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Home My WebLink About12385-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z12564 Date June 15 ~ THIS CER I'IFIES that tIle~o~d~g' lnground sw%Inml.n.g.p.oo ............ Location of Property ... 5.7 9.5. ............. .~.o.cX~, ?.oAn. e...R.o.~, d. .......... ~.a PA .~..aF!q~. House IVo. Street Hamlet County Tax Map No. 1000 Section .... 02;L ..... Block ...03, .......... Lot. P.q3..~..0.9.4 ..... Subdivision X Filed Map No. X Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated ....M.ay..t..8 ............ 19.8.3. pursuant to which Btdlding Permit No. . 12385 Z dated June 16 19 83. was issued, and conforms to all of the requirements of the applicable provisions of the law. The oecupaucy for which this certificate is issued is ....... ~ ~¢grgucd swinm~ing p. ool. The certificate is issued to ............. .G.R.A..C~, .F.....I.I~..Y..~. O..N.D .......................... {owner, le~ ~rmmmtl of the aforesaid building, Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO N 6 0 6 2 8 0 Building Inspector Rev. 1/81 ~OB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 12385 , Z Permission is hereby granted to:¢~_, ,~ ~, ........ .~../..~ ~....~.....~.,~z2 .......... ........ ......... to ....... ~x.. ~..~./..~.~.........~.~......~~_,~,.'... ~_....~.~,~,~..~.~.~-~ at premises located at ....~...~....~... -~...:.......~.~.~..,~..~. · .~..."~, ............................ County Tax Map No. 1000 Section .....~.....~..~.. ......... Block .....~..../.. .......... Lot 1~.~..~.~...~.~~- pursuant to application dated .... ~.~ ....... ~.....~...~ ............... 19 .~..., and approved by the Building Inspector. Fee $ ........................ ,PERMIT INCLUDES APPROVAL TO REMOVE EXCESS FILL FROM ABOVE PREMISES BY REGRADING LOT / DRIVEWAY CONSTRUCTION CE~,SPOOL CONS'~ RUCTION CELLAR. CONSTRUCTION Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ,~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitte~13!~cct: to the Building Inspec- tor with the following; for new buildings or new use: 1. Fine( survev of property with accurate location of ail 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. Commemial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Amhitect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. 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 topogreph 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: Certificate of occupancy $5.00 1. / Certificate of occupancy on pre-existing dwelling/' ~and use 2. 3. Copy of certificate of occupancy $1.00 ~ --Fre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date... ?.?. ~...-- .............. New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property..~: .7...? .~.. ........ ~o.~. k~...~..*. ~'~..~'. ....... .~'. ~ (~Z~ ~ Hou~ No, Street Ham/et o~.~ o~ o~.~,~ o~.,o~rt~ . ~~ ........ ~ ......... ~? ~ * ~. ~ ................... County Tax Map No. 1000 Section .~..t ......... Block .... ~ .......... Lot ..... ~ ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./.~..~..~..O~, .~. Date of Permit ..... Applicant .~...g~. .... .1~..'Tf' . ./~4..~...,~.. '.~. ..... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. 1000344 THE NEW YORK BOARD OF FIRE UNDERWRITERS ~t~ BUREAU OF ELECTRICITY ~-- 85qJOHN STREET, NEW YORK, NEW'YORK 10038 Oate June 16, 19S3 ~ppllc.tio. No. on fie 218955-83 N 6 0 8 ~ $ 0 THIB CERTIFIES THAT only the electrical equipn~ent as described belotv and introduced by the applicant named on the above application number in the premises of Mrs. G~ F~ Ra~,~,~t, 52 Rocky Point Rd., ~'East Mari~n, N.Y, in the following location; [] Basement [] 1st FI. [~ 2nd Fl. O~tsid~ Section Block Lot wasexa,ninedon Jufle 13, 1983 and found to be ln compliance with the requirements of thls Board. FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FIXTURE SWITCHES INCANDESCENT FLUORESCENT OUTLETS DRYERS 1 SYSTEMS NO. OF FEET OTHER APPARATUS: 1G..C.I. S E R HO 01~ ECR C~CON D OF CC COND. NO OF HI-LEG A, W G OF HI-LEG NO OF NEUTRALS (Swimming Pool) This certificate covers compliance at the date Of inspection only. B~ause oi unusual environments it is advisable to have frequent test and/or repairs mad~ by a qualified person. AWO, OF NEUTRAL 12 Dem't St. Port Jeffersca~ $~atioxy,, N.Y., 11776 LIC.#ll01 z. GENI~RAL MANAGER This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be [denti by their credentials. COPY FOR,BUILDiNG DEPARTMENT. THIS COPY OF CERTIFICATE MUS~ NpT BE AI~TE~ED IN ANY MANNER. FIELD INSPRCTION COMMENTS FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & FLUMBING INSULATION PER N. STATE ENERGY o FINAL ADDITIONAL COMMENTS: ' '; ' '301 .I01i.I00 'olIloll.