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Home My WebLink About11817-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Zfi. ! 3.3.8. .......... Date ........ F.e..b.v.u.a.v..y..2.5. ............19.8}.. THIS CERTIFIES that the building .a Cl cl~_.t.J. O a ...................................... Location of Property . .5.0.0.5. ................ .P.e.q.u.a.s..h..~.v..e.n.u.e. ......... .C.u.~..c.h.o.g.u..e.. House No. Street Ham/et County Tax Map No. 1000 Section . . .I.1.0. ...... Block Oh .Lot 002 Subdivision....R.a.v. 9 ~ 9.n.e.. R..e.a.]: ~. ¥ .......... Filed Map No..5 .3.9 ..... Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ~..u .3_.y.. ~ ~ ......... , 19 ~ .2. pursuant to which Building Permit No .... ~. ! .8.1.7,..Z .......... dated ....... .~.u.]: 7' .2.2. ............ 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 ......... ........ ~.n...<d.q ~..~.~.o.q..tp..e.z..~.s.M.n. ¢..d.~.e..Z.Z).n. ~: ................................. The certificate is issued to ........ &le[~ A..~..&...L, .Z.Ixl,D.g.. 9p.L.D.S. ?i.I.T.H. ....................... (owner, ¢e~'~F~'~ of tile aforesaid building. Suffolk County Department of Health Approval ...n/.v. .................................... UNDERWRITERS CERTIFICATE NO .......... .~..5.7. ~/.6.7.{ .............................. Rev, 1/81 Building Inspector :N°. llS17 z Permissio~ is hereby granted to: · BUILi~IN~,FEI~!~I (THIS PERMIT MUST BE KEPT ON ~HE PR~/~I$ COMPLETION OF THE WORK AuTH~,R, JZ~b:) i,, pate .:~.. Couhly Tax Map No. 1000 Section .. .-.;.,:~. BI purS~uont to application dated B~ail~lng I~spector. P~ ,.Z..., ................ UNTIL '~!U LL and approved by the 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 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 or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conf~rming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topograph ic 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 dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date .. /~/,~/~ 2~ , .. New Building~..O0~.., '"' '" 'I~'' 'i ,~ ', ... Old or.,Pre-existing/Building(X) .......... ~/Vacant Lan~ ............ Owner or Owners of Property ../4~/~ ~. ~ ~?~ . ~ z_ ~[ ~ , r~. County Tax Map No.,lOOO Section ./.L ~ Block ~ Lot...~Om Subdivision .~U.~/~N...~P.t~ ........... Filed Map No. [~.2 ..... Lot No. ~,~ ;~.~:~. ~ Permit No. //~/~ ~ Date ~' ,~- ./..,7. pplloan~ .. Health Dept. Approval .... ~[~ ............... Labor Dept. Approval ...................... ~. , Unde~riters Approval ~//~/~Z ~j?~i) ~ ,Planning Board Approval .................. ~,.~ Request for Temporary Certificate ..................... Final Certificate ................. * Fee Submitted $ ....... ~" ........ Construction on above described building and permirmeets all app~cable~codes and regulations. Rev. 10-10-78 lOOO771 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRI~IT~ ~) 85 JOHN STREET, NEW YORK, NEW ~ORK 1003~8 B.t,, September 24, 1982 A..,ic.tio,.No. onyile 1813~1~82 N 577674 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant ~a~ed ot~ the abbve application nu tuber in the premises of Alan Goldsmith, 4595 E~S Pequa~h Ave.~ Cutehoguep N.Y. in the followlng location; [] Basement [] 1st FI. w,~a,ni.edo,~ September 16, 1982 FIXTURE OUTLETS 10 DRYERS ~ECEPTACLES 18 SWITCHES FIXTURES NCANDESCENT FLUORESCENT 12 10 [~ 2nd Fl. : Section Block Lot and found to be in compliance with the requirements of this Board. OVENS DISH WASHERS EXHAUST FAr'IS SYSTEMS OTHER APPARATUS: 1-Smoke Itetector C OF HI-ERG NO OF ~IEUTRALS OF NEUTRAL Ruland Floc. Co,, P~O. BOX 143, ~' \ I i l/Il / j~~~~.b~a~lt:~n.y.~ma_nn:er; return to tho off,ce of ,h~? Bo~rd if tnc~{~rec,, inspectors ma~:e idont~~ ...... ~ ............ ~~~ ~ ~ ~UPT f~K ~;~ING DEPARTMENT. THIS COPY OF ~:~&;.Li~A~ m~,~ ~.~ ~. ~.~_,_~, ~ ~" ~ ~ ~ * ~ ~ )~ ~ ~.:n~ (~D~.I A~Y MANNER. IN~ P~?~TI ON DATE COMMENTS ,ATION (1st) ~AT,~ON ( 2nd ) ~/~ /?~ -~ 7~-~ [ FRAME & PLUMBING ,TATE ENERGY C~ODE FINAL ADDITIONAL COMMENTS: FIELD 1. FOU~ 2. ROUGH 3. INSUI 4. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined · ..~ .... ,1 Approved .~./~...~..?/. .... , 1~.~..~. Permit No.../[ .~./~./.