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Home My WebLink About12011-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certi[icafe O[ Occupancy No...7:! ] ~.1.9. ........ Date ........ .N. qv..e.~.b.~.~..3.0 ............19~.3~. THIS CERTIFIES that the building .a.d.~ .~.~3.o.n.. ?,..p.o..o.~ .............................. · r rt 500 Cent~r Street Mattitnck Location of P ope y ...................................................... ' ......... House No, Street Ham/et County Tax Map No. 1000 Section . 1. 2. ~ ........ Block ....0,2, .......... Lot . .0..1 9 ............ Subdivision X .Filed Map No. × .Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... 0.? .t.o?.e.~7. ?..7 ..... , 19.8.2. pursuant to which Building Permit No ..... ]fl. 0. ! J..Z. ......... dated .... .N.o. ~?.~.b.~ r...~.0 ........... 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 ......... The certificate is issued to Gelor~e I~. & Caroly.n.P. Dupr'ao (owner,-t~se~ of the aforesaid building. Suffolk County Department of Health Approval n / ~ UNDERWRITERS CERTIFICATE NO ............. }j..5.8...3 7.4.4. ........................... ...... Building Inspector Rev, 1/81 TOWN OF ~oUTH01~D: BUILDING 'DEPARTMEN*I TOWN H~,LL $OUTHOLD, N~ Y. BUILDING (THIS PERMIT MUST BE KEPT ON THE PREMISES COMPLETION OF THE WORK AUTHORIZED) UNTIL ~ULL PermissiOn is hereby granted to: ........... ~:...~..~.:~....~i .... ~:..~.~A./,.7../..... ......... ~&~........~ ..... ,..,...~..,,..,..~.~,....z~ ..... :, ................. ~o ....... ~,..~..~-~..~.~.......~.,.,..~.~..~.....:_~:.....,~.~,......,~.,...~..~.~.z ./~,~. ...... ..~.Z..~....~..~..~..~....~.~.......~..~ .......................... ~.... ...... ot p~<~.e~ ~ot.d ot.~.~ ........ ~.~....~..~..., .......... ~ ............. ~ .......................... ............................................................. ; ...... ,.~...,~~,..~.~.~.,. ~ To~ ~op No ~000 s.~t o~~..~..~. ........ B~E ;~.:...;... ~Lot No. ~.~ ........... Building Ihspector. Rev. 6130180 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold, 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. 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 buiMing. 5.Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to Apri~ 1957), Non-conforming uses, or buitdings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property Tines, 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. / 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 $5,00 Date.. New Building ............. Old or Pre-existing Building(X)., ......... =/Vacant Land i ............ Location of Property . ~:~,~.?.. ¢¢/? Nouse No../? .$treet Ham/et Owner or Owners of Property ~,<~ 4 County Tax Map No. 1000Seotion Z~.?. ....... Block .. ~ . Lot ..... 2 ......... Subdivision ................................. Filed Map No ........... Lot No...' ........... .......... ~¢~// Date ~'.'-'~. of Permit .Applicant. .¢. ~../~,:( ~. ....... Permit No Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Unde~rJters Approval ..... ~s'. .......... , ....... , ,Planning Board Approval .......... Request for Temporary Certificate ..................... Final Certificat~ ........ Fee Submitted $ ............................. Construction on above described building and perrnit'meets all app~cable~codes and regulations. Apphcant ., ~..~..._ ....... · ~ DATE: 'P' ~// /"~'-- '/~ Y: 76548~2 9 AM TO d PM FOR THE 1, FOUN~ATION - TWO REQUIRED FOR p~URr'D CONCRFTE 2. ROUGH -- ERASe!NC ~2~ pI.uMBING 3. INEUI.AE ?N 4. FIN/d. ~ - - · ' BE C~/~ ~'-FE FOE C O. ALL CONf~TRUCT~ON SHA~L ~AEET THE REOtjlRE~z~ENTS OF THE N.Y. STATE CON~,TRUCTION & ENERGY CODES. NOT RESPONSIBLE DESIGN OR CONSTRUCTION 1135021 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 1003~ ,,.,e ~ove,~ ~.8, ].982 App,ieat,o,,No.o,,/i,e 192565-S~ N 5 8 3 7 4 4 THIS CERTIFIES THAT o.ly the electrical eq~ip,nent as described below and introduced by the applicant named on the able application number in the preo*ise$ of George Dupree, 71 C Center St., MatC£Wack~ N.Y. in the following location; [] Basement [] 1st FI. [] 2nd FI. O~:~i~ Section Block Lot was examined on ~O~d~ 1"~ , 1~$2 and found to be in compliance with tko requirements of this Board. FIXTURE RECEPTACLES FIXTURES RANGES COOKING DECKS ' OVENS DISH WASHERS EXHAUST FAN! OUTLETS FLUORESCENT DRYERS SYSTEMS NO. OF FEET OTHER APPARATUS: S E R V I NO, O~E~ C~.CONO OF A' W, G. NO` OF HI-LEG CC COND AW, G, OF HI-LEG NO. OF NEUTRALS 1-G.F.I. (Swhnning Pool) This certificate covers complian~ at the date of inspection only. Because of unusual ermiror~%ts it is advisable ~o have frs= test and/or repairs made by a qualified person. OF NEUTRAL Three "C" Elect. Ix~c. Rt. 1 ~Ox 45M Sound Ave. Riverhea~, N.Y., 11901 Lic.