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Home My WebLink About11832-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildln~ Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the b~ihlin~., poo,L .......................................... Location of Property . ~.~ .............. ~i~,t~l~t~p..I~B.e. .............. gp.t~ql~gg.~lq .... Hous~ No. Strut Hamlet County Tax Map No. 1000 Section . 0~.$. ....... Block .0J ............ Lot .. {)~.3. ........... Subdivision..~91e. t~l~9.o.4~ ................. Filed Map No. ~.4{S~9....Lot No..~.~ .......... conforms substantially to the Application for Building Permit heretofore fdod in this office dated .... 4t~i12t..~ ........... 191~. pursuant to which Building Permit No. ].~.8.~ .~..Z. ............ dated ..... /1 ~ g.t~ i;. ~ .............. 19 .l~, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ..... ~n..~,~gr.o. qo~. ~.~$~l,z~g. p.q~lL, ............................................ The c~rtificate is imued to ... ~.ucl$1;b..l)gL~.cla ........................................ of the aforesaid building. Suffolk County Department of Hoalth Approval ... ri/A ................................... UNDERWRITERS CERTIFICATE NO ........... !~..~ ~ ~ 5.?.~ ................... ' .......... R~. 1/81 P~r~nission is hereby graoted BUILDING BUILDIN~i COMPLETION OF THE WoRK AUT~R}jZ~D~) ,'~S UNTIL ~ULL a~prem~ses located at Cop~ty T~x Map No. ]0~00 Section pi~rSuant ~o application; dated ............. Rev. 6/30Z80 ' ' r ;~ : :~ ; approved by the FORM NO. ii 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 btJ[ldings 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 dlsposal--(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 oi' 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-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. 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.. $~ptember 9 82, .. New Building ............. Old or Pre-existing Building(X), ,: ........ =/Vacant Land i ........... Location of Property ....... -,SQ. ~'~,~,,]~ .eWS..~. ,a~. ,e. ,C,u. ,~,c?_,o,c~,e.: .................. ~-. ......... Hous~ No, Street Ham/et Owner or Owners of Property ....J,u.~L7. De z..u.o.a.~..-:,, ................................... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. 8./(. 2/,8.2., .. Date of Permit ~..Z.8.3..2 .... Applicant . ,S~..1:.q~¥..Dj;p...~.o.o.:]:s. .............. Health Dept. Approval ........................ Labor Dept. Approval ...................... ,,. Underwriters Approval ..... En¢.],osed. ......... Planning Boyd Approval .................. ~ ,., Request for Temporary Certificate ..................... Final Certificat~ ....~.-¥.x,~.x.~.... Fee Submitted $ .... .~.5... ..................... , Rev. 10-10-78 Construction on above described building and permi~ meets all app~cable_,co_des and regulations. ^ p,cant .... ~000663 THE NEW YORK BOARD ,OF FiRE UNDERWRITERS BUREAU OF ELECTRI 'IT~ THIS CERTIFIES THAT ou~~, ~ ~ ~ '~ ~ ~r. ~oz ~ ~, ~, m.~. in the /ollotving location; [] Ba~e3~¢nt was examlned on ~Sj~ ~ ~ ~.~ Section BIocl~ and found to be in compliance ~vith the requirements of this Board. FIXTURE FIXTURES RANGES , OVENS EXHAUST OUTLETS SWITCHES FLUORESCENT 1 [] 1st FI. Lot DRYERS SYSTEMS NO. OF FEET E R I C NO OF CC. COND PER ~ OTHER APPARATUS: ?anelboards :l-Scir. lOOnieS i~G.F.L NO. OF NEUTRALS (SwIza~[~ Pool) This ce~i~tca~e ~over~ eo~plianc~: afc ~ dace Of tr~ImaCtion only, ~aca~tse of unusual e~viror~ats it is advisable to ~haVe Ereque~ ~est and/or repairs made by a qualified person. Glare R. Bradley, Horton Ave., RFDt169., ~tc~, N.Y. 11952 , Lie:ii27 This certificate must not be ~n any manoer; return to the office AW.G, OF NEUTRAL GENERAL~MA~AGER, : Per ' ma)/ be identified credentiaJs. ANY MANNER. FIEL~ IN.