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Home My WebLink About12314-zBUILDING DEPARTMiNT~ TOWN '. LL ': SOUTHOLD,, N.Y. , BUILDING PERMITi' ~HIS PERMIT MUST BE KEPT ON THE PRE~ S~S UNTIL ~'ULL COMPLETION OF THE WORK AUTHOR!~ED), i' at premises located at Cour~ty Ta~< Map No I000 Section .... ./.ee:'../......:..... BiOek-.li.%,~..~~.ot No. .... ,. and ,approved by the pursbant t;o application dated ..... ~.~,.,ig..., Bullc mg Ir)spector. r , ;~ Building~,nspecto~ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..g. 3 ~ 95.6. ......... Date ...... .Op.~.q~..e.~..5. ................ 19 ~3. THIS CERTIFIES that the building . .A..~.D~.~.~.Q.N ..................................... Location of Property .. 3.6.39...~.~(~.~..w.~.~.e~...A.¥.~... ............... .~.u.~.q~.. 9~.u.~. ......... House No. Street Hamlet County Tax Map No, 1000 Section .... .q. 37 .... Block ....0~ .......... Lot .... .O.q.!'. .... ~... ~ Subdivision .~,. ~....l~l~..~.e~ . ~ ......... Filed Map No..~ ~.0...Lot No ...... 9~m~.. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... A~:P;~JE. ~J ~ ......... 19 .~Spursuant to which Building Permit No. q. ~5fi.¢.~ .............. dated ..... F/ay..~.2 ................ 19 .~}3, was issued, a~nd conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .... ~or..an. afl.di~i~ .~o..an. e~is~i~g, dw.e. llimg ............................. The certificate is issued to . .AIxI~IONF~E. 12~vl~O[oh;n'o'r.__ Ys~de't~r't~a'n't) ............ ' of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO. 1~607&7~ · Rev. ~18~ Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Depar~men~ Town Hall Southoid, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewrfter OR ink, and submit,ed m duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Final sur~,ey of property with accurate locution'of all buildings, property lines, streets, and unusual natural or tooograohis features. 2. Final approval of Hea~th Dept. of water supply and seweraqe disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Unde-rvvriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar building~ and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the buildin§. 5. Submit Planning Board approval of completed site plan requirements where applicable For existing buildings (prior to April 1957), Non-conforming uses, or buildinas ahd "pre-existing" land uses: ~ 1. Accurate sup/e,/ 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. Da£e of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. · /, 1. Certificate of occupancy 85.00 ¢ 57/$ 2. Certificate of occupancy on pre-existing dwelling c/r land use ~t¢/ 5.00 3. Copy of cert f cate of occupancy $1,00 ( Date yT/~ New Building ............. Old or Pre-existing Building(Z) . ~ .... =/Vacant Land ............. Location of Property . .~.~,~.O. ......... 5.~-.,/,~.Z'. F.u'¢~-.'.~,~; ./e...,~¢, ,~,~ , : :'. (~d~ Owner or Owners of Property ..~.%.~ .. ._ ............... ...................... County Tax Map No..1000 Section . /.~ .'2 ........ Block ~ / Lot. Suboi , o, .... ..... .... ' .... :..Lot No. ' .......... // Health Dept. Approval ~ ~ ' .... ' ............... L~aor Dep . Approval ....... -. ,. ............. ,.. Underwriters Approval P~anning Board Approval - ' Request for Temporary Certificate .F~nal Certificate ................. Fee Submitted $ ~ Cpnstruction on above described building and permlt'me~ts all aPp[~cable~,codes and regular o_ns. Rev, 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS J[21() ,~"~:, ]-~,~3 85 JOHN STREET, NEW YORK, NEW THIS CERTIFIES THAT only the electrical eqff~mF~t ~ describqd beJQw and introduced by t~ p~li~n~atned on the above 9~pli~ation nuntber in the pretnises of ~y ~ ~[~ ~/~ ~'tillw~t~r ~vcm~, 1~/0 '~'~ AV~e, (~t~e, N.Y. X in the following locatlon; ~ Basetnent ~ Ist FI. ~ 2nd FI. Section Block Lot was exatnined on ~ ~ ~ ~ ~0~ and found to be in cotttpliance with the requiretnents of this Board. FIXTURR OUTLETS DRYERS FIXTURES RANGES OVENS DISH WASHEk~ EXHAUST FANS SYSTEMS NO, OF FEET E DIMMERS OTHER APPARATUS: E E V I C NO Oi~E~C,~COND.JA W, ~, NO OF Hi.LEO A W, O, ~40 OF NEUTRALS A W O, OF CC CO~D, OF HI-LEg Of NEUTRAL El~v~t ric~ Co, 143 Lic#242 Per_ GENERAL MANAGERll ~_~'> .