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Home My WebLink About12053-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southold, N.Y. Certificate Of Occupancy No. Zqq6z[6 Date Hay 5 ., 19~..~ THIS CERTIFIES that the building Addition Location of Property 905 Ruth Road Hattituck House No. Street Ham/et County Tax Map No. 1000 Section . .q..0.¢. ...... Block ...? ........... Lot...J7 ............ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in tbJs office dated November q 5 19 .~.2` pursuant to which Building Permit No. '12053Z dated ....D.e.e.e..m?.e.~...2 ............. 19 .8.2, ,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 ......... .................... .~%~.~.o.~., .~.o..~.:f¢?~ .<~. ??.z.z.~.~..~ ............... : ......... The certificate is issued to . .1~.~. ?~..K.~..~.5_?.~.5.? .......................................... (owner,/e~ee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .N/.A. ................................ .~ .... UNDERWRITERS CERTIFICATE NO... ?..~.9..~7.9.5 ...................................... tmilding Inspector Rev. 1/81 TO~N or ~0U~O~D BUILDING DEPARTMENT TOWN HALL SOUTHOLD; N. Y.' BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISEs UNTIL COMPLETION OF THE WORK AUTHORIZED) N? 12053 Z :ULL Permission is hereby granted to: r ..................................................................................................... Coun~ Tax Map No 1000 ~cflon ........................ 8 ~k .L..~.~ No ............ : ............. Building ~spectOr. Fe~ ~ ........ ...... Building I~tot FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY ~nstructions A. This application must be filled in typewriter OR ink, and subr~dtted in duplicate to the Building Inspec- tor with tho following; for new buildings or new use: I. 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 Under~/riters. 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 Aprit 1957), Non-conforming uses, or buiMings 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 o~r land usa~l~;/$5.00 3. Copy of certificate of occupancy $1.00 ! / · Date ..... ~ . . New Building ............. Old or Pre-existing Building{}¢) . X- .... =/Vacant Land ............ House No. Street ,I Ham/et Owner or Owners of Property J')~ [~ ~ .~. ~'~ .F~T_.. j I~ ~ County Tax Map No. 1000 Section ............ Block ............ Lot ............... Subdivision ................................. Filed Map No... '-- .Lot No.'" ............. PermitNo. L~.~).5~..'~.;;~ Date of Permit .J~ ...Applicant .../.0/~3.../~..~.4¢..~.~¢'~¢¢~. ........ Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval ....,~. ~..~' ............... Planning Board Approval .................. · ../.. Request for Temporary Certificate ..................... Final Certificate ............ · Fee Submitted S .... , ................... Construction on above described building and permit'meets ail apC~cabfe~odes and regulations. A cent PP -: .....,,.- ........ ..... %/ .......................... . ..... lOOO41~ THE NEW YORK BOARD OF FIRE UNDERWRITERS r)~ BUREAU OF ELECTRICITY ~- 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electrical equipment ~ ~scrlbed bel~ and introduced by the applicant named on the able appHcatlon number in the premises of ~ ~t~s, 905 ~th Rd., ~ttit~, N.Y. was examined on ~ ~ 7 ~ ~ 98~ and found ~o be i. co,.pliance with the requirements of this Board. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT 14 10 DRYERS OTHER APPARATUS: 1-G.F,C. I. 1-4.5 K.W. Ho~ Water Heater. E R V I C E NO OF~C~COND. A W,G. OF CC COND. · NO. OF OF HI-LEG NO OF ~EUTRAL$ A-W G OF NEUTRAL 1 P. O. Box 222 Aquebogue, N.Y.~ 11931 Lic.~304 Per This certificate must not be aJtered in any manner; return to the office of the Board if incorrect. Inspectors may be identified FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. STATE ENERGY G,ODE FINAL ..;~ONAL COMMENTS: Ioot APFg?._~ED AS NOT'O FEE:~/~ BY: ~ NO~ BUILDING D~PA~TM~NT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWJN~ ]NS~CTIONS: 1. FOUNDATION - TWO FOq 90~D CONCRETE 2. ROUGH ~ FRAMING & PLUMBING 3. INSULA?~0~ 4. FIN.~L CON!T~U? i3N MUST BE C~MpL?TE FO~ C. O. ALL CONSTRUCTION SHALL ME~T THE REOUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY ~DES. NOT RESPONSIBLE FOR QESIGN OR CQNSTRUQTION ERROR~ /! FLo~R Iq' If COpper tubing is for water distributing system; piping shall be of types K or L only ! -I ,/ 15'--- , , / FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ~ TEL.: 765-1802 Examined ~~.~.., 19../~.~ Approved 'Z~.¢.,.... ~., 19~.~Permit No.Z~..~..~.~ ? Disapproved a/c ........... i: . .~.. .......... .~.~ ....... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely f'ffied 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 ~iving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. ¢. 