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Home My WebLink About12047-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ....7.1 ~ .7.4.6 ....... Date ......... J~n~. ~B ................ 19 .aS THIS CERTIFIES that the building .... A 1 t ~'.a t $ or: ................................ Location of Property . .27.~ ............. Nassau. ?.c~ia~:. ~.cl ............. Cm.t~qb0g. m~. House No. Street Hamlet County Tax Map No. 1000 Section . .10.~ ....... Block ,..Q 1 3 ......... Lot ...Q0~ ........... Subdivision ..... Na~ga au..?.o ~ n~ ............ Flied Map No..1.5 ~ .... Lot No.. J .0 .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. ~.oeeml~.ec..~ .? ..... ,19 B.2 pursuant to which Building Permit No. q.~ 0.~.7.~ .............. dated .. D et.em b er.. ~ .............. 19 82., 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.l.[ara.t.£on, on. ex3.a ~in& .dwe~Ll±ng ......................................... The certificate is issued to RICHARD WALL of the aforesaid building. Suffolk County Department of Health Approval ..... N¥.B ................................. UNDERWRITERS CERTIFICATE NO. ~ 605 ~ 60 Job started under B.P. 10016Z as approved by Z.B.A. #2486-Nov. 9, No kitchen allowed. Building Inspector 1978. Rev. 1/81 tOWN O~ ~O~I~O~D~ BUiLDiNG DI~AaTMENY TOWN HALL SOUTHOLD, H. Y. BUILDING pERMIT (THIS PERMIT MUST BE KEPT ON THE pREMISES UNTIL COMPLETION OF THE WORK AUTHORIZED) ~ : N? 12047 Z Permissioh Dote ...~'~¢d.,..~ ...... iULL Rev. 6/30/~0 Building nspector~ 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- tar with the fo~lowing; 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-g 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 featu res. 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 ~r land use $/~/$5.00 I 3. Copy of certificate of occupancy $I.00/ ' ~.._ FI/~, ~Date .. New Building ............. Old or Pre-existing Building(X) . ~". ...... = fVacant Land i ........... .. c ......... ..... ' Location of Property . .,'~..~., .'~ ~.~ .~. s.~...~ ~.~. ,~, .~../.~.Z~.~.....~'.~. ...... - ........ House No, Street Ham/et Owner or Owners of Property . . .A~../.~ ............................. County Tax Map No. 1000 Section ./. ~..¢ ..... Block../..~. ......... Lot ............. Subdivision,..~..~i~...'.~. ~ ,',..Filed Map No ........... Lot No ...... ~.y ...... Perm,t N o.~ ~,~,, ,~'~.Oate of Perm,t ~/ ppi,cant , .,~...~~ · · .... 7, · · ......................... Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approva ................. Planning Board Approval .................. Request for Temporary Certificate ..................... Final Certificat~ .....~..'. ......... Fee Submitted $ .................... Construction on above described building and permit mee~s all apPl~cable~co.de,s and regulations. Applicant ..; ~~_.~ ......... 1000771 THE NEW YORK BOARD OF FIRE uNDERWRITERS ]D~ EIUREAU OF ELECTRICITY ~- JUI~c~ 7~, 1953 e5 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT o~ly ~he electrical equipment as described below a~d i~troduced by the appllca~t ~a~ed o~ ~he above applicatio~ ~er in the premises of i~d~d A. ~E,1, ~l/~ ~o~s~ ~o~ ~A, 700' ~/0 ~~ ~,, ~rc~, ~.Y~ in the follo~vlng location; ~ Buse.~ent ~ 1st FI. ~ 2nd FI. ~ction Block Lot wus examined on ~ ~ ~ ~ and found to be in compliu:~ce with the require.tents ~ this Board. FIXTURE FIXTURES RANGES OVENS DISH WASHERS, EXHAUST FANS DRYERS FURNACE MOTORS TIME CLOCKS MULTI-OUTLET' DIMMERS SERVICE DISCONNECT OTHER APPARATUS: 1-Smoke Oe~:ector 1-G.F:.C, L t-/;. 5 K.W. ~C Wa~eic tie,~s 1-1500 K.W. liar Water ~Ieaterso S E R V I C E I 2/0 F~land glecu, P. O. B~x 143 Mattit~.k, N.Y,, 11952 GEN,R^ This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspedors ~may be identified by their credentials. COPY FOR BUILDING. DEE f M~NNER. FIELD INSPECTIO~ ,, ~ COMMENTS FOUNDATION ( 1 st) FOUNDATION { 2nd ) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C~DE FINAL ADDITIONAL COMMENTS ' /7 " '~. - - FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined...~..~.~..( ...... , 19~.~ Approved .. ~'~, ./ ...... , 19~,~Permit No. ~. o~..~.,2--- Application No. I.o~../~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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. Tho 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)__,nspections. ~ ....P..