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Home My WebLink About11556-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z 109.Q6 ...... Date ....... [v~,~. ch..16.. :. ............. 1982. THIS CERTIFIES that the building ................................................ Location of Property ...~.3~65 ............. C.(~unt;¥..Road..48 .......... Sou.t.b. old ....... House No. Street Hamlet County Tax Map No. 1000 Section .. 0~52~ ...... Block .. 0 .1 ........... Lot ... 02.0. .......... Subdivision..X ............................ Filed Map No..X ..... .Lot No. X ............ conforms substantially to the Application for Building Permit heretofore fried in this office dated · F.e.l~l?oa.~.y...4 ......... 19.82pursuant to which Building Permit No....1.1.556..7. .......... dated ....F..e bpl~.a~.y. 9 ............. 19 ·82, 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 . gh.~ .... · .c.o. alp~L.e.t;.~ 00..Qt. ~;h.e..~o.c.o. ncJ. ~'.],qOr..QE. an..~;;[~.t:~,~g..b.y$ ~.d.~,ng. ~'.o.~.. 0~'.~,~0. ~ pace. The certificate i~ issued to .... ~.~c~..~.RY.. ~.f..~gu.t;.hq~.~l..,q,q ~ 9.c.~,;f 1;~ .................. of the aforesaid building. Suffolk County Department of Health Approval .... .n/.~. .................................. UNDERWRITERS CERTIFICATE NO .... p. go.d.~r~g ...................................... Rev. 1/81 Building Inspector FORM NO, ~ TOWN OF SDUT-OL'~ BUILDING DEPARTMI~N~: Town HALL souTHOLD, H~ Y. BUILDIHG P~!T~ (THIS PEmlTrMUST BE KEPT ON ~H,~ P~EglS~S COMPL~ION OF THE WORK AUTHORIZED) UNTIL ~ULL N? 11556 Z Date ~'-~-"~'~..(~,...~....~..,~....';....~.., 19..~~ Permissiod is hereby granted to: z~..~.~... :..~, ......... ~.~ ....................... +...~., ........... , ............. ~ .......................... ~, p~,,, ~,~ ~, ................. ~....~..~.~ .... ~ .... ..... ....... .......... .................................................... Co,n~ ,ox ~op So. moo S**t,o, ..... .........~ ...... s~ .;~..~g.: ....... ~[ot ~o.....~O ....... p~sa~nt ¢o ~pplic,tion d~t,d ..~~.~....:..~...., 1 ond 0pproved by the BUilding 13specta~. Rev. INFORMATION FOR BUILDING DEPARTMENT WE ARE IN 'YttE PROCESS (~F ISSUING A CERTIFICATE OF COMPLIANCE FOR THE ELECTRICAL INSTALLATION AS COVERED IN AN APPLICATION FILED WITH OUR DISTRICT OFFICE. THE NEW YORK BOARD OF FIRE UNDERWRITERS 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. 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 occupancv on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $I.00 Date ..... ¢~.~/../.~. · .~. ........ New Building ... ~..... .... Old or Pre-existij,~ Building . ~ ..... Vacant Land ............. Location of Property ...... .~..~..~..~,..b: .... Cd" "~h' :" · '~' ' · ~' '~' ~'~ ........ : ~...~,. !.~t../?~ ...... House No. Street Hamlet Owner or Owners of Property .. County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ~..t?. ~..~.. Date of Permit..".~l~/.~'?'fApplicant...~./:e~.'(..~..~.~..': '/~"7 ' ¥' Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Fina~ Certificate ...................... Fee Submitted $ .... '~..', .[~..; .................. Construction on above described building and permi~ m~l appJ~cab~e~de~,and regulations. L.,~- '- ~ -- ~ Applicant ...... ~~. ~,~-X~ ,~ ...................... FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) DATE COMMENTS o~ ADDITIONAL COMMENTS: 2o ROUGH FRAME INSULATION & PLUMBING PER N· STATE ENERGY C,ODE FINAL ~' TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned ,.~.~.~,,.,.; ...... Approved .~..~-~.~. ....... ~ ............... , 1 .9~....~... Permit No.....~..../.~..~..~.<~..~....'~.... ..... Disapproved a/c ...................... .~.;; ~.;;~. ........ 7.'. ....... .~ ...................................... / (Building Inspector) Application No..../.~,~,.~.~..'~.~.. ............... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. 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 port 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. ............ .... ............. (Signature of applicant, or name, if a corl~oration) (Address of applicont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............... ................................................................................................................................................... Name of owner of premises . , d~ if applicant is a corporate, signqtu%e ,e~c~,uly~authoriz/ea of~cer. ........ ......... Builder's Lic~se No ...............7/ ................................. ~ , ~ ectr'c'a s ice se No..~..