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Home My WebLink About11637-zFORM NO. 4 ~TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. 7. l 127.6 ......... Date . .D.e..c?~.b.?y. fl. 0. .................. 1982. THIS CERTIFIES that the l~laing . .pop 1 .......................................... Location of Property .. ~95. ............... .I{.qq~[~..~.qq~l..I~r;o .........H~l:.t;.t,~99K ..... House No. Street Ham/et County Tax Map No. 1000 Section .. 1 0,?. ...... Block .. 0 ~ ........... Lot.. 003 ............ Subdivision...~ ........................... Filed Map No..g ...... Lot No. X. ........... conforms substantially to the Application for Building Permit heretofore fried in this office dated ..... ~ I~ r J-.l,. ~ ........, 19~.~. pursuant to which Building Permit No.. J .1.6.5 ?. ig ............ dated .... MaY..~.0. ................ 1~8.~., 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~. ;tp~.q~.d..~;tra~g..~op;t ................................................. The certificate is issued to .... .fi.o.b.e..~.t;..H. ,..&..~.a..m.a.n.~h..a..~.a.$9.1. ....................... (owner ~ er.~aet) of the aforesaid building. Suffolk County Department of Health Approval ........ n../.a ............................... UNDERWRITERS CERTIFICATE NO ................ i~. 51~.7.1 ~ 3 ......................... Building Inspector Rec. 1/81 Perrhissior FOI~I ~ TOWN 'OF~ S BUILDING D~ TOWN H~LL ' · SOUTH'OLD, N~ Y. is hereby g BUILDING' PERM!T (THIS ,PERMIT MUST BE KE'PT ON THE PRE/~,IS~S UNTILaULL COMPLETION OF THE WORK AUTHORIZED) , : Z Date .....~.~....!~..~,,, ,:' . 19.. tO at premises located at ...~., .~.. ~,~ .......... ~ ................................................... ~:, ~, ~___,..., ~ ~,~ ......... CoU~ IaF Mop No. 1000 Sect,on ......... ~. Block .!~.. .~. ........ : ~-Lot No ........ pursuant to application dated ..~.~....~ ..... ;,....~,...., 19~r' and ~pprov~ by the Bud~ing I~spector. . : Fee ~..../..-~ IrLspe~to~ FORM NO. 6 TOWN OF SOUTHOLD Buitding Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and subr~itted in duplicate to the Building Inspec- tor with the following; for new buildings or new use; 1. Fina~ 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing aH 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 $5.00 3. Copy of certificate of occupancy $1.00 Date .. ~/..~ O New Building . .~.??.( ...... Old or Pre-existing Building(X) ._~'~ _.~ ~Vaoant Land i.., ......... Locat on ofPro ~rt ~.. ~/'~)LL-L~/~//¢/~ ~-~ ~//~7~/ P Y ..................................... ,~-, ~ .... ,~ ~-~ .. ...... ~-. ......... House No, I'~ , Street ' / ~ ~[~t Owner or Owners of Property ...... ~.~~..~...~. ~..~///~ ~.. '..~. '~'/~'/~-- County Tax Map No 1000Secton ~0.~ , Block ,~, /:Lot Subdivision ..... ~ ........................... Filed Map No .......... .~ot No .............. ' Perm t No.//.~..~,~, . Date of Permit ~,~.~, .~.Applicant,,./j,~., .~.~_.~7.,, .~..4~ ........ Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval Planning Board Approval Request for Temporary Certifica, te ...... 2. .............. Final Certificate ................. Fee Submitted $ Construction on above described building and~m.~e~all app~cable.codes and regulations. loooo6o THE NEW YORK BOARD OF FiRE UNDERWRITERS ~'~ BUREAU OF ELECTRIC~,ITY ~- 8.5 JOHN STREET, NEW YORK, NEW YORK 10058 THIS CERTIFIES THAT only the electrical equipment os described below and introduced by the applicant named on the above application nu tuber in t~ premises of was examined on ~ and /ound to be in compliance with the rbquirerr~ents of t~is Board. FIXTURE OUTLETS 10 JECEPTACLES 1 SWITCHES i iO FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS ;PECIAL REC'PT TIME ~LOCKS ~NIT HEATSRS MULTI-OUTLET DIMMERS SERVICE DISCONNECT~ S E R V I : C Pa~elboard/s, 1-2cir. 60amps. 1-G.F.I. 1-G.F.C.I. NO OF CC COND NO, OFNEUTRAL$ (Swiu,~ir~ Pool) This certificate oovers compliance at ~ ~e Of ~p~tion o~y. ~ of ~1 ~~S it ~s a~sable to ~ ~ test ~d/or rapers ~ by a ~lifled ~%. Fre~ ~rsch : 354 Glen Dr. Shirley, N,Y. 11967 1ie.2555~~- This cert!ficafe must not be altered in any manner; return to the office o{ the Board ]{ !r~cot~rect. Inspectois may COPY Fo~R BUILDING DEPARTMENT, THIS COPY OF OF NEUTRAL !redentiaJs. FIELD INSPECTION FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION FERN. STATE ENERGY CODE (2nd) FINAL ADDITIONAL COMMENTS COMMENTS: r~agulatory Affairs Stony ~rook, ~w York 11794 (516) 751-7900 Dep~U,e~t has ~ an ~e ~ono We have _Therefore, pursuant to Part ,661, Official Oc~Pilation of and ~ of ~e S~a~e o~ ~.{~or~ ,se~U~ ~6L~b). FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ' ~./.