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Home My WebLink About11720-zFORM NO. 4 TOWN OF SOUTHOI~D BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z.1.1.1.5 1 ......... Date ...... .~.u,g .u.a.~..2.~ ................ 19 .8.2. THIS CERTIFIES that the building .O~l.d~..g.~.9B ...................................... Location of Property ~ 3.0.0 ............... .~.q~.g.h..0..a.k.~.0.o..d..R.qa..d ....... t.auee]. House No. Street Hamlet County Tax Map No. 1000 Section . .1 ~.7. ....... Block . . .0.6 ........... Lot....0.1.2. .......... Subdivision ..... I~8~r'.e.],, ~¢X'.k ............. Filed Map No...2.1.2....Lot No...4. .7 ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated lq.a.y. ~B .............. ,19{I.2. pursuant to which Building Permit No...1.1.7..~.0..Z. ........... dated .... 4~lla.e..9 ................. 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 ......... ..... an .e~.a.~,~$o~..e.q..~.~,0 .~.n.g..a.~.,.X..~.X.n.g.. ................................... The certificate is issued to .. · ' id;,'o'r,'~"~irh'J ...................... of the aforesaid building· Suffolk County Department of Health Approval ..... n~/~ .... ~. ............................ . .~.~.~.~: f. c~ ..... UNDERWRITERS CERTIFICATE NO ........ nuilding mspector Rev. 1/81 (THIS PERMIT Must BE KEBT COMPLETION OF ~issior~ is hereby granted to: ;Bate ~,.'.. ~emise~ located at C~)~r~ty Ta~ Mop No. 1000 ~ection p~ant t~o-application dated gev; ~6/30980 ~roved by the I~ORM NO. 6 TOWN OF $OUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and' sqbmltted in triplicate to the Building Inspector with the fallowing; for new buildings or new use: 1. Final survey of property with accurate location of oil 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 .R~Sidences and similar buildings and installations, o certificate of Code compliance from ~he ^rchi}ect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plcn requirements where applicable. B. For existing buildings (prior to April 19,57), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey o'f property showing oll 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 in- formation required to prepare a certificate. C. Fees: I. 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 ........ ~'. .......... Vacant Land ............................ Location Of Property .~.l~..~...~...~.~.......~...~.l.~...~....c4.~..~.....L.~..~. ......... ~.~..~...~.~..~ ........................................ Owner Or Owners Of Property ~./~..~..l.~...~...../~'./(~...~...~..t..~.. ....... .~./,?.),~,,C.'..?,..~,.~ .............................................. Subdivision L..~...U...~....~....~.. ...... ¢(~...~..l.~. ....................... Lot No...~.:~..,. Block No ............. House No....~.~....~ O i1¢'~ Q tl ~7 . Permit No,.l..:l..~.u....~ Date Of Permit .......... Applicqnt ............................................................... Request For Temporary C~ertificate ........................................ Final Certificate .......................................... Fee Submitted $ ....,,~. ............ .~-. .......... Construction on above described building arCd permit meet.~all applicable codes and regulations. Applicant Sworn to before me this /"'x//~',.J~ "7ZO Notary Public .................................... County (stamp or seal) C O. ¢ 1115-1 FIELD~INSP, ECTION FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C,ODE FINAL DATE COMMENTS 7~ ~ ~--~ z ADDITIONAL, COMMENTS: "' 1001~65 THE NEW YORK BOARD OF F!~R~ UNDERWRITERS BUREAU OF ELECTRICIT ~-- ~te,tx~r 20, 1~ ~o.. s.~*, ~w ~o.~, ~ ~o.~_ ~oo~ · * ' 576798 THI5 CERTIFIE~ THAT ~ only the el~trlcal equip~nent ~ described belo~ a~d introduced by t~ applicant ~d o~ the above application ~umber in the ~remise~ of i. ~/o,,,w~.g~o~.,io.; ~ ~..~.n..~ ~ ,st r~. ~ ~nd r~. ~ s~tio, mo& rot '" ~ 13, 1~ was examined on ~ and found to be i,, com~liahce with the r~qulrements of this Board. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES IHCAHDESCEHT FLUO~ESCEHT 18 19 18 DRYERS C A. W G. NO OF NEUTRALS A, W G OF HI-lEG OP NEUTRAL i 1/0 OTHER APPARATUS; 1-Smol~ De~ec$or ~ DillieS;am 2~ Mrmy Ave. Laurel, N.Y, ; Per ," . __ This certificate must not be altered in any manner; return t0 the bffice of the Board!if iinc'c~(rect. InspectOrs may be identifipd by their credentials. TH S COPY.~OF cE I A' U, ~ E ~ E~ED: N MANNER. FORM NO, 1 TOWN OF SOUT:,HOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 7G5-1802 ~t~nmng inspector) APPLICATIOAJ FOR BUILDING PERMIT INSTRUCTIONS: a. TMs application must be completely filled in by typewriter Or in ink and submitted~m-li~to the Build 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 pubtic stre or areas, and giving a detailed description of layout of property musi~ be drawn on the diagram which is part offthis ap! 