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Home My WebLink About12718-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N.Y, Certificate Of Occupancy No.Z]2729 Date August 28 .......................... , 19 84 THIS CERTIFIES that the building ...... P. 99.1. . a..n .cl..~. e..n .c.e .......................... 2386~ Mai~ Road Orient Location of Property h36s'e'tv'o; ..................... 's't/ebi ...................... hb3iei County Tax Map No. I000 Section ............ Block ............... Lot ................. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Pen'nit heretofore filed in this office dated ·.. 9c.~.. .~ .8 .......... ,19 .8.3. pursuant to which Building Permit No...!2. 7.3.8. Z. ............ dated .... ~.o.~.... ,q ................. 19 ~.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 ......... Residence with pool and fence. The certificate is issued to .......... G.? p.f.p.e. ¥..a.n.~, .H.o.~.e..n..P.p. gu..d ...................... (owner, ~,I~X~X Y~ObYJ of the aforesaid building. Suffolk County Department of Health Approval ....... ~./?. ............................... ~)N6~6831 UNDERWRITERS CERTIFICATE NO .................................................. Rev. 1/81 Building Inspector TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12718 Z Date ....~.~.. ....................................... , Permission is hereby gronted to: ............................. ....................... ..... ...%~..:.......~.~ ........ ~ ............................ '. ..... .... .~.~....~.....~.,.....L!..~...~..~ .... to.. ~.........q~.~.........~-.... 2~...~....~... ............................. ;~....~ ................... .... 1~ '~ ............. ~ ................................................................................ ' .................................. at premises located at ...~..'.~...?..~....~.~ .......... ...~.~,;.....~...l....~.~ .............................. County Tax Map No. 1000 Section ........ J...~. ......... Block ...................... Lot No ......... ,,~, ............ pursuant ,o application doted .... .(~..~.....~,.,~. ................ , 19..~..~ and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ~outhold, 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: I. Final survey of property with accurate location of all buildings, property lines, streets, and unum]al 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), ~Jon-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 features. 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. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land use 3. Copy of certificate of occupancy $1.00 --Pre-Existing C,O, $t5.00 Vacant land C.O. $ 5.00 . va~e ....... ~ o , . 4 ............. New Building . ,~, · ,~? ..... Old or Pre-existing Building ........... Vacant Land ............. Location of ProperW .......... ~,, ............................................. /~;r~/;~ House No, ~, Street .~-~ ~ Owner or Owners of Proper~ ........................................................... .~., .~ ./. ~ ~ County Tax Map No. 1000 Section ............... Block ............... Lot...~.t. ......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No../~, . .~Date of Permit . ,l .Applicant . ,~... Health Dept. Approval ............ ~** .~.~.~(~.~1 ........... Labor. Dept. Approval. ........................ Underwriters Approval ......... Planmng Board Approval ..................... Request for Temporary Certificate ................ ~Final Certificate ................... TOWN OF $OUTHOLD ....... THE NEW YORK BOARD OF FIRE UNDERWRITERS 8~ JOHN STREET, NEW YORK, NEW ~ORK I003e THIS CE~IFIES THAT only the electrical equipment ~ ~scrlbed be~ o~d introduced by t~ ap~l~can~ na~d on the able applicatlo~ number in the premises of ~f~rey ~ Mai~ ~, Ta~>r &!latt ~, O~t, ~.Y. in the followlng location; ~ Basemettt ~ 1st FI. was examined on M~~ l~ ~0~ FIXTURE OUTLETS DRYERS ~ 2nd FI. Outside section Block Lot and Jound to be in compliance with the r~cluirements of this Board. FIXTURES RANGES OVENS DISH WASHERS FANS SYSTEMS NO. OF FEET E DIMMERS E R V I C ~ OTHER APPARATUS: 1-G. F. C. I. A~t hut Ruroede $~in Road Orient, N.Y. 11957 GENERAL / Per_ 11 This certificate must not be altered in any manner; return to the office of the Board if i~cor/ect. Inspector~ may be !denfified by their COPy FOR ~UIL:DI~G DEPARTMENT. THiS copy OF C~R!!Fll ' BE~ ALTER, ~;O IN AN~ MANNER. FIELD INSPECTION COMMENTS FOUNDATION Ilst) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qOD YJ FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION REMARKS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved .~~..~1., 19"~t Permit No../..~.~. ~ .8'i~. Disapproved a/c ...... ' ............................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 throu~aout 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 necessary inspections. .... -:.']6 x . . l q 2:, . . ...... (Mailing address of applicant) State whether applicant is owner, lessee,~age~, architect, engineer, general contractor, electrician, plumber or builder. (as on the 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 .......................... Plumber's License No ......................... Electrician's License No. /~.. ~....~. .... ~.~.~..t~.~ - Other Trade's License No ..... ..~.. ~.'.. .......... Location of land on which proposed work will be done ............ Subdivision ..................................... Filed Map No. 77. ....... ] .... Lot .. ~ ............ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Existing use and occupancy ~ .~...~.f !4'~./d/~ ...: . ......................... bl Intended use and'occupancy' i :.i ~.'.~.:i:i~.~'..:.ii .......................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... phi Re r .............. Removal ...... Demolition Other Work 4. Estimated Cost Fee ~r...~-. ~../. ~ (to be paid on filing this application) /. 5. If dwelling, number of dwelling [units .... ~ ........ 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 structures, if any: Front ..... ~..~. .... Rear ... ~ .~.~. .... Depth Height .... /t~ ....... Number of Stories .... ~ ................................................. Dimensions of same structure wlth alterations or additions: Front ................. Rear .................. Depth'. · · · ;.. Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... tteight ............... NuMber of Stories '. ................................. 9. Sizeoflot Front .-~..~.....~ ........... Rear ..... ~.0/~'?. ......... Depth 10. Date of Purchase ..... /. ~].'2. ~ ................ ~me of Former Owner ....-~-r.. ....................... 11. Zone or. use district in which premises, are situated .... ~...~..~ ~ ......................................... 12. I ocs proposed construct]on violate any zoning law, ordinance or regulation: .... ~..O. .......... J.--z--_--_--_--_--~ ...... 13. Will lot be regraded . .t~.~..O..~_. .................. Will excess fill be re.m, oved from premises: Y(~.~_ No 14, Name of Owner of premises . .~.-~.. [2/~ ~0 .... Address/~./~...~.~.~.~.~.q4'*:~'7... Phone No.~,~.3. 7' .~.~ ~. ~,.~. Name of Architect.,.: .... ;i ................ Address ................... Phone No ................ . Address/~.,~e~. ~d~..,/]~../D. .... Phone Name of Contractor'S,..~. ~.,~.ff~/;. O-. ~'~. · . NO. ~.~. ~! ......d PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block ~umber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEWff¥OR, K, - ~ S cou ¥ ....... ~. ~.b". o(..': · · a. r ."e4'>x'~4 .~q. · ............ being duly sworn, deposes and says that he is the applicant (Name of individual signmg----conlract) above named. He is the ...................... i ................ ~ .......... ,; ......' '~ ............................ i (Contractor~corporate officer, etc.) of saki 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 . .... ......... ...... Notary Public, . ....... ~. ............ County ' '~/~~;~p~licant, No. 52,81258511, Term E~pires Nlarch 30, lO