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Home My WebLink About12263-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...ZI 18.4.¢ ........ Date ............ AugJa.at..lB ........... 1983. THIS CERTIF IE S that the b uilding ...a d d i.%.i o ia..t.o, e x :[.a t i ng.. d u e 2.1 i n g ............ Location of Property ... 68.6 ................. The. $.tv. ancJ ............. Eas g./~laeiD.n.. House No. Street Hem/et County Tax Map No. 1000 Section .... 03.6 .... Block .... 02 ......... Lot ..... 0B.~ ........... Subdivision...~e bb. le. Be.ac h. F.av. res ....... Filed Map No...626fi..Lot No ..... 1.30 ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. N. Qvem.b. ev.. 3 ....... 19 ~2 pursuant to which Building Permit No... 122.63Z ............ dated .... JLpv. i~_..1.5 .............. 19 8.2, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which tlfis certificate is issued is ......... ..... Second. fl.aor, b.e. droom .to..e. xisi.t, ng. d.w. elling,, ......................... The certificate is issued to ........... Kg, THER.INE. S/~A FERJ2AS ......................... (owner, ~,~.w of the aforesaid building. Suffolk County Department of Health Approval ............... iq ~ ~ ........................ UNDERWRITERS CERTIFICATE NO ....................... iq 6 .12.¢~ 6 ................... Building Inspector Rev. 1/81 N~ ~2263 permissior TOWN OF BUILDING DEPARTMjN~ TOWN H~LL SOUTHObD, N. BUILDING pERMITi (TH S PERMIT MUST BE KEPT ON THE PRE~IS~S UNTIL ULL COMPLETION OF THE WoRK AUTHORi~E~) ~:: Z Do~e ~. .~...~,.../..~ 19.. s hereby granted to: ...... ~.~ ......... ,rem se$ located at ........... ~.'C~.. .......... Z~.C...~..~ ~.., ......... ~U~ Ta[ Map No. 1000 Section ,.,~.~..'.;...;.,,:; BUj ~lng I~spector. ~ee ~ ................. Rey. ;~/3o4eo ~ FORM NO. 6 TOWN OF $OUTHOLD 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 featu res. 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 features. 2. Sworn statement of owner or previous owner as to use, occupancv and condition of buildings. 3. Date of any housing code or safety inspectioq of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: I. Certificate of occupancy $5.00 ~ 5/$ 2. Certificate of occupancy on pre-existing dwelling land use ,~/ 5.00 3. Copy of certificate of occupancy $1.00 Date ~~-~..~.~..I. ~].~'-~. · New Building ~. Old or Pre-existing Building .. ~ ..... Vacant Land .. ............ Location of Property.. ~. ~.. (~......~.....~.o~.~...o~ .... House No. ~. . ~ ~ Street Owner or Owners of Property . ~..~.~..~ ........... County Tax Map No. 1000 Section .. (~.-~ .~. ..... Block .~....~ ........ Lot. ~ .~..~', · ..... Subdivision ..~.~ ~. ~.~..Filed Map No. ~o. ~,.~ ,~, ,Lot No, .~,~ .C~ ....... Permit ,o. I..~'.?~.~.~.~. Date of Permit(~. '.~[ .J~//' .~.3Applicant .~")~. Health Dept. Approval ........................ Labor Dept. Approval ..................... Underwriters Approval ........................ Planning Board Approval ................... Request for Temporary Certificate ..................... Final Certificate ..................... Fee Submitted $ .... ~ ~.~ ................. Construction on above described building and permit meets all applicable codes and regulations. Rev, la-10-78 FIELD I~?E°~T I 0 N FOUNDATION (1st) COMMENTS FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY FINAL ADDITIONAL COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY BB JOHN STREET, NEW YORK, NEW ~ORK 10038 THIS ~ERTIFIES THAT only the electrical equipment ~ described belom and introduced by t~ applicant na~d on tl~ above ap~llcation ~u tuber in the premises of i. the~oliowlng location; ~ Base.