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Home My WebLink About11622-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy 74o.~. J .29.5.9 .......... Date ...... ~q¥¢¢.h~. THIS CERTIFIES that the building .. ~(I3.~.~.0~ .................................... Location of Property . .~.~.5 · ~.~e.~;e~..l~l~ ................. ~.o.~.~ho2.d. i.. House No. Street ........ County Tax Map No. 1000 Section ...0.~.9 ...... Block ....q.q ......... Lot ..... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..Ap~-.1, .20 .......... 19. ~2pursuant to which Building Permit No.~l ~f522Z ............... dated . g.D~il. 20 ................. 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 ......... .... ~0r..am. ~.ddi~5~a~. ~r~..am. exi~:kng, orm. £amSly. &wel~:Lug ................ The certificate is issued to .. ~L~.Y..&. ~R]~ .2P~KOIgICZ ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .......................................... N6q 6&86 UNDERWRITERS CERTIFICATE NO .................................................. 1/81 Building Inspector FORM~ ~o. ~ TOWN 0F S0U. BUILDING DEPARTMEFIT; TOWN HALL SOUTHOLD, BUILDING FE~IT (THIS PERMIT MUST BE KEPT ON TH.E PRE~Mis~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Nfo. 11622 Z Dote .,..~.,.i...2 P.ern~ission is hereby granted to: ...... . ..: ......... ............ /.. ........ ...} ~o ............................................... ~ .......... ,... x~...,.q .................. d.~ .................. ~ ....... et prem,se~ Iocoted et ............................................... ..., ......... ,...~.~. ............ ~ ............. , ......................... ....... , ..................................................... ; .................... :.~..,~ ...... ; ....... ~ .......,, ....... g ....... ,.....: .......................... ..... ,.; ......... ~ .................................. ~ ............................. , :'"; .......... ?..~........ ....... ~.~. ............. .......................... Cou~ ToXMop No. 1000 Sectmn ............. ~ , Block i, ~ ., . ~t No. ;.~ ................ aumuant' to ~ pllc~tmn do ed ....................................... , ...... ~...., .... ~ ,PP Y euik:jing Ir~spector, Fee {.....t...'~,.: ............ ~specto~, FORM NO. 6 TOWN OF SOUTHOLD Bu ilding 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 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-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 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. C. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling ~/r land use $/5/$5.00 3. Copy of certificate of occupancy $1.00 t Date .... ./.~'.~?//~. .............. New Building ............ ~xisting ~].~ ............ Vacant Land ............. Location of Property ...~..~.'~.~. ...... ' .~. VF..k/.~. ,~.. ~.~. R.~ ......... .~ o ~;'~ I~) No. Street .......... , ......... Owner or O,,,ners of ProperW .. County Tax Map No. 1000 Section .... ~.-~' ........ Block .... /~.~ ........ Lot. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.//. ~??-..5~... Date of Permit~,~z~/~'~ . .Applicant .......... ~ ...................... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ~;./~.. J/~/~./..~. ..~.~. ....... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate.~. ................... Fee Submitted $ .,,)~ ;~.~. ....................... Construction on above described building and permit meets all applicable codes and regulations. Applicant .............................. R~. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS E~UREAU OF ELECTRICITY 8S JOHN STREET, NEW YORK. NEW YORK 10038 ~g ~e~r 1.4 , [983 ~ppl~catlo~ No. o. /ite 232809/83 N 61648 THIS CEETIFIES THAT only the e~ec~r~c~ equipment ~ ~scribed below a~d introduced by the applicant na~ed on the able application ~ber ~n the premises of ~1~ ~1~, S/S ~rs ~e~ ~ld~ N.Y. ~' ~. of ~ld in the/allowing location; ~ Basement ~ 1st FL ~ 2nd FI. Sectio,, Block Lot wasexaminedon ~ 8~ 1~8~ andfoundtobeincompliancewiththerequirementso~thisBoard. FIXTURE FIXTURES RANGES OVENS DtSHWASHERS EXHAUST FANS OUTLETS NCANDESCENT FLUORESCENT VAPOR 9 ~2 6 9 DRYERS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT S E NO. OF CC, COND R V I C A.W G NO OF HI.LEO OF CC. COND Or NEUTRAL OTHER APPARATUS: Electric i~a heaters: 2-1.Okw~ Pallelboards: ),~cir, 3J~Sal~s. Harbor Lane Cutchogue, N.Y. This certificate must not be altered in any monner~ return to the office of the Board if Jncorrect. may be idenfif COPY FOR I~UILDING DEPARTMENT. THIS COPY OF CERTIFI~ r' BE ALTERED IN AN~ MANNER COMMENTS · & 'FIELD INSPECTION 1. FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TCWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1802 Examined ................ ,19... Approved ................. ]9 . . . Permit No ............ Disapproved :~/c ....... "_z--~---~.