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Home My WebLink About11803-zFORM NO. 4 TOWN OF SOUTHOED BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z.1.1.1.4..6 .......... Date .......... g.ugue.~..19 ............ 1~.2. THIS CERTIFIES that the'b=itd'ing'., p.o.q 1. ......................................... 3635 Location of Property :3.4.0..5. ................. Leslie R. oad Peconic ........ ~'r'eet' ....................... County Tax Map No. 1000 Section 9.8.6. ........ Block ...0.4. .......... Lot . .0.0.~..&..0.0..8 ..... Subdivision'...~ .......................... Filed Map No, . .X. ..... Lot No...X ........... conforms substantially to the Application for Building Permit heretofore Cried in this office dated .~..u.l~/..1. 5. ............ , 19 .8.2. pursuant to which Building Permit No... 1..1.8.0.3...g ........... dated . . . .d~.l.~...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 ......... an above g~'ound e*zimm£ng pool The certificate is issued to Ihomae & Fel~.ct, a Ge:Ls[e~' & Edw~.n ..................... i oYn'o'r, ...................... of the aforesaid building. Suffolk County Department of Health Approval ..... n.[? .................................. UNDERWRITERS CERTIFICATE NO .......... .1,t,, 4. 9.4.5.~ ] .............................. Building Inspector Rev. 1/81 TOWN OF ~{ ~UTH~D~ TOWN HALL $OUTHO~D, N~ ¥.! N9 11803 Z Date granted to: BUILDING FERMI~ ~ (TH S PERM T MUST BE KEPT ON 'THE PP, E~ ~ES UNTIL i:ULL COMPLET ON OF THE WORK AUTHORIZED,) i ~ at premises located at .. County Tax Map No. 1000 Sectmn ....... ~ .... ? BI.~,~I~,. .,,..,:...,t,l~ot No~ ...~.. ..... p~r~uant to opplication doted .................... ;..,~;.,~..~r...~.~;..,, ]~.~ond ,approv~ by the 8~,fdlng ~pec o. ~ Revl 6/30/80 : ~ ~,~, ~ t FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. 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 Iocatibn 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 or Engineer responsible for the building. 5. Submit P~anning Board approval of completed site plan requirements where applicable. B. 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 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 or land use $5.00 3. Copy of certificate of occupancy $1.00 Date.. .. ....... ~ acant Land ............. New Building ...... Old or Pre-existing Building(:~), ~V -' Location of Property . .. ............................................... ~ .- ........- .......... Ho~ No. Street Ham/et Owner or Owners o~ Propertv ..... - ~ ~ ~ ~ ~' L ~ountv T~x ~p ~o. ~000 Section .... ~ Block ~ Lot., Subdivision ................................. Filed Map No ........... Lot No .............. Permit No..(./..~E..~...2~. Date of Permit ...~//.~/¢. ,~'Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ......................... Underwriters Approval ..................... i..Planning Board Approval .................. Request for Temporary Certificate ..................... Final Certificat~ ................. · Fee Submitted $ ............................. Construction on above de~Hbed building and per~eeSs all ap~cabi~de~ and regulations. Pp ....... ~(~ ...... /. ~.'~ ....................... THE NEW YORK BOARD OF FIRE UNDERWRITERS nUREAU OF ELECTRICITY 0etober 3 19~ JOHN STREET. NEW YORK, NEW YORK 1OO~E / Thomas Oel~er,Leslie's Hd.,Peconic,L.I. ~/ in the following I~.tion; ~ B~e~nt ~ 1st FI. ~ 2~ FL ~t~n B~k ~.~o. September 28, 1978 ~foundto~in~mplia~e~itht~ulrementsofthlsB~. SeRVK:~ DISCONNECT [ NOME~ RANGES · ~1 AL BEC'PT, 1 20 S R I,~2W ~,8'3W 3,8'3W 3~'4W NO.O$~C~.COIqD. TRANS. ~ SYSTIMS OF CC, C(~ID. V I EXHAUST FANS D4MMERS E OTt~ER AI~ARATUS: [] (~l~wwn~ Pool) Thi~ certificate cove~ co~llanee ~t ~he d~e o~ tuspectlon only. Because of unusual envlro~en~s It Is advisable to h~ve f~equen~ test and/or repairs ~ade by a qualified per,on. ~. J. Elect. Co. ;~till Wster Ave. Cutchogue,N.Y...-~935~" ' Lie. 505E This certificate most not be altered in any manner;, return to the office of the Boord if incorrect I~,~_~e~s~ _~rs may be identified by their credentials. FIELD INSPECTION FOUNDATION ( 1 s t) FOUNDATION ( grid ) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL COMMENTS ADDITIONAL COMMENTS: /~ '~ z 't Approved .............. ~., l~?. :¢erm~ ]No ............ Disapprowd a/c .............. ~-~ZZ~ ~' ' ' ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .................. , 19... INSTRUCTIONS 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 ~nay 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, buUding code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ......... ............. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) whether applicant ~ssee, agent, architect, engineer, general contractor, electrician, plumber or builder. State .... Name of owner of premises ..... ('."~..~. · .'~:: . .~. · · ...~..:. ~ ~. 'a'm/' "~,'z?d ............. (as onn/ta4ee taxtax rroll or latest deed) If applicant is a corporation, signature of duly authorized officer/. (Name and title of corporate officer) Builder's License No .......................... Plmnber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done. House Number Street County Ta~ Map No. 1000 Section ......... ~ .. (,4,m.-a.. ~c.- Subdivision ...................................... (Name) Hamlet Filed Map No ............... Lot ............... 2. State existing use and occupancy of premises and intended use and oCcupancy of proposed construction: a. Existing use and occupancy .............................. ....................................... b, Intended use and occupancy .....~..~..~Z...~d( .e44-.~.~.....~..ep~... .................................. : : .... .~ .., t i, i~,~ ~ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost .............................. Fee ..................................... (to be paid on filing this application) 5. If dwelling, number of dwelling hnits ............... Number of dwelling units on each floor ................ · number of cars . It garage,' ........................... ~ ......................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................... 7. Dimen{ions of existing structure§, if any: Front ............... Rear .............. Depth ............. Height ............... Number of Stories ...................................................... Dimensions of same structure width alterations or additions: Front ................. Rear ................ Depth Height Number of Stories 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............. Height ............... NumBer of Stories ............................... ' ....................... 9 Size of lot: Front [ Rear Depth 10. Date of Purchase ........... .................. Name of Former Owner ............................ 11. Zone or use district in which prelmises are situated ................................ ' .................... 12. Does proposed construction viol~te any zoning law, ordinance or regulation:. ............................... 13. Will lot be regraded ............................. Will excess fill be removed from premises: Yes No Name of Architect . Address Phone No Name of Contractor ' 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 ~umber or description according to deed, and show street names and indicate whether interior or corner lot. SVAVI Or NSWVO C ~g ~.~~.. ? ........... being duly ~worn, 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:pr owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e ~d file ~is application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work will' be perfomed in the manner set forth in the application filed therewith. Sworn to before me thi~ ............. !. ........ .flay of~ ....... ~o. 52-0844~63 ~ ~mmis*~n Expires March ~0 19 County . (Signature of applicant)