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Home My WebLink About12354-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificnte Of Occupnncy cellar THIS CERTIFIES that the building ................................................ Location of Property ...5..2.1:0. Great Peconic Bay Blvd. Laurel norse ~o.' ...................... 'S'V:ee; ....................... h~d, Je~ County Tax Map No. 1000 Section ... $.2.8 ...... Block ...0..2 .......... Lot ...0..2.2 ........... Subdivision X p N ............................... Filed Ma o ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fded in this office dated .... .M.a.[;... 6 19 .83. pursuant to which Building Permit No. 12354Z dated ......... .M.ay. ...... 3. .1 ....... 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 ......... cellar Under Existing Dwelling The certificate is issued to MAURICE JEZO (owner, I~ ~r-~rtant') of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO. · N611609 Building Inspector R*~. 1181 TOWN 'o~ ~OO?H°[ ~ !: BUILDING DEPARTMI H~ TOWN !HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEpT ON TH~ PREA~IS~S UNTIL C~PL~ION OF THE WOR~ ~uTHORI~ED) ~ ~ 12354 Z Date Perfnission is hereby granted to: .~.,..c~. ...~.~.~.. , ........ : ....... z~.~.....~.~...~....., ........ ......... ~..~.; .... ~L.~... ,o ..,..~.c~..~..~.~..~.. ........ C~.:LL,~,~ ....... ~. ~.~. .~ ~.....~ ... ...... ~ ..................................................................................... ~~?"~ ............... ~'. .................................... · · ...... "' .:...~ Z~. /'~ at prem,se, located at ..... t~... .~.. ~.~..~ ..... ~ ......... ~.c~.. ............ .... ..i .......... ................................................................. : ............. :....:~ .......... ;...i.L ............. ~.~,~.-../ Cou ty Tax Mop No. ~1000 Section .../...~'..~.~. ........ Block .~... .... iLar No .....~ .......... pursuant to application dated ...... ~..,~...~.~ .............. i.. :....;~ , 19 and approved by the Bull~lng Ihspector. ' Rev, 6/30/80 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- 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. 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 $5.00 2. Certificate of occupancy on pre-existing dwelling ~'r land use -~/~'/ $5.00 3. Copy of certificate of occupancy $1.00 Date . ,'~,~ .~, .~.H.~.~.~...t..~. I.~ .~, ..~ New Building ............. Old or Pre-existing Building ~ Vacant Land Location of Property ..... .~'...~-.. J..~?. ......... ?..~.~.O..~. I..~..~-~. ~.~/..~.. ~.~._~. ........ .~.,~.~..~.~'...~.. House No. Street Hamlet Owner or Owners of Property . . ~'/~ .¢.~!. f-~l~.~. . . .-J~"~./~. '~: .O. .................................. County Tax Map No. 1000 Section ...... ( .~..~-~, . . Block ....... 9. ?T'..... Lot .... .(~..~"...~.. .... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.i~ ~ .~ >~..~..'~'Date of Permit/(f~¥.~ ~/~7.~.Applicant .. ~....~..~. :2;-.O ................... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval . ./t.~.. ~'./. (.~..~..~. ....... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ~ Fee Submitted $ ~ ....................... Construction on above described building and permit meets.,a~Lappticable codes and regulations. ~J~r~ ~.'~"~" ' q ,' Applicant ..... ~ .~.~ ........................ oqoo THE NEW YORK BOARD OF FIRE UNDI!RWRITERS 1~ BUREAU OF ELECTRICITy ~.i,~,L~L~.,~.'; ].~ 85 JOHN STREET, NEW YORK, NEW~7~8 ~ ~.~.o,, ~,,. o.~.~ N 61!6~ THIS G~ffTI~I~$ THAT ~he followZng location; ~ Basement ~ 1st FI. ~ 2nd Fl. Section gloc~ Lo~ examined on J%~ ~ ~ ~ and~ound ~o be in compliance wi~h ~he r~quiremen~s o~ this Board FIXTURE FIXTURES RANGES OVENS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT VAPOR DRYERS FURNACE FUTURE APPLIANCE FEEDERS T ME CLOCKS MULTI-OUTLET DIM/~IERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R i V I C OTHER APPARATUS: NO, OF CC COND, PER ~ i 2/0 NO. OF Hi-LEG AW.G, OF HI-LEG NO, OF;EUTRALS OF NEUTRAL 2/0 11 This certificate must not be altered in any manner; return to the office of the Board if Inspecto[rs may be identified by their ,RTMENT. THIS COPY~ MANNER. ,D IN~PE~T~ION DATE COMMENTS ~--~: ~ ~DATION (Znd) PLUMBING ULATION PER N. Y. STATE ENERGY ADDITIONAL C¢~MENTS: ~ ',~ / , FIELD 1. FOU~ FOUNDA 2. R~UGH 3. INS 4. 