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Home My WebLink About11585-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Halt Southold, N.Y. Certificate Of Occupancy No..Z.I~ 07.1 .......... Date ......... .~.u.~y..9. ................ 198..2. THIS CERTIFIES that the building ................................................ Location of Property .2.7..0 ................. !~p.~.~. I.1. .S.~.~. e. .e.t. ............. C. u. .~.c.h. ?¢p.e. . . . House No. Street Hamlet County Tax Map No. 1000 Section .. 102 ....... Block . .Q5 ........... Lot .... 0.1.8. ......... 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.~..u.a.r,.y.. 2.6 ...... , 19.8.2. pursuant to which Building Permit No...1 J~.8.~..Z ............ dated ...... HO l'la~. 19 ............. 19.8.3, 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 ......... ...an. o~i.~.~.~. ~.0n..~tl¢..aA .~.e?.a ~. ~.o.n..q.r..a.~...e.x.~.a ~..~z~ .d..u.o.Z.~.~..ng ................... The certificate is issued to ' . g.~qp.o.],~O.o..P.~Ota.e.y. (owner, 'l ~e' ~r~t~:~t~. ..................... of the aforesaid building. Suffolk County Department of Health Approval ...n../.a .................................... UNDERWRITERS CERTIFICATE NO .......... ~. ~.6.4.8. 1. .4 ............................... Rev. 1/81 Building Inspector FO]~M ~0. 2 · r°w~ o~ sOu~r"oq> BUILDING DEPARTME TOWN HALL SOUTHOLD, N~ Y. BUILDING PE~IT: (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL tULL COMPLETION OF THE WORK AUTHORIZED) ~o. ~sss z ~o,e ...:.,~..~:~ ...... ./.:..~ ....... ,,.. Permission is hereby granted to: ~ ~. ~~:~ ,, ~ ................ ~..~.....~ .~ .... .,~ ~,..~ ....... ~:.....~~.~ .......... . ....... , ................ ~.. ........... ~ .......................... ................. : .................................................................. : ............ ~...:~ ................ ~, ............ ~ ......................... co,nm ,~ ~p ~o. ~o00 so~t~o~ ...~.~.,..; ~k: .~:.~ ......... o~ Uo. :~.~ .......... ~.~ opprovod by th~ pursUont t* opplic~tion d~t~d .; ~ .: ...... , 19 ~nd 8uil~ln~ I~p~ctor. : } 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: I. 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. For existing buildings (prior to April 1957), Non-conformin,g 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 3. Copy of certificate of occupancy $1.00 $5.00 Date... ~ ....... Old or Pre-existing Building(X). _. ~.~ _ ~ ~Vacant Land ........... New Building ... Locat,onofPropertyH ? .... ...... . . o. Street ~ Ham/et Owner or Owners of Property ................ ~-, .................................... County Tax Map No. 1000 Section ......... Block ...~ .......... Lot ............ Subdivision ................................. Filed Map ~.~ .......... Lot No./~ ......... · 'if ~ ............ z ....... ';._..h" ...... ~.,...;~/j /~) .................. (~/~' Health Dept. Approval ........................ Labor Dept./Approval ...................... ,.. Underwriters Approval...~...~. ~ .~'~..~./.L~. ...... Planning Board Approval .................. ~.., Request for Temporary Certificate ..................... Final Certificate ................. * Fee Submitted $.; . ' .................. Construction on above described building ~/d~rmit'meets all a , Jlations. /FIELD INSPECTION JDATE COMMENTS - H tJr� . FOUNDATION ( 1st). ( � FOUNDATION ( 2nd ) 2 . ROUGH FRAME & PLUMBING H 3 . x INSULATION PER N . Y. y STATE ENERGY CODE FINAL h ` b ADDITIONAL COMMENTS : x 0 7 H • x H x 'd r� H THE NEW YORK BOARD OF FIRE UNDERWRITERS EIURE~AU OF EL. EC'FRICITY 85 JOHN STREET, NEW YORK, NEW YORK 1003B ~ J~e 9, 1982 · ' 170392/82 ..t~ ~'p.,,c..onNo. onZ"e N 564814 THIS CERTIFIES THAT only the electrlcal equipment as described belo~v ~nd introduced by the applicant ~med on the above application number in the premises of Jacquerie $~ney, North $[r~eC(Ma~% ~ & School) Outcho&ue, in the following location; ~ Base~nent ~ 1st Fl, [] £nd FI. Section Block Lot was examined on and found to be in compliance with the ~quireme~ts o~ this FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FIXTURE SWITCHES DRYERS SYSTEMS NO, OF FEET OTHER APPARATUS: E R C NO, O~CR~,COND1 A W.G. NO.OF HI.LE~ A W.O. NO. OF NEUTRA£$ A 'W' ~ OF CC. CO~D, OF HI-LEG OE NEUTRAL To~:~ Harbor Lane 5out~ld, N.Y. 11971 l~c~28Z-~ This certificate must no be aJtered in an~ manner; reJurn ~o the off[ce oJ the ~rd JJ .nco~rect nspedors may be dent J e~ b~ the r cr~en[ aJs. COPY F~R BUILDING DEPARTMENT. THIS ~OPY OF BUILDING DEPARTMENT E×om ned .... pp No. ........ ............. Approved / / 19..../.... Permit No. Disapproved a/c .......................... - ~ ::::~;;:iiiiiii~:i:::~: iii::iii ......... {Building Inspector) APPLICATION FOR BUILDING PERMIT Date ........... INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildin Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of Iot and of buildings on premises, relationship to adjoining premises or public streets c areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this applicotior 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 perm 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 Occ~panc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to ti~e Building Dep~rtment for the issuance of a Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descrlbec The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors on premises and in buildings for necessary inspections. of applicant, or nam ,~ __.,~__tion) ....... ....... (Address of applicant) 'q~) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or Name of owner of premises .~ ~..~...~..I.~.~. ~ (./LI/~z~ ....... P/~WAJ/'~ ~./ ............................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .............. .~...~'. ................................ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ........................ Street and Number ..~...~..~. ~..~.~.....2~.. ~ .. ~...U....?...~..?..~..~...~.C........~...~.~.. ..................................... /O ~,, L~-6c-~-~ ,~'-- /-~T- ~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ... '~.~.~.t//,~.~.~. ....... ~.~.../.~).......?.......~..(;:~.~.,/.....~.~.~..(,~.~. ........................ b. Intended use and occupancy ............... ..~'.~../~...,~;;.~. .............................................................................................. 11. 12. 13. 14. Nature of work (check whlch appli Repair .................. Roma?al ........ Estimated Cost ' If dwelling, number of dwelfing ur If garage, number of cars i ............. If business, commercial ? mixec Dimensions of existing structures, if :able): New Building-. ................. Addition ...... ~ ..... Alteration ................ .......... Demolition .............. ,~ ..... Other Work .................................................... -~ ,.,- ~ / (Description) . .. ............................ Fee ......... ./.% .......... .................................................. (to be paid on filing this application) its .......... /. ................ Number of dwelling units on each floor ........................... occupancy, specify nature and extent of each type of use ....HL.,'~?.G. f4 ......... any: Front ............................ Rear ................................ Depth .................... Height ........................ Namber of] Stories ....................................................................................... ......................... Dimensions of same structure with alterations or additions: Front ....................................Rear ........................... Depth ................................ . Heigh~t ............................ Number of Stories ................................ Dimensions of entire new construcjon, Front .................................... Rear ............................ Depth ....................... Height .................... Number of S~ories .................................................................................................................. Size of lot. Front ............ i ............. ] ............................. Rear .......................................... Depth ............................... Date of Purchase ............ i ............. 1 ............................. Name of Former Owner ....................................................... Zone or use district in which premi],es are situated .................................................................................................... Does proposed constructioo violate Will lot be regraded ......... i .............. Name of Owner of premises L ............. Name of Architect .......... i ............. Name 'of Contractor ...................... Locate clearly and distinctl alt bulk property lines. Give street and iblock m whether interior or corner lot. )ny zoning law, ordinance or regulation: .... Will excess fill be removed from premises: ( ) Yes ( ) No ..................................... Address ................................ Phone No. ..................... ..................................... Address ............................. .'.. Phone No ........ ~ ............. ..................................... Address ................................ Phone No ........ ~ ............. PLOT DIAGRAM ings, whether existing or proposed, and indicate all set-back dimensions fron tuber or description according to deed, and show street names and indicat~ STATE OF NEW~Y~'~,K. ~ £~ ¢ c / {Nar~ of individual signing above named. He is the .................................... ,'~...~ ,.?..l~./)~..t~.~6~...being duly sworn, deposes and says that he is the applicon )ntracf) ,ntractor, agent, corporate officer, etc.) norized to perform or have performed the said work and to make and fik ~ined in this application are true to the best of his knowledge and belief; of said owner or owners, and is iduly out this application; that all statements cant thor the work will be performed in the ma 3ner set forth in the application filed therewith. Sworn to before me this ....day of ...... ....... ...... .......... :~ ,, ,, ' N~. 5218125850 8 ffok Co~ .. ' , , " , ' J