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Home My WebLink About11626-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate OI~ Occupancy THIS CERTIFIES that the building addition and deck Location of Property .. ~35 Sou~dview Rd. Orient ho.s; hiol ....................... 's'*/o~i ....................... County Tax Map No. 1000 Section ~ 5 .Block 3 .Lot 9 ................... 2777 .................. Subdivision..O?.~°.n..~.-.B.~.T.~?.'~S..e.~ .......... Filed Map No. 3/I/I/I .Lot No. 2/4' conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... .A~.~. 5:..~. ?.0. ...... , 19 ~2. pursuant to which Building Permit No ...... J O.C.2. G..g ......... dated ..... Apm.±l. 2-}. ............. 1982., 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..second. sto~y, a~dition, an& .deck .om. existing, dw.e. lling, ........... The certificate is issued to ......... i~USSF_,LI~ 1~. ~t{EL~D ..... fo.,nor, ~') ...................... of the aforesaid building. Suffolk County Department of Health Approval .... ~ .............. N/.~ ..................... UNDERWRITERS CERTIFICATE NO .......................... t¢end, ir~g ................ Rev. 1/81 Building Inspector FOBM NO,~ ~ TOWN OF $OUTHOLD BUILDING DBF~RTMENT TOWN HALL SOUTH'OLD, N~ Y; BUILDING P,ERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE 5 UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) , N:9 ltl ~ 2 6Z Dote ................... , Perm,ss~on,~s hereby granted to: ~ __ ~o ~/.~..~..~.....~. ~.-~...c.~..' ..~,.-./.,.~,~...~...~,~C at premises located at pursc~ant t~ appication dated..~.~..'.~.../..//. .d.,~..... qpprov~ by the Building Impector, ' Fee . 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: 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 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: Certificate of occupancy $5.00 / L 1. Certificate of occupancy on pre-existing dwet~ing ~r land use ~/~/$5.00 2. 3. Copy of certificate of occupancy $1.00 / Date .~..~.~.~...,_/...~.~. ~.]...//~..~..? House No. ~.~.~:~,~,_~ //~/~.~..'~.~...~.Street . Ham/et Owner or Owners of Property ......... ~ ...... County Tax Map No. 1000 Section ............... Block ............... Lot ................ , . ...... Subdivision..c~,-"~./. ~-,/~. T .~/.. ~. ~ .~. ~ .~-./.~. ' .... Filed Map N o~.~/-,/y ..... Lot N o. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept, Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $....~¢..~.~. .................. Applicant . ~. · .~"/'...t,,_~¢~. ~~_,~. ........ Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITy ,~,[~[/L~I~ 5, ~8,.~ J0~H STREET, NEW YORK, NEW ~ORK 10038 THIE CERTIFIES THAT only the el~trical equipment as described belo~ and intr~ltced by the applicant ~med on the a~ application number in the pren~ises of t~ell Fx'e~, ~dvi~ Avenuo, ~ddle of ~ ~ Sade ~d. ~n ~/S., Orient~ N.Y. was examined on S~g~q~ ., A.~A~D and found to be in compliance tvtth the r~quire~nents of this Board. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS 6 DRYERS SYSTEMS NO. OF FEET R V I C A W O, NO OF HI-LEG A.W.G NO OF NEUTRALS A OF CC, COND, OF HI-lEG OF NEUTRAL OTHER APPARATUS: i~G.F.I. 1-~oke Det~o ~or. Jo,~;eph ~ohoho~f.r MaS. z~ Hoed. 8oUthoid, No¥. ll~YJt GENERAL / This certificate must not be altered in any manner; return to the office of the 8oard if inco~rrect, may by COPY FOR BUILDING DEPARTMENT. I' mE ALTERED IN ANY MANNER. crede~tlals. FIELD INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY FINAL ADDITIONAL COMMENTS: FO]~.M I~O. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Approved ~(~ ... ~ ", 19~ Permit No...~.~.~.~ ........... Disapproved a/c ............................................................................................ ............................................... .......... ::: ................... ..... Application No .......................... APPLICATION FOR BUILDING PERMIT ......... ................ INSTRUCTIONS a. This application must be completely filled in by typewriter or 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 oF areas, and giving a detailed description of layout of property 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 o Certificate of Occupancy 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 Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations or for removal or demolition, as herein described. The apphcant agrees to comply with all applicable laws, ordnances, bu Iding code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner, ofpremises ~.