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Home My WebLink About12475-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificafe Of Occupancy No...g.1.3.1.§.1 ......... Date ..... J.a.n.,...2.2., ................. 19.8.5. THIS CERTIFIES that the building ...... P. ,o9}, ..... (.f.e, .ng,e.) ......................... i ~ · 5200 Nassau Pt. Rd. Cutchogue Locat on of I rope, tyHouso .............................. No. County Tax Map No. 1000 Section ...1. l..1 ...... Block ...0.8. .......... Lot . .0.1.5. ............ Subdivision~ ~ .N.a.~.s..a.u..P.~, .C.i.u.B...P.r. qp, ...... Filed Map No...1.5.6....Lot No...1.4.6 ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .g4>.c2[.: .... 3. ....... , 19 .8.3. pursuant to which Building Permit No ...... .1.2.4.7.5.5 ......... dated .............. ~u.q,.... 9. ...... 19 .8 .3., 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 ......... .... .I.n, qr. 9U.n.d.. $.w.i..r0r~..~.n~..PQp.i. ............. .(.w/.. f.~..n.c.o. ), ........................ The certificate is issued to ............... I~.~.V. ID..N.O.L. bN ...... (owner, ,~.*r-*e~a~'t) ................. of the aforesaid building. Suffolk County Department of Health Approval .......... Ix!./. ~_ ............................. UNDERWRITERS CERTIFICATE NO. N614128. & N648810 Rev. 1/al Building Inspector FOILM~ NO. ~B TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12475 Z Date .... ~..~.~........~.. ................... 19.~..~. / Permission is hereby granted to:^~jZ ~ premises located ..~..' ................. ~ ........... ~ .............. ~. ....... ..~..C,~ ......... .~.. ~. ........ ~...~ :~.: .... ~ ........................................... ~ .. . County Tax Map No. 1000 Section ....... L!..! ........... mock ......... ~ ........... Lot No ...... L.~ ........... pursuant to application dated ..... ~...~L~.~...,~ .................. , 19.~...~ and approved by the Building Inspector. Fee ...... '. .............. Building Inspector Rev. 6/30/80 FORM NO. § TOWN OF SOUTHOLD Building Department Town Hall ~',outhold, N.Y. 11971 APPLiCATiON FOR CERTiFiCATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in dupltothe Building Inspec- tor wlth the foilowing; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natura~ or topographic features. 2. Final approval of Health Dept, of water s6pply 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, For existing buildings (prior to April 1957}, Non-conforming uses, or buildings and "pre-existing" land uses: 1, Accurate survey of p~operty 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 safeW inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. Fees: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling , 3. Copy of certificate of occupancy $1.00 4.Vacant Land CoO. $5.00 $15.00,,, Oate...¢~=..'..~,~.%~ ...... New Building .... ,~. ....... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .............. 5200 .................. N .as,sa~. ~ ,P~.,. Rd. . ............. (~9.~,c. ho, cJ.u,e.. House No. Street Hamlet Owner or Owners of Property DAVID NOLAN County Tax Map No. 1000 Section 111 Block 08. Lot. 15 Subdivision ............. ~ ............ ~ ...... p No .......... Lot No. 1. ~,.6 Amended Map - A Permit No. ,t.2.4,7, ,5,~.,, Date of Permit . ,8/,9,/..8,3..Applicant .......................... Health Dept. Approval ........ ~, [,A, ............ Labor Dept. Approval ........................ N614128 Underwriters Approval Cs )..~.6.4, ~ ,8.1.0. ........... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...... ;~ ................ Fee Submitted $ .5.,0.0 Construction on above described building and permit meets all applicable codes and regulations, ~" ~<~¢'~ App,icant ..... ~~ .................. Rev. 10-10-78 F~IELD ~ INSPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY QODE FINAL ADDITIONAL COMMENTS: ~,~:L~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~;~ ss Jo.. STREET, NEW '~ORK, NEW 'tuRK ~OO~ THIS CERTIFIES THAT only the electrical eqolpment as described below and introduced by the applicant named on the able appl~catlon number in the prorates of David Nol~, N~au ~int ~d, ~c~g~e,N.Y ~, ~yo~o~.~ ~o~.t~o,,; ~ ~,~m~,~ ~ ~.~t r~. ~ ~,,d r~. ~tside s~tio. ~o~ not was examined on ,~1~ ~ 4~ ~.0~ and found to be in compliance with the r&quiremeats of this Board. FIXTURE FIXTURES RANOE$ OVENS DISH WASHERS EXHAOST OUTLETS SWITGHES i I DRYERS MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS NIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R 5p~C~ A.W,G NO O COND OF CC COND, C NO, OF Hi-LEG AW.G OF HI-LEG OF NEUTRAL OTHER APPARATUS: .