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 issue a Building Permit to the applicant. Suck p~;n shall be kept on the premises available for inspection throughout the work. e. No buildiag shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupar shall have been granted by the BuiIding Inspector. APPLICATION IS HEREBY MADE to the Building Department for th~ issuance ora Building Permit pursuant to Building Zone Ordinance of the Town ~f Soutbold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of' buildings, additions or atteraQoaS, or for removal or demolition, as herein describ The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessfiPc'mspectk~s. . //'' ". (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicaut is owner, lessee, agent, architect, engineer, :general contractor, electrician, plumber or build N,'une of owner of premises - (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 Licens". No.. El~ctrician's License No.' ~ ~'.O , ' Other Tradc's License No. -/'7. 1~' ,i~ , 1. Location of land on which proposed work will be done...P~./f. /,J'0~'D¢ O/~.~vooD d'~D , . House Number Street Hamlet County Tax Map No. 1000 Section .... 1. .2 .........mock :. 9..a.... ......... ....... Subdivision..~..~..~ t~ C'l.- ............. Filed ~ap No...~..~..~.. ...... Lot ............. (Name) 2. State existing use and occupancy of premises and intended usc~ a.nd Occupancy of proposed construction: a. Existing usc and occupancy ,,/2~-72~/~ ~.-r i.l~ ,,..__ ' b Int d d and ~.~tl~&-'t~'~f~-~.- · ' ' ' .-:; · ca e use occupancy '. ' · · ;;::, ' ~: ........................... ~. ....... 3. Nature of work (check whicbl applicable): New Building .......... Addition ........ Alteration ........ Repair .............. Rqmoval .............. D.:,molit~on .............. Other Work ............. ....... '...3, z o. qg. ' 4 Estimated Cost .O....O '.. Fe ....... (to be paid on filing this applicatk,-~ ' .~..., ......~.Num bcr o f dwelling 5. If dwclli,~g, number of dwellihg units ..... units on each floor ..... '.: ....... If garage, number of cars ,. i ...... ! ..... .(. ~ ~O.',g.~r. 3 ......................................... 6. If business, commercial or mixed occupancy, specify fi~ture and extent of each type et' use ....... .tX.. ~/q, ..... 7. Dimensions ofcx~stmg structures, if any; Front....15'. ~. ........ Rear ... ~:$~.. ....... Depth .... tve..~ ..... Heigttt .... I.ff. .......:. N!lm bet et' Stories .......... O..*V...~'7 ....... ~ ................... Dimgnsions of same structure; w t,a terations or additions' Front ............. Rear .... ~... Depth . .3'7.9 . ; I-Iei~ / ~ Nt ber of Stori ............ , .... it ........... lm es . . ~3.' Dimensions or'entire new con'struction: Front /%r//~ Rear Depth Hmgbt ............... Number of Stones .............. ~ .................................... Size oflot: Front ........ l!6.O., fi,r,, ...... Rear.. . l~ tar' D. epth . ~.O.. · to e.o .&. ?!s Date of Pnrchase ...... ,/ ' . . .'!... Name ......................... of Former Owner · Zone or use district in which premises are situated ' .~.q~. tt~ .15'~--D-.. ~q~ .~"r. '" Does proposed construction v!iolate any zoning law, ordinance or regnlation: ..... .tV.' .';r%. .... Will lot be r o.a&d ......... 75(~.~$ .............. W i excess fill be removed from premises: Yea Name. ofe Owner. ~°f p r e m i s e sJ.A:~J.~. ~..t~.tJ' .cp. tr (-~. .... Address. C'/':6.-4 g. ~°~. ~ .~. ~,~;~_ ./L~:> ....... Phone No ......... Na~ne o, Arcl r;;ct ........ I ................. '.. Aadress ................... Phone No ............... Name of Contractor [ Address Phone No PLOT DIAGRAM Locate clearly ~nd distinctly ¢i1 ou'hlings, whether existing or proposed, and. indicate all set-back dimensions fro~ property hnes. Gh'e street and block number or description according to deed, and show street names and indicate wheth, ',aterior or corner lot. . tO. I1. 12. (3. (4. ~'TATE OF NEW YO R,K,/ -- COUNq'Y OF .~. S.S 9 co'c,---, ........................., . . . . ; ................... ·. being duly sworn, deposes and say~ that he is the applicm~ (Name of mc w~dua si~ning contract) above named. ~e is the .......................................................................................... I (Contractor, agent, corporate officer, etc.) of said bwner or own'e~, m~d is dob, authohzed to perform or have performed thc said work and to m~e and file ~i a ~plicatioq; that all statements Con. rained in th s a~olicat o ~ ara true to the best of his knowledge and belief; and that th work w'll be pedormed m the mender set fort ~ h~ tl'~ applicatio~ filed therewith. ~orn to before me thih ..................... .......... ~ota, Pubtic.~.~. ~~ ...... , ~~ ~ .~.~~. ~t nty // // / / LA= c/5~ S~ APP, ROYED AS NOTED -~ FEE:lJlS--- BY: ~ NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: ,1. FOUNDATION - TWO REQUIRSD FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. PIN~L - CONSTRUCTION MUST BE COMPLETE FOR C. O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N,Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS, i~:,~', P, z:,JC~>,>~j ~'i \-~ "z~"a'"r-'Vu~: /o/9(='0 (v:¢~, I .11 ~ 12-'-- ~ S T,~ V E TSONTAKlS CONSULTING ENGINEER NYS PE~¢ 42817 P4 Unauthorized ~lterntion or addition to this document is n violation of section 7209 of the New York State Education Copies of this dacument not bearing the engineer's inked mai or embossed seal shall not