-'- m_ ~ Th s cert f cate must not be a tered in any manner; return to the office of the Board f : ncorrect, nspectors may be dentified by the r credentials. ~=~1"~ g . COPY FOR E~UILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NO~ BE A~LTER~D N ANY MANNER. ~ FIELD iNS~D~TION COMMENTS FOUNDATION (lst) F'OUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY GODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved Permit Disapproved a/c .... '7~'..~ . . i'. .......... ~ ........... (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No...~.~..c'.~.'('. ~Z.. ........ Date .../~../?.? ........ , 19~..~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 issue 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 applic_able 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 buildings for necessary inspections. ..... .... ...... (Signature of applictant, or name, if a corporation) .... . .~.o..x...x.~. ~... ~. ~. zw..,....~/../..x.~.. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nameofownerofpremises .~tld]5. q~''e~'~- ...~.~..~...~..~. ....................... i .................. '~ 3~(~j_ (as on the tax roll or latest deed) If applicant is a corporation, signature of d~ly authorized officer. Builder's Licens~ No ....... f~ ............... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done.. ~./~...~.?(§~.~?..T.~..~....'.~..~f..~ ................. House Number Street Hamlet County Tax Map No. 1000 Section .../.~y .......... Block .... / ............ Lot.. ~..// ............. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: 3. Nature of work (check which applicable): New Building .......... Addition...../-~..... Alteration .......... Repair .............. Removal . .b,'Z". .......... Demolition .............. Other Work ............... (Description) 4. Estimated Cost ............. i./~ ~.o t,.4 ,..o..~ .......... Fee ................................ i (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits ............... Number of dwelling units on each floor ................ If garage number of cars I 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure~, if any: Front ............... Rear .............. Depth ............... H eight Number of Stories Dimensions of same structure wi'th alterations or additions: Front ................. Rear .................. Depth . Height Number of Stories ..... pth 8. D~mensmns of entire new construction: Front ............... Rear ............... De ............... Height' Number of Stories 9. Size of lot: Front .......... l .... Rear ...................... Depth ...................... 10. Date of Purchase ........... , .................. Name of Former Owner ............................. · Zone or use str c n whlc r mlses are muate ..................................................... 12. Does ,proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ....... · .: .................. Will excess fill be removed from premises: Yes No 14. Name of Owner ofpre~mises/~..!..~)~. ,/~ ~... Address .,.~77/./~-tM~i .t~4g..~t[0~hone No. C~T.C/q-O.~.e. Name of Architect ... ....... i ................ Address ................... Phone No. PLOT DIAGRAM Locat6 '~learly and distinctly all'buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. G~ve street and block number or description according to deed and show street names and ~n&cate whether interior or corner lot. STATE OF NEW~7'~RK. - ,~ ~- - COUNTY O~7~i., !~'5 . ......--/~.~. · .~./~..~ .~.~... · .~.~... '~' .~. f.~.~.~.. ........... being duly sworn, deposes and says that he is the applicant . (Name of individual signing contract) above named. : He is the ...................... i ................................................................... 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 b6fore me this , .......... /~.f~". .... day o! .... ~) .... , 19~.~ ~ ~~~', (Siguat/~r~ ~f applicant)