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Home My WebLink About11611-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z 1.1.494 Date Zebruary 24 85 addition THIS CERTIFIES that the building ................................................ Location of Property . ./4-.8.Q .I..s.l,a.~qt¥;i.e.w.. l~n~ G:lT~ep28. ort County Tax Map No. 1000 Section ............ Block ............... Lot ................. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·. ~.asT¢~ 29 ......... , 19~.~. pursuant to which Building Permit No....q. q6J.'1.2~ ........... dated . ,a.p~..il. 2. .................. 19~2., 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 ......... addition to existin~ dwellin~. The certificate is issued to ..Lor~aip~e. A. Hoey ............... [owner, ................ , of the aforesaid building. Suffolk County Department of Health Approval , .N/g. .................................... UNDERWRITERS CERTIFICATE NO ....... .~gq .~,59 ................................... Rev. 1/81 Building Inspector Permission!is hereby granted to: BUILDING TOWN sOuTHOLD, BUILDING PERMIT (THIS PERMIT MUST BE. KEPT ON TH,E PP, ENgS~S UNTIL F~LL COMPLETION OF THI~ WORK AuTH°RI~ED) ~,:,,~ ...~..~...-:/....~...~.....:. ........... ~.~ tO at p~emise~ located at Courily To~ Map ~o. 1000 Section . .~... . purulent t~ opplic~tion dated Rev. i6/30~80 ipproved by the FORM NO. § TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY ~nstructions 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" [and 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, 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.. Hou~ No,Street Ham/et Owner or Owners of Property ..;.~.S:~~ , ~(.~..~-,-~ -.../~.~ ...................... County Tax Map No. 1000 Section .... . .......... Blook ....... Lo~ ............... Subdivision ............... ~-~'. ............. Filed Map No. ~ ,Lot No~-~ ........... Health Dept. Approval ......... ~ .............. Labor Dept. Approval ......................... Unde~riters Approval .~.~ ~.~. ' / ' .Planning Board Approval ................. , ,.. Request for Tempora..~Certificate ........ .~. ........... Final Certificate ...~'. ............ * Fee ~ubmitted $..~.. .... .~. .................... Construction on above described building and j~r~nit' meets all appl~cable~co_de~ and lations. regu ~0oo3o7 THE NEW YORK BOARD OF FIRE UNDERWRITERS 8S JOHN STREET, NEW YORK, NEW YORK 'lOO3e ~a~ January ~7~ 1~3 1745~1/82' App,lcatio. No. onS,~ N 591359 THIS CERTIFIES THAT only the electrical equipment as ~scr~bed belo~ a~d ~ntroduced by the applicant ~med on the able application ~u ~ber in the premises of wasexao~inedon J~ ~ 1~ and~oundtobelncompliancewith ~her~quirementsofthisBourd. FIXTURE OUTLETS 4 DRYERS rECEPTACLES SWITCHES FIXTURES RANGES OVENS DISH WASHERS FANS NCANDESCENT FLUORESCENT VAPO~ 11 1 FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: S E AW.G. j OF CC. COND. NO. OF HI-LEG A.W.G. NO. OFNEUTRAL$ A W g OF HI-/~G OF NEU?RAL 4 Joseph J. Frohnhoefer Box 817, Roul~e 25 //oul;Lold, NoYo 11971 COPY THIS ANy MANNER. FIELD z~NSFt~TION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & FLUMBING INSULATION PER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: FORM NO, 1 TOWN OF SOUTHOLD BUILDING DE?ARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined f.~.~, d~'...~.. .... 19 ~ .... ? Disappro:d a/c. ....... '. .... f. ........... (7 ......~'q' " ' .../ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS /./(/./ Application No .............. a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi 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 stre~ or areas, and giving a detailed descriptiou of layout of property must be drawn on the diagram which is part c~this apt: cation. c. The work covered by this application may not be cmnmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Sucl~ pen~ 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 Occupan shall have been granted by the Building Inspector. APPLICATION IS HEREBY blADE to the Building Department for th~ issuance of a Building Permit pursuant to t Building 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 describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessa~ i!!spections. (Signatur~ 9f applican~or name, 'f p ' ) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build ....