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Home My WebLink About12023-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No... g. 1.186.7 ........ Date ............. Augu~.t. ~ 7 .......... t9/3.3 THIS CERTIFIES that the building ...... o r~ e.-.f, am 5-2.7.. d w.e.11, ing ................... Location of Property ......... 2 ~ 0 ......... I~a¢.c.c~o~./~.d .................. I~a g.t~.5, t;uctc. House No. Street Ham/et County Tax Map No. 1000 Section ..... 1 9.6 .... Block ..... l 0 ........ Lot ...... 7 .......... Subdivision ............ x .................. Filed Map No.. x ...... Lot No ..... x ........ conforms substantially to the Application for Building Permit heretofore flied in this office dated ..... N.q ~ ~ m ~.e. c. 5 .... ,19 ~ 2. pursuant to which Building Permit No ........ q.2023.g. ....... dated ...... 5.qu e m.b.e,r..1.7 ......... 198 ~., 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 ......... ·.. q)~.e.-.Eam£.~,7, d.~.e:L ]-5-r~g ...................................................... The certificate is issued to .............. ,¢.ETEI~..iVlcI)13Jq.~JLL ........................... (owner, lessee or tenant] of the aforesaid building. Suffolk County Department of Health Approval .. ,12.-.S 0 ~-.~. ]. $ .... $ / 5/g3.. R.ab e r.l;..g, ± J- Za. UNDERWRITERS CERTIFICATE NO ......... ~ .e .n.d.5. n. $ ................................. Building Inspector Rev. 1/81 BUILDING DIEPARYMEN1 TOWN ~HALL. ~ SOUTHOI~D, N. Y. BUILDING' F~RMIT (THIS PEPJv~IT MUST BE KEPT ON THE PREMISES COMPLETION OF THE WORK AUTHORIZED) UNTIL t2023 Z Date .... ~. ULL at premise~ located at ¢o~,~ Toh ~o~ Uo: lOOO s~,on ..../.~..d.....:. ~oc~ .:...~.; ....... ~'°~ ~o. i:.~.~ ......... Building Ihspector. Rev: 6/30~80 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. Approvat 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 featu res. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Data 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 $5.00 / 5/$ 2. Certificate of occupancy on pre-existing dwelling 9~r land use $ / 5.00 3. Copy of certificate of occupancy $1.00 / ~,/~ .~j.... .~.... Date ................ New Building ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .................... .~.4 C.(~.~..~...~. ....... .~.4.'/~. ~..~.~.~.~7.~. .~/..~'... Ow.er or Owners of Property ..... ......................... County Tax Map V000 Section., ~...~....~. .... Block .... /..~. ...... Lot .... i .-'~. · ........ Subdivision ..... ./~. ........................ Filed Map No ........... Lot No .............. Permit No../'.~. ?..'.~...~Date of Permit .......... Applicantr.~..d?.ff.....~..~'.~(.Q./~/~.~.(~.:: .~.~. .... Health Dept. Approval ...... / ~....~..~../~abor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. ~Construction on above described buildi~F~it meets all a~p~,i~able codes and regulations. FIELD INS~ECT~ON COMMENTS FOUNDATION (1st) FOUNDATION 2. (2nd/ ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ~~ / ~%~ ~ i~ CODE ~j / __ ~ FINAL ADDITIONAL COMMENTS: BUILDING ~DEPT. INSPECTION FOUNDATION IST [ ] ROUGH PLBG. FOUNDATION ZND/~ INSULATION [ ] FRAMING [ ] FINAL REMARKS: /, DATE 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: /, ,-~./~ DATE: ~Y/', ~' // ./ INSPECTOR FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ~/.~..../...'~..., 19 d~..d Approved..~. ·~..~.../.:..., l~Pem, it No. Z4~4~ APPLIGATION FOR BUILDING PER~IT Application No ........ INSTRUCTIONS a. Tiffs 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~ode, and regulations, and to admit authorized inspectors on premises and in building for necessa~h~.' p~t~ons, x-~ .~,~ ~ t~ ~ II ....V.~..:~.5.. F./.. ~t~d ~_.-:.o..~. ~..~ Cl~nature of aovli, ca,n~t or 12am~ if a cgr-2or~ttion) o~n~,~ ?~.o. .~. . lY, ~. /17_?,~, , .......... ......... I~l'ailing address eli applicant ) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... ..... :::'"'i .................. ....... .............................. Name of owner of premises .... ~ .~.~i~..~. .... .