~ 01~0[pu! pu~ S0tm:U 1aa. IlS ,,,,,Otis pUU 'poop O1 :Su!pJo00e uo!ld~sop 2o Joqtt~nu ~olq puc loolls oA[9 .sou[i llloJJ SUO}SUOIIi}p ~0~q-1os lie oleo}pul pu~z 'posodoJd 1o ~ulls[xo jotll0tt~ ,s~u}pl[nq I~ XllOU}ls[p puc Xlleop ~luoo7 ~DVI~ &O~d ................ ON *uoq8 ................... ssosppV .......................... -rolaexluoD jo ottmN ................ ON ouotrd ................... sso.~ppv ................. oN ouoth:I ................... ' lao:[!qvaV jo om.N sso'~PPV .................... sos~ ON sox :sos.tmo~cI utoaj poaotuo~ oq i[.tj ssoaxo II[PA ........ .uso~d jo ~ou~0 JO oturN ............................. - · ........ pop*2~ox oq FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined. Approved ~..2~ ., 1~-.-- Permit No ............ Disapproved a/c ........ [..Z,'"'E....' ..... . --. ?,~. ......... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No../..~.~.'"..~.7 ........ 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. e. The work covered by tiffs application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued 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 building for necessary insp~ions, ...... Q. o .m ............. (Signature of applicantOor nan~ qorporati,.qn~ .... (Mailing address o~applicant) State whether applicant is owner, lessee, agent, architect, eng~eer, general contractor, electrician, plumber or builder. Nameofownerofpremises ..... ~i;.~.' '. i~.~ik~.'iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiill (as on the ta roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. b~ Plumber's License No ........ .~].//~. ............ Electrician's License No ..... /l 0 [ - ~ Other Trade's License No ..... /~.//~. .......... 1. Location ofland on which proposed work will be done/ ...... ~r ~2~b~ d/~0...~5.'~¢ /~) ...,OZ.. ................ : ................. ....................... House Number %~ Hamlet t County Tax Map No. 1000 Section ................. .... O~. ]. Block .]. ........ X4 Lot ..... ~ -5' '~' ........ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... ~-~O:4~tr).~. ............................................. b. Intended use and occupancy ../~.t~.(~... ].~t~l~...~.. [./W.~,O(TJ~. H~. ~..~../4/ / 3. Nature of work (check which apphcable) New Building .......... Additio ...... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... i ~ / ~.,_~ (Description) 4 Estimated Cost I~"1~'.0: ..~.. .................. ee ...... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... 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 structuresi if any: Front ............... Rear .............. Depth Height ............... Number of Stories ......................................... Dimensions of same structure with alterations or additions: Front ................. Rear .. Depth .................... i. 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 premises are situated ..................................... 12. Does proposed construction~violate any zoning law, ordinance or regulation:. ,..~... ................. 13. Will lot be regraded ·.. y.t~..., ................. Will excess fill be removed,from premises: 14. Name of Owner of premises ~,.~,t~..~...~.t"f~l~.~.~.. Address t~.~.~. J~.~...~:. Phone No. Name of Architect . .~.~ ....~4//.?: ..... .?, ....~.~. . Address . ,,., ............... Phone No. Name of Contractork.~l~..,~.t~r~... ~..O.~../.~... Address ~..i~ti~.~ ...... 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 rmmber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK- ..... COUNTY OF...i,.,,~,~..~9../..,.~-... ~'.~ /.,, ' .. i ................(Name of indi'~idual~-/J'~'"/'~"sign{ng contract)'6 .~. }...~./~ .... being duly'sworn, deposes and says t~e is the applicant above named. ' is the ...................... i.i ....... (C~tractor, agent,' ............................................... corporate officer, etc.) of said owner or owners, and is dul~ authorize~t to perform or have performed the said work and to make and file this application; that ail statements conta, ined in this application are true to the best o~,}_~edge and belief; and that the work will be performed in the manne[ set forth in the application filed therewith. Sworn to before me this : ...... './..~'~ ......... day of'. .... ¥~, .(z)~. ...... , 19 .~..~ , r,r. £il~ir~s tl~r¢l~ ~11, l~[25~0' ~ufloll{ ~ / ~ /(Signal~re of applicant) ~J