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Home My WebLink About12732-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 ...... A.. gg.e.s.s. 9.fY ............................... Location of Property 5200 Nassau Pt. Rd. House No. Street Hamlet County Tax Map No. 1000 Section . . .1. 1..1 ...... Block . . .Q 8. .......... Lot . .0.~.5. ............ Subdivision..N.a.s.s, ,a.u, .?L.: .C.l.u.b.. ?.r. qp, ...... Filed Map No, .1.5.6. .... Lot No...1.4.6. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .... 9.c.L.: ..... 2. .7 ..... , 19 .8.3. pursuant to which Building Permit No. 12732.7. dated .............. N..o.v......4 ......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 ......... .... Ac.q~ ~.o.r. yr~.z~.r' .q~.r.ag.e. ..... N.O, ,NT,H.A.B..I?.A.B..LE.,..~tgragq...O.N. LY ........... The certificate is issued to ................ D.A.V. ID NOLAN (owner, of the aforesaid building. Suffolk County Department of Health Approval .~.. [ .~.. UNDERWRITERS CE RTIFICATE NO .................. I~16 .4.8.8. 0 $ ........................ Rev. 1181 Building Inspector I~ON,~ NO. ~ TOWN OF $OIJTHOI. D BljILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~ z ~o,, .... .~.~.~......¢ ........... ,~,..~.~ Building Inspector, Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ,?,outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in tvpewriter OR ink, and submitted ±n dupltothe 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. B. 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 propertv 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*existJng dwelling , 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 New Building ..... X. ....... Old or Pre-existing Building ............ Vacant Land ............. Location of Property 5200 Na.ssau P,t,. Rd. .~.u.tp. ho. gp.e, House No. Street Ham/et DAVID NOLAN Owner or Owners of Property ............................................................ County Tax Map No, 1000 Section 111 Block 08 Lot 15. ....... S.h~;%,l~inn Nassau Pt. Club PropertiesFiled Map No. 156 .Lot No. 14.6 Amended Map - A PermitNo 1.27.3.2.Z Date of Permit ,~,/.4.~.83. Applicant .... Health Dept. Approval ........ ~',A, ............ Labor Dept. Approval ........................ .N64.8809 d App Underwriters Approval ...................... Planning Boar roval ...................... Request for Temporaw Certificate Final Certificate ~ . . Fee Submitted $ 5.00 F~ELD~'iNS?ECTiON FOUNDATION {1st) COMMENTS FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK. NEW YORK 10038 THIS CERTIFIES THAT David N~u Point Eo~d~ Van~ton was examlned on J~le 1% 198~ and found to be in, compliance with the requlrements of thls Board. FIXTURES FIXTURE SWITCHES OUTLETS FLUORESCENT VAPOR ? i RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS DRYERS FURNACE MOTORS FUTURE AP~UANCE FEEDERS TIMECLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO:OF~FEET DIMMERS SERVICE DISCONNECT S E R V I C OTHER APPARATUS: Pm~etboex~ ±-7c:~c~ l~5~nps~ A, W.G. NO. OF HI-LEG OF CC, COND NO. OF NEUTRALS OF NEUTRAL A!e~uder G~ Hub 'b~u Box 222 Aqueboque~ N.Y, tl~k~l L~Lc. 3C~ GENERAL MANAGER Per- ll This certificate must not be altered in any manner; return to the office of the Board if incorred. Inspectors may be identified by their crede'nhals. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FORM NO. 1 TOWN OF SOUTHOLD gUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL,: 765-180:3 Approved ...~.o...I.,5~..~..L[.., 19~.~.. Permit NoJ..~.~..~..~.'~.... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ........ L~/~.)I I,: 9 }] 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. e. 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 regulation?, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ............. .~).C~.././~. ...... .~f..0.k...,~..~. ...................................... (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 .......... /./. ?..O..