~ECTION COMMENTS FOUNDATION 1st) FOUNDATION 2. (~nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TCWN C,F SOUT',qOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 CBuilding Inspector) ~ APPLICATION FOR BUILDING PERMIT INST RUCTIONS Application No ........... Date ..... a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi 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 stre~ or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part oPthis ap[ cation. c. Tile work covered by this application may not be commenced before issuance of Building Permit. d. Upon apprc.'al of this application, the Building Inspector will issue a Building Permit to the applicant. Such pern 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 Occupan shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADF; to the Building Department f~r the issu)a'tCe~f a Building Permit pursuant to t Building Zone Ordi lance of the Town of Southold, Suffolk County, New Yor~, and ~fher applicable Laws, Ordinances Regular'ions, for the construction of buildings, additions or atterations~ or fj;ff remoy,~l or demolitioff, as herein describe' The applicant agrees to comply with all applicable laws, ordinances, bulldog cod, e/housing code,.~nd regula~ons, and admit authorized inspectors on premises and in buildings for necessary i!~s¢c~ '~~ ~'o .. . ...... (Mailing address of applicant) State whether apFlicant is oxvner, lessee,~architect, engineer, general cmrtractor, electrician, plumber or build N,'unc of o~'ner of premises x (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and titlc of corporate officer) Builder's License No .......................... Plumber's Licens: Ne ......................... Other Trade s LicenSe No...~.~... ............ 1. Location of land on which proposed work will be done ....... ~/ ................................ . ::":': ....... ........... ........... House Number Street Hamlet~ ~. ~, / : .... : County Tax Map No. t 000 Section ............... Bloc ............. Lot ................. Subdivision ................ Filed Map No ............... Lot .......... (Name) 2. State existing use and occupancy of p~mises and intended us~ and Occnpancy of proposed construction: .... ...................................... b. Intended use ~d occupancy .... ~, ~ ~2:~;~;";.c. ................ 1. Nature of work (chcck whicb?pplicable): New Building .......... Addition .......... Altera~on I ' '~" .... (to be paid on filing this application) ;. It dx~'elling, number of dwellifig units ............... Number of dwelling units on each floor... ~ If garage number ot cars [ . '~. ... ...... ;. If business commercial or m~xed occupancy, specify n~tt m and exte it of each type of use t. D,nensmnsofexistingstmctures, ifany: Front ........... Rear .~ ........ Depth ..~.~ ....... Height ............... Nt,unber of Stories ........ ~ .......................................... Dimensions of same structure iwith alterations or additions: Front ' Rear ' Depth ' Height Number of Stories ). Dimensions of entire new construction: Front ............... Rear ............... Depth .......... He ght ........ ,~., Nu nber of Stones ........................... ). siz, or~o~: ~ton~ ..t~.S/..i .... '.. ......... 'i2t ;..;.>]&~:~;.[;;,,'bl,ii ..~0.~ .... ], .~ ). Date. df Purchase ......... ~ .................. ~ame of Fom~er Owner ........................... {. Zon~ or use district in which premises nrc situated.. ~.~. ~ .,~ ................... ?. ............... L Does proposed construction violate any zoning law, ordinance or regulation: .... ~..~ ...................... ).~t,'i, lot be regraa=~ . .W. ~..', ...... ~ .......... Will excess fill be remaved from premises: ~ ~ . Nc Name of ArcMtect · .~.,.. . ~' . Address Phone No ............. ...,..~....,~,~. ................. . ~ PLOT DIAGRAM Locate clearly ~d disffnctly ~I buikffngs, whether ex/sting or proposed, and, indicate ~1 set-back d~ensions'fto~ roperty ~nes. Give street and block mnnber or description according to deed, and show street n~es and indicate whsthe~ ,tefior or corner lot. rATE OF NEW..YOF~,, ~ : °u~rYla~,w~.~"'~'"~l~'~'"'r-_ ~~'~ s.s ~ . (Nanie of indMdual signing contragt) ~ow: named. e is the ................... ' ' (Contracto corporate officer, etc.) ~ said owner or owne~, m~d is d~dy autho~zed" to pen~m or have performed the said work and to m~e and file ~plication; tlmt all statements con,rained in this application are trne to the best of his knowledge and belief; and that the · ork will be performed in the man~er set forth h~ the application filed therewith. worn to before me this ' · ................ ........... ,,,? PrOPErTY O~ -~.~'Z~/~-,~/ ~;~ SITUATE AT ~:~ SUFFOLK COLJNTY, ~. y SCAL~ ..._~ ~_.~: ....... DATE ~ FILED MAP NO. ~4~ DATE FI[ ED