~ ~..~../,..~. (Signature of applicant, or name, if a corporation) (~) J State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .. ~~_ .-~-.. ................................ Name of owner of premises · .fi~../~ ....c~...~...~..~. ......... DAT.5./~/~ p ..... (as on the tax roll or lates~rdeed~. Z-. If applicant is a corporation, signature of duly authorized officer. NOT F'~' .................. (Name and title of corporate officer) 1. }:OUt '-'~-: V'H - TV¥O REQUIRED /.~.~. & -o~ ,., Builder's License No ......................... 2. ROI.!(':' ~ _ FPAM~k.,C £, PLUMBING Plumbers L,cense No ....... y. ........ ".......aC?: · ~ ~6'~7~./~¢' ,~.~O~ , ' .'-'-,.'~,' !OH /~d!JST . BE CrV'C;.: "':E fOR C. O.' Electrician's License No, .,~..2 ,Z_ ~ x/t.) ~5 L* ALL CONST.~{]JCI ION SHALL PAEET rte REO!]IR?:\4F..NTS OF TI-Ir/ N. 'F. Other Trade's License No ...................... STATE CONSTRUCTION & ENERGy CODES. NOT RESPONSI8I E FOR ]. Location of land on which proposed work will be done ................... DE$[GN .OR .C'eNS'TR'UGT~ON. ERRO.I?S' . .?. 7.:>C. ........... *.~.~z~..~: ~. ~ ........ ~ ~ ~..c:#.e.~?:.~. ................. Itouse Number Street Hamlet County Tax Map No. 1000 Section . ../.~ ..¢. ......... Block ... ~.":.2. ......... Lot... ?.~...~: ......... ~ubdivision... ~..m~:~?....&?.( .......... ~iled ~ap No.../.¥~ ....... Lot :..~. .......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. E×isting use ana occupancy ....~.~.Z/..~. ~.4r::.~ ........ . ............................. ,. ......... b. Intended use and occupancy ... ~ e' .......... ...... . ...... ,~; ....... . ........................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ' (Description) 4. Estimated Cost ...... .~. ~' ~'~, .~. Fee ...................................... i (to be paid on filing this application) 5. If dweiling, number of dwelling iunits ....~....,f~..z~. .... Number of dwelling units on each floor .......... i'. .... If garage number of cars .,2~..~,-5~.~ 6. If business, ~ommercial or mixed occupancy, specify nature and extent of each type of use .............. 7. Dimensions of existing structures, if any: Front... ~.-~. ........ Rear . .~..Q ......... Depth, .'.~.( Height . .'~.. P .......... Number of Stories .. ~..r~..o. ........... ~ .................... ! ............ Dimensions of same structure with alterations or additions: Front .c .5~.~ ............ Rear ' ~.<~ ............ Depth' .~.. ~. (".fo.~ .......... .. ,Height...~. f-?..~ ,~. ~. ), ........ Sumberrof ~S?ries..tP..~.~ ........ .~ ...... 8. Dimensions of entire new constrnct~on: Front...~. ~f.~': ~-,. ..... Rear . ,f. ~'..'~ ~., ..... Depth . .~-, ,~, 54. ~. ..... Height. ~..~7~ ./ ......... Number of Stories...~2. ~.~'. .............................................. 9. Size of lot: Front ... ~,~.~.~.'~2(.¢,~/..~ ....... Rear ...................... Depth ...................... 10. Date of Purchase ........... .... Name of Former Owner 1 i, Zone or se d~strlct in which premises are s~tuated ....................... ,.,~ ........................... 12. Does proposed construction violate any zoning law, ordinance or regulation: . ./.v'..~ ........................... 13. Will lot be regraded .... ,~.~....~ ........ /. :~;. Will excess fill b,e_remov~cl l~om premises: Yes ~/Nog 14. Name of Owner of premf~es ,,~. ~,'~,~ ~ ,~2~...&/~/-z(Address~¢~d-~'~.,~.~o~ ~-,,~]~'~.~. Phone No ~.~ f~(.-- d, ~ ~,~ Name of Architect .......... , ..... . ............ Address ................... Phone No ................ Name of Contractor .,,r~..,~.~ ~,tdc~.. ,f~,~ .,~.,K. r~.,4fz,c.t~l~lress~fr~.,d.~..~.'~. ~.~. ((?~. Phone Nor~,~.~.~, ~..~,,~.. PLOT DIAGRAM Locate clearly and distinctly all' 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 ~ft~l:~K~, t~ , cOUnTY OF. S.S ... . (Name of individual sign!ng contract) above named. , f"~n~raCtor,_~gent', 'c;;~;;a't; 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 bg performed in the manner set forth in the application filed therewith. Sworn to before me this Notary Public, ................. ~[ Cotinty ~ ~ , ~ ~,~ ~0, ~~¥~7) (Signature of applicant) OCCU]~AI,,~CY OR USE IS V~iTti~'f C,~11FICATE (IF OCCU?A~Y If copper tub,no ,$ used for water distributing~ , . . ~ system; p~p~ng shall be ~. ~pes K or L onlyy