~ SOUTH'OLD, N, ,Y. i ~' BUILDING PERJ~IT}: (THIS PERMIT MUST BE KEPT ON TH,E,PREi~,IS~S UNTIL COMPLETION OF THE WORK AUTHORIZED) ~ ., ~154 9 Z Date ...... ,...., ......... ULL Permission is hereby granted to: /; ' :~ .............. · ..... .~..o.. ~.,...,...,..~.,..~.,,.;...,..:,...:..,~...:. ............... to .~..~.......~,... ......... , r ~ -~ , at p~'emlse~ located qt ...~...~..~........~.~.t~,~.t~....~.t~..~.~ .........~. '~F'- ~ .......................... ~ ' ... ,. i. ; .~.,..~.,~..:~;.4...~..~..~..~ . C0~t,/ T~X Map No. 1000 Section ....... i. Block ;. ,,,..,: .or No. ,..~.~.~.~. ....... ~..~-oh,~.,+ ~ .... t~,-,.,*;~,-, rial d ~<.~..~ ~f; . 19, ¢ and ~pproved by the Buil~flng I~spector Re~. 6/30/80 .... FOR~ NO. 6 TOWN OF SOUTHOLD Building Depertment Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and sut~itted in d~plicate 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. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar building~ 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 requiraments where applicable. B. 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 New Building ............. Old or Pre-existing Building(X) ,,.~ ...... =/Vacant Land -. .......... House No. Street Ham/et Owner or Owners of Property " County Tax Map No. 1000 Section .... ~ ~,, .~ .... Block ..... &;~. / ...... Lot... ¢~. ~J. ~ ....... Subdivision ................................. Filed Map No ........... Lot No .............. Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval ' Ptanning Board Approval Request for Temporary Certificate ..................... Final Certificate' . ...... .~. ........ Fee Submitted $ ~' Construction on above described building and p~rrp, it'meets all apP~eable~code, C'and regulations. Rev. 10-10-78 ]ooo~.zl THE NEW YORK BOARD OF FIRE UNDERWRITERS IlS BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT i,~ thefollo~i~glocatio~ ~ Ba~,~t ~ /st FI. ~ 2nd Ft. Section Block Lot ~.. ~..,i.~d o. Fe~y 28, 1983 and found to be in compliat~ce with the r~quirements of this Board. FIXTURES RANGES ~OOKING DECKS OVENS DISH WASHERS EXHAUST FANS FIXTURE 4 5 4 DRYERS SYSTEMS NO. OF FEET OTHER APPARATUS: S E R C NO O~E~C~COND, A-W. G. NO. OF HI-LEG A OF CC COND OF HI-LEG OF NEUTRAL Paul Bumm ~ou~hold, N.Y., 11971 Lie.#282 This certificate must not be altered in any manner; return to the office of the Board if incorrect, Inspectors may be i their credentials. ILDING DEPARTMENT, THIS COPY OF CERTIFI( ' BE ALTERI D IN ANY MANNER FIELD INSPECTION FOUNDATION (1st) COMMENTS FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: ¢, ' 'Tq,,,. ,,,.,. Iff;;.,, . ~,,,..'2, ..,, ',' g~,~,".~. 6' X". ~,4.,,., j.~, ,;/,,,-~,v '''''~ ~.z,¢ cZf,,,,.,.d,, ................ : .......... A~?~O~D- AS' NOTED': NOTIFY BU!LD!NG 765-1~02 (~ A,'q TO z PM FOR THE · · l. 'FOtP,r-'A' !?~N - TW3 REQUIRED .. F?,7 F"!i2'-f~ CONCR~TF. 2. ROUG~, .. ~'RAMING & PLUMBING -- 3. INSU: A AEL C,..h ..... CTION SHALL MEET- THE R~QlUPFA4ENTS OF Tkr~ N.Y. STATE -CONSTRUCTIO~ &. CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ~RORS. ,7 7~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ~ TEL.: 76'5-1802 Exami.ed ..CZ Disapproved a/c · ' (Bu/ld~n~spector) APPLICATION FOR BU1LDING PERMIT Application No././. ~.~. ~. INST RUCTIONS a. This application nmst 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 premises, relationship to adjoining premises or public stre¢ or areas, and giving a deta/Ied description of layout of property nmst be drawn on the diagram which is part of this apF cation. c. Tile work coYered by this application may not be commenced before issuance of Building Permit. d. Upon apprc'.'al of this application, the Building Inspector will issue a Building Permit to the applicant. Such pern shall be kept on the premises available for inspecfion throughout the work. e. No buildiag shalI be occupied or nsed 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 ~f Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for tile 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 inspections. .z3 (Signature of applicant, or name, if a corporation) :;.,.. . .xd...Y., .:/.?:?! ...... (MMling address of applicant) State whether applicant is oxwmr, lessee, agent, architect, engineer, general contractor, electrician, plumber or build Nameofownerofprcmises ~.kD.