The URL can be used to link to this page

Home My WebLink About11558-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z 11 14 1 Date ........ g~.~U~.. THIS CERTIFIES that the building ................................................ Location of Property ...¢~g.q;0. Q ................ ¥.~., .5.n..~o..a,ct ................. .0.~.?. ~.x.~ ..... Mouse rue. Street Hamlet County Tax Map No. 1000 Section .Q 1 $ ........ Block ... 0..6 .......... Lot . .0. 2. ~ ............ Subdivision...X ........................... Filed Map No..X. ...... Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated .... r'i q ~?.u.a.~. y..8 ...... , 19 .'3 ~ pursuant to which Bmld~ng Permtt No. , ~ ,35.5~. ~ ............ dated .... F.e. ~) ~' CAE ~. 9 ............. 19 .~3.~, was issued, and conforms to all o f the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ~p.~v.~¥~.5..qr). p.~.9.x.i,q~$~3L~..b..u.i.l.d.J:.r)~;, to a ono-tam:Llv dwellzn~-~,.. .......... The cextificate is issued to F~ter & Floren. ce ~rippe (owner, Jessee. er-tene~t,¢ of the aforesaid building. Suffolk County Department of Health Approval n / r UNDERWRITERS CERTIFICATE NO ........... I~..5.7. ] ¢5.6. ............................. Building Inspector Rev. 1/81 TOWN oF BUILDING DEPARTMENT TOWN HALL sOUTH*OLD, N~. Y. BUILDING PERMIT: (THIS PERMIT MUST BE KEPT ON THE PP, EglSES UhlTIL COMPLETION OF THE WORK AUTHORIZED) N9 11558 Z ULL Permission is hereby granted to: ....C.~~ ~.... ~z&~..~.....~.~ ,o ..~d.:,~....~,~...~.....~.~.~ ~?~...~..~...~ ............... ~/~ ~ ~ ~ ~~~ ... : ....... ....... .............. ~ ..................................................... .~.... .............. ,~ ~" ; .................... at prem,ses ,~ated at ...... r~.~.Z~...~~....~~......:~ ...... ~ ........ /...~:~' ~ ' ~. ~- .r co~ ~ ~o~ ~o. ~0oo so~o~ ....~.~ ....... ~o~k~ :~. ~ Cot uo...~ ......... Building Inspector. and approved by the Rev. 6/30/80 FORM NO. $ 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 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 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. .5- 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 'bertificate. 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 New ou,,u1Trg ...'E~./¢.~. 2..~.'~, Old or Pre-existing Building(:~), ......... =/Vacant Land ~ ........... LocatonofPropert ~.~_./(~ . ~ ~ ~ ..... ~.~(~%~.. y ...................... ~ .... ~... -, ~.. Owner or Owners of Property . .. /r" ~ ~' ~L0~¢~ Co,,,*~,M~,No.~000S~o~ion. .O.(X. ,~o~ .~.G .... Lo,...g.,, ........ .............. ~- ~ 2.~ Subdivision ...... ~' ......................... Filed Map No ........... Lot No .............. Permit No../Z¢~ate of Permit ." Applicant,., ~¢~ ................... Health bept. Approval ...... A/.¢~ ........... Labor Dept. Approval .. ~¢.¢ .............. ,.. Unde~riters Approval ...................... Planning Board Approval ............ ~ , .~ Request for Temporary Certificate ..................... Final Certificate .... ~..- ........ , , Fee Submitted $ ............. Construcdgn on above described building~d permit meets all ap~cabl~odes and regulations, Applican¢ ' FIELD,INSPECTION FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. Y. STATE ENERGY CODE FINAL COMMENT~ ~ ADDITIONAL COMMENTS: 1000708 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, J",IEW YORK, NEW YORK 1OO3~ D.te Aught: 5, 1982 161215-82 THIS CERTIFIES THAT intkefollowlnglocat~l~lt~?Basi~~ ~ lstFI. [] 2nd Fl. Section Block Lot was examined on --'x~--~ ~ ~ and found to be in compliance with the rpqulrements of this Board. FIXTURE OUTLETS DRYERS FURNACE MOTORS FIXTURES RANGES COOKING DECKS OVENS =ELDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET EXHAUST FANS DIMMERS SERVICE DISCONNECT OT"E~-K~.F'!~: I. 2'G.F.I. 's 1-Smoke Detector Panelboards: 1-Scir. 125aml~ S E OF CC COND, I C E NO OF HI-LEG A W G NO OFNEUTRALS A W.G. OF HI-LEG OF NEUTRAL Sal Prato, Elec., rt, N.Y. L~c: GENERA~ MA~N~GER 11 ~ / This certificate must not be altered in any manner; return to the office of the Board if incorrect, inspectors may be identified .by t~eir THiS COPY 4 ANY. ~NNEE. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 Disapproved a/c ....... -'.- ............................ ~-~/z4~ /~2/'~or~/~/-- "~ /._¢'~,~- (Building Inspector) V/~7'///~- ,~-~er'-- ~/~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date . ~ ............. 