~7~7 Disapproved a/c ........ . . .~. . . . : : . . ~ ~' ......... .~. . . / (Buildifig Iffspector) APPLICATION FOR BUILDING PERMIT Application No.//t~././~.. ........ Date . ¢ ./.~. .......... , 19 INSTRUCTIONS a. This application must be completely filled 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 regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. . . . ./. ?. .6/. . &. . . ..... (Signature of applic'ant, or name, if a corporation) /4.?. ,... ............ (Mailing address of applfcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................... /'X. ~ /./-. ~. ¢z~ : ............................................. Name of owner of premises ...d~-/~. ~ .~....~....~. f.AJ..,Q..,~:.....~.~.~.4G..'~../.~.J.'/ ........................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate ~ffficer) Builder's License No ....... ~...~. .............. Plumber's License No ..... ~..~ .~.¢~..//(?~. ....... Electrician's License No .... /rff..~..k ./q..~'p. ........ Other Trade's License No ...................... 1. Location of land on which proposed work will be done.. %,fl....../~..C~. ~?..~'.~]...//.Ye ................. .~ ~ : . l .... 2 House Number ................ h&61;i ............. County Tax Map No. 1000 Section .... ~w[ / 0 . . Block . ,Q.~ ............. Lot.. ~ ........... Subdivision..~~... ~~'' 'Filed Map No...%.~ ~ ....... Lot. ~.~ .~ 7.. (Name) 2. State existing use and occupancy of premises and intended use and o~cupancy, of proposed construction: and ........................... b. Intended use and occupancy .................................................................... 3. Nature of work (check which apphcable):,New~mldlng~._ .......... Addition .......... Alteratzon Repair .............. Removal .... ~r, ........ Demolition .............. Other Work ............... B ' ,.z,/C' esc on , (D ripti ) 4. Estimated Cost ........ .~..O. ~ i.o.o..o., .~ .~. .............. Fee ..................................... ' (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits ............... Number of dwelling units on each floor ................ If garage, number of cars ' 6. If business, commercial or mixedI occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure~, 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 ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ' ' Rear Depth 10. Date of Purchase ..... I .... 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 ....... ~ .Q .~ ............... Will excess fill be removed from premises: Yes No 14. Name df Owner of premises ./-/: .~b.4~..F/rA ./7-/-/Address . .tP~ ~. ~ ~q5 P/:../9.~Phone No ............... ' Name Of Architect .......... : ................. Address ................... Phone No ................ Name of Contractor ./~/./i:'~/.g:.Z./..~.6 .~o~ ./~t.~Address ~.9 ~...ff~. ~.../f~.~zZ-Phone No. Z ~..~.-7 ~...~ ~. ~ PLOT DIAGRAM Locate clearly and distinctly all Ibuildings, whether existing or proposed, an& 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 cbrner lot. STATE OF NEW YORK, COUNTY/)/OF .,~/..~..~.t~...~..4~. · ..~. ........................ /..', .............. being (Name of individual signin~ contract) above named. NOTARY PUSL,IC, State of New Yor~' No. 52.4524771 Quahfied in Suffolk 0ounty Commission E~p res ~er~,ll aO.~ tlt~ ~ duly sworn, deposes and says that he is the applicant .e is the .................... '. ....................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dui ~ authorized to perform or have performed the said work and to make and file this application; that all statements cont dned in this application are true to the best of his knowledge and belief; and that the work will be performed in the mannc rset forth in the application filed therewith. Sworn to before me this '' ......... ]' '~' ' "~j' -~2:P~ ..... d~,~3°~ ~/']~ '~' ..... Notary Public, ~/Y/-~4~..~... ~k-~. LINDA iF; KOW^LSKi \ .. . . .e?~.... (Signat7 of ~l;1;liia'n't i :4. F h Al. ' l '. :,:BE COMPLETE FQg C I O. [ sTATE CONS~RU~IO~' ;& EMERGY CODES,' NO~ :R~SpONSIBLE ~OR l DES G~ OR:COb 5TRU~ION:ERRQ~ ' r' , i. ~ ll ll,,:., l, : : i OCCUPANCY OR USE IS UNLAWF~JL ~[f[i[l[T CERTiFiCATE 9F OCCUPANCY