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Home My WebLink About11761-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin[ Inspector Town Hall Soufl~old, N.Y. No. ~.1.1~.0. ......... Date ...... ~ p.l;.qml~ls~'..~7 ............ ,19 .~ THIS CERTIFIES that the building ................................................ Location of Property .390 .............. I~av~.~$ ~. House No. County Tax Map No. 1000 Section . .100 ....... Block ...Q3. .......... Lot 004 Subdivision. ~al~,J,r. 9. J~.s.t~ .a.~.e.s. .......... Filed Map No..~.6..8.2...Lot No. ~.4.2 ........... conforms substantially to the Application fOr Buildi~ Permit heretofore ~ed in this offic~ d~ted ...... ~lala.~ .1~ ........ ,19.8.~. pursuant to which I~ail '~din~ Permit No .... .~.1.7. 6..1..Z. ......... dated ...... ,lgP9..3. Q .............. 19.8.~., 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~ciyt~.t~. . ppe..:f, amtll/'. ..... ..........dwelllng.,. ................................... ... Thom,as & 0d.ell St;urnlolo The certificate is issued to .................... of the aforesaid building. Suffolk County Department of Health Approval 1~.-.S0-59.~..9./.14/.8.~.~.Robt. A. Villa P.E. UNDERWRITERS CERTIFICATE NO ............ 1~ 5..76.7.7. 3. ................................ Buildin~ Inspector Rw. 1/81 Permission is hereby granted to: SouTH'OED, N~. Y, ~ BUILDING I~ER~! i i~ ' , ~ {THIS PERMIT MUST BE KEPT ON THE P~EglSrS, UNTIL ILULL COMPLETION OF THE WORK AUTH~RiZEDi ~! Date ~.;.~.~'~'~'~.....~ ....... : ............. , ~ at premises located Couhty Ta;x Map No. 1000 Section~,...~..~..~)..:.i,~..~ Bj°cl~ i ; ~ NO. ,,4:~.~....~.-.. .... pursuant to application dated ...~ ........... ~,.~.,, ,..;.., 19. ,, and approv~ by the Building I~spector. ~ ~ ~ Fee $~..~ ........ ~. 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 subn~itted in duplicate to the Building Inspec- tor 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-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 o7 Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to Apr. 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. ,,' Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwe{ling or land use 3. Copy of certificate of occupancy $1.00 New Building .......... Old or Pre-existing Building(;() .. ........ =/Vacant Land ............ Location of Property....~'. ?~..~-~ .'~..~,, ....... "..~/..~..~.~-'.--.~. ~.. ~.'. ....... ~~.~,< Hou~ No. Stoat Ham/er Owner or Owners of Property .. ~~ .~ ..........~Z~ ~~ ......... . ounty .x 000S ., on .... ...... .... 3. ........ .... ¢ .......... Subdivision ................................. Filed Map No...; ....... Lot No .............. P ermitNo. ,~.~f, ,~,/... Date of Permit. ,~,//,?~.~,, .Applicant...~,, ,~, ,~.~'. ~,, .~...~'~., .... Health Dept. Approval .4~.q~. .-..~...~ ~.~. ...... Labor Dept. Approval ...................... ,.. Underwriters Approval ........................ Planning Board Approval .................. ~ .., - Request for Temporary Certificate ................., .... Final Certificate ...... - ......... - Fee Submitted $ ............................. Construction on above described buildin, Ap~ Rev. 10-10-7B THE NEW YORK BOARD OF FIRE UNDERWRITERS 'BUREAU OF ELECTR 85 JOHN STREET, NEWyORK. NE~V yORK I005~ THIS CERTIFIES THAT . only the electricol equipment as described below attd introduc~ by t~ applicant ~d o~ tb~ above ~p/~ation numar in t~e preottsez of ~ a Oa~lL S~0~, 390 ~e~ ~ "es~,~.~ ~ is~ FI. ~' 2nd FI. Section Block Lot the followlng location; ~as eza,~i~d on $~r $3, 982 ,nd found to be'in co,npliahce with the requirements of this Board. 19 30 z6 19 RANGES OVENS DISH WASHERS EXHAUST FANS DRYERS FURNACE MOTORS ~ MEiCLOCKs MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT 1-G.F~I. 1-fimoke DeCeit:or NO, OF CC. COND A W, G. ; HO. OF HI-LE6 AW-G. NO, OF NELJTRALS A.Wo, 1 4" 1 4 Towle & Sons Ira, 33 ~ Ave. This certificate must not be iJtered in any manner; return to the office of the Board may be i MANAGER ANY MANNER. FIELD INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. STATE ENERGY C DE FINAL ADDITIONAL COMMENTS: FORM NO. 1' ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y., 1.1971 TEL.: 765-1803 D~sapproved a/c ...... i'' 7 ............ '/~ ......... '// / ~ ' (Building Inspector) APPLICATION FOR BUILDING PERM IT INSTRUCTIONS Application No. //./~.. (./. ....... a. This application must be completely filled in by typewriter or in ink and submitted-&:. ~!:._~l~-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, an~gulations, and to admit authorized inspectors on premises and in buildings for necessa~~~,. ~~,/~. (Signature of applicant, or name, if a corporation) .