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Home My WebLink About12012-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. $J .1.380 .......... Date .... .lq.o.v. 9~.b.e.~.' .3.0 ................ 19.8.2. THIS CERTIFIES that the building ................................................. Location of Property ... 5. .0.0 ................. .C.e.n..t; .e ?..S. ~.r ,e,o, ~. ............. .?l.a.~. ~ ~ .~.u.c.k. House No. Street Hamlet County Tax Map No. 1000 Section . .1.~ 3 ....... Block ...0.2. .......... Lot ..... .0.1.9. ........ Subdivision...X. ........................... Filed Map No...X. ..... Lot No...X ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. 0.c.~;.qbo~'..27 ...... , 19 {32. pursuant to which Building Permit No... ! .2.0.1.2...g ........... dated ..... lq.o.v, luOl).e.~.. :113 .......... 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 ......... ....... a..n..a.qc. 9 .~.~.q~. y. p.~9 .a.a~e.. ~ [~.e.d.: .......................................... The certificate is issued to ..... .O.ep.~ .e..H.....&..C.a.~..o.l.y.n...P....D..up?.e.e. ................... (owner, leaeee.e~te~t~ of the aforesaid building, Suffolk County Department of Health Approval .... n.o..~..~e..q.u~?.e..d ........................ UNDERWRITERS CERTIFICATE NO ............ n. o..t;..17. ~1 .u.t.~o..d ........................ Rev. 1/81 Building Inspector N? TOWN OF ~OUTH0£D BUILDING 'DEPARTMENT TOWN HALL $OUTHOLD, N. Y. ,' BIJILDING' PER~iT ~HIS PE~IT MUST BE KEPT ON THE PRE, ISiS uNTIL ~ULL COMPL~ION O~ THE WORK A~HORIZED) ~o1~ z . ~,, .... ~~~.;...z~.., ,~...~ Building Inspector. Fee $.../..~,~. ............. P~rmiss/on is hereby granted to: ........ ~. ...... .~2.~.~ ..x~..~.Z~.~..4~,.,,.2~...~.~" ~ .......... , , ~o .......... ~~.~.cT. ~....~~ .............................. ...............................................................~`...............~ .~~ ~;~.r;~ at promises I~ated at ..: ............. ~ .................................................................... ~ .......... ;....;~ ......... ~~.~,~.. ~ ~o~,~ ~ ~o. ,ooo ~.~,o~ .... ~2.L.... ~,~.;..~.~......~ ~o. ~.~ .......... Rev. 6/30Z80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Ha~l $outhold. 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. B, 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: 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 .. New Building ............. Old or Pre-existing Building(X) .. ......... ~ ZVacant Land "i ............ Location of Property ..... . ....... ~¢.-. . House No. Street Ham/et Owner or Owners of Property .~ ~-~ ...... <. x ....... County Tax Map No. 1000Section ../.~?.~..~. ..... Block ..~.. ......... Lot .... '~.!.~. ..... Subdivision ................................. Filed Map No...; ....... Lot No .............. Perm t No/¢..~. (~ /~c~- Date of Permit ~ .~-...Applicant .. ?.~:'~_~ .~..../~.. Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval ........................ Planning Board Approval .................. Request for Temporary Certificate ..................... Final Certificat~ ........ - ......... Fee ~ubmitted $ ............................. Construction on above described building and permit'meets all apP~cable_.codes and regulations, A;p,i ant.... .............................. .?.~..~' % ' . ,~. .~{~'- . ; '-.t -; . 1135021 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK loo38 ..,e Novu~e= 'J.8, ].9~ A..,ie..o,,No.o.S, le Zg~-a N 583744 THIS CERTIFIES THAT only the electrical equipment as ~scrlbed bel~ and ~ntroduced by t~ appllcartt named on the able application number in the pre~nises of G~rge ~r~, 71 C ~ter S~., ~ci~, N.Y. was examined on ~ ~ , ~ ~82 and found to be in compliance with the require,nents of this Board. DRYERS SYSTEMS NO. OF FEET EXHAUST FANS E R V I C NO Oi~ERCC~.COND.OF A W G CC, COND NO, OF HI-LEG A W.O. NO OF NEUTRALS A,W G OF HI-LEG OF NEUTRA[ OTHER APPARATUS: 1-G.F.I. %~a~ua£ emr~oi~e~ts it is advisable to have f~equen~ test and/or repairs made by a qualified person. 'm~e c ~"ec,:. :mc. ~.. 1 Box 4~ Souv~i Ave. ~ This certificate taus, not be aJfered in any manner; refurn,o ,~e offke o'the Board if in,orrect ' ....... ~--- P~' .... ~:. ~/~. J-.,-~ Memorandum from.... BUILDING INSPECTORS OFFICE TOWN OF SOUTHOLD TOWN Ht~LL, SOUTX~OLD, N. Y. 11971 ~4oc%e ~},ed FIELD INS~ECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION FER N. STATE ENERGY qODE YJ FINAL ADDITIONAL COMMENTS: '% ,~,,.. I 5~.0, .. PROtT',I.STY.: F~R~&!