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Home My WebLink About11574-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N.Y. Certificate Of Occupancy No, Z.1.Q986 ....... Date. ...... MaF. THIs CERTIFIES that the building . ,...ac ca.', s ov~ .zap'age ........................ Location of Property .. 15 .15 ............. L owe!,..I~ oafl. .................. Sou ~;J~o l (t ..... House No. Street Hamlet County Tax Map Ho. 1000 Sect,,on ...069 ...... Block .... 05 ......... Lot . .0.1.3 o B.0.2 ....... Subdivision .... ~ .......................... Filed Map No. X ...... Lot No... X .......... conforms substantially to the Application for Building. Permit heretofore filed' in this office dated ·. F.e.b.e. htat'7..~§ ...... , 19 ~3.~ pursuant to which Building Permit No... ] .15.?.t~..g ........... dated .... F.e. brua~.y.. 26 ........... 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 ......... ·. ~.la..e,<~c.e.s.~ OI'y..t,'49.-.c.~V. ~. ~,g.e ............................................... The certificate is issued to ..... /[l~.tlhtJr'. .G,. ¢~1,~ o~ ................................. (ownar~a,~see of the aforesaid building. Suffolk County Department of Health Approval ......... n/. r .............................. UNDERWRITERS CERTIFICATE NO ............. iq. 5.5t~ 9~.8. ........................... Rev, 1/81 Building Inspector Ni°. 11574 Z FO~ NO;; ~ TOWN OF s~UTHOLJ BUILDING DEPARTME TOWN H~LI. SOUTHOLD, N~ Y, ¥ Permission is hereby granted to: Cour~ty Tan Map No. 1000 Sect,an .......... B ack .~0~ ........ Lot No. ~ ~ put'ant tb application dated .~~.~},. ........ , 19, and 6pproved by the Bui~ / ~ ng Inspector; ~ ~ Fee ~' ~: ~- BUILDING P, ERMiT ~ (THIS PERMIT MUST BE KEPT ON TH,E PREN S~ UNTIL FiJLL THE WORK AUTHOKIZED) · ' COMPLETION OF Date .... ~T~ .~...., ......... , 19.. ~ORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This appJ[cation 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 P~anning 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 peopert¥ showing all property lines, streets, buildings and unusual natural or topograph[c featu res. 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. ; 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 Date New Building .". .O;. Old or Pre-existing Building(Z) ......... = fVacant Land ........ Location of Property...t,~,-~, .,.~. ........... ~[J~.../~..4~, ......... ~.'.-.~~/d Hou~ No, Owner or Owners of Property ..~~ .... .~,. S~~............... ~,,, County Tax Map No. I000 Section .......... Block ...~ ....... Lot ..... ,~ Subdivision ...... ~ ......................... Filed Map No...~. ...... Lot No.. ~ .......... . Permit No. ~(~ +.~Date of Permit ...... ~..Applicant..~~..~(.~ ....... Health Dept. Approva[ ...... ~.~. ............. Labor Dept. Approval ...' ~ ................ Unde~riters Approval ......... ~ ~ ~ ........ Planning Board Approval ............~. ~ . . ~ Request for Temporary Certificate ..................... Final Certificat~ .... ~ .- ......... ~ Fee Submitted $.. ~ ~ ~ 1000343 THE NEW YORK BOARD OF FIRE UN ng BUREAU OF ELECTRICIT'~ [~ ~(~'[ 24, 1982 as JOHN STREET, NEW YORK, NEw ~ORK 1~ THIS CERTIFIES THAT only the electrical equipment as described bel~ and int~duced by t~ applicant ~amed on t~ ~x.~,~do. ~ 22, 1982 and found to b~ in compliance witb t DERWRITERS 038 N 55492~ above application number in the premises of thold, N.Y. Section Block Lot Itc r~quirernents of this Board. FIXTURE OUTLETS R~CEPTACLES SWITCHES FIXTURES RANGES , OVENS FLUORESCENT DISH WASHERS EXHAUST FANS DRYERS SYSTEMS E OTHER APPARATUS: A. WG PER ,6' OF CC, COND 1 A W.G. NO, OFNEUTRA[$ OF HI-LEG AWG, 3/O Coodale [tec. c~c. ~~/~ ~~~ RR 1 Box 1~ ~ ~. ~tti~, N.Y. 11952 ~r 1~ GENSRAL,MANA~R / I~~:~;r=anner;' return ,o the office of the Board if ,~co~rrect. Insdecto~s ma7~:: J}~tlfied ~; their clde~t/als. COPY FOR BUILDING DEPARTMENT. THIS COPY OF ~KI!FICATE[MUst~ flOT~E ~iTERED i'~ ~.v FiELD,INSPECTION~ ~. ~ FOUNDATION (1st) COMMENTS ..... ~ ~ ~', ,.~ FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY QODE FINAL ADDITIO~ENTS: FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, H,Y. 12971 TEL,: 765-1g02~, Exa~nined ~-~"t ^ppro,,ed..~..~:... ~ ..... l~ ~ermit ~o././~.77..¢...~ ......................... (Building Inspector) APPLICATION FOR BU[LblNG PERMit INSTRUCTIONS Application No..//.&. '.~..