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 premisss available for inspection throughout the work. e. No building shall be occupied or ussd in whole or in part for any purpos~ whatever until a Certificate of O~¢upancy ~mll have been ~'anted by the Building Insl~ctor. APPLICATION IS HEREBY MADE to the Building Depa~ment for the isanance of a Building Permit pursuant to the Building Zone Ordinanc~ of the Town of Southold, Suffol~ County, New York, and other applicable Law~, O~linan¢~ or Rsgulations, for the ~onstmction of buildings, additions or alterations, or for removal or d~nolition, u he~in de~rib~d. The applicant a~re~s to ~omply with all applicable laws, ordinances, building code, houdng code, and regulations, and to admit authorized inspectors on premises and in building for necessa~ inspe¢fions~h (Signature of applicant, or name, if a corporation) /~x.O.~I~_.g~mg~f a.P.plicant)~-~ ..... .~..~..~.-~. ?. ~.. ~?..~T.. ~?..?~.. 6 ........................................................... Name o~ owner o~ premises ...~..0..~./... ~ ~.. ) ~ ~.~ ............................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. .. ~..~.a..~.,.-..-~...~..-?...a..w.~.0...~..... (Name and title of corporate officer) ~ilder's License No... [ .Q.O.~...~...~. ! .......... Plumber's License No. ~ .~.'r..~.~.'?.~.~....~.'..'~x..... Electrician's License No ....................... Other Trade's License No 1. Location of land on which proposed work will be done .................................................. ~,o.<,,,,,~.~t.l .... .~ ~ .............. .m..~..~. !.~.~..,. u~,-w,...t:~ ........... House Number Street Hamlet County Tax Map No. 1000 Section ... 1.~). .~. ......... Block ..... .'~. .......... Lot .... )..~. ........... Subdivision ..................................... Filed Map No. .. ~ ........ L6t ". .............. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~9.E-.a.r.Q..~. ~./?..c.... ~ v.~.c. ...................................... b. Intended use and occupancy ............................ I~r 3, Nature of Work (check which applicable): New Building .......... Addition .... Alteration .......... Repair Removal Demolition Other Work ' /$-'"' Descriptio,,) 4.Estimated Cost .C>O..O ,..oo Fee , (to be paid on filing this application) $ If dwellingi number of dwelling units Number of dwelling units on each floor - - - If garage, number of cars .... .................................................................... 6, If business, commercial or mixed occupancy, specif nature and extent of each type of use ................... ~ . 7. Dimensions of e. gisting structures, if any: Front. ..~..o. .... Rear ... '.~.o. ........ Depth ....5~.~. ........ Height ..,/.~.'f. ...... Numberlof Stories ...... /~ZP'~.. ........... k'-~, ............ a~k~-¥' '2~:~' I .... Dimensions of ~a~e structure with alterations or additions: Front ~'.. ~ . . Rear ~ Depth .... ~.. ................ Height ..... ,/,~, .... ,- ......... Number of Stories .... ~2~t'tf~ .... r ....... 8. Dimensions .Df entire new construction Front ~ ffq, ...... Rear ....~. ~..~ ..... Depth ~ .~. Height /./'/....~... .... Nunfiberi~ofStories ~..~..~. .... ,,, . ' '. "t'" ,~i ....... 9. Sizeoflot: Front ..... ./Ofl~ . ' Rear . /.010. i i. iii'iiii ~);;~' 'i'/.'~.~.~'-~ .... 10. Date of Purchas, e ............. ,'. .............. Name of Former O~vner .... ,'..ii.i,,ii i i i 1 1. Zone or use district in which premises are situated ................................................. 12. Does proposed eonstruction violate.any zoning law, ordinance or regulation: ..... ~. .~ .......... ~ ....... 13. Will lot be regraded ...... ~..~.. }...: ...... : ..... Will excess fill be removed from premises, (,,,_~Ye~ No 14. Name of Owner of premises . [gdD~.~.../l-tq.-A".?~..~./~... Address 3.~'.. ,3.(..~?..~..... Phone No. ~..;Z. Name of Architect ......... ~. · Address /-/...$?.o~.~//g,g //lt~ Phone No . Name of Contractor . ~.t~K/.t¢-'5. ,q~.. ~t~,~.~f... Address . Pz, a'z~r/~./[~..; .~-~,,,~:,~. .... Phone No. ,~ ~,.-7 ~.~.~.. PLOT DIAGRAM Locate clearly and distinctly all bhildings, whether existing or proposed, and, indicate all set-back dimensions from prop.arty lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. £/ ,?. /~ ~ above named. being duly sworn, deposes and says that he is the applicant He is the ....................................................................................... nt, corporate officer, etc.) of saki owner or owners, and is duly affth~a~zeat~,~q~rm 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 b6 performed in the manner set forth in the application filed therewith. Sworn to before me this i ............. day of. ., 19~.~ NOTAEY pUBLIC, State of New Yel~ll No. 52-8125850, Suff01~ Ter[n [xeire* March 3(I County (Signature of applicant)