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HomeMy WebLinkAbout12419-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y, 'Certificate O[ Occupancy No...g.'l.'l.~.6.'l. ......... Date ......... O..c.~p.b.e.~. 5 .............. 1983. THIS CERTIFIES that the building Location of Property . .'lfl.6. SO. 12.~.~. ,..~.~,. ff..'l.Q,, House No. Street Ham/et County Tax Map No. I000 Section ....~.7. ...... Block .... .'[ ......... Lot ....... .jc)... ~.. Subdivision ............................... Filed Map No ......... Lot No .... ' .... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ~T~n.~ .'J 0 .......... 19~33. pursuant to which Building Permit No..~ Zq:.'t9~. ' . dated ..... ~T¢~L~ .q 3 ............... 19 .$3, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which tiffs certificate is issued is ......... .... ~dcLfc~±orx .~;o. a~eezsax7, b.u±Id:kng ........................................ The certificate is issued to h/-E~L~S SOU~H HARBOR COt~. ..................... ?d¢do;, '/3~;o¥r 'tbt~a'n't) ............ ' ......... of the aforesaid building. , . Suffolk County Department of Health Approval ................................. UNDERWRITERS CERTIFICATE NO 316q ~3'10C) ' Rev. 1/81 Building Inspector l~OE.~ NO. I~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ..... ............... ,o .......... ~..~-~.~..~.. at premises located at ...d,~.Z(~......~..~..~.../(~, ...................... ~'~"~'"'"'~':7' County Tax Map No. 1000 Section '""'~"" '~"7" ........ Block ....(~. ......... L Lot No....(~Z..~.. ......... pursuant to application dated ..... ~..~Z~..~..:......~....(~.. ................... , 19f~.~..., and approved by the Building Inspector. Fee $ ..... Building Inspector Rev. 6130/80 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-existing". land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 9'r land use 3;/ $5.00 3. Copy of certificate of occupancy $1.00 ' ,//Date... ~. .~..~. New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property....~..~:~....~.~....~...~.~. :.~../...~ .................................... Owner or Owners of Property .~...?//~. ~ ,~: .......................... County Tax Map No. 1000 Section .... .~.~. ....... Block ....... I ........ L~t ...... 1.0 ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./~../Tr./. ,q., Date of PermitT/~,~.~/~.~.Applicant ,~,, ,L¢//~::., ,~, ~,' ~ ,~-..~,~, ,f'~,..~ Health Dept. Approva~ ........................ Labor Dept. Approval ........................ Unde~riters Approval .~. ~. 5.~;.~ ...... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...................... Fee Submitted $...~.~. · ~.. %. ~.1.~ ....... Con~tructio~ on above described building an~ permit meets all)pplicabie code) and re~ulations,~ I THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW ~ORK 10038 Date ;~k}p'~lle~r 2rl~ 1~ /IpplicatlonNo. onfile 234727/83 N THIS CERTIFIES THAT 618109 only the electrical equipment os described belotv and introduced by the applleartt nalned on the above application number in the premises of gell~ ~uth II~rL~r Corp,~outh ~w'kor Ro~., f~oWzholcl~N.Y. in the following location; [] Basement [] 1st FI. was examined on ~)~C~ftlbe~' ~2 ~ ~9~ [] 2nd FI. Section Block and found to be in compliance with the requirements of this Board. Lot FIXTURE FIXTURES RANGES OVENS EXHAUST OUTLETS SWITCHES NCANDE$CENT FLUORESCENT 4 6 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIMECLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: 1~4.5kw Hot wa~er L~ater. S E R V I C E NO OF HI-LEG A,W.G. NO OF NEUTRALS A.W G OF HI4EG OF NEUTRAL Town l~a~.bor 'Lane ~- ~-~t5 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors COF IG THIS COPY CATE may be identified by their credentials. NER. FI~L~SPECTION ~ FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY %ODE FINAL COMMENTS ADDITIONAL COMMENTS: GEORGE WELLS GLEN HEAD, LONG ISLAND, AREA CODE 516 676-2056 NEW YORK 11545 JUNCTION. GLEN COVE ROAD AND CEDAR SWAMP ROAD FORM NO. 1 BUILDING DEPARTMENT SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c .................