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [2'1 FINAL DATE /. /?/~? *'~ ,, INSPECTOR CONSTR~CTION~AND GL^SSWORK 41WYONA AVE LINDENHURST, N.Y. 11735 957-5077 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 (Building Inspector) APPLICATION FOR BUILDING PERMIT~ ~V d 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 authorized inspectors on premises and in building for necessaw inspections. (Signature o~ appfican~,or nan , ' p ' (?. ~....c~..~... H:~...¢ g.~. 0cc..c~..~..v.~..W,.~r. ...... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... ~.w..v. ~.a. ...................................... Name of owner of premises .,..b'f~(/IZ~c.~ .... .'-~-..~..~..o. ................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No...~...~....~,:"~..~. '"~' ~53F~'~"--ff~'"%' 1. Location of land on which proposed work will be done .................................................. 'r~.L.~..~?.-~. ~,~.~ .lt..FY. .... .e.e..e,.o..v,.;.,...~h .&Y...~. &v:' .~. ........... /_..~..v.& .a..z_ ..................... House Number ~"~c~ [ O Street Hamlet County Tax Map No. 1000 Section ... !-.~.. ~ ........ Block ..... O...~... ....... Lot... ~ . .~..--:~--~ ....... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ... ~...~)...Vv'. ~ ~../../..&Q~. .... d??'/~.. . ~ ............... b. Intended use and occupancy . .?~..~..."~... If. ff .~.~..Z. [..&q..~..'7... '.~//~..~..q :~./'.- .c5:~.. .............. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ..... Repair .............. RemOval .............. Demolition .............. Other Work.../~. ......... 4. Estimated Cost .... .~.~0~9:~, g~,., ................ -~'ee ,'~,e-M/O .............. ?.~¢.a/~ (to be paid on Fding this application) 5. If dwelling, number of dwelling Onits ...... .[ ......... Number of dwelling units on each floor .... ~ ........... If g~age number of ears ' ~. 6. If business, commercial or mixed occupancy, spec~y nature ~d extent of each tvve of use . .~ ~A.6 ~G..q 7. D~ensions of existing, structures, if any: Front... Z ~..~... Rear .. ~ ~... Depth... ~o. ~... Height . . . [ ~.~... Num,ber of Stories ..... f. .......... , .... ~...,... ~ ...................... ~ ...... D~ensions of sang st~cture width Eterations or additions: Front .g~ ........ Rear . .~.~ ....... Depth.. ~a. ~ ...... ... Height .... Z ~ ~ ....... ~umber of Stories .... [ ................. 8. Dimensions of ettire new const~ction: Front ..... (g.~ ...... Rear ............... Depth ............... HeiSt ............... N~m:be~ oi Sto~es .............. . .....~ ........ , ~ ./..~ . .~. 9. Size of lot: Front .... / ~ .~..:~ ~... Rear ...... ~ .'~ ...... Depth ...[~.q./. "~ ........ 10. Date of Purchase . ~'g.~. ~ ~.~ ........... Name of F~er Owner ~-4 ~ ~C~.. ~ e.~ .... l 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violhte any zoning law, ordinance or re~lation: .... ~ ......................... 13. Will lot be regraded .... ~ ~.. · · ~ · ~ ............ Will excess fill be removed from premises: Yes 14. N~e of Owner of premises ~.~¢~Z,~.._~o... Address ~.~O ~ ~ . . Phone No.~q I. g. 5 q. Name of Architect .......... . .~ .......... Address .~ ~-:~ . Phone No.~l. ~q~. N~e of Contractor ...... ~..~ ........ ~.~ ~.~ ~ ~.~ . . ...... ~' Address ..... Phone No ...... ~ ...... PLOT DIAGRAM Locate cle~ly ~d dis~nctly ~l~build~gs, whe~er existing or proposed, ~d~indicate fll set-back d~ensions from property ~nes. Give street ~d block humber or desc~pfion according to deed, and show street names and indicate whether interior or corner lot. : . ..,' , /1 · ........ ? / I ?,,//'A ,.t , i / ~ ~.~ .~ ~ ~. ~.~.~ ~..~, .................... being duly sworn, d~poses and says that he is the applicant '(Name of individual signing contract) abo~e ~am¢d. Heis the .~, ~.~..~ .......... i ................................................................... !. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ 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 i ............ day of .......... , Notary Public, tI ~&~p.~O~,'~D AS NOTED FOLLOW -. ~u~ REQUIRED ~ FOR pOURED CONCR~ 2. ROUGH - FRAMING & pLUMBiNG 8. I~U~T}ON ~. FINAL - CoNSTRU~ION ~g~ ~LL CON~RU~ION sHALL ~E REQUIREME~S OF THE ~.Y- ~A~ CON~U~[ON & EN~GY CODES. N~ RES~NSIBLE D~GN OR CON~ION ERRORS. k -%_ o