19. a. This application mnst be completely filled in by typewriter or in ink and submitted in triplicate to lhe Buildi Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. PIt3t plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stre~ or areas, and giving a detailed description of layout of property must be drawn on the dia~am which is part of this apg cation. c. The work covered by this application may uot be commenced before issuance of Building Permit. d. Upon appm.'al of this application, the Building Inspector will issue a Building Permit to the.applicant. Such 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 0ccupafl shall have been granted by tim 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 L&ws, Ordinances Regulations, for the construction of bnildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housiug code, and regulations, and admit authorized inspectors on premises and in buildings for necessar~ inspections. (Sign~ure of applicant, dg,,fiame, if a corporation) · C/ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build ...6.~. ~,.,~ .~ 1.. ~ ~..~': ~ .~?t. ~ r~ ...................................................... ~ a o,~n, o~ p~m~ .~ ~ .~ r~. ~ ~ .~..~.~*Y.*~.~ X. ~.r.t~g~ ................. (as on the tax roll or latest deed)~ ' If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No...~.l. ~ ................ Plmnber's Licens2 No.~4 .,..~&l~ ~4 ..... ~n's ~,,~ ~o.~,./..&~ ~. ~ ....... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ................................................ · ......... ........... c ..................... House Num her Street Hamlet County Tax Map No. ~0O0 Section . .~[.~ .......... Block ...d. ( ........... Lot. ~.Z<~ ....... Subdivision ~ ' -- Filed Map No Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use an occupancy b Intended use ~d occupancy ............ ). I. 3. Nature of work (check whict, ~pplicable): New Building .......... Addition .......... Alterat on ... ' Demolition Other Work Repair Removal , (Description) Estim'ated ................................. * ........... (to be paid on filing this application) If dwelling, number of dwelling units ........ Number of dwelling units on each floor ....... Ifgarage number ofca~s i ] ............................ If business, commercial or mixed occupancy, Specify ha. ture and extent of each t~;pe of use . ~,, .~a.I. · · Dimension, s pi existing structures, if any: Front .~, ~ ......... Rear . .~,,~[~ ........ Depth . ~.? .... Height . .I.~ ........... Nu)nber of Stories ...... J .......... _. .................... .~ .......... Dimensi%ns bfsame structure With alterations or ~dditions: Front .,~"&B$~, ........ Regr ~,,~)~ .~'~.~ .... Depttl . ~. ~,~Te'l .~, ......... i · · · Height .'}. ~. ~ g. ......... '... Number of Stories..I.. ~; .......... Dimensions of entire new construction: Front .~.~.v:~,.~ ...... Rear ~ ~,.t"~.'~ ....... Depth ~:~.t:~.~,,., ..... Nu'mber of Stories ' Height ~.~ 3't~.q~ ..... ~'~' '~ 'q'~~ ............................ t' ......... Size oflot: Front ...l.'-~..O. '.! .... ' ..........Rear..I.~'../. ............. Depth ~..,,~ O. ........... Date of Purchase' ....t.~.. .7...,~.. :. i ................. ~.~ Narn. e c]f F~r~)~r O~vner . ...~.. ................ . Zone or use district in which plremises are situated lq ~ ~ .~eJT.-Z-. t :~.1. Does proposed construction violate any zoning Iaw, ordinance or regulation: ........................... Will lot be regraded ... fi,~?...' ............... ~.. Will excess fill be removed from premises: Yes Name of Owner of premises &~.c~. t..~"for¢i~.c~.~.e~t~ess . .~.~-.~. ~,, .......... Phone No.c~.~. ~'.': .~.(~ ~. ~.N.o. Phone No ... Phone No~7o/~.':.~'..~. 2.Z .... Name of Arclntect ........ ! .................. Aadress ............... ' .... Name of Contractor ~----~.~,*~c .~ t".r.7 .... , PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and. indicate all set-back dimensions from roperty lines. Give street and b o~,k number or description according to deed, and show street names and indicate whethe~ ~terior or corner lot. ', TATE OF NEW YORK,-- OUNTY OF..d'.¥.~A/2,~. ..... S.S ..(~. ~.~..~..67.'?' .... ./~.... · · .~.~.~.~ ........... being duly sworn, deposes and says that he is the applican~ (Nanie of indMdual signing codtract) )eve nalned. e is the .................... ~ ................... ., (Contractor , agent ,~corporate officer , etc . ) f said owner or ownc~, m~d is d. uly authorized to perform or have performed thc said work anti to m~e and file )placation; flint all statements co~tained in this application are true to the best of his knowledge and belief; and that thc 'ork will be performed in the manher set forth h~ the application filed therewith. worn to before me this 0t~ Public, ............... . .. LINB~.F, g~3~l.. County a