~LS',S'E.C..~..~, ' If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Electrician's License No..~.r...'~--~x2..,~.~..~...~....' Other Trade's License No ....... ~..~ ~2' . ~qt~ bd J_v±s £o.~ 1. Location of land on which proposed work wdl' be done. Map No.: .......~.~S'¢/~ f~E~ ........................ Lot No .................... Street and Number ~ .~...~.. ,~.o..~....~...~.. ~..~...~ ~...~/. .......... ~.~./.~./g...~. ....... i. ii'i Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exis[ting use and occupancy ...................................... v ................. m ................................................. .~:. ..... , { , Nature hack which applico le): New Building.. ................. Addition ...............Alteration ................. Repair .................. Removal '"'"~'""l ...... Demolition .................... Other Work ................................................. ..,, (Description) 4, Estimated Cost ...~... ~.~.~.~.CJ~: 5. If dwelling, number of dwelling unit.~ If garage, number of cars ...; .............. 6. If business, commercial or mixed 7. Dimensions of existing structures, if ar Height ..... ~..~.. ............. Number of S Dimensions of same structure with al (to be paid on filing this application) O/C/~ , , ............................ iNumoer of dwelling units on each floor ............................ ccupancy, specify nature and extent of each type of use ............................ y:Front,, '5'0/ ..... Rear ,..~',,..0./ ................ Depth .*~.~',. ........... aries ......O..A~'.~. ................................................................................................... / · . . o ~o terat~ons or add t ans. Front .... .~.! ........................... Rear ............................ Depth .....~.~ ..................... Height .... ..~...~. ................ Number of Stories .........~ .................... 8. Dimensions of'entire new constructior~: Front ....... .,~...~ ..................... Rear ...... ~.~. ................ Depth ......... ~ ............ Hmght .......~. .......... Number of Statues ...................................................................................................................... [0. Date of Purchase ............... ~ ............. 11. Zone or use district in which~ premise 12. Does proposed construction 9iolote o~ 14. Name of Owner of premises ..~.~.~?.~/.c.. Locate clearly and distinctly dll buildi~ property lines. Give street and block nun whether ifiterior or corner lot. : STATE OF N~ORK, .4:~' [ c S COUNTY OF~ ........ ....................... .... (Nam'~of individual signing co ......................... Name of Former Owner ........................................................ are situated ......... ~..~./. ~. ~..~...~. f..~...C. ............................................................... / zoning law, ordinance or regulation: ........................................................ Will excess fill be removed from p~mises: ( ) Yes ( ) No ..,~'....,~, ....... Addre~ ,,,,~1.~,~ ............. Phone No, A3-~?~/ .,.~.~ ............. Address ~(~,~,~g~,~,CPhone No. ~,~,=~.~,9 ..... · ~. ...................Address .....~.9.~A~ .......... Phone No..~ ....... ~..~.. PLOT DIAGRAM ~gs, whether existing or proposed, and indicate all set-~ck dimensions from ~ber or description according to deed, and show street names and indicate ................. . ........ being duly sworn, deposes and says that he is the applicant'? tract) above named, i ~' He is the ......... . i ........................................................................................................................................ - (Co, of said owner or owners, and is d~ly auth, this application; that all statements canto tha~ the work will be performed in ~he man~ Sworn to before me this . ~ day of ....... ELIZABG[H ANN NE~I,L~ / NO. 5~.8{25850,, Suffolk lCou~/ T.m ;E,~pires M,roh ~,~lg~ tractor, agent, corporate officer, etc.) ~rized to perform or have performed the said work and to make and file ned in this application are true to the best of his knowledge and belief; and ~er set fo~h in the application filed therewith. .....,,......,¢ ..~..'., C~ ..fy .............................. , ........................................................... ~ ~. ..... (Signature of applicant)