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Home My WebLink About11555-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z ] .q.0. Q 9 Date ...... ~i~j..26. 19~?. THIS CERTIFIES that the building ............................ Location of Property . .1. l ~O .............. Qq~..oy. Creek Lane Southol d House No. Street ................. -" ' County Tax Map No. 1000 Section . .0.7.8 ....... Block .... q/f .......... Lot 016 , Subdivision...C. orOY..(;v.e.e.k.. $.s.%.a.~e..~ ...... Filed Map No..6.9.2.3....Lot No.. 1. .~ .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ·. [;~ e.lm u a r.y.. 3 ....... ,19 f3.;Z pursuant to which Building Permit No.. q. ~. f~ [5 .5.. [ ............ dated ... ¥.e.b.~.U~p.×. ~ ............. 19 ~,2., 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 ......... The certificate is issued to Sandva P. t~ave & Navy P. Tloczko~ki ..................... ?oYde;, ..................... of the aforesaid building. Suffolk County Department of Health Approval .1 2-S0-07 ,..5./.2. .5./.~.2. ~ Robert A. Villa, P. E. UNDERWRITERS CERTIFICATE NO. ~.eDdin~, Rev. 1/81 Building Inspector TOWN OF $OUTH0~D BUILDING DEFARTMENT TOWN HALL SOuTHOLD, N. Y. BUILDING PERMIT: (THIS PERMIT MUST BE KEPT ON THE PP, EMIS~S UNTIL COMPLETION OF THE WORK AUTHORIZED) N°. i1555 ULL Building Ihspector. Rev. i6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building 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 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. Commercia~ 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, s;[reets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner ~s 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 requ ired 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 $5.00 New Building ....~.. ...... Old or~pre-existing Building(Z) ........ ~ ZVacant [,~nd -i ........... .... .... Owner or Owners of Property ......... ~ ~ ~ co~.t~ T.~ U~. No. ~0~0 S~io. .... q.?.~ ...... ~o.~ . 0. ~ .......... Lot. ~/..~ ......... Subdivision... '~ ~') ' - ' ,. ·. ~'~?;~ ?~( ........ .~-~-~ .~o~ No ........ Perm,t No ........... Date of Permit. ~ ~ ~,~l,ca,t . . .~'~ ~. ~ 7 ..... ...................... ,.. Hnde~riters Approval ~~ ............ Plannin~ Board A~proval .................. . Bequest for Temoorar~ Certificato ..................... Final Cortificato ........... Fee ~ubmitted $ ............................. ~__~ ~. ~.~ 2ooo~ 1000771 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~- 85 JOHN STREET, NEW YORK, NEW YORK 10038 ..re Say 2s,zga2 ~,,~.,,o.~0. o..~,,~ ~2-Ot N 563480 THIS CERTIFIES THAT only the e~ctdcal equipn~ent ~ ~scribed bel~ and introduced by t~ applicant ~med on the above application nu tuber in the premises of Sandra Rave~ w/s Corey C~eek ~, 1500'$/~/~ayv~ew, $outhold,~.~. i.~he/otlowinglocatio~ ~esq~W¢' ~Is~FL ~ ~,~d rt. 3:d. was examined on ~yzU ~ ~ Section Block , Lot and found to be in compliance with the requlre~nents of this Board. FIXTURE FIXTURES RANGES OVENS EXHAUST FANS OUTLETS SWITCHES NCAND~$CENT FLUORESCENT 39 44 37 2 DRYERS MULTI-OUTLET SYSTEMS NO. OF FEET S E R V I C O~ECR C~' lW'O' NO+OF H"LEG A'W G' NO, O~NEUTRALS NO COND, OF ~C, COND OF HI,LEG OTHER APPARATUS: 2 GFI, lhot watez heater, 1-4.5kw. 1 tLme:, 3 smoke detectors-- Motors: 2 frac.hp-- 16' track lighting~- AWG, OF NEUTRAL 1 RuZand Elec. co, P.Oo ~ox 143 Mattituek,N.Y. 11952 1lC. 242E G'NE"AL~ANA~a This cerfific~le must not be ~ feted in ~ m~nner ' · . ~- . '~ / / ' y , return to the office of the Board ~f ~nco~rect. Inspectors may be ~dentified 'b~r fhe)~ ~redentials. QPY FOR BUILplNG DEPARTMENT. THIS COPY OF CERTIFICATE M~S~ NO~ BE A~TERED IN ANY MANNER. FIELD %NSPE~TION FOUNDATION (1st) FOUNDATION (2nd) COMMENTS ~ ~ . PLUMBING INSULATION PER N. Y. STATE ENERGY C,ODE o FINAL ~~ ADDITIO?~L COMMENTS TOWN OF SOUTHOLD .BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned ................ Disapproved o/c ........................ ~ .............................................. ......... ............. 7 zr ............................ Application N o./. ,/'-~...~.. ,.'~. ................ APPLICATION FOR BUILDING PERMIT Date .................. .~../~. ................... , INSTRUCTIONS a. This application must be completely filled in by typewriter aa.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 iecotion of lot and of buildings on premises, relationship to adjoining premises or public streets o~ 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ...... (Address of appli;ont) ......... 7 ............. State whet~r a, pplicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. crc,/ .................................................r e ~J'~,6~/Z)~ ................................... l~/ ~ .................................................................. ~,.e : ..................... b~/d~ ~ .......... Name of owner of p em ss ........................ .~..~......~...~. .......... .~......~.~.....~... .........~../.....~...~-<'..~-. ............ .~.~../. ............. ........ ................ (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No...,,,~.....~....'~.,....Z/~..~/.£~..~- Electrician's License No..~Z,~,~,.~,,....~,~.~.'~-''~ Other Trade's License No ............................................... Location of land on which~roposed w~or~.~w, ill be done. Ma.~ No.: ....... ...~.-~-.'.~'?...Z ............ 'IT' Lot No..,/.' ,.~., .............. Number ..~.~.~.~.~ .~.~(..~..~-..~....~..~(~ .................. c,J~c~'./~..u./.~.x/.~.., . Street and ......... ~. .................................................... ....... State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ......... ...~...~..C~.../7....~....Z..~'..../?..C/. ......................................................................... b. Intended use and occupancy ........ ..~...~.~..~.. '. ..... ,'~ ....... ../~......~.-,~'.4/~.~.....~.. ......................................................... ! ~ ~ Addition Alteration 3. Nature of work (check which applicable): New Bud ng . .............................................. Repair .................. Removal .................. Demolition ........ .~',,.:...'.~.. Other Work ..................................................... ~.~r~ (Description) (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 ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth Height ... Number of Star es 8. Dimensions of entire new construction: Front ........ ~.~ ..................... Rear...r-~'..P. .................. Depth ........................ 10. Date of Purchase ....... ~ .......... · ........ 1 1. Zone or use district in which premises are situated ....... T. ......................................... ../~ ............................................... 12. Does, proposed construction violate any zoning Iow, ordinance or regulation: ..... ~.:...~. ............................................ 13. Will lot be regraded .....~.. ........ Wi excess f I be removed from premises: ( ) Yes ( Name of Architect .............................................. . ............... Address ................................ Phone No ....................... Name of Contractor ...~...~./.[~../. .. .' ........... Address ................................ ~'~ <'~[~'~' ' Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and 'indicate all set-back dimensions from property lines. Give street and black number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~,~RK/,/ ~ ~;oS COUNTY O~ ...... ................. ;...~'~".'~..._..'.~...'.....~....~...~..l~..C:q!...(, .................. being duly sworn, deposes an~ soys that he is the applicant (Nome of individual signing contracf) above named. /2 He is the .......... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~Jy authorized to perform or have performed the said work and to rn~ke and file this application; that oil statement's contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the appllcation fi?~therewith. Sworn to befgre me this ? ..................... ..... . ............................ I~o. 52-8125850. Suffolk C0u~ Term Expires March 3D, 19,.,...,..c~-'- F eto '~ .<0 ? >. ~ m ,< 0 0 Z 0