< f. 7. Application No .......... APPLICATION FOR BUILDING PERMIT Date ........... , INSTRUCTIONS 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 sho,.ving location of Iot and of buildings on premises, relationship to adjoining premises or public stre~ or areas, and giving a detailed description of layout of property must be drawn oll the diagram whicl~ is part of'this apr cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon apprcval of this application, the Building Inspector will issue a Building Permit to the applicant. Such pen~ shall be kept on tile 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 si:all have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t Building Zone Ordinance of the Town' ~f Sou:hold, 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 !~ comply with ~iI applicable laws, ordinances, ~}ilding~cod.~ousing code, and regulations, and admit authorized inspectors on premises and in buildings for necessa~.'~~/' -'~ '~'~' '~'*~' ' · '~' '~.-'-~ (Signature of a~plicant, or mqr~, if a corporation) . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........................ Plumber s Deans.. No ......................... Electrician's License No.' ...................... Other Trade's License No ...................... Location of land on which proposed work will be done ....... t..'~ t'] ]~ L~.. ,.tn tx..-. :.L/~/~.~ ~.-w.~.~ .............. .r51.. :'.... House Number . Street Hamlet County ~a× Map ,~o. ,000 Section .... !0.7 ......... mook ..... 6 ........... Lot..$. ............ Subdivision ..................................... Filed Map No ............... Lot .............. (Name) 2. State existing use and occupancy of premises and intended usq, and occupancy of proposed construction: a. Existing use and occupancy .... .~.. .~/~ ........... ~ ~ .............. b. Intended use ~d occupancy ..... ~ffg~/~ ~/L ~ ~ · ~~ ~ ., 3. Nature of work (check which, applicable): New Building .......... Addition .......... Alterationx$ ........ Re a'r R,: no;'al , D~mo it on ~ V n k ~ p .............. ~ ~ ~ ...... : ....~ ............... Otl er l_r ................ (~~ ~ ~/~1~ ~'.....~] ~ (Description) Esti~at~dCost . ~./~ ~ ... Fee ~. (to be paid on filing this application) ;. If dwelling, number of dwelling units .... ~ ..... Nmnber of dwelling units on each floor...~ ........ If garage, number of cars i. If business, commercial or mixed occupancy, specify natnm and extent of each type of use .... ~ .......... ~. Dimensions ofexistingstmctures, ifany: Front...x. ~ ......... Rear .~ ......... Depth .............. Height Number of Stories ~ Dimensions of same structure with alterations or additions: Front .. ~ ........ Rear ...~ .......... Depth ..... ~-7. ........ Hei~lt ...................... Number of Stories ..................... /. Dimensions of entire new construction: Front ..... , .......... Rear .: ........ ; .... Depth .~ ........ Height ..... ~ ....... Number of Stories ...... '... i ..................... ' ........................ }. Size of lot: Front ..... l '.' Rear n~th ' dismct' ' 5' 'whiCh'. ' '" ............... ~ ' ' ' '~{*l~/" ~' ' ' or u~= m prmmses are situated .... ~~ ................... :;/.. ............ 1. Zone 1. Does proposed constrnction ~ol~ny zoning law, ordiaance or regnlation: ..... ~.. ~ ....... ~ ..... reg~aded .... ~ ...... , ~,, ........ Will exg~ss fill be remoyed from premises: (Yea) Nc Will lot be [ Name of O, 'n. rofpremses ~ ~ Address ~0~ " -- "~/-- ............. rnone mo. ~: ~.~.W~ · · NameofContractor ~'~'*~.~.=~$~8.~~..,honeNo ...[ .J Locate clearly ~d die,hotly ~1 buildings, whether ~xisfing or proposed, and, indicate ~1 set-back d~msions f~ roperty hnes. Give street and block nun-.ber or description according to deed, and show street names and indicate whethe,. .teNor or corner lot. 'FATE OF NEW YORK, OUNq'Y OF .5~ ~,.~j'f.-.e%<...~...... S.S · .~...0..~.~. ~,.T.. './~. ~.(t~.~.C: ... being duly sworn, deposes and says that he is the applic',nt (Name of indMdual signing contract) - )ov.? named. e is the (Contractor, agent, corporate officer, etc.) f said 8wner or owners, and is duly authorized to perform or have performed thc said work and to m~e and file ~is )plication; flint all statements contained in this application are true to the best of his knowledge and belief; and that the ork will be performed in the manner set forth h~ the application filed therewith. ~orn to before me this ~ /' . ...:: o ..ty "./ , , - er.,.: ....... ........... ..... SUV-'~EV~P M ATTI'T UC Y. " G = P~PE \ \ '-- L- I \ ' ; ~:~..~R~C~ CAKi TUYL RC, SUFFOLR CO~TAX MA~ DEL~iG,",,b\T! I..~,:' :c ' '