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Home My WebLink About12677-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building One family dwelling Location of Property .8fi. 5...B.a.y...I/t.o.m.e...R.d.....&..5.0...~.i.l.l.o.¥..~.~.... ~.d.. .... .S. qu..~.h.o.l.d. ...... House No. Street Hamlet County Tax Map No. ]000 Section ...0..5 .6 ...... Block . .0.5. ........... Lot . .3.3. ............. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. fi.c.g.,.. 7 ........... 19 .8.3. pursuant to which Building Permit No. 1.2.6. 773. .............. dated ........ 0. c..%.. ~. 9 ............ 19.8.2., 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 ......... ....o.np., ..................................................... The certificate is issued to ERNEST & MARY DONATICH (owner, IR~c~. ]~K ~ge~91~ X of the aforesaid building. Suffolk County Department of Health Approval 1 3- S O- ] 6 9 UNDERWRITERS CERTIFICATE NO ............... #N6 ? ~ 3 1 8 Building Inspector Rev. 1/81 FOEM NO. ~ TOWN OF SOUTHOLD BOILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) 12677 Z Dote .~ ........................................... , Permission is hereby gronted to: ...~..~ .~ .... "'B"~ ................ r ..... :.' ...................................... , .......................................... at premises I~ated at ..................... ... .......................................................................... Coun~ Tox Map No. 1000 Section ..... ~ ........ Bilk .... ~.~ ........ Lot No....~.~ ........... pursuant to application dated ...~.~.~...2~. ...................... , 19..~.~, and approv~ by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ~uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions (~ This application must be filled in typewriter OR ink, and submitte~'p!icct= to the Building Inspec- tor with the following; for new buildings or new use: ,-~1. Final survey of property with accurate location of ali buildings, property lines, streets, and unusual natural or topographic featu res. --)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 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-existing dwelling/ land 3. Copy of certificate of occupancy $1.00 use--Pre-Exist~ng C.O. $15.00 Vacant land C,O. $ 5.00 New Building ... ~'/ Old or Pre-existing Building Vacant Land Location of Property ~..~...~../~.Z.../~/...°.~/..~....~..°..~.~... O ers of Prop ty Owner or wn er ............................. County Tax Map No. 1000 Section ,.. ,¢.~,-.c ........ Block .... (2.,I;~, ....... Lot.. ~,~, .~.~. ,'~,? .... Subdivision ................................. Filed Map No ........... Lot No .............. Permit ............................ ~;., ......,, __nt .......... ~ · ~ ............ Health Dept. Approval ................. Labor Dept. Approval ........................ Unde~riters Approval. ~.TZ~ .... ~ ...... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit F)~et~l applicable codes_and regulations. Applicant~~.~<f-~.~....~. ..................... Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 Oate ~ppli~.tlon ~o. on y.~ ~ /~4 ~.,~ ~.~,~,~ ~.~, ~.~4 N 671318 only the el~trical equipment as described below and irttroduced by the applicant named on the able application number in the premises of in the following location; ~ Basement ~ 1st Fl. ~ 2nd FI. Section Block Lot and found to be in compliance with the requirements of this Board. 984 FIXTURE FIXTURES RANGES COOKING DECKS OVENS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT vAPoa 55 ,58 63 55 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS MULTI-OUTLST DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: S E 1 R V I C E OF CC, COND 2/O NO OF HI-LEG AWG, OF HI-LEG 2,/0 Motors: 1 3/4 ti P 35 She--d L.%ne Per : This cerfificale musf not b~ al*ered in ~ny manner; re~urn to fh~ offic~ of the Board if incorrecL Inspacto[s m~y b~ idanfifiod b~ ~hoir ec~fffi}i~is. COPY FOR BU kD NG DEPARTMENT TH S COPY OF CERT FIC~TE t U ~ T NOT BE LTERE~NNER 765-t802 BUILDING DEPT.- INSPECTION~, FOUNDATION IST ~ ROUGH PLBG, FOUNDATION 2ND [ ] INSULATION INSPECTOR FIELD INSFECTION COMMENTS FOUNDATION I 1st) FOUNDATION I 2nd ) ROUGH FRAME & rLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 Examined..Q3~..]. I>.., 19~ .'~. Approved . .t37.~. ?..D.., 19~.~. Permit No.J.