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Home My WebLink About11739-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..g..1.1.1.9..2 ......... Date ...... ~.e.p..'9.e.m.b.q ?..1.7. ........... ,19 .8.2. THIS CERTIFIES that the lyt~lflt~g .. pg.o.~. ......................................... Location of Property .....3..1. 9.5 ............... .t'9.q.u.a. ~..h' fi.v..e: .............. ~.u..~F.h.q&u.e.. ¢fou$o lye. Street Ham/et County Tax Map No. 1000 Section ...1.0.3. ...... Block ...1 .~ ........... Lot ...0.0.9. ........... Subdivision...P.e.qu..~.e.h..~.gr.e.~. ............. Filed Map No..5.6.9.~...Lot No. ,1. ........... conforms substantially to the Application for Building Permit heretofore ~ed in this office dated June 2 .8.2 11739 Z ..................... ,19. pursuant to which Building Permit No ...................... dated .... ~. u..rig..1. 4. ................ 198.2.. , 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 ......... ..... & p.o.o..Z.. ............................................ The certificate is issued to . ...~%.1..1.~.a.m...I'....b...~.13. e.e..n' .A.:..C.a.e.e.o..13 .................... (owner, Jee~e.~ 4e~en4) of the aforesaid building. Suffolk County Department of Health Approval n/a UNDERWRITERS CERTIFICATE NO .............. ~. $.6.9.1. 2. .6 ........................... Rev. 1/81 Building Inspector N? 11739 Permission BUILDING D! PARTMEN sou~.,o~, (THIS PE~IT MUST BE KEPT ON '[H,E PREMIseS UNTIL ~ULL COMPLETION OF THE WORK AOTHORJZED) Z *o~ ....~ ~.....~...~...... .............. ~.~ is hereby granted to: ..... County TAx Map No 1000 Section ....,4'.~...~:~..,..i.~. Block ;.~ .......... pUrSuant ~o application do~ed ..... at premises located at ........................................ ,.,.; .~ ............ ~ ...... :.b~,~¢~.:~.~ ...... ~...~ '~'"~'~ ......... F' '~ · f ' , , ' ~ ~' ~ . .......... .................... Lot NO. :.(~...~..~.~.. ........... ~,and approved by the Building Inspector. LUDE~ APPROVAL FROM ABOVE PREMISES ~vs,~e(~ co~sr~ucrio~ C~$s~ooL c o~sraucr~o~ FORM NO. 6 TOWN OF SOUTHOLD Building Department, Town Hell Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and subr~itted 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. 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 o? Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B, For existing buildings (prior to Apr. i.I 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 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. Co Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 New Building ............. gJ~L¢~4~ -ece~t,L~uilding(X) ......... ~/Vacant Land ............ Hou~ No. Street Owner or Owners of Property ' O AA ~ ............... County Tax Map No. 1000 Section ............... Block ............... Lot ..... Subdivision .... .Filed Map No ........... Lot No .............. H IthD pt App al L b D pt App I e8 e , rev ........................ a or e . rova ........ ~., Request for Tempora~/Certificate .......... ....... .....................Final Certificate' Construction on above described building and permirmeets all app~cabl~odes and~egulations. 1000662 THE NEW YORK BOARD OF FIRE UNDI[RWRITERS BUREAU OF ELECTRICIT~ ~-~Jb 85 JOHN STREET, NEW YORK, NEW YORK 1OO3B THIS CERTIFIES THAT only the electr~al eq~i~m~ ~s descr~ed belo~ a~d ~ntrod~e~ t~ aooJica~t na~ ~ the ab~ appllcation number in the premises of in the following loc ti n; ~,~ ~ent [] 1st Fl, was exa,ninedon '~j~n~ FIXTURE FIXTURES [] 2nd FI. O~l~ Section Block Lot and found to be ir~ compliance with the r~quiren*ents of this Board. RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS IME ~LOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: 1-G.F.I. S E R V NO OiF~ERCC,~COND. OF/'~cWcoGhD. I C E NO OF HI-LEd A, W. G NO OF NEUTRALS A W.G. OF HI LEG OF NEUTRAL (b~r~miX~ Pool) ~ois ce~ifLcate coverz ~x~plizne~ at tt~ clat:e of inspection o~1¥. ~eue of ummual env~ it is a~'J.