~.z:gy.e.-'l&~..n.d..4y.e...,. ~¢s~c Ql~og~g¢, 1~,7 ...... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... 9.e.n.e.r.a),. 9.o~.?. 99.e.o. r ................................................................ Name of owner of premises .~.h.o..mp..s..?.~..0.c].e..~..~. (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 License No. · .~. · .} · · f~~~-~d~ Electrician's License No. ~'~... ' ~/ Other Trade's License No ...................... PERMIT INCLUDES APPR43VAk TO REMOVE EXCESS FILL FROM ABOVE PREMISES BY LOT. _ / CESSPOOl/CONS t RUCTION ~" CELLAR ~CONSTRUCTION OTHER 1. Location of land on which proposed work will be done. #~9.0..~6'g.v.e CrP.e.s. t. %~ne, g~.12rO~.in~ag.e.3, y ......... :.. .............. House Number Street Hamlet County Tax Map No. 1000 Section . J.O0 ............. Block .... 3 ............. Lot...00~1 ............. Subdivision...PI.a.p.. o..?..~a. 2. ~.~:J:.z'. ~. ~!~ .~? ........... Filed Map No..4..6.8~ ......... Lot...4.2_ ........... (Name) ., 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: xis' ' ~acan t Land a E ting use and occupancy ..................................................................... .. -;/..-.f b. Intended use and occupancy . . .R~;s.&cJ ?41.c.~ .. {~'.~JP~.~ ..................... [ .............. 3. Nature of work (check which applicable): New Building . .Tq ....... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work 4. Estimated Cost .... I .45.,.Q99...0.91 .............. Fee ......... ~ ............. ; (to be paid on filing this application) 5. If dwelling, number of dwelling Units 1 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 ................ r)epth ...................... Height ...................... Number of Stories .................... 8. r)imensions of entire new construction: Front ...63..-f..~,.6.'[... Rear . .6. 3. ;f.~i ~ ~ !'. Depth ,2.7. Height...12. . .f.~.,. ...... Number of Stories .. J ................................................. .. 9. Sizeoflot: Front ...~.0.6...f.~...i Rear...~.0.(} .f~.. ............ Devth ¢.4.6. r~., ...... 10. rlat~n~l~,,~,hooa March 15, 1982 W~m~W~nwn~r J ~ fl Hochstrasser ..................................................... ............................... 11. Zone Dr use district in which premises are situated ...... -;,,.~. . .: .............................. no 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................... 13. Will lo~ be regraded . y.~ ~ ....................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ?. ($. 9..s.~ura~9~*p.. Address . ~/.&Ck~.v.j..~[.e.,.3J, 7..Phone No. 9~.1.~ ..... Name of Architect .................. Address ._,. ................. Phone No ................ Name of Contractor ......... 'C'ti~i~)_'e'~ Olsen .......................... Address ~J.as.~..q.u. qg.u.e.,.I~.: .Y..Phone No..7~8-:~2.24 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. See Attached Survey STATE OF NEW YORK. COUNTY OF.. ?.u.f.l'..o.]..k. ...... . S.S Charl e s O1 sen being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. : Contracto. r 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; that all statements con(ained 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 : sUFFoLK CO. HEALTH DEPT. APPROVAL" H. S. '~ ~ ~ ~ ,' ' ' STATEMENT OF ~.~.~ ' THE WATER SUPPLY AND SEWAGE DIS~AL ~ ..... SYSTEMS FOR THIS RESIDENCE WILL ~ ~ CONFOR~ TO THE STANDARDS OF THE SUFFOLK CO. DE~. OF HEALTH ~RVICES. ~S~, , /[ ~FFOLK COUNTY D~T, OF HEALTH // SERVICES -- FOR APPROVAL OF . ~ CONSTRU~ION ONLY for this loaatio: hRve bee~ ,; / SUffI~C~..K CO. HEALTH D~PT. API~OVAL H.$. NO. ,%_ T~ WAT~-~Y ~ ~A~ DI~AL ~ : : ~ ~ TH~ ~~ WILL / i ~ ~ T~ ~A~R~ ~ THE ' ' " i, , · '3 ~ ~NTy ~. OF H[ALTH ' .~NVlCII - ~O~ AF~NOVAL OF ', ~, . ~ : ..... /~ ~Vl~ ~9[C~ I;~:~:~_.._. " the possibili~ exists t~t ~he ~c~---,o,',"' ~'",~-- .~ -'~ supply may contai~ ~a?~~ · ~ ,~ ~,~ ~T. ~ ~nts of ~sticides a~lar ~e~. ~ .... . , m., v,~ .,~ ~. ' W:~ ,- ' Ot~T D oo f~. USE IS IJNLJ~VIi:t)L Q[: OCCIJP~NC¥ APP, RO/VED AS 'NOTED . N~ BLffLDING DEpARTMEN/ 765-I~02 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: .I. FOUNDATION - TWO REQUIRED FOR pOURED CONCRETE 2. ROUGH - FRAMING & pLUMBING 3. INSULATION 4~ FINAL - CON'STRUCTION MUST BE COMPLETE FOR C, O. ALL CONSTRUCTION SHALE MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS, ,/ga