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ... 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 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 shali 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 inspections. 5..5o.0. ................ (~OR~ WEI I ~ (Signature of applicant, or name, if a corporation) E~I~ C;F.Z)AR ~WANIP ROAD ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . J6! .~..~.].~.~.'...~.~..U..'{-./~...o.~./¥.~.. (~..~..~.....~.~../-~. ~.~ ............................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. Builder's License No. 2:.o, c..g .tn.: .~..t ?:...~?.~. !~!'.r~... t'~ I - ~- 5- 5~ G Pl~o ......................... Electrician's License No. ?~.~ ~..~ ............. ethaNe ...................... 1. Location of land on which proposed work will be done .................................................. ......... .... ........ ..................... House Numbe~/dfi'O ~/(~ ~/O Street Hamlet County -Tax Map No_. 1000 Section .... ~..7. .......... Block ...... /:~ ........... Lot ..... f. ~ .......... -' Subdivision .......... ~ .............. Filed Map No...~. Lot..~ ..... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . .~. ~.',z .F.. ({~.~.tv.i~...-. I.~...o~...~.Tq.~.G~... ~.4. Q.~l ~..tz..~.., ............ b. Intended use and occupancy ............................................................... 3. Nature of work (check which applicable): New Building Addition ~ Alteration Repair .............. Removal d~o, per, ct4 Demolition ......... Other Work.. ' (Description) 4. Estimated Cost. o ........... . ......................... Fee .................................. ~ (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 natur, e and extent of eac~h,typ? of use ........ 7. Dnnensmns of ex~stmg structures, if any Front...~.6.'.m~. ....... Rear ..-~....~. ....... Depth/~?.g...%l~.~.¥.. ~ .4. f Number of Stories t I-teight .................................................................... Dimensions of same structure with alterations or additions Front ~ 5~?. 8 ~'. Rear -2-~'t-tg" . 8. Dimensions of entire new construction: Front .. P ....... Rear ... /... Depth ../~ ~ ......... l*[elght ...... ~ ........ Number of Stories ....... /. ................................................. 9. Size of lot: Front .... ./&-~.' ......... ~... Rear ..... .,~..o.' ............. Depth ... [.I./..~.: ............ 10. [)ate of Purchase ~ .~g?.-.¢.2:: .i J.? ./.~. ~. ~'.<~. :13(E.L. LfName of Former Owner d'~¥.~E./dS.W.t,5~.. CA ~J~ ...... 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 ........ ~. 0.. ................ Will excess fill be removed from premises: Yes No of Owner of premises ...... i ¢.~?pAddress .tT~.h-.~ffP~.t2 .~f, V4i.~R Phone No. Og 6..;Z....:*..~. Locate clearly and distinctly alli buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block inumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~_ORK~ ' S COUNTY OF. ..... ,S. ........ ~...~..p..P-..C., .EF.' .O~..,.. ~6[~ &.~ ............. being duly sworn, deposes ~d says that he is the applicant (Name of individual signing contract) above named. I , ,~lk ~ ~ He is the .. ..... ~ .................. . ......................... U ; (Contractor, a~ent, corporate officer, etc.) of said owner or owners, ~d is duly authored to perform or have perfo~ed the said work and to m~e ~d file this application;that all statements contained ~ this application are true to the best of his ~owledge and belief; ~d that the work will be perforated in the m~ne~ set for~ h the application filed therewith. Sworn to before me this : · ~~ .... ' .....~.day of.~ ............. 19~ . Not~ Public~ · ~~ ...... ~. ~ounty ~,. ....... . .....