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Home My WebLink About11906-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold~ N.Y. Certificate Of Occupancy No. Zfi. ] .8).8. .......... Date ...... .~.u?.u.s..t..1.8. ............... ,19B..3. THIS CERTIFIES that the building .. a..d .d.±.6. ~. 9 .n ..................................... Location of Property ...2.3.0. ................ S.o.u..~.h..L.a..n.e ..............~..a.s.~..~..a.r~.qn.... House No. Street Ham/et County Tax Map No. 1000 Section . 9.3.8 ........ Block ...0.6 ........... Lot .... .0.1.5. ......... Subdivision, .X, ............................ Filed Map No..X. ...... Lot No...X. .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..A.u. g .up.~...3 .~ ........ , 19~. ~.. pursuant to which Building Permit No.. ,~ J.9, Q 6.. ,g ............ dated .... S.e..p .~?.n!b..e .P..1.5. .......... 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 ......... The certificate is issued to JANET T. THOR ? (owner,4es~ee. er-~enen~- of the aforesaid building. Suffolk County Department of Health Approval ....... N../..R ................................ UNDERWRITERS CERTIFICATE NO ............... ~. ~ 9.8.q ~ 5 .......................... Rev. 1/81 BUit. DIHG ~EPARTM~? ~ TOWN H~LL SOUTHOI~D, N~Yo , BUILDING~ pE~IT ~ (THIS PERMIT MUST BE KEPT ON THE P~EMI5~S UNTIL ~ ULL COMPLETION OF THE WORK AUTHORIZED) ~:1906 Z Permissiod is hereby granted to: at p~remiseg located at ................................................................. ,, Couhty Tax Map No. 1000 Sect,on ....................... Bilk ;;...~':;..~.....,.,..;..jLot No ......................... T~1;'~;~' -4at~4 ~w?..Z' ~/~'~'. i 19~... and ~ roved b the pursbant !o ~.~, ................... t'"'~ ............ · ........... ~' ?'"'""'"' ' ~'" Pp Y BuilOing I~spectoro i~ pEP~MIT ~NCLUDES AppROVAL TO R~MOVE EXCESS FILL F~OM ~OVE p~EM~SES ~Y REGRAD NG~ LOT ~ DR~WAY ~ON:ffRUCTIO ~ ~ C~LLA~ CONS'[~uC~°N oTHER Re,. ~/3o~8o ) ~- ~uilding ilnspectot FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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, propertv 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. 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~/rr land use ,1;/5'/$5.00 t 3. Copy of certificate of occupancy $1.00 -- ~Date--... -~. ~/~./.~,~}/' 'j ....... New Building ............. Old or P_re-existing Building .......... .. Vacant Land ............. LOC p ty ........................ ;~ ............. ,~ .................. House No. Sl~reet Ham/et Owner or Owners of Property.... .................................. . . County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision .......................... ~ ...... Filed Map No ........... Lot No ........... i' ' Permit No. ~,;~.0,,~, ,,, Date of Permit . ,~/~,~, )~Applicant Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ..... .~.. ............... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $...~.,.~. ................... Construction on above described building an~err~it meets all applicable codes and regulations. ................. ~ooo~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY [~)~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 197454-82 ,,pp,, atio,, No. o,,j,,e N 608025 in theJotiowing Ioc3~~ ~ sBas~ [~] 1st FI. [] 2nd Fl. Section Block Lot was examined on and found to be in compliance with the requirements of this Board. 3 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FRET DIMMERS SERVICE DISCONNECT S E R V I C E NO, OF CC, COND A W O, NO. OF HILEG A-W O NO OF NEUTRALS A,W g PER ,~ OF CC COF~D OF HI.lEG OF NEUTRAL i OTHER APPARATUS: Glenn R. Bradley, P~D 1.69 ~{orton Ave.~ ~attituck~ N.Y~ 11952 Lic: t227 11 This cert[flcate must not be aheted in any manner; return to the office of the Board if incorrect. Inspecto?s may be ider by their COPY FOR ~BUILDI, NG DEPARTMENT. THIS COPY OF CERTIFICAT~ M~ST NQT BE ALTERED IN ANY MANNER. FIELD INSPECTIO~ FOUNDATION (1st) COMMENTS FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 ...... ,19 Approved . .5~/. / Disapproved a/c ..................................... ·, (Building~lnspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No... (.F..~ ....... Date ~'~2' '~''/ ..... 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 Cmmty, 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 necessaryjfa.Spectio, ns. ~ // / . ................. (Signature of applicant, or nail!e, 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 of premises...~....~--'~V/O ~--.'T .... 'i. 3..~... ~ O. ~ .~. ......................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Electrician's License N ~ F/~ ..... Other Trade's License No.~. ~. 1. Location of land on which proposed work will be done .................................................. House Number Street County Tax Map No. 1000 Section ... 0~.~ ........ Block ..... & ........... Lot ..... Z~ ......... " (Na~e) 2. State existing use and occupancy of premises and intended u~nd occupancy of proposed construction: a. Existing use and occupancy .... /... ~< .~ .................................. b. Intended use and occupancy ... ~~ ...................................................... 3. Nature ofwork (check which applicable): New Building .......... Addition ....L/f~..... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... .~../~. ~___ (Description) 4. Estimated Cost...~c~y/Q.,~. ~./. ff.Z~) ....................... Fee ................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of ears ........................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Bimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ r)imensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories .......... , ............ 8. Dimensions,of/entire new construction: Front .. ~O..7. ........ Rear ............... Depth . ~.f_a .......... Height . ~'.,,~.. .......... Number of Stories ... A'. .................................................... 9. Size of lot: Front ........... ........... Rear ...................... ,J~epth .................... ........... .................. Name o f Former Owner d././.,22~_e~/~ ,,zo~,.,~ ~z_,~r2_~..U: ./:,c.: ~ 10. Date of Purchase 11. Zone or use district in which premises are situated .......~ .............................................. -- 12. Does proposed construction violate any zoning law, ordinance or regulation: .................... ~ ...... 13. Will lot be regraded ... ~ ~> ................... Will er~.c,ess fil! be removed from premises: C~Ye~,/ No 14. Name of Owner of premise~.."7~o r.~. .... Address k~.c~.~.t.l{e .~ ...... Phone No ................ Name of Architect .......................... Address ............. ~... ,~. Phone No. Name of Contractor .Jr~c~D.: .Cc>~o 5'/r-e, te-~ 00.. Address (~Ot,t,v:~ .~:~hone No. i~r~4 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 STATE OF NI~W ~j~K, .///~ ~ ~ CO[~rY OF ~~. ... ~.~. ~. ~ ~b ....~:,..'777~. o.~.-~/0 ................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the.. (~. ~,,~/7-,,e~,qc'~.,~,-~ ...................................................................... (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 County , · ~ ' ~' ' (Sigilature 6f'applicant) Ah'tv ~?~'tLL~ fllll~,W PUBLIC, Stere of Flew ¥or~ 52-6125860, $idfol~ Coup,