~. .... a. This application nmst be completely filled in by typewriter or in ink and submitted in triplicate to the Build; 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 pnbllc stre or areas, and giving a detailed description of layout of property must be drawn ou the diagram which is part of this ap[ cation. c. The work covered 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 pen shall be kept on the premises available for inspection throughont the work. e. No building shall be occupied or nsed in whole or in part for any purpose whatever until a Certificate of Occupan shall have been granted by the Bnilding Inspector. APPLICATION IS HEREBY /,.lADE to the Building Department for the issuance of a Building Permit pursuant to t Bailding Zone Ordinance of the Town ~f Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describt The applicant agrees to comply with all applicable laws, ordinances, building code, housing c~gde, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. ,/] ~fl ~ (S~gnature of applicant, or name, if a cor~B'ration) · .Z x5....,, zz.. '. (Mailing address of applicant) ' 'J ' ' $'tate whether applicant ~s owner, les,see, agent, arc!fitect, engineer, general contractor, electrician, plumber or build · ..0. W.~..~£ ................................................................................. Nmue of owner of prcmiscs .ff~/f~.7'../f.~.'('~..U~.~'. .................................................. - (as on the tax rollor latest deed) If applicant is a corporation, signature of duIy authorized officer. (Name and t/tlc of corporate officer) Builder's License No....~T~..~: ....~...-F~./..~.. ........ Plumber's License No. ~...... .................. ELctncmn s Lmense No. . . C..Z¢' Other Tr~de's License Location of land on which proposed work will be done ................................................ ./~./07 .................. d ~z£../~ ................. - ...&~,~w~.~ a. ...... House NumberStreet Hamlet County Tax Map No. i O00 Section .................. Bloek .................. Lo ............ Subdivision ..................................... Filed Map No ............... Lot .............. (Na~ne) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . b. Intended use and occtmancy ~ ~. 4- ~.. ' ....N~ture ~d~ork (check ~htLhj~gptf¢~:t,fe)' ...... New $o,(Idir~ ./~ '.kdditik~n ' ' Alfer,9~ov~' . ........ Repair Remo~' al gemolJdofl O/2er ~txw~cd P.o~ ................. Fee , .Z .... ' .......... d//..fl. (to be paid on filing this applicl~tio~o, If d',ve!!iag, number of dwelling units ......... Nmhber of dwelling units on each floor ..... ' .......... If garage, number of cars . ."~.'6t).O....I].~.I'/.Z¢ ~..~ .................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use, ................... Dimensions of existing· stmcteres, if any: Front . {D,. ~ .... ....~-. Rear .(22. ........... . Depth . ~Y,.~. ...... Height Dimensiq~scff same structure!with alteration,~/or additions: Front ...c/..~. .......... Rear . .Y../-~. ........... D ptt q:~..7. H 'gl /c, Numbe[ofStor' Dimension.s 9f entire new con:struction: Front..z/.d~-. ......... Rear ...~..~....' ..... ; Depth .c~,'~. ......... H,',ht ,/. ~ Nub f Stodes /. · ' Size of lot: Front ......... ~ ..... '.. ..........Rear ............. '. ........ I~epth,,j..2_f)... ~ ............. Does propo~,d construction v~olate any zonin, law, ordinance or reoulatio'n: 1~.0 .......... ' .............. ., Will lot be regraded ~..~....~..' ...... ~ ..,~ .......... Will excess fill be remrwed from premises:~. ,.,Yes ~ N Name of Architect ' Address ' : Phone No Name of Contractor Address - Phone No PLOT DIAGRAM Locate clearly and distinctly all m ildings, whether existing or prol~osed, and. indicate all set-back dimensions fret ~roperty lines. Givelot~Street and blo,ekrn~mber¢j""T~°r dg/,~/d'//,/7-/~,~.f /7 77-// C /,/ cr~' ' .: ~tcrior or corner ~ ~/p/.,~i ~ description according to deed, and show street names'and indicate wheth~ STATE OF NEWc~ORI¢,, ... ~' .............. being duly sworn, deposes and says that he is the appIic~f (Nanie of indMdual signing contract) above named. ' '. , . k.[e Is' the ~.~ .~. .~...~ ~. ~ .................................................................. ~~,' ~ ~(Contractor, agent, corporate officer, et~.) Of said owner or owners, m~d is duly autho~zed to perform or have performed the said work ~d to m~e and file application; that all statements co~ttained in this application are true to the best of his knowledge and belief; and that tt: ~or ~ wfl be performed in the man.ncr set forth fl~ the application filed therewit~ / ~wom to before hie this ~ . -~~/~ ....... ....... ..... , ., . , , ,, ~ ~ k, ~,, [ ~m ~P~res March 30, lg..~