~able to ~ ~eque~ te~t and/or repairs This Glenn Bradley, Morton Ave., RFD 169, Mat=iDack, N.Y. 11952 not be altered in any manner; return to the office of the Board i I~Lc11227 may be by their credentials. ANY MANNER. , ./ FIEL~D IN'SFECTION FOUNDATION (lst) COMMENTS FOUNDATION 2. (2nd) 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.: 765-1802 Examined ~_-~,,,~ ~:./~...., 19~.~,~ .... l .2 , it ..... (~,i~ ~"~-~,;;;i ....... APPLICATION FOR BUILDIN~ PtqqMIT INSTRUCTIONS Application No~L,~.. ~..~. ........ a. This application must be completely idled in by typewriter or in ink and submitted in triplicate 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 issue 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 code, and ra~ulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ..... ,. .... (Signature of applicant, or name, if a corporation) ,B~.. ~.,..2'.'.3. /k2~z-~', /v't.v.' t.~'.. (M.iliqg address of applicant) / / ~ ~- L State whether applicant is owner, lessee, a~ent, architect, engineer, ~eneral contractor, electrician, plumber or builder. ............................ ~...o../~ .z?. ¢.~ ..................................................... . /~/~/' P',~. .v-£,'/~ A, Name of owner ofprem~s ... ~.~..~..+...Zt!...~. $....../~.1 ...... .'9.~...C~ .,~l ~ ~./,.~. ................. (as on the tax roll or latest deed) It' applicant is a corporation, signature of duly authorized officer. .... (Name and title of corporate ~fficer) , Builder's Licen~ No ....... ~..~.. ................ Plumber's LieenseNo ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done..~./~......~'.,~.~..e. ~2~. ,~...~.ff..C/.<'.. ,K~.. ~ .~..~..~..~..c~..o.~w f~l) , C O TC ,~ o ~;/ o ~' ..... ~ ,~.../..~. ~, ........... ~..~..~..~'..7...~....~. ?.c../.< Hamlet House Number Street County ~ax ~ap No. 1000 S~ction .... .~.O..} ........ mock ..... ' .~..~ ........ Uot.....~___~...O.~Q ~,, ......... iled apNo. ..... Lot .... / ........ State existin~ use and occupancy of premiss and intended use and occupancy of proposed construction: a. ~xis~ use and o~pancy .... ~...~.¢..~.Z./..~..~.~ ............................................. b. Intended use and occupancy ./~...~.~..O.a~/~.....~..~./.~..~/.~..~... ~.~ ¢~.....¢-....~..e..~.C..~' ............. 3. N~}ture_ of work (check which applicable): New Building .......... Addition .......... WorkAlterati°n--2~ .......... Repair .............. Removal .............. Demolition .............. Other ,~-e~.~.. -. ....... ? /. ¢.- ( .4: (Descripti°n). 4.Estimated Cost ....... P. 0 .o., .o..~. ................. 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 cars ........................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front .... .~.0. ........ Rear .. ~ .......... Depth ............... Height ............... Number of Stories ........................................................ 9. Sizeoflot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 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 excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect .......................... Address ................... Phone No. Name of Contractor . .". ~ .~,'~o:n,~,, ,9¢~. Address ................... Phone No. 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 NEWYll)RK, . ~ :~ ..... .~... ~..~...~-~. ~,! '.'X~..®. ./..~..~./),~.' .......... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ................... .~.. ?./. ~ .~..~./.~..- ....................................................... (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; thai 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 ........... ~...day of ...... Nota~r~Publi% ...... ;,' ·/'h,' · · ·: ' ,~ C0unty ~ (Signature of applicant)