< · ~ ......... (Building Inspector) APPLICATION FOR BUILDING PERMIT Application mo ............... INSTRUCTIONS a. This application must 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 accordiog to schedule. b. Plot plan showing location o1' lot and of buildings on premises, relationship to adjoining promises or public strc or areas, and giving a detailed description of layout of property must be drawn on the dia~am which is part offthis ap cation. c. The work covered by this application may not be commenced before issuance of Building Pe~it. d. Upon apprc,'al of this application, the Building Inspector will issue a Building Pe~it to the applicant. Such pe~ shall be kept on the premises available for inspection ~hroughout the work. e. No builclJag shall be occupied or used in whole or in pa~ for any purpose whatever untg a Certificate of Occupat shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Bnilding Department for th~ issuance of a Building Pe~it pursuant to Buildiug Zone Ordinance of the Town ~f Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, tbr the construction or buildings, additions or alterations, or for removal or demolition, as herein descfib The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, ~d regulations, ~d admit authorized inspectors on premises and in buildings for necessa~ inspec~. "(Signature of ap~canL oi name, if a co~o~tion) (Maumg address of apphcant) State whether app!icant is owner, Icssee, agent, arc3~itect, engineer, general contractor, electrician, plumber or buit; Nmue of owner of premises ........ ) .................... (as on the tax roll or tate~ d~d) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No Plumber's Licens: No .............. r.z~x .F~ ~lactrician's License No.' ........... Other Trade's License No ...................... 1. Location of land on which proposed work will be dqne ................................................ .... ............ .......... .: ............................ House Number Street Hamlet .......... .... ........ ........ .... ............ Subdivision ' Filed ,Map No Lot (Name) 2. State existing use and occul~anc¥ of premises and,intet,~tled usq. and occupancy of proposed construction: a. Existing use and occuuancv .................................. ........... -:..: b, Intended use and eec an ' · "' ............................ Il. (4, 3. Nature of work (check whicl,I applical Repair .............. R,2mo','al . 4 Estimated Cost , ..~ $. Ifdwclhng, number ofdwelhng units If garage, number of cars ..., ...... 6. If business, commercial or mixed occt 7. Dimensions of existing stmctpres, ifa Height ............... Nlunber o Dimensions of same stmcturei with alt Depth .................. i .... He ti. Dimensions of entire new constructim Height ............. Nb nber Size oflot: Front Date df Purcl'.ase Zone or use district in which premises , Doe~ proposed construction vlio[ate an Locate clearly ~d distinctly all et 'kl: property lines. Give street and block numb~ ',nterior or corner lot. e): New Building ........ or Alteration ........ ............ D,,rnolm,,n .............. Other Work ............. ,._~ ,~l,,5~ o, ~,~.,.,_ . /.~.~"~ (Description) ./1'-4. ................. Fee ...................... , ......... (to be paid on filing this application) · Number of dwelling units on each floor )ancy ~pecffy ~ature and extent of each type of use ¥: Front ............... Rear .............. Depth ........ Stories ................................................. rations or additions: Front ................. Rear ........... i~t ...................... Number of Stories ............... : Front .............. Rear .............. Depth .. Stories . ....... Rear ...................... Depth ........ ............. N~rne of Former Owner ....... are situated ":. F zonfng law, ordinanc~ or reg, l~tim~ ................... Will lot be regraded ....... :. · .' .................. Will excess fiI1 be removed from premises: , Yes , N Name of Owner of premises .i, ....... ' ............ Address ................... Phone No ........... Name of .\rchiteet i ] · Address Phone No Name of Contractor ; Address ........ Phone No ............... ,. PLOT DIAGRAM ngs, whether existing or proposed, and, indicate all set-back dimensions £rm r or de!;cription according to deed, and show street names and indicate wheth~ .] ~TATE OF NEW YORK, COU;\~FY OITq, ............. ' .., S'Sk · '; i~[l ract) . being duly sworn, deposes and says that he is the applie,',.n above nmned. / ge is the ' ' ' of said turner or owne~, and ~s duly autb nzed to perforn~ or have performed thc said work and to m~e and file a/~pli, cation; that.all statements contained ir this application are true to the best of his knowledge and belief; and that th. ~'ork will be performed in the mann, er set fo th h~ the application filed therewith. ~worn to before mc tiffs ~..'.. Count5 ,~ ,.; ......,Term E~pim~ M~rd,,aO,-19 ~ '1 (' .' .,, . ,~ ',''' '-~ · ~ ......... . :,'?':', ,":,':' '" · ' , ~:.', . : .... ' ,. - ' , , ' (SignOre ofapplica~t ' ! ;"" ' 4 :"" ''" "' ' ' "" ""/'' ~''''', '"'