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Home My WebLink About12300-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No Z12806 Date ..... .Sp.p.~., .25 ..... 198.4. THIS CERTIFIES that the building ...... &c~ cl $.t.~,Q ~ ................................. Location of Property ....1. ~ ,05..C.~ p .~....I~ $ cl.d..D V ........................... Ha ~ ,~ 3.~.~ ¢ l<.. County Tax Map No. 1000 Section 106 .Block 05 .Lot 012 Subdivision..~ .ap.~.... ~.t.d.d...g.s.~.U .~ ?p ......... Filed Map No...~ .6.7.2...Lot No ..... ! .8.6. ..... conforms substantially to the Application for Building Permit heretofore fred in this office dated .... .~ p?.t. ~...~ .2. ........198..3. pursuant to which Building Permit No..~ .2.3.0..0 .Z .............. dated . .M.a.y...6 ..................... 198. 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 ......... ...b.d¢.i.~. ~..o.n. to...a.n..~..x.~.s.~.$ .rig..c!.¥93.~.~.n.g.. ................................. The certificate is issued to Mr. & Mrs. B. T. Shaskin ..................... .................... of the aforesaid building. Suffolk County Department of Health Approval ......... ~./.~. ............................. UNDERWRITERS CERTIFICATE NO ................. .#?.6. ] ! .5.8.2. ....................... Building Inspector Rev. 1/81 ?OWN 'o~ soOti~O£b BUILDING DEP,~RTMi~N1 TOWN HALL SOUTHOLD, N. Y. ~BUILDING PERMIT! (THIS PERMIT MUST BE KEPT ON THE PRE~ Si COMPLETION OF THE wORK AUTHORIZED)! N? 12300 Z S UNTIL ~ULL Permission is hereby granted to: ' ............... .~.~.z ..... ~ ~ ........... Date ............ , ...................... 19 ..... at p~emise$ located at ...... 1.~.:~.,~..,; ...... pursaant tO application dated ...... ,..~.,..,...:..,:....; 1c) and 6pprov~ by the Building Idspector. REGRADING LOT CESSPOOL C~N$ rRUCTION CELLA(~ CONSTRUCTION QTHER! PErMiT 'iNCLUDES APPROVAL ]TO R~MOVE EXCESS FILL FF~OM ABOVE PREMISES BY FORM NO. 6 TOWN OF SOUTHOLD Bu ilding Department Town Hall · ~:~uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted-J~=edpUc:t: 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing ail 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. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land 3. Copy of certificate of occupancy $1.00 use--Fre-Existing C.O. $15.00 Vacant lland C..O. $ 5.00 Date ..... (~..I..~.0. [~ ~. .......... New Building..~.~..I¢~Jf..~.. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ~ Hou~ No. Street Ham/et or o ,rop.rtv , :... J d County Tax Map No. 1000 Section .... / ~ ~ Block ~ Lot ~ .(.~. Subdivision .~0~.7.'..~f.. ~7.~ .... Filed MapNo..~..I.~..Lot No .... ( ~.(( ..... Permit No./.~ .'~. Date of Permit ~.~ .~ [~.Applicant..~. ~~~-. .... Health Dept. Approval ...................... Labor D~pt. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..... ~ .............. Fee Submitted $ .... . .~.~.0. 0. ................... Construction on above described building and permit meets all applicable codes and regulations, Applicant .... Re~, 10-10-78 THE NEW YORK BOARD OF FI,RE UNDERWRITERS BUREAU OF ELECTRICITY 8~5 JOHN STREET, NEW YORK, NEW YORK 10038 THiS CERTIFIES THAT only the el~trical equipment ~ described below and introduced by the applicant named on the above application ~umber in t~ prernlses of in the/allowing location; ~[ Basement ~ 1st Fl. ~ 2nd FI. Section Block Lot was examined on J~ly 25 , ~83 and found to be in compliance with the requirements of this Board. FIXTURE OUTLETS RECEPTACLES SWITCHES 11 6 6 DRYERS FURNACE MOTORS FIXTURES RANGES ~OOKING DECKS OVENS DISH WASHERS EXHAUST FANS FLUORESCENT MERCUeY VApoR FUTURE APPLIANCE FEEDERS ;PECIAL REC'PT TIME CLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: S E R V I C E NO, OF CC. COND. A W. G, A W O NO, OF NEUTRALS A. W G PER ~' O~ CC. COND. OF HI-LEG OF NEUTRAL NO. OF HI-LEG, 1 2-G.F.C.1. Room t ~teacers:l-l,25 K.W., 1-~5 K.W. Ale~xanc~r G. Hubbard P. O. ~ox 222 Aq~bogae, N.Y., 11931 ,LIC. #304 This certificate must not be altered in any manner; return to ~he office of the Board if may be 11 iS. COPY )P¥ OF ( ' MANNER. ~IEL~ I~SP~CTION COMMENTS FOUNDATION (1st) F'OUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CgDE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING ~/~ FINAL DATE 76S-'t802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] RouGH PL~BG. FOUNDATION 2ND [ ]INSULATION' [ ] FRAMING [] FINAL __l.., , ' [] 765-1802 BUILDING DEPT. ~INSPECT,ION~ FOUNDATION 1ST [ ] ROUGH p~BG. [ ] FOUNDATION ZND [ ] INSULATION [ ]FRAMING g~ FINAL DATE ~NSPECTOR FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined. ~.