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Home My WebLink About12335-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ....~ ~k 2.5.3, 3 ....... Date ......... .J.u..rig..5. ................1984 THIS CERTIFIES that the building. A%¢.e.r.a.~..i9.n. ............................ Location of Property 295 Jackson Street ~e.v. Suffolk ,County Tax Map No. 1000 Section ....~.1.7. ..... Block .... .0.9 ......... Lot 002 Subdivision .... .X .......................... Filed Map No. X .... Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... Ap.x:i~[..2.2 ..... 19.8..3pursuant to which Building Permit No. 12335 g dated ........ .M.a.;/..1.8 .............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 ......... alteration from .g.a.r. gg~ (attached) to bathroom & living facilities. The certificate is issued to ......... ~IJ~I~$I~. ,l~qN. G. Qlfl~.S.. 5..R.O. BERT JONES (owner,'cessee'dr:t~r~) ...................... of the aforesaid building. Suffolk County Department of Health Approval ... ~TfA ................................... UNDERWRITERS CERTIFICATE NO. , N..fi ~ 433.5. Building Inspector Rev. 1/81 ~o~ ~'O. I ?ow~ OF sOU*H~L BUILDING DEPARTMI TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT: (THIS PERMIT MUST BE KEPT ON THE PRE/~IS~S COMPLETION OF THE WORK AUTHORIZED) 12335 Z UNTIL ~ULL permission is hereby granted to: ...... · ':' ..... ~'~'~ .' .~'!-'-, ~,..,:....~;....x.z~,~ ,o.~ ~ .,'~.~...~.../.,¥~.~:::.~.z~...~.....~.i.~.~.,~.././..,~.. ...... ot ,~e~,e~ ~oco*ed ot ...................................... : ..................... .:....~ ................ !..( ~..~.. ........ ~Lot No. ;...~.(~.*.~.'. ..... Coumy Tax Map No. 1000 Section ...... /.t(.~.....,.... BlOCk 'i pumJont tb application dated ..... ,~.~.~Z......;~.'~.J.;!;... 19/~ and ~pproved by the Building I~spector. Rev. ;6/30480 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~ tot 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 ~ 2. Certificate of occupancy on pre--'~[i=~=Fsting dwelling or land use 3. Copy of certificate of occupancy $1.00 New Building ............. Old or Pre-existing Building ....... Vacant Land ............. Locat,on of Property .... .................. House No. Street Hamlet Owner or Owners of Property ...... .~.~ .~.~..~/...~..~..~...~.5: .... .~... ~..~..b.~.~..~..~.~..~.~- ......... County Tax Map No. 1000 Section ...... ././. 7. ....Block ...... .~.¢ ..... Lot ..... .Z~..4:~..~-%. ..... '~ Lot No Subdivision ................................. Map No .............................. Permit No. /..2-.5. ~..~..~, Date of Permit ........ Applicant ............ ~ ................... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval .......... ; ........... Request for Temporary Certificate ..................... Final Certificate ... ~ ................. Fee Submitted $...~ .~..~T.~. ........ ~: ...~. Construction on above described/ng and per~et~//~l'e codes and regulations. ~0 ~ ~ ~ .~plicant ~~~ .... ~~ FIELD INSPECtIOn[ COMMENTS FOUNDATION (1st) F'OUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. sTaTE ENERGY q?DE FINAL ADDITIONAL COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN ~TREET, NEW YORK, NEW YORK 1OO$~ THIS CERTIFIES THAT mdy the electrical equlptne~t as described below and introduced by tl~ appllca:~t ~med on the able application number in the premises of P~b~rt L. Jon~s, Oack~n Aven~, N~ S~fo~, ~uthold, in the following Ioca[ioa; ~ B~se~ne~[ ~ 1st Fl. ~ 2~td ~1. Sectiot~ Bloc~ Lot ~.s ~.ml.ed o. Feb~'y 14~ 1~ ..d found ~o be ~ cor~tpliance w~th the requ~re~e~[s of ta~ Board, FIXTURE OUTLETS RECEPTACLES SWITCHES FIXTURES RANGES ,OVENS DISHWASHERS EXHAUST FANS DRYERE FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT S E R Panelboards; 1-10c'ir. 125sm~s,. t-~.F.C.I., l~-~oke Detector. ~,[o~Ors: 1-F., Electric Roan Heat~r~: NO. OF CC COND. A. WG, pER ~ OF CC. COND. 1 1/0 I C E . t/0 Gary IX)x'oski 42 D Mon~ell Lane C~tchog~e, N.Y. 11935 Lic. 2941 GENERAL MANAGER This certificate mgst not be altered in any manner; return to the office of the Board if !ncorrect. Inspectors may be identified by their COPY FO, BUlLDI~e DEPARTMENT. THIS COPY OF CE.TIFI 7G5.'i 802 BUILDING DEPT. INspECTIOiN [ ] FOUNDATION 1ST [ ] ROUGH PLBG [ ] FOUNDATION ;ZND [ ] INSU~TION, [ ] FRAMING [ N REMARKS: DATE FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 li!