~. ..................... Other Trode's License No ............................................... 1. Location of and on wh ch prooosed work wi be done. Map No ............ ,.,. Lot No ........ Street and Number .~..~..~...4;&~ ...~..~/~.¢~- /~., '.~. ~. ~.~-~t(.~.. ........... ii .... / Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...... /. 4~. .. .g~.?. ......... ¢..~ ........... b. Intended use and occupancy 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alterationr .................. Repair Removali .................. ~ .................. Demolition .................... Other Work ..................................................... 4. Estimated Cost ~. u~) .~., cD ,~ .~ ' Fee .................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If galrage, number of cars ....... · ...................................................................................................................................... 6. If basiness, commercial or Fnixed occupancy, specify nature and extent of each type of use .".~.~/.'.~ ............. 7. Dimensions of existing structures, if any: Front ........~.~D..~/.t~ct,/,,~, Rear ................................ Depth .................... Height ........................ Numb]er of Stories ................................................................................................................. Dimensions of same structurei with alterations or additions: Front .................................... Rear ..... Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new coqstruction: Front .................... - ............... Rear ............................ Depth ........................ Height ........... Number of Stories ..... .~ .................. ;M~5';' .................................................................................... 10. Date of Purchase ................. i ...................................... Nome of Former Owner ........................................................ ! 1. Zone or use district in which premises ere situated ..................................................................................................... 12. Does proposed construction vialate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regroded . ............. 4 .............. Will excess fill be rem~ve, d from premises: (r) Yes ( 14. Nan' ......... r of premises ~..i .......... ~'] .............. .......................... Name of Architect ............... i ............................................... Address ................................ Phone No ....................... · .................................. ffnone 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 Iol. STA]'E O~ NEV~]~)RK -- ~ ~ c COU N'TY: ~S~ff~--~....... ~' :': ,, ~~....~...]..~.. ?...~../0.~. !l. b~ ,g duly sworn, deposes ena says that he is the ................ :]'~ame of ind v dual s ~ning contracf) above named. ~~0~ He is fhe ............... ~ ~ ~ ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dbly author zed to perform or hove performed the said work and to make and file this application; that ali stotemen}s contained in this application ore true to the best of his knowledge and belief; and tho~ the ~ork will be performed in }he manner set forth in the oppHcohon flied therewith. Sworm, tp b~fore me this~~/~~~,] ~ ~ Noto~ Public, . ....... u...~ .......... ~oun~ ~ ......... ;~.;-..... ......... 7 ....... ;;'""t7 ............................. ~~~~~/ ~,gno~ure or app,,con~, ~~' - ' ~HELIZABETH ~ANN N~l~ewNEVI~E ~0. 52-8[25850, Suffolk Coun~ T~ ~plres March 30, ': ;.: -~' "' ~""~":-~: ' 4 ~"' · ' ""&~'"'::;: -'-;... "'.,.-~ ....... ,..: ~.-.~ ~ ~'1~'~ ~ ~m 6'~ ~eh ~. , / ' ,"- .... ~ ..... ~e o ~ tank ~ ~ted ........ ~ ......... ; ...... ~. ,. ,:,- t ,, ~ ,,~: :~ ?~.., ~: ~ ~a~ ~ made te the ~s,~ ~'"~'~?t -T~:' ~ '~ ;,' .... ~,-'~, , s '~" J{ ~;1:'"' -~ '. -.' , N~o~ - -', ,: ,' .,. .' , , ........ ., .'-, -' -. ,?~s finish fl~r, V~w Box ~ rec''ed, where t~ic~ted on plafl cut r~ess sta~hng .......... from f;oo~ t0 bottom of viewer. Exit e~e Is .......... . wIGe x ........... high x ....... deep~ ~ sup~ied by d~tor {ns~ll~ by X-R~I~ Be~g ~ provide .......... ~ wt~ex ........... deep ~IdW~ back}ng ~om floor to {not drop oelling). Must ~ ~ei~forced to r~ist e 500 ~un~ ~IL ' X-Ray Back~g for 'Co~ot Box ~ Re~a ~t~{l~l ~ see Oen~al Dental Rep, for back~g requirements ~here ?pptioebte ~e M.F.G, [empl~te. Celli~ Mount~ ~ntel Lighl ~ install ~u~ting boa~ & ~iling ~ete es per manufactures aullt In Fiia-- wdh storage above Clothtng