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Home My WebLink About12642-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of' the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building . 3,0.Q~.S,g~'~' .................................... Location of Property ... 1120.9. [0~E. 14g.~R~, ,I~xl~ ............ .0RI]/~ ............. House No. Street Hamlet County Tax Map No. 1000 Section ...'J5 ....... Block ..... ~ ......... Lot .... ')8..~ .....':.. ] Subdivision 0~ier~.'b..by. ¢~e. sea .......... Filed Map No. 27.??...Lot No....'1.7. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated · .. Jaly..'l.q: ......... , 19 ~.3 pursuant to which Building Permit No. q.26 ./42Z ...... ' ........ dated ..... ~ep~c~l~lbe:~. 29 ........ 19 8.~ , 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 ......... .... An. aegessaa~y, sw. immir~ .poo& ............................................ Thc certificate is issued to lV~RIE. ~vl~IC~-RG. ............................. ~ ......... (owner, lessee or teoanO of the aforesaid building. .. ' Suffolk County Department of Health Approval ................................... . ...... UNDERWRITERS CERTIFICATE NO ..................................... N61~84-8 ........, .... Building Inspector Rev. 1/81 FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12642 Z Permission is hereby granted to: ,~) ~.~ ....... :...~.~..~ ....... .¢~ .... ...~.~.~...)..I..~....~. .......................................... .... .~.~.,...~..q.:. ....... !.L.?.~..g. ............ .................... County Tax Map No. 1000 Section ........................ Block ......... ~. ./ ~ .......... Lot No./~'- ....................... pursuant ,o application dated ...~...~.....I...L~. ........................., 19.~.~, and approved by the Building Inspector. Fee $..~...~...: ............. Building Inspector 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. Su bm it Plann lng Boa rd approval of comp leted site p lan requ i rem ents 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 ! use -1~/ /'5.00 2. Certificate of occupancy on pre-existing dwelling fr land 3. Copy of certificate of occupancy $I.00 Date... ?'. ~-~.¢~5.~-'...~.?..../'?..~.~.. N~ .... .?. ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ................................................................... House No. Street Hamlet Owner or Owners of Property ...¢~../~.~¢/~ ~ /,-¢~-/¢-/~L=,~/¢~, County Tax Map No. 1000 Section ...... ./.J~' Block cC' Lot .... /...~. Subdivision..~..~.~,..~.,.~..~._..,~.~-..~,..j~.c_~4z . .Filed Map No.~..¢..'.~?. .... Lot No..../.~ ........ PermitNo. /.~0.~..~, DateofPermit..~h,~{~/~.~i .Applicant .. ,~..t~ .... ~'4R~lA~4~. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ..... .~. ................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ........ 0'" ................ Construction on above described building and p?r~meets all al~cable codes and regulations. F~ELD~INSPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING COMMENTS INSULATION PER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 To Whom It May Concern: Please be advised that the Certificate of Occupancy which you requested has been issued. The fee for a C.O. is $5.00. Please stop by, or send us a check, and we can give the C.O. to you. Thank you. Building Department FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No ................................ To /~../-O:'~-..~zT~./~=~,~/.~7..'$(..~...~ ..... .. &.v. ....................... . . 0,,¢z~,~.¥/ , .,4x, . ~ ..... PLEASE TAKE NOTICE that your application dated ..... ~/~--~Z .x~....'/.~ ....... , 19~..~.. Location of Property . ,/. k~'~-r-~-,.. ( ~ Ho~so No. ' .... 's'tle~i ........ County Tax Map No. 1000 Section ...~./'.~'7. ..... Block . .(~.~ ........ Lot ...(~. [~ ...... Subdivisim{~'~,27. ~>7/..~./~.~iled Map No .... (~ ~. 7. ~. .... Lot No..../~. ............ is returned herewith and disapproved on the following grounds ...Cc:~X~..7',z~d~7~.C/.~....dv.-'~/..Ad~.. .-~o.r.~ ?q~. . . . .~.c2~. .4 . . /. ?~ T~. .Z /. ~. ./.~/d. . . /:4 (z. ~.z . ./~. . . . ,4'. r Z c.~z~"~ .... .