~ ~.~ TEL.: 765-1803 ,~med ~. .., Approved ..//.~. .... l .~. · Permit No. . ....... ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS App.cation ........ a. This application must be completely filled in by typewriter or in ink and subfi,.itted 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 build/rigs 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 Re~lations, for the construction of buildings, additions or alterations, or for removal or demolition, ss herein described. The applicant a~es to comply with all applicable laws, ordinaficea~ building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for nece ' *' ctions: (Si/nature of applicant, or name, if a corporation) (Msillng address of applicant) State whether applicant is owner, lessee, agent, architect, engine~L.~neral contractor~, ectrician, plumber or builder. I ion, d officer. (Name a~/,i~le of corporate officer) ~ ff Builder's License No ...... .~../..~....---'. ..... ...~"~'~--~ Plumber's License No ...... .'~'..,. ~. :. ~ ........ Electrician's License No .... . .~.,. ~.,. ~.: ....... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ................................... ~ ........ .~,~.. ............... .... .......... ......... _ House Number Street County Tax Map No. 1000 Section .. 1.{..~. ........... Block ....... ~ .......... Lot ...... .~. ..... . .'"~/... 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 ......... ~....O~.~....~. ~. O. t~. ..... ~..~.. S. ,,.d~.~~ e~..-~,~ ................. b. Intended use and occupancy .... /~...(~-. ~..~. **.O.~,. .... ~..~. S.i .4.~,.~k~..~-..~. .... .? .............. 3 Nature of work (check which applicable) New Building Addition ~ ~" · : ................. Alteration ..... Repair .............. Remdvai .............. Demolition .............. Other Work ............... 4. Estimated Cost ............ ii. ~ ~'~ Fee f- oO~ · (Description) ~ (to be paid on ~ing this application) 5. If dwelling, number of dwelling 0nits ............... 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. Dtmensions of existing structures, if any Front ~.0 Rear ~ ~ Denth .~. ~. Height . ...,~ .4/. ...... Num:'ber of Stories ...... · .'~. · . i. i. i ..... iiii~.ii.iiiii...~..iiii.iiiiiiiiii Dimensions of same structure with alterations or additions: Front ...... ,.t~..(~ ......Rear .. ~ ..¢~. ..... Depth ..... .~..~. .......... L. Height .... '~' Z ........... Number of Stories ...... i~ ........ iiii 8. Dimensions of entire new construction: Front ....... .~...t~.... Rear ...... '~.. fi .... Depth .... ."~. ~.. ..... Height .... ~. ~. Number of Stories ~ ..... 9. Size of lot: Front ........ .'T'~...!.t~.~/ ....... Rear ......... ~..~ .... i '~;~it~'. i. i i i ~.' i .~.': ~ ;i i .'~. i i 10. Date of Purchase . 5~,-r-~...~ .~-I~, .-%w..~t~.~,4NTame of Form,er Owner .,..,¢-J. ~ ............... 11. Zone or use district in which pramS/es are situated ........ .irC..'~-.. ~.o..4.*. ~,~.~¢,,.~. . .. 12. Does Proposed construction violate any zoning law, ordinance or regulation: ..... .~.O...-T .................... 13. Will lot be regraded ....... ;. ~ ........~ .......... Will excess ~11 b_e rem.o, ve~from premises: Yes _ No 14. Name of Owner of premises . 1~, ~.~. ~ ,.~, .~... Address . ~l ,h ~. ~U*. ~, .~.,.. Phone No. 7~...~. % t~/. ~ 0.. Name of Architect ......... i' ~ .............. Address ~ .................. Phone No. Name of Contractor . ~ .~..~.',J~. ?~.. %. ~ ........ Address .. ~,, ..~.~ .... Phone No. PLOT DIAGRAM Locate clearly and distinctly all!buildings, whether existing or proposed, and, indicate ail set-back dimensions from property lines. Give street and block ] tumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW,'V'~K., ~ S COU -V, OF. .. :S. // (Name of individual sign!ng contract) above named. · being duly swo;n, deposes and says that he is the applicant j t~___~ra~o~gent, ~.~.[a~. ) of said owner or owners, and is duly authorize~Fto 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 ......... ~. ~-~. ...... day ofi..,. Nora~~~..,..... Publi~, ..... .. >,...~ ..... '~'4'~ ~' . 310TAR¥~USLI& State o~ ~aw York ,/'~/- .......... '~ '~' 'r./ .... '..~,; ' ~'~"~ '~. · · ·: .... : t~o. ~t2-S2SaSO, Suffolk Coulgab' C/' J (SignaturCqf apphcant) i : Term ~p[res I~l~rch hr, ~, dls~r boring ' ' CODES. NOT RESPONSIBLE' FOR D[SIGN OR CONSTRUCTION E~RORS' P 'W