~.?~-...t~...., 19 .~.ff Approved .~..e-~/...0~...., 1 ~"P,~. Permit No.//d~.(5~. ~~' Disapproved a/c . .......................... 2% ........ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ............. , Application No.. ~.C~'~.~. ...... 197:.¢ 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 throu~tout 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 tee 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~ons. ,d\ o~y,-t~.<_,~_.~._- .....-Z4. ?.v:.;..-.~.,J .............................. (Signature of applicant, or name, if a corporation) ...7,. ?.,. ! !79 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . It .'70.(~:..~. i'.~-7-.: .... ,S: .~..~h...~..~.( B/ .............................. (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.../.~.O.'..3.7./.Ti/ .......... Plumber's License No..(O.: .Q.'.. Electrician's License No...fS.kT..'...~! ~.~..~5...Q ?~. (?.. Other Trade's License No ...................... 1. Location of land on which proposed work will be done.~.. Ih% Pr Ti' I-Cot c_ I'~ bkJ~ \/- ((o..-5 ..... ...... ............ .ry. .......... House Number Streg~t'~ Hamlet County Tax Map No. 1000 Section..~- ..... Block..~ ....... Lot...(~-i ...... Subdivision.. CO~......~. tr~(iq~.a~)z~f~ Filed Map No ...... '.~'."/. ~... Lot ~ ....... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ Ii). .¢. ~./.~. ~'.T.' .J.~. ~.. .......................................... b. Intended use and occupancy ... 3. Nature of work (check which a~plicable): New Building .......... Addition...~.....,, Alteration .......... Repair .............. RemOval .............. Demolition .............. Other Work I , ,~- .- ___:--~ , (Description) 4. ~stima~ed Cost .... ].~/..~.ffy,i ... y.~. .................... Fee .... ~ .~.... J: ........................ (to be paid on filing this application) 5, If dwelling, number of dwelling iunits ... ~ ............. 'i~ ' Number of dwelling units on each floor ................ If garage, number of cars 6. If business, commercial or mixed occupancy, specify nattlre and extent of each t,zpe of use .. :.-:-..... :- .,, . . .... ' '8: ' :"?=; .... 7. D~nens~onsof.er~st~ngstructures, ifany: Front... ~...7..~.~2.. Rear . .-~...~..-.~ . . Depth... 2~ . . ' i ...... ' .... ................ i' · g ......... '~ . t ....... )ejr ~o / ' · ........ r ./. 4; ...... 8. Dimensions of caere new constm~ ction: Front ..... /.& ...... Rear .... /. ~.. ........ Depth .../. ~ ......... Height .../, ~. ........ Number of Stories ...... e~.~. ....................................... 9. Sizeoflot' Front ]. 0c-)! Rear . .~'.F20 Depth 10. [)ate of Purchase ........ - ..... 77.'. ............ 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 .... .~..O...: .................. 13. Will lot be regraded ..... .~. ~..~.~., .... ~ ~. ,.,....,... Will exces_s fill l~Igmoved from premises: ~ No 14. NameofOwnerofpremises ../P.r./.L..-~..~?..~..tl./?...Address .ff...~.~..'.~.~.~. ....... PhoneNo. Name of Architect .......... i ................. Address Phone No .............. Name of Contractor. ~.~.~.t~ .&~.... ~(~. ~.&pt~.... Address i '.'~]~&'~f~/~¢ '~4ii~.'.~'.~.i Phone No..~..~.2 .~. PLOT DIAGRAM Locate clearly and distinctly aill buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street am interior or corner lot. block !number or description accord!ng to ,zoo f o r7 STATE OF NEW~O~K~ ..... (Name of individual signing contract) above named. deed, and show et names and indicate whether being duly~ deposes and says that he is the applicant J<~ (Contracto~r~ai~,ent corporate officer etc.) of saki owner or owne~, ~d is ¢~ a~fized~o pc- rform or have perfo~ed the said work ~d to m~e ~d file ~is application ;~ that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~ner set forth in the application filed therewith. Sworn to b~fore me this Term Expires M~h 30, I h - ' I M ~OR THE . TWO 2, CTION Must sHALL MEET oF .THE N.y., E~ERG¥- FOR ~4 %"0o