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Home My WebLink About11590-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.. Z.l.1 17.7 ......... Date ....... gep.[.e~ro.b~Jr'..10 ........... ,19.8.2 THIS CERTIFIES that the building ................................................ Location of Property .. 1980 ................. /llhe. Long. House No. Street Hamlet County Tax Map No. 1000 Section . .030 ....... Block . .0.2 ........... Lot ... 127 ........... Subdivision...P. ebb.],e.Be~ch.¥a~.m~ ....... Filed Map No. .6.266. . .Lot No. . .67 .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... M&r c~, · 1 ? ...... , 19 f~£ pursuant to which Building Permit No... 1 .15.9.(}. g ........... dated .... lq~r. c h. 26 .............. 19 B~, 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 ......... · a. ~r. ivaJge, on~., la,ail y .'d~te lling, w~.~h. ~l e.c.k. ~.d.d ~, ~,~ p.n. ~ .................... The certificate is issued to .... Pa.ul. &. Ilo~o.t2~y. Ko. gate;La ........................... (owner, I~ of the aforesaid building. Suffolk County Department o f Health Approval .1.2 -. $ O.-.~ 5 ,. ~./. ~ .~/.8.2 ~. ~.o.~ .~ ,. A ... ¥ ~,~. [. a. ~. UNDERWRITERS CERTIFICAT~ NO ........ I~..57.~56 ................................ Rev. 1/81 Building Inspector BUILDING TOWN HALL SOUTHOLD, N. Y. 1~590 Z .(THIS PERMIT MUST BE KEpT ON~ TH,E PI~E~,IS~S UNTIL FpLL cOMPLETION OF THE WORK AUTHORIZED)~ iI i'~ Pernhiss~on~s hereby granted ,o ,......C.i~ ').cz...~....~. at p~emise~ located at Sui d,! g I~spector, Fee ,.../[..~. ............ ? ¢0~a, ~'a~ Mo~ No. lO00 Sec~o~ .,..~.~.'..,~ pur~nnt ~ oppDcoflon datod .... , //J70 No. i/~.7.. .......... and ~pproved by the 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 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing alt 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. 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) .......... =/Vacant Land ......... Location of Property . ZY~-.~.D) ........ '~./~...Z_.~'~'...~...~..z~..~. HOL~Se No,~.~_~. ~ / Street/ Ham/et Owner or Owners of Property/~/¢.Z...~./)~ ~.~.~¥._ .Z~'q.~ ~ .Z-..¥/. 5 ......... County Tax Ma 'No 1000Secton .---~. /~, - c:~ '.,~'~'~' ~ .... P ............... D~OCK ............. Lot /~ .// ,. Subd'v's'o,.-~-~.':.~': ~.~.~.~ .~.~....~,ed ~p No. ~..~ ~..'ot ~o...¥.? ...... Oat o, ............ Health Dept. Approval . .~ ................... Labor Dept, Approval ...................... ,.. Underwriters Approval...~. ................ Request f°r Tempo rarYv~,rtificate ..................... Final Certificat'.,: Fee ~ubmitted $ ............. ~ ........... Construction on above described building and permit'mee~s all app~cable_.code~ and/f~ulations. ' APp cant (~-"~./~-,~ ............ i 01071'.~: ~ THE NEW YORK BOARD OF FIRE--UNDERWRITERS'.::~-/:, .:. : , : BUREAU OF ELECTRICITy ,,, ' 85 JOHN STREET, NEW YORK, NEW YORK 10038 °nly the ~l~ct~cal equlpn~en~ az descrlbed below'and in~r~duced b Y ~ aPPttcant ~med on the above application number ln~the prem~es , ~. ~. pa~ ~patsis, ~e ~ Way~ 3rd,~Ho~e P ~ncewlththereq~lre~entso RXTURE ~ FIXTURES. ' Thi~ certificate must not;be altered id any manner; ~'eturn ~ tl~e o~fi~e of the Board if - ' .... ' -: '~' ' ' ' ::,- inco~red~' I~specto?~ may be 'identified by their c~edefltials. FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY DATE COMMENTS Vl~ . .. ~ ~ .~ ....... ADDITIONA,L COMMENTS: FINAL d ,5' TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×om,ned ~,-~ ~~.....~ ...... , ,~&. ~,~,~ ~o..zI~o.~ ...... o~o~,o~ ~ ........................................... 0 ................................ G ...... ........................................................... ...... ............ ..... {B~din~ In~pector) Application No../[~..'..'~Y~. ............ APPLICATION FOR BUILDING PERMIT Date .............. ~7. .......... .p.. ...... , INSTRUCTIONS a. This application must be completely filled in by typewriter off 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 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 Occupuncy 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 Lows, 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 neces.~jry inspections. (Signature o/f/applica~, or name, if a corl~';;t~i~ ........ (Address of/applicant) / ~ .... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly outhodzed officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No. {'~...~.d.~.g zr.J V ,xjdl O,) Electrician's License No ............................................. other Trade's License No ............................................... Subdivision 1. Location of and on wh ch prqposed work w be done Map NP~.'~..~./.~..~..cM-c~.~ Street and Number ......... [~G. ............ ~......~..~ ...... ~.~ Municipali~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ~. Exisitin, use and occupancy ...... ~"~'~'"'"~'":'~/c-- ....... ':i"~ ........ 7' b. 'ntended use and occupancy / ~/' ~t ~oun,, ~× ~p ~o. ~s,. ,00o soc,o. ~,~ B,oc~ ,~ ,o, /47.' 3. Nature of work (check which applic¢ Repair .................. Remova.I ........... 4. Estimated Cost ................... ~...~... ///5.1 If dwelling, number of dweljling unit / \If garage, number of cars ...] .............. I 6.~lf business commercial orJ mixed / 7. Dimensions of existing struct[ures, if I rHeight ........................ Number of t ,/Dimensions of same structure with L / Depth ................................ .Height ._8 Dimensions of'entire new c~nstructi Height .................... Numb0r of Stol hie): New Building. ................. Addition .................. Alteration ......... ....... Demolition .................... Other Work .................................................... 7~ ~ (Description) ........................ Fee ....z. ....... t ............. · ............................................................. (to be paid on filing this application) .................... .~ ...... Number of dwelling units on each floor ............................ >ccupancy, specify nature and extent of each type of use ............................ ~y: Front ............................ Rear ................................ Depth .................... ~ories .....................................................................; ........................................... terations or additions: Front .................................... Rear ............................ .......................... Number of Stories ................................ ~: Front .................................... Rear ............................ Depth ........................ 10. 11. 12. 13. 14. Nome of Contractor ........... ; ............. Locate clearly and distinctly dll buildi property lines. Give street and block nur whether interior or corner lot. STATE OF NEWd'CGRI,f<-, _xz- L/, ~c S COUNTY OF .~..¢...l. Tl~.J~. ....... i~ ~,' ................ .......... (Name of indivi~Jual signing ~co above named. ' ~'He is the ....................................... ....~..~.. (Co of said owner or owners, and is dbly auth, this application; that all statemen'ts conta tl-,oz the work will be performed in }he manl Sworn to before me this i ...... of :fy Public, Size of lot: Front ............. '~(',7,~' ; ............. ;L' ....................... Rear .......................................... ~./~J/_/"/',l.~.Dqpth ................................ ote of Purchase ..................... of . ...... ......................................... Zone or use district in which premise~ are situated ..................... ~...~. Does proposed construction ~iolate a~y zoning law, ordinance or regulation: ..., .................................................... ~ Will. Iai be regraded ............ ~ ............. ~. Will excess fill be removed frompmmises.(' ) Yes (~No Name of Owner of premises ...[ ............. 4 ............. ~..., ................ Address ................................ Phono ~o. Name m' Archftect .~.~/ ........... .~.~ ................ Address ................................ Phone No ....................... .................................. Address ................................ Phone No ....................... PLOT DIAGRAM gs, whether existing or proposed, and indicate all set-~ck dimensions from bar or description according to deed, and show street names and indicate duly sworn,depo~o~y~ thor h~ is tho tracf) Term Expi?es March 3 tractor, agent, corporate officer, etc.) rized to perform or have performed the said work and 'to make and file ~ed in this application are true to the best of his knowledge and belief; and er set forth in the application filed therewith. ......... /(Signat~f~e of applicant) .............. : .............. County VrLm£ New Y~k The.. sewage dis~os~ PP ' Y -..7 ' VA~AN T' SUF FOiaK . HEA~.TH H.s. ~o. OF TITLE No. ~ uNAU'momZtO 'rlT~URVEY OF PROPERTY AT . ,, ~ '/* !Ii: ~_ L d z~¢.~ ~ z~_?_' . ', ~" 2 { .. ~ ii,J, ~ / ~ .~:x~.~ ' '~ :'::': ' _',,j~ __,~___________ . ~- ........... , .;.. ,,~ ~1-~. ~, ~' _ = _~ '~?~. ~ ._ ,,~o. ~ ......... ~ .................................. ~,~ ~,' ................................................. ? ................ </_?_.' -~ NOTIFY BUII_e~NG DEPARTM~ AT [ T .... FOLLOWIF'G Ih'cPECTIONS: ·...... ... . . . ...,., ,-~ ___ . _____ , ~ ~/~ ~ ~ /~' ~ ~ ~ m ~/ STATE CONSTRUCTION & ENFRGY ~" ~ ,,J j OESIGN OR CONSTRUCTION FRROqr C ' ~ , --, ,, ~ , ,, , , /I;5~' ~ j r r' ,~' . ,I~,~;~* ~ / '1 r +. Jt I~ LBVATIO N I