~ent ~ 1st FI, ~ 2nd Fl. Section Block Lot was examlned on ~t S ~ 1983 and found to be in compliance with the ~equirements of this Board, FIXTURES OVENS DISH WASHERS ~:XHAUST FANS FIXTURE SWITCHES 5 7 8 5 DRYERS FURNACE MOTORS ! FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF PEET SERVICE DISCONNECT S E R V I C OTHER APPARATUS: LIC. #1049 This certificote must not be oltered in any manner; return to the office of the Board if incgrrect. Inspectc~rs may be IUILDING DEPARTMENT. ' BE ALTERED IN ANy MANNER. their credentials. Memorandum from .... BUILDING INSPECTORS OFFICE TOWN OF SOUTHOLD TOWN HALL, SOUTHOLD, N. Y. 11971 765-1802 Memorandum from.... BUILDING INSPECTORS OFFICE TOWN OF $OUTHOLD TOWN HA~L, SOUl,tOLD, N. y. 11971 765-1802 Memorandum from.... BUILDING IIqSPECTORS OFFICE TOWN OF $OIJTHOLD Town Ha~L, SO~J~Hozt~, N. Y. 11971 765-1802 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180;2 (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No.l .~.,~. ¢~.?. ....... 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 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 auth°rized inspect°rs °n premises and in building f°r neces:a2~. ~ ....... (Signature o f aPplicant~or nsm~ ~f a cor,poration)/ (Mailing address of app icant) / / ?,~ State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. (as on the tax roll or latest de~d) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ¢~.' - ~ mlumber's~icenseNo...~7~..~ ~ Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. . ......... ?. .................. House Number Street tHamlet County Tax Map No. 1000 Section ..... .~..~..O ....... Block .... .O...~. ......... LOt...~.. ~..~.~. ......... Subdivision .?¢J~.(2~.. ~L~..~ l'.10rl,~ ....... Filed Map No...(6! ..~(0. ~7... Lot .... t. ~.Q) ...... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~.~x. b. Intended use and occupancy .~..~.4~.~..~'q~ ............................... 4. Estimated Cost ...... .~..,./~ [ .... 5. If dwelling, number of dwelling hnits Nature of work (check which applicable): New Building .......... Addition ...... Alteration .......... Repair .............. Remqval ............. Demolition .............. Other Work ............. (Description) ................... Fee ..... ??. ......................... (to be paid on filing this application) ............. Number of dwelling units on each floor ................ If garage, number of cars ..... ................................................................... 6. If business, commercial or mixeO occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure's, if any: Front ...... Rear , .. Depth ... ........... Height ............... Number of Stories ...................................................... ' Dimensions of same structure wlth alterations or additions: Front ................. Rear .................. Depth .. ................... ,.. 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 ........... i .................. Name of Former Owner ............................. 1 1. Zone or use district in which pr~mises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regnlation: ................................ 13. Will lot be regraded ......... . ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .. 'i ................. Address ................... Phone No ................ Name of Architect .......... : ................. Address ................... Phone No ................ Name of Contractor ........................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly alii buildings, whether existing or proposed, and, indicate ail set-back dimensions from prope~y lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ~ STATE OF NEW Y~'RI(z / ,t ............................. i .................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the , i (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 manne~ set forth in the application filed therewith. Sworn to before me this 19 .o~..~ ............ .'TZ'. ...... day of .... ~t~ .... , Notary Public,,ur)lls'~'c .~..!: . .~.'T. XmRY: ~ ....... Count .~~Y~] Notary PuB[[c~ State o7 New York ................... NC. [~2-03449'63 Suffolk CountyF~7 pplicant) I~ommission E~<pires Ma~ch 30, l~:~r,~-~ 4, If cOppe~. for Wore 0/: fYpes ubing is Usec di*stributing ilng shall be ', or L only NOT,~TN~ ~E~A~?~NT AT 765-l]g02 9 AM TO 4 ~M F~, ~N'~ FOLLOWING ~NSPECT ON'~' .1,. FOUNDATION - TWO ~E~O'I'~ FOR p~URED CONCRETE ~. ROU~ - p~rw~ & PLUMBiN~ 8. i N'sErEAT~,d N ALL ICONSTRUCTION SHALL ~E~ ~HE ,REQUIR:~ENTS OF THE N, Y. ~.~~_.' ES. NOT RESPONSIBLE FOR r¸ J