~F-S. :i : EFL. 15.85 SUFFOLK COUNTY DEP'[ OF FOR APPROVAl,. OF GC OAT[. ....... APPR¢ rHF V'~f[R ~UPPI.Y AN[)' SFWAGE DISPOSAL ~YSrL~S FOH THIS R~SIDfNCE Will =~l) Till; ~TANDAR~ OF THE SUFFOLK ~TY ~PA~TMENT OF HEALTH E~EVATION OF THiS PROPERTY HOT SHOWN, EXCEP~ AS iNDICATED. ......... -.~=--~-.-~'--.~ ,.- , SIDNEY...R,, BOWNE SON LIC. PRO.,'~'R~'~' & LAND SURVEYOR ~0T s ~ ~~ I ~ MEASLI~E~ENTStU. ~ S~NI~ARD , ~k,.> , ' ,/u /- ' *..¢' tA.::( .d,,' ; ~ ~ .,~ ,x FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y, 11971 TEL.: 765-1803 Examined /~..~.... (.~. .... , 19 ~.d [~O//Z Approved ~..~..Y~.../.~.J. .... , 1~..~. Permit No../.~?./..~. ~ Disapproved a/c ........ ~ .......... ~ ..... /' (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No../..~.~ ./..~'~.. ....... Date /(~) -- ~ ..~. r~ ............... , 19. 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. · ' i~ig~r~r'e'gf'i~liia~, ;; nmne, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· Name of owner ofpremises (xgdc>iCd ~C.D. ~? .... ~' (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.. :.4~.:~.(.~.. ................................................. Y. .................................. House Number Street Hamlet County Tax Map No. 1000 Section ... ~. :5~ ........ Block .. 2~-. ........... Lot Subdivision ...... ~. ............................. Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: . a. Existing use and occupancy .... ~?~:( ..:..~ ........................................... ............. .............. ............... ,;.: ....... ,....... 3. Nature of work (check which applicable): New Building .......... Addition i: ..... i... Alteration .......... Repair .............. Rem6val .............. Demolition .............. OtherWork ............... ~ ,Q 4. Estimated Cost ~..~.c°...~.- 6.? Fee ~'/0 .... : .................................. t/ ..................... f ...... I (to be paid on filing this application) 5. If dwelling, number of dwellinglunits ............... Number of dwelling units on each floor ................ If garage, number of cars ' 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. I)imensionsofexistingstructur~s, ifany:Front...~.~-.O... Rear ~..~' . Depth.~..fo .......... Height ............... Number of Stories ...... /f... iii ii i ..... i. i iiiii, iiiii .................... - Dimensions of sa, me structure with alterations or additions: Front .. ! ' Rear Depth .................... J.. Height .............. , ...., ....Number of Stories ...................... 8. Dimensions of entire new construction Front ~o..e.e.ct .-~. {3 ~' lO Rear . Depth ............... Height ............. :. Nun~bar of Stories ........................................................ 9. ~ize of lot Front /.~O ~ Rear loci) De~th ~.~.~. 10. Date of Purchase . .~.f¥/.~. ............ .~'.~.f;-..q ....... ............... Name of Fo,mar Owner 11. Zone or use district in which pr~mises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ./~../O ........................ 13. Will lot be regraded ........ . .,~...O. ............... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises: .~)'~f' .~.~.d. ........... Address .~e~.'& .r'.,Sf../~. P'fT... Phone No...~.~.f'.:...~..R..O.. Name of Architect .......... i ................. Address ................... Phone No ................ Name of Contractor ......... ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly alii buildings, whether existing or proposed, and~ indicate all set-back dimensions from property lines. Give street and block !number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW Y~)R~,// ~, "S COUNTY OF ......... F~". %.'~.U~.'..:.. ~-~.~. g.~ .... being duly sworn deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ' - (Contractor, agent, corporate officer, etc.) of sakl owner or owners, and is dul~ author~ed to perform or have perfo~ed the said work and to m~e and file this application;:~at ~1 statements contained ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed in the m~nel set forth in the application filed therewith. Sworn to before me thisw ' ......... ~~..:..dayof:~ ...... ~~.,19~ . ~,,~'%-u~ (Signature of applicant) ~g~ ~/res March