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Home My WebLink About11849-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building .gp.22.~.g.e.p.d.d..5_~.5_.q~: ............................ Location of Property ...2.95 .................. .~.5:~.1. 9.w..7977.~.e. 9 ............ 973.e.n..~.,. House No. Street Hamlet County Tax Map No. ]000 Section .... 2..~ ......Block ........ .~. .....Lot ....~.~. ........... Subdivision ................. ~ ............. Filed Map No ..... ~....Lot No .... .~ ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... .~.u.g .u.s.~..5 ...... ,19 .~.2. pursuant to which Building Permit No ..... q..'1 ~.¢.~..g ........... dated .... 2. ~4g.u~..c) ............ 19 .~?., 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 ......... · .Gar.age, a.4cl5~$~_,o~. ~:9..ex~-~.g.5,r~..4we .1.~.5,~.g~.. ................................. The certificate is issued to ......... .WZ~J.~. 3....I~ ,..d-~., .............. (owner,~ .......... of the aforesaid building. Suffolk County Department of Health Approval ......................... ~T/& ............. UNDERWRITERS CERTIFICATE NO ............................ ~:~JI)~12~Cx ............. Building Inspector Rev. 1/81 FOR~ ~ TO~'N ~OF; BUILDING' i souTHOL~, N. y. Per~nission is hereby grant,'d to: BUILDING!!] I~EIIJ~I, (TH S PERM T MUST BE KEPT ON -~H.E PR~IS COMPLETION OF THE WORK AUTHOR!ZED)!., at pFemise~ located COunty Tc~x Map No. 1000 ~Section; p~J~!uant to application dated BL~jl~ling I(~spector. ~ UNTIL ~OLL ~pprovod 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-conforming uses, or buildings and "pre-e_xist!ng" 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 ~r 3. Copy of certificate of occupancy $1.00 ! land use $/~'/$5.00 Date New Building .... ~ ...... Old or Pre-existing Building(X) .......... ~ ~Vacant Land Location of Property z-./- ~ /Zx¢~-~ House No, Street ~-~ . Him/et Owner or Owners of Property ~.,,~L z_?,~-~-~, ~. ~/-~r/~/~,J' N//~ · County Tax Map No. 1000 Section ... ~--.¢ ....... Block ... ~.~ ........ Lot..../. ~ ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. . Date of Permit . pplicant .....~..~..'~... ~' Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval .'~.. !¥..~.c~ .~ ......... Planning Board Approval ......... ~ ........ ~ .. ~ Request for Temporary Certificate ..................... FinalCertificate .... ~ .- ......... * Fee Subm Construction on above described building and p.rm,r m?,s,.ll ,,~cabl~,.d re,~t. ~ns. ~C.O.~ ~)~q Applicant ~~~~~ ~: ............ [ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY~ ~- SE JOHN STREET, NEW 'YORK, NE'~J ¥,~,ORK 10038 ~.,e aU~ ~),~ ....~..on~o.o~.~ ~1~ N 704114 THIS C~RTI~I~8 THAT only the e~tr~al equipment as described be]o~ and introduced by the applicaltt na~ed on the abobe application number in the premises of in ~he folto~fng location; ~ Basement ~ l s~ FI. ~ 2nd ffl. Section Bio& Lo~ was examl,ea on ~1~ 5, ~9&~5 and yound to Ve ln compliafice w~th tbe req,lrements of thls Board. R×TURE RXTURES RANGES OVENS 2 6 t 2 DISH WASHERS EXHAUST FANS DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT C S E R NO OF CC. COND. A, W G OTHER APPARATUS: 1 OF NEUTRAL 2/O William 285 Willow Orient, lq Y must not be altered m an, manner;, return to of the Board if Per_ may be identified by F I E~D ~'i$~S PECT I ON FOUNDATION (lst) COMMENTS FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ~. *..., ISl.~ Approved .7..., l~..O~.'~eennitNo..Z~.O~..~...~ (Buitdi¢ Inspector) APPLICATION FOR BUILDING PERMIT ........ , INSTRUCTIONS a. Timid application must be completely filled in by typewriter or in ink and submitted :;u-la-~M'~- to the Building Inspectm:, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. P16t plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas,1 ar~t giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. L) 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 insRections. (Signature of applicant, or name, i a~_orpor2tion) ~ "5~o k, ~9' ~ ~ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ... ............................................................................... Name of owner of premises .... ~././.*.~./.a..~...../¢.. ,...X.~.~...4~.~ .~.. ~ ............................. (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 .............. /-p ......... ectricia s License o .... ~..,r ................ Other Trade's License No ..... ; ................ 1. Location of land on which proposed work wilt be done... ~.O.. ~7..../..~.. ................................. '-z7 .7 .... .... ................. .............. ttouse Number c~ c~ ~ Street Hamlet County Tax Map No. 1000 Section ..... e~. ........ Block .... ~ ........... Lot .... ./. ~ .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing nsc and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy..~../~....~'.~../.~..~...A~...~./..~..<?....~..O../~..~.--~. ............................. b. Intended use and occupancy ..... .~..'~'-..~'..'~'. ?.-. :~....%.,~~--~.~ ............................... 3 :' ,.:.,:. ,vnich applicable): New Building .......... Addition . .~. ..... Altera~aon ......... Repair Rem6val Demolition Other Work ~ ~t~C% t~o / O~'. ~ (Description) 4. '- · ~ .......... Fee ..................................... ~:~m~ai.~ ,~os: ..... / .... ! ............... (to be paid on filing this application) $. If dwelling, number o f dwellinglunits ............... 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 ................... i.. Height ........... ,.. ,, ........ Numbex of Stories ..................... Dimensions of entire new constrUction: Front..../.~;/. ...... Rear ...~. ~ J./. ~'.... Depth .,r~ ./?..': ..... 8. f~iegh t ............... Nu~m~er °f St°ties ' ' ' '/' '/' ''~/ ....... · ............................ 9. Si of lot: Front ..... *'~-?'.~ ........... Rear .... ./~..~... 10. Date of Purchase .~.C..7. .... ~1.~..~. ............ Name o~o~.rmer Owner .., .~r..~.~..~. ................... 1 1. Zone or use district in which pr~mises are situated ....... ~¢.': ......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .............. . ................ 13. Will lot be regraded ... AZ.~.; ..... : ............. Will excess fill be remov~lt from premises: ~ No · , 14. Name of Owner of premises IA J, .~ t .,.,:. ~.~.. ~...~. Address .. ~/.. 4-#..~...]?~3[,~. Phone No..~, Name of Architect .. ~...~.-. ! .~...~. ?..O:p..e~.~.~. Address ................... Phone No .... Name of Contractor ........ i ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clehrly and distinctly al! 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 OFr~EV~RK~,,~,' COU~NTY .... ~i.~.. ~..~. being duly sworn, deposes and says that he is the applicant "~' (Na~ne of indivi ua sigr ng contract)~ .... above namod. He is the ............... ~ .............................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfomed the said work and to m~e ~d file this application;that all statements contorted ~ this application are true to the best of his knowledge and belief; and that the work w~l be perfomed in the manner set forth ~ the application filed therewith. Sworn to before me this ........... ~...day o~. : ....19~ No, fy Public, ...... ~ [~RY PUBLE~ate of/New V~ (Signa~of applic~t) , : ~ T~,Exptm March 30, 19.~ . ~JEW ',I /N-~ OTES '. C~EIO E ~,L NOTED BUILDING 7654802 9 AM TO 4 PM FOR FOLLOWING INSPECTIONS: I. FOUNDATION - TWO REQUI! FO~ PmURED CONCRETE 2, R~UGH - FRAMING & PLUMB 3. INCULA- !ON 4. FINAl. - CgNSTRUCTION BE Ci"A,~?I. ETE FOR C O, ALL CONSTRUCTION SHALL M REQUIREMENTS OF THE & CODES. DESIGN I t / j ~n GFIR AGE ADDITION