(~.. .... .ff..' . ~'.~. ..... .~ ........................... (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 ~'/~ 7 '/t~ Electrician s License No .... :...~.d..~;.~'i ....... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ........ d. : .o. .............. . .h. .... ¢.d .,, ...... .:. .>. .::. ............ House Number Street Hamlet County Tax Map No. 1000 Section .... /.0.6 ....... Block ...... 10 ........ Lot .... "'7' ............ Subdivision .......(Name) Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Existin use and occu anc tr-~/~ 1~ t~,,'e .~. 1.4'. .~dy!d~..~. {a/0 t) ~ .e'~ Z,,'~/b · g P Y ........... T ....... {2 .... 7 ......................................... b. Intended use and occupancy /~..0)/d/.d'~. O/...Oflq {~'.//d'. Id~""' · : ,, ,., 5 ;'~'~,,,',' ~:,',::.":':~2,;; ">-':~ '~: ': ~ ' .................. 3. Nature of work (check which applicable): New Building ...... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... , ~_~ (Description) 4. Estimated Cost ...... 1 .................... Fee .............................. (to be paid on f'fling this application) - 5. If dwelling, number of dwelling Units .. O ~ Iz Number of dwelling units on each floor If garage, number of cars ............ d)/U'.~ .............................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .... ~2. ;4Ji J Ji J ..... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... H eight ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... i. · Height .......... ~ ........... Number of Stories ...................... - 8. Dimensions of entir.e new construction: Front .... ,~..,5. ~..~. .... Rear . .~.~. ~ .-?. ...... Depth ....~..~. (~. ..... Height ...... '~,.~...( .... Number of Stories ..... ]..i/.~. .............................................. 9. Size ofilot: Front .... /.~..~,.~z/ ........ Rear ...... /..~. ~../~. ....... Depth ?.~.2.~.,..~.-~. ............. 10. Date of Purchase .... ~.~./'~,?.,:/...."/././.~. ~.'.g~.. .... Name of Former Owner A O.Od/~f.'u.~.c../~.~../'(..~. ....... 11. Zone or use district in which premises are si!uated .......................... ~! ......................... 12. Does proposed construction vio.l~te~any zomng law, ordinance or regulation: ..... /2q .0 ...................... ~, 13. Will lot be regraded ...... .~. .-5.'. ............... Will excess fill b .rcmoved from premises: Yes (~) 14. Nazne of Owner of premisps~q-~L~ .'~...~..e.~?,~.4/.~..q%. Address~ ¢/j~./.d~..f~t0¢ff...~.... Phone No..c/.~ FT-.J~. q/~..'~.. Name of Architect . . /VI(~... ................ Address ....... ~. ............ Phone No ................ Name of Contractor ~.?~/~... ~.'~q<~.~. ........ Address ."I)P~I~: ./-,d.z.P.~J~.~.~._Phone No. 7. .~. ~..~--q- .~.Z.'-.$.~ PLOT DIAGRAM Locate clearly and distinctly allI 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-O~K COUW -¥' Ft 3.. k .tlc . .... '[7 [.~..' .~. '. '.~..~. i~/'. '. '. './~, '.¢rJ ./?//Sf.~.~.L. ~ ........... being duly sworn, deposes and says that he is the applicant (Name of individual sig~ing contract) above named. He is the ......... ~ ~ ................................................................... ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is du~y authored to perform or have perfo~ed the said work and to m~e and file this application; that all statements contgined ~ this application are true to the best of his knowledge and belief; ~d that the work will be perfomed in the m~nor set forth in the application filed therewith. Sworn to before me this ............ ..... .... ............ ~ ,tmon, ~, [,mtt, '" ............. (Signature' ~ '~' { ~ ~RY PUBLIO, St*t~ of N~ Yor~ t Term ~p[res ~a~ch 30. 5c.~le: .50'= t" ¸42 copper tubing is used ~:or water distributing syslem; pip ng shall be o1~ types K or L only~ 2 R~ ~,: , - , ~ ALLCC~,~ -n~' ~. ....... , , , ,~"E~ THE REQ~¢P;'~F~q~ ~ 'r;~' ~ Y~ STAT~ CONSTRUCTION & ~Fr[~v' CODES. NOT RESPONSIBLE Fn~ DESIGN OR CONSTRUCTION ~R~qqS, Phmle"~,477 0400 ~,~ Mah~ R<,~rl h me 47%04'0i5 ':~ Main R,x,d