~...~.,..I.M. ~...r-: .................................................... , .................. . ...... N,'une of owner of premises . . .~.,,o.~ .h a. ~/'a.z: .. C~k .... (as on the: If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's ice ns , o .-vJ. roll or latest deed) PERMI'f I ',K l'UL)iY:S APPRovAL fi'"~[SS FILL [;~OM ,;~gOVl~ PREMIsEs RFCi, ,' J?iG LOT Dfi~V;_w/~y CONSTRUc FION CESSPOOL CONSTRUCTION CELLAR CONSTRUCTION OTHER Otller Trade s Liceil~e No ...................... 1. Location of land oll which proposed work will be done ......................................... ..>~..... House Number.~..?0. ...... .~...O.: .O-:...' l ~'./.~. r3cJ .',X. ! .Street 'e 'M')'' '~' <' ''~'' .':2. :~ ................ Ham,~.~ ~,O. ff~) .O .~. ]../ ! ~/:'.. County Tax ivlap No. ! 000 Section . .O. ~'..~., .O...~. ..... Block .O.(~, .O. O ....... Lot .O.-~.~.: ~ :, ~... Subdivision... ,.. ................................. Filed Map No ............... Lot .............. ] (Name) 2. State exist/ug ucc and occupancy of premises and intended usq, and occupancy of proposed construction: a. . isting se'an oc,cupancy ...... .O., ./. ,t./. ......................... ~,~- -: *-'b" ,Intended, use, and occupancy ..... D..~/5-)O.~... -],,~( .... ~C~. J 1. i~ ~ .......... ~ ......... '.' ,~. Nature of work (check whicb, lapplicabt¢): New Building .......... Addition . Re ~alr .............. Rc!noval . .] .......... De, molition ....... Estimated Cost ........ ~' . .. Ir dwdl/ng mnnber of dwelling units If garage, number of cars ..., ...... If business, commercial or miked, occu :ancy, specify nature and extent of each type of use ........ Dimensions of existing stmctflres, if ar y: Front ............... Rear .............. Depth .... Height ............... Ntxmbcr of Dimensions of same structureiwith alt~ Depth .................. i .... He: Dimensions of entire new constrnction Height ............... Number of ........ Alteration ......... ... Other Work .............. (Description) ........... Fee I ~.. 0~,..-. ., ......... (to be paid on filing this application) ..... Number of dwelling units on each floor. .............. Stories ............................................. rations or additions: Front ................. Rear ....... ~t Number of Stories : Front ............... Rear ............... Depth .... Stories ' Size of lot: Front ......... , .... '. '..] ........ Rear ...................... Depth .... ~ ............... Date 6f Purchase ............................. Name of, fformer Owner .......................... Zone or us~ &s~nct m vh~ch prenuses~re s~tuated ........ ~ ....................... . ....... D CS ¢^ ' " O propoo~d constrnctlon vlolate an~, zoning law, ordinance or regulation: ............................. WiU lot be regraded ....... i...' .... Name of Owner of pram scs . ] Address .............. Phone No .............. Name of Architect ........ i .......i .......... ... Address ................... Phone No ............... Name of Contractor : ~ Address Phone No PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions fron roperty lines. Give street and blodk nun:b.~: o.r. description according to deed, and show street names and indicate whethe .tel'/or or corner lot. 1 e is the .................... f said owner or owffers, and is )plication; tJmt all statements cofit:fined ir 'ork will be performed in the manher set fo. worn to before me this ant, corporate offic,~r, etc.) ' ~mrm or have performed the said work and to make and file this this application are tree to the best of his knowledge and belief; and that the th ht the application filed therewith. County ..' (S~nature of apphcant' being duly sworn, deposes and says that he is the applic.'tn! N~'¥