~..T....R,...L.&.T..~..~.0.N...~ ................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and titlu of corporate officer) Plumber's License I'6o .... ~./~.~'~...~...ff'~?..~*~ Other Trade's License No. - ........ Location of land on which proposed work will be done .... '.'~-.. ......................................... I~l;~e' ~;;~}l}:r ................... Street ¢c,~ MC Hamlet County Tax blat> No. !000 Section . .t~) .(0:% ......... Block ..... .(~)..[ .......... Lot...0, .I.~ ........ Subdivision ..... .'77-7.. ............................. Filed Map No. ...-7 .......... Lot .. 77 .......... (Name) State existing use and occupancy of pre~nises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............................................... b. Intended ,,se E~d occuoancy Repair .............. Removal .............. De.~,nolidon .............. Other Work i ~--,*-~d.-~mv~, ,,--~v~-~,.~- ~ (Description)-- , :..:~:~.. :;;~,.: ..... ,.~...~..r~. ................... ~'c~ ./ ...................... (to be paid on filing this application) If dwelling, number of dwelling units .............. Nmhbcr of dwelling units on each floor ............. If garage, number of cars .... . ................................................................ If business, commercial or mixed occupancy, specify ~ature and extent of each type of use ................... Di si f i ti ifa y: Fr R ' Depth men cng o ex s ng structnres, n ont ......... . , ..... ear . , .............. .. ... ... .. . lleight Nu ~ber of Stories ' Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ' Height Number of Stories Dimensions of entire new construction: Front ............... Rear .. .............. Depth ............... Number of Stories Heigh t ........................................................................ Size of lot: Front ' Rear ...... ' ...... Depth Date df Purchase i Name of Former Owner ' Zone or use district in which premises are situated ' :~ D d ' '61 ' g 1 ocs propose constructmn w ate any zomn aw, ordinance or regulation:-.....~q.~, ......................... Will lot be regraded ........ i..' .................. Will excess fill be removed from premises: Yes No Name of Owner of premises .................. Address ................... Phone No ................ Name of Architect ' · Address ' Phone No NameofContractor ' Address . .-..'... Phone No ). I. .). 1. PLOT DIAGRAM Locate clearly and distinctly all bnildings, whether existing or protSosed, and. indicate ail set-back dimensions from roperty lines. Give street and block number or description according to deed, and show street names and indicate whether ~terior or corner lot. ' rATE OF NEW YORK, S.S OUNT,.Y~ OF ---- .... '-.~','. '. '. ,~.,~11~l~ '~e ...... ................... ~ -being duly sworn, deposes and says that he is the applicant ....... , (Nanie of indMdual sig~ing contract) )ove nanled. : isthe .... ................................................ , ............................. (Contractor, agent, corporate officer, etc.) f said owner or owners, m~d is drily authorized to perform or have performed the said work and to make and file this )plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the 'ork will be performed in the manner set forth in the application filed therewith. worn to before me this ~ ' ...... . ,~...~..h~.. ........ day ;f.. ~ .~M.~ke~ ..... , otary Public, ~ .~..~~:~,.~1 '~o~.~ ' NOTARY pUBLIC, Stato (,f l',eW YOFI Ne 52-45241'D. ' ~ · ~ualii,ed in Sufk,ik County ' '; ,t~ )" Comraissior~ Expires March SO~