~Sw~__}~. Pool) ~his certificate ~s ~ti~ce at the ~ge:of t~ction only~ ~-~A-5:f-'~ envi~)~nts it zs sdvis~le to ~mve ~u~t test ~/or r~atrs m~ by a q~lified Alexander G. Hubbard Box 222 Aquermxlue, N.Y, 11931 GENERAL MANAGE~R il ~, / TNs certificate must not be altered in any manner; return to the office o( the Board if incorrect. Inspecto{s may be identified by the/ir c?e~entials. CQPYiFOR B~JLDING DEPARTMENT. THE NEW YORK BOARD OF FIRE UNDERWRITERS 85 JOHN STREET, NEW YORK, NEVI ~ORK 1003.0 in the followlng location; [~ Basement [~ 1st FI. [~ 2nd FI. O~t~i~ Section Block Lot was examined on All~rll~ 15 ~ ][~ and found to be in compliance with the r~equirements of this Board. RXTU~E FIXTURES RANGES ] OVENS OUTLETS SWITCHES FLUORESCENT 1 1 DRYERS S E R' V I C NO O i~e RCC~rCON D. OF A'CC W'CONI), O' oFA' ~[- I-~G w' G' NO, OF NEUTRALS OTHER APPARATUS: ~e of ~t~l enrichments it is ~vis~le go h~ fr~uent test ~/or m~ by a q~lifl~ ~rson. paul }~a'n Southold, N,Y. 11971 This certificate must not be altered in any manne~; return to the o~flce of 1he Board if :~incc~-rect. COPY FOR a ma), FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1802 Approved .~ .k~.~..cl.., 19~.~. Permit No.]..~.~'.7.'?..~.. Disapproved a/c ..................................... ................................ .... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 ~ust be drawn on tlxe diagram whiclx 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 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 regu!ation~s, and to admit authorized inspectors on premises and in building for necessary...~ .~.~.inspecti°n~ ............... (Signature of applicant, or name, if a corporation) .. 7o....s:,/.~ ~ ~.-~..~(-.~.....t,.9~. -Z2/~q?. 7~... ~.~. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... ~,¢:,-~..~.. 2~.~.7dy~..aTJb....& ........................................................... Name of owner of premises .............. ~..O.L..~...~..) . . .~..g~ .q.~*.~.....-~.. ~ ................................ (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. ~ 7~ Plumber's LicenseNo ......................... Electrician's License No ....................... Other Trade's Licensb No ...................... 1. Location of land on which proposed work will be done .................................................. · .y2o~... ................. /e.,~.,rs;~.q..'?o./.~ .~ ........... 2~..~.~.. ~q..c.. .... ~.V..../.. House Number Street Hamlet County Tax MapNO. 1000 Section.ti.~.. Block ... 8 ............. Lot./.5~.. ....... . .~'.y Subdivision ./~...~ .~:~..t.,t'..?0./.~'..]..~.]~, ~.'~.~. i~i i Filed Map No .... ??~.~. ...... Lot..~/.q.~.. ..... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... [. '.~..~./~/...~..~. · .'~../".].~. · ./-?~. · .................................. b. lntended use and occupancy .....~..O.'.~...~.'./..y//~2---- L..~.~ S~tJ/.~./~]j]C]/~r-' 3. Nature of work (check which applicable): New Building .......... Addition . .~'..-- Alteration Repair .............. Removal .............. Demolition .......... Other Work ............... ~/.~ Otg. ,O't22> ]-~ (Description) 4. Estimated Cost.. O ...... Fee i (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, hum bet of cars ......................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structur6s, 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 ~O..~ ......... Rear..o.q, Of. ........ Depth .. ~4~91~. .... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ....................... Rear ...................... Depth ...................... 10. Date of Purchase ........... .................. Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction vioiate any zoning law, ordinance or regulation: .... ~.C? ........................ 13. Will lot be regraded ....q~-~. ................... Will excess fill be removed from premises: Yes 14. Name of Owner of premiges "'i ................. Address ................... PhoneNo ............... ~. Name of Architect ........................... Address ................... Phone No ................. Name of Contractor' .~.~t~ ,,~g~.~...~.~.~g.. Address 70..-~.q .~..~.,'.77~/,O',L~Phone No..2~.1~ 7 ~7.7. PLOT DIAGRAM Locate clearly and distinctly alli buildings, whether existing '~r 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 OF NEtWffO.I~K~.~ ~,,~ q S above named. being duly sworn, deposes and says that he is the applicant He is the ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this Commission Expires March 30~ 19~).~' t.~lgnarure et applicant) ,[';~X;. eNnOA I* eNnoA .,.,,.,,,,,.