~..~.~. .... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. nocat,o, of land on wh,ch proposed work wall be done ........ ~g.~??.~..r~...*:.'%'.tt.....'r. ............. ..... ,,5. 9. .............................................. ............ House Number Street Hamlet Co.n. Tax Map Xo. 1000 Sect:on' ' ....... Ill ......... Block ...... aS.. ......... Lot ......... / .~. ....... Subdivision..~.. ~.-~. ~%.%-....//!?i(..~t./-!-5.'~k. ./L.fl.~;~;~): Filed Map No ..... /..~r.~..~..~.... Lot.../.(~. ~ ...... 2. ' te existing use and occupancy of~pi:~mises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... .~.'./~..~.~t..~..~.~7. ..... :~...~. './~.~?'. f~..~.~.-.'~.. ........................ b. Intended use and occupancy . ./_~ . :.'~. .... . ./~..~/'~: ,.5/"tT/e~.../5~...L..q. ............. 3 Naturd of work (check which applicable): New Building .. ddition .......... Alteration .......... Repair .............. Re.re?al ............. Demolition ..... ~ Other Work ............... fi3~. : -~-o ~ (Description) 4 Estimated Cost .......... ~J~.! .~.~..~. · · · · .'~-. ........... Fee..~.~.,./..0.....~. ........................ (to be paid on filing this application) 5. If dwelling, number of dwelling iunits ............... Number of dwelling units on each floor ................ number of cars If garage ..................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any' Front ~ ,~ C> . Rear ~ O. Depth ~.~ .......... Height .... 2./. f ...... Number of Stories ..~-... Dimensions of same structure with alterations or additions: Front Rear .... Depth ...................... Height ...................... Number of Stories .................... 8. DimenSions of entire new const~uctinn: Front .... 2, 2~ ....... Rear ... 2~ .~? ........ Depth ...~...~. ...... Height ...... ~.~i~..* ..... Nmfib~ of Stories ......... i.../ .......................... ~ ...... > ....... 9, Size of lot' Front ........ · ,'--' · ':, ............. .c~ .~. .......... ep ..... -~. ............. 10. Date of Purchase ....... .--2. ,Z .~. ~..J .............. Name of Former Owner .... ~.~/..~../~'. ~,~..~?....Z~.~.--.~ .~- 11. Zone or use district in which pr?mises are situated ......... 12. Does proposed construction vic!ate any zoning law, ordinance or regulation: ............... J~ .O~ ........... 13. Will lot be regraded ........ !~. ~. ............ .... Will excess fill be removed from premises: _ Ye~ N~ 14. Name of Owner of premises . 1~,~-.~.1.17..~.~.. Address ./~..~. 76~'t...~6./..~..~Phone No...~t.~.~,.~: .~..~.?~1,.. Name of Architect . .~..[I.~...:: ~.td[/~O/.M. 6..~.q.t~. Address . ~.~.fl....°;...t~.q .t?~..L~'.. ,//Ad. ~hone No .... ?~..77~.6. ?.O. Name of Contractor . .tCL.~..~..-~..~'.~.. q.57.~/..~..-?. Address d~.~...raY. 2.. ~.~.~?(~EPhone No... 7.~. ~.'7.J.~.(o [.. PLOT DIAGRAM Locate clearly and distinctly alll buiidings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF :NEW YORK , COUNTY OF..~.q .~.~.'.~.~'; ....... S.S .... Z .l . . .u.) .... >' ............. (Name ' of individual sign.lng contract) above named. being duly sworn, deposes and says that he is the applicant He is the ..................... (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 contoined in this application are true to the best of his knowledge and belief; and that the work will be performed in the mann{r set forth in the application filed therewith. Sworn to before me this , 47...'Y. ;" ..... ................. day o ........ Notary Public ...... .,~:. ,~ .-... ~ L)NDA F. KOWALSKI ~IOTAP~¥ PUBLIC, State of New Yorl¢l~ No. 52.4524771 ........ Qualilied in Suffolk County ~ Coramission Expires garcl~ 30, 198~ / Of applicant) :/ INOTE: "=MONUMENT FOUND 0 YOUNG & yOuNG CLIFFORD ,JAMES EVERT I~ GERALDI NE EV~T, ~ ~., N.Y. i® A~7.1Li ~ A5 NOTED ~ ,FOUNF'AT ON - TWO REOIJ[RED 4"co~c R~ ) L -'1 'i SGALE DATE' APPROVED BY