&-..Lt..~.'.9. '.~... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date 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 auth°rized inspect°rs °n premises and in building f°r necesT~7~~ .... ~.~~~.. (Signature of applicant, or name, if a corporation) /.7. .f. . . . . .:. . e. ......... /-~/ ,~ , , (,Mailing address of applicant) I7¢:/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ... :. .,rd.n. ........ Z:. & . . .: 3 7>. ................................. Name of owner of premises ~.~...~'-../77 .... ~.~}.(a,~s:th~.e/. /~Z/..?f.' .................................... t 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 .... .'~ZI¢'~. ~...~.~.2/.: ...... Plumber's License No ......................... ~0~" Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ....... ~.~.~..b(.. '.7-'~. ~: .z./. ~ ........................ · ......... A'?.p.,.'/z.:....: ............................... House Number Street Hamlet County Tax Map No. 1000 Section ..... .O.~ ...... Block....~...~.. ......... Lot ..... .~'~ ......... Subdivision ..... {,0 ........................... Filed Map No...4..~..X~ ..... Lot... ~,~_~ .~. ....... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... ~.0~..~.. ........................................... b. Intende. d use and occupancy . .'~.¢~. I0. 11. 12. 13. t4. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair: .............. Rem6val .............. Demolition .............. Other Work ............... ...~-:~ i (Description) Estimated Cost....~ ~ ~'..O. ::..oh'S.. ..................... Fee ...................................... (to be paid on filing this application) If dwelling, number of dwelling cnits ............... Number of dwelling units on each floor ................ If garage, number of cars ..... i ~14..~. ............................................................ If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure w!th alterations or additions: Front ................. Rear .................. Depth .................... '.. Height ...................... Number of Stories ...................... · ' ' ' ' t~.~.'..'~.4f~ ~.-d~R ~.~? ,~z.~.'.~.~(. pth ~....o~-.. Dimensions of entire new construction: Fron ear De Height .~.0 ........... Number of Stories .... ~ ................. ~ ............................... Size of lot: Front ........... ! ............ Rear ...................... Depth ...................... Date of Purchase /O. 7.7. ~. ~..~.. ............... Name of Former Owner,~?~,d/~.~ ~...D.~ 411F'~c~2~. ~.... Zone or use district in which premises are situated ..................................................... Do~s proposed construction rio!ate any zoning law, ordinance or regulation: ................................. Will lot be regraded ......... ' ............. ..~ ..... Will excess fill be removed from premises: Yes No Name of Owner of premises..~.44.~ ~.~'. ,,~. ~'.,~/,~-/~/~Address .~.o,/~.T~ .~'.~./.,~.. Phone N .o~/-.~'.~d.~. 77./~. Name of Architect .......... ' ................. Address ................... Phone No ................ Name of Contractor · . ./. ............ Addres ......... Phone ,--. . Locate clearly and distinctly all property lines. Give street and block interior or dorner lot. PLOT DIAGRAM buildings, whether existing or proposed, and~ indicate all set-back dimensions from aumber or description according to deed, and show street names and indicate whether STATEOFNEWkI~K,// ..¢V' ISS ' COUNTY OF..c:::~(-.--_--_--_-~... i ' ...... being duly sworn, deposes and says that he is the applicant ! (Name of individual signin~ contract) above named. ' ', He is the ................................................................................. , (C gent, corporate officer, etc.) of said owner or owners, and is duly autho-61~mt-tO'~erform or have perfomed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work w~l be perfomed in the m~n~r set forth in the application filed therewith. Sworn to before me this ............. ~ ....... dayo~.D~:~-.~/, / ,' ..... ,19~ Nota~ Public, .~ ......... ~ ...... ; ...~County ~ ~;~ ' m~ pumc, st~ q ~)~ ' ' ' ' ....... / '~/ ....... 5;. - 0' . SURLY FOR HEAL~ DEPARTMENT-DATA F~ APPRO~ ~ C~STRUCT ~.0 ~ ,Is e~H~F ~ THE TtTC~ ~tALDE~ W'~UHG' PROFE~ION'L ENGINE ER OP SUffOLK ~OUNTY ON JUN~ I~,I~G P~ FIL~N~ ~. HOWARD W. YOUNG, LAND SURVEYOR