~.v~z'z./_./. ................................................... ~/~,i ............. Building Inspector RV 1/80 Z000708 THE NEW YORK BOARD OF FIRE UNDERWRITERS ][~b~ BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electrical equipment as described below and intr~uced by the applicant named on the ab~ application number in the premises of Wi].li~n A. ~r'l~b~g, 1290 ~ree Waters ~., ~ient Po~t, ~,Y. ia the/allowing location; ~ Basement ~ ls, FI. ~ 2nd FI. ~tside S~ct~on Bra& rot ~.~ ~x.~i.~d ,m A~t 18, 1983 and Sound to be i,t compliance with the requirements of this Board, HXTORE FIXTURES RANGES OVENS DISH WASHERS EXHAUST OUTLETS RECEPTACLES SWITCHES FLUORESCENT DRYERS MULTI-OUTLET EYSTEME NO. OF FEET E R V I C E NO. O~,COND. OF AccW'coNDG' OFA' Hi. LEoW O NO OF NEUTRALS (~w~laning PooL) Tiaa certificate ccsyers co~pli~e at ~he date of inspection onlyo f~cause of u~imual envtrors~nts iE is advisable '~o b~e frequent tesEs ~r~/or repairs .mdc by a qtlalifie~ person. AWG, O~ NEUTRAL Sal Lane Greerk~ort~ N,Y~, 11944 LIC.J/1049 GENERAL MANAG~ El This certificate r, ust not be aJtered in any manner; return to the office of the Board if incorrect. Jnsj:)ectoi-s ma}, be identified by their ~credent aJs. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765~1803 Approved ~ .~..~..c~.., 19~ .~. Permit Disapproved a/c ..................................... ~ : (Bu~for) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No,. ]...~..~..~. ~ ..... Date ./..~.-. 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 c,o4e, and regulations, and to admit authorized inspectors on premises and in building for necessary inspect'inn~'~-dk'(-2~ -~ff' ~-- /'~~ -~Sv~')/)z ~' ~ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .... .~..~ :~.~: · "'~ on' t'~e' ~a'x'[o'li ;} ilt~}t' ......................... If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No.....~..~.~. Plumber's License No ......................... Electrician's License No.~... t .~.~ .~ .......... Other Trade's License No ...................... 1. Locationoflandonwhichproposedworkwillbedone...d~'..~.:...~....~..~.~f~.,.,.~.:~..~".~... ..... .................. House Number Street Hamlet County Tax Map No. 1000 Section ..... ./'.4.: ........ Block ~ Lot. / ~ Subdivision .~.~-.~.: .~..~. ~.../.. Filed Map No...~...~...~..7. .... Lot..../..~. ........ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... .~../~.....~..~...~....~... ~ ............................... b, Intended use and occupancy . . .~..~.. ~...~...~ ....................................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration . ~_.... h... Repair .............. Removal .............. Demolition .............. Other Wot .t~...~ .... ~rao~.. (Description)' 4 Estimated Cost ~.~/~0~ ~. (~...e.~.. ....................................... Fee ........................... (to be paid on filing this application) 5. If dwelling, number of dwellingmnits ............... Number of dwelling units on each floor ................ If garage, number of cars .... ~ ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front .............. Rear... Depth ...................... Height .../.~'...~..~..~. .......... Number of Stories .................... 8. Dimensions of entire new construction: Front ......... , ..... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ Size of lot: Front ...................... Rear ...................... Depth ...................... Date of Purchase ............................. Name of Former Owner ............................. Zone or use district in which premises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ........................... Will lot be regraded ..../~...~ ..................... Will excess fill be removed from premises: Yes Name of Owner of premises .................... Address ................... Phone No. ~.2. ~.. 7.~..~'?...~.. Name of Architect ........................... Address ................... Phone No ................ Name of Contractor ........ ~ ................. Address ................... Phone No ................ 10. 11. 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blockinumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NE~WV2OI~X'/~ , SS · (Name of individual signing contract~ above named. being duly sworn, deposes and says that he is the applicant (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 manner set forth in the application filed therewith. Sworn to before me this _ ' ~mmission ~pires MOrch 30~ 1~-