~f3327-S PEr This certificate must not be altered ~n any manner; return to the office of the Board if incorrect Inspectgrs may be identified by their credenhals cOPY F R BUI DING DEPARTMENT. THIS C;O~y OF Memorandum from.... BUILDING INSPECTORS OFFICE TOWN OF SOUTHOLD TOWN HALL, SOUTHOLD, N. Y. 11971 / FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE COMMENTS FINAL ADDITIONAL COMMENTS '% 7a9. ' , :. ¢ 2.¢ ~, ~,., ....... ';,a~, ...... ~;~ * ~ ...... ¢~1-~ fl~,[' V',~TER SLPP.Y. AND' ~;F~/AGE DISPQ~AL '1) rill; ~TANDAR~ OF THE SUF~DLK ~TY ~PANTM/NT OF HEALTH 5ERV CE~ EuEVATION 0F' THiS PROPER~Y NOT GHOWN, EXOEPT AS INDICATED. LIC. PRO,.~d"R & LAND SURVEYOR .-~~ ~l.~¢~)--.~/2¢ '[)/~T/¢ JOHN 6, GREGG NO. 26093--CHESTER 6 KELSEY Ho 36923 BLOCK FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y, 11971 TEL.: 765-1803 Examined/&/.vs~.....~ .... ,19 F.d t -o//Z Approved ~..~..~... A.~. .... , 1~..~. Permit No../.~..e.g./..~. ~ Disapproved a/c ........ ~ .......... ~ ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No. ?..~.~./..Z~.. ....... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted 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 of property must be drawn on the diagram which is part of this appli- cation. 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 issued 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 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 applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Sigmffure of applicant, or name, if a corporation) (Mailing address of applicant) A/~// State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... ................................................................................ Name of owner of premises F~z~c?.;.~.~....'?~..~..J.~..r-.O.,~/..~...."'.~...c~..'.~..~.~. ..................................... (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 License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done.. /.~../O..~ .~.. ~ .... ?~../.~. ~...~.~ .cji. L]....~.~. ~c.~.//. ./.'~..4..~c.~'.,/,~ House Number Street Hamlet County Tax Map No. 1000 Section ....~..~.. Subdivision ...... .~. ............................. Filed Map No ............... Lot ............... (Name) 2. State existlng use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ./.~:. ? .-~..~. .... ,.~-~ ./'.~/.-'~.~ ........................................... b. Intended use and occupancy .... 3. Nature of work (check which applicable): New Building/ .......... Addition ;,, ......... Alteration .......... Repair .............. Removal .............. Demolition .............. Ot~h?r ~york .............. : ~ ~ ~[~ ~a # (Desc~ption)/? 4. EstimatedCost / ~)~.. C~ ~ ~ / 0 ' ~&'l d;; ~O(f .......... : .......................... ~ .......... b~ .....* ...... ~ ..... ~../.~ .'. ,... ~ (tO be p~d on filing ~is application) 5. If dwelling, number of dwelling ~units ............... Number of dwelling units on each floor ................ If g~age, number of cars .... ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front...~ ......... Rear .~ ......... Depth .~ .~ .......... Height ............... Number of Stories ...... ~ ................................................. D~ensions of sqme structure wi~ alterations or additions: Front ..... '. ............ Rear .................. Depth ....................... Height .............. , ...., ....Number of Stories ...................... 8. Dimensions of entire new construction: Front ~Q~bkl .-~. 0.~ I~ Rear ............... Depth ............... HeiSt ............... Number of Sto~es ........................................ 9. Size of lot: Front ~Oc) : Rear /Oc~) . Devth · .................................... 10, Date of Purchase ......... ~ ~ ................. Name of Former Owner .... ~....~...'... /.. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or re~lation: .... ~(O ......... ~O ............... 13. Will lot be regraded .............. ~ ............. Will excess fill be removed &om premises: Yes No 14. N~e of Owner of premises :~.t~2((.C ........... Address ~e~.(6(~.~ ~'.. Phone No N~e of Architect .......... ~ ................. Address ................... Phone No ................ N~e of Contractor ......... : ................. Address ................... Phone No ................ PLOT DIAG~M Locate clearly ~d distinctly ~1~ bufld~gs, whe~er existing or proposed, ~d, indicate ~1 set-back d~ensions from property lines, Give street and block number or description according to deed, and show street n~es and indicate whether interior or corner lot. STATE OF NEW Y~RK,/~ ,, ,~ .~ (Name of individual signing contract) above named. being duly sworn, deposes and says that he is the applicant He is the ...... .C! ~.Lg. ¥~.~.~:. ~,' ........ ' ................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this/; ......... ~..?.~..:..day of:,-v '~ ~-.-~--~------''/~ ...... .~. ~~..., 19 .'~.~~L---- · il~lb. ~'(2~}',32~'.'t~. a?_~.;~.~. (Signature of applicant)