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Home My WebLink About12757-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Zt2339 Date March 12, 1984 .,19... THIS CERTIFIES that the building .... N.e..w..D.w.e..1.1.i.n.g .............................. .B.a. yy.i.e.w.. Bo.a.d. ................................... Location of Property .3.78.9..N.a..i.n. Southold House No. Street Hamlet County Tax Map No. 1000 Section . .0.7..8 ....... Block ...3. ........... Lot ...5.2. :.1 .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated ·...Ng.v.e..mb..e.r' . .29 ..... ,19 .8.3. pursuant to which Building Permit No. 1.2. 7. .5.7.Z. .............. · dated .N. qy.e.r~..~ .r..2.q .............. 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 ......... ·.. N~.~ .Dw~.llin.9. .............................................................. The certificate isissued to Joel & Judith Whittington (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval 13- SO- 189 UNDERWRITERS CERTIFICATE NO ........... 6352.9.6 ................................ Building Inspector Rev. 1181 I~OB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, iq. Y. NO. BUILDING PERMIT CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~ z ~,.....~~~...~ ........... . ,~..~ ~.~....~-.~..~.. ~.~.~.~...~.~.~ ......................................... ,o .~.~....~..~...~...~~......~.~~.....~ ............ ~.~..~ ......................... , .......... :~ ................. .~ : ........ ?..~ ........ ~ ......................... ~ ....... ~, ~==,~,,~,,~ ~,....~..~a~ ...... ~.,~_~.~.~,.....~ ....... .~.~.~L& .... .... ...... ............................................................... Coun~ Tax Map No. 1000 ~ction ................................................................ Building Inspector. Building InsDector 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. 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 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. C. Fees: 1. Certificate of occupancy $5.00 ~ ~_/$ 2. Certificate of occupancy on pre-existing dwelling land use ~;/ 5.00 3. Copy of certificate of occupancy $1.00 Date .~1.~..~...~-r.V~.... ~..~.~.~.t. * · . New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location ofPrope ...... .... .... House No. Street Hamlet Owner or Owners of Property o ~_ u County Tax Map No. 1000 Section ...O..~. ~ ....... Block ....~. ......... Lot...~F..°~.'./. ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. I~..I. ~h.r~.~- Date of Permit ~.0~..~.0~ .~.~Applicant ~o..i~. ?.. Health Dept. Approval. ~/~Z~ .............. Labor Dept. Approvam --". .................... Unde~riters Approval ................... Planning Board Approval ................... Request for Tempora~ Ce~ificate ..................... Final Certificate .................... ~... Fee Submitted $ ~0 ~ Construction on above described building and permit meets all applicable codes and regulations. Applicant..~'. ~(,4.~_ ,.~.~ .~..~..~..(~...~..~.~..E..~...~.~'. ?... .............. Rev. 10-10-78 FIXTURE I FIXTURES I RANGES ICOOKING DECKS I OVENS I DISH WASHERSEfHT.A~ST ~AeN$ OUTLETS~ R~EPTAC~ SWITCHES i.CANDE~ENT FLUORE~ENT ~w ~T. KW ~T K.W. ~T. K.W. ~T K.W. ~T. ".P. 38 25 15 221 F ~ DRYERS J FURNACE MOTORS ~ FUTURE A~IANCE FEEDERS JSP~IALRECP1 TIMECL~KS I BE~ JUNITHEATERS MULTISTAT SERVICE DISCONNECT NO OF S E R V I sEev,c~ mSCOaN~CT ~,+~ C ~ ' OTHER APPARATUS: 1-G.F.i. 1-Smoke ~)e~ector Motors: 1-F. Three "C" Elect. Rt. 1 Box 45M Sound Ave. Riverhead, N.Y., 11901 LIC.#3327 GENERAL MANAGER This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials, COPY FOR BUILDING DEPARTMENT. THIS COPY OF CE __,~'~/~--~< __u__~ FIELD INSPECTION FOUNDATION (1st) COMMENTS FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY QODE FINAL SDDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION []FOUNDATION 1ST []ROUGH PLBG. []FOUNDATION 2ND []INSULATION []FRAMING []FINAL DATE INSPECTOR FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined· ~..t~....~...~.o..., 19~..3.. Approved J~).~....~....-X.o.., 19~.~. Permit No. I .~'.~..~ .~..~. Disapproved a/c ..................................... ............................... ........ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date N ~.~..../~/. ........ 19~?.-~ INSTRUCTIONS a. This application must be completely filled hi by typewriter or in ink and submRted 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 detafled 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 necessary inspections. .../,~ ~.~...~..-.~.s..i~¢. ........ (Signature of applicant, or name, if a corporation) · .f'.o...e.o.X....q:3~...4 .~.~ .~.: ~..~.T...N.: .,( .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...'~..~.~-~. ~.. ~..~.. ~. 9..~.. ~ ~'.~...~..,. ~ .~.. '.~.-~.k.'?.13.~.c'..~. ·O .~. .................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. .... .~ .o..~.~ .~.. k...a.?. ~.e. ~..:..¢~ ~... (Name and title of corporate officer) Builder's License No .......................... Plumber's License No...*7..f~..: ?. ............. Electrician's License No..~...~.?.: .~. ............ Other Trade's License No ...................... ~,,~ .g 1. Location of land on which proposed work will be done../V/~.' ./'].&,.,?l..~..,5'.¥~&~.. ~.l).-.. ~...37.?..~.-,/~.'~.' .. ,.,-7..'-/~.0 ............ m//.~.,.*../.~. ~a..~...a. t,... ............ .s?..4Z.,.~?. s.~. .... ~-.Y. ............ House Number Street Hamlet County Tax Map No. 1000 Section ...~. 9. ~) ........... Block ...,.,-q. ............. Lot. ,~. ~.Z..--....'~.~.e ./ .... Subdivision ...... ./Yq ?'..~. .... .~ .................. Filed Map No ..... /~. ........ Lot ..... .5(. ........ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...k(.. ?. ?. ?. 75.-~..: ........... ' ...... .' .................................. b. lntended use and occupancy · · .O..~..~.....~..a?..~. ~..~..W'..../). ?'..c~(,.~.( .e~..6... ............................. 3. Nature of work (check which applicable): New Building v// Addition Alteration Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost .... ~..~..O..~. q: .o..o ..................... Fee . ). ~ ~ :.c~ .Q .......................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....~. .......... Number of dwelling units on each floor .'~. q~.-. ~ .u..P ..... If garage, number of cars .. ~: .~ ~ ................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of, o,~fj~fisting structures, if any: Front..~r~. ........ Rear .~[~.. ........ Depth ~ .......... Height ... ~[~.'. ....... Number of Stories . .'~J~ ................................................... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ......... ., ............ Number,of Stories ....... ;... y .......... 8. Dimensions of entire new construction: Front . . .~.~e':.., . .... Rear . ,:,~.~.: ......... Depth g,T~o° ............ Height ...~..3 ......... N~mber of Stories 'I~' ' ' 9. Size of lot:Front ..... S.O .............. . 2~.7'................ ............... ~);3[t~ i~',-~i~.'5 1 10. Date of Purchase ............................. Name of Former Owner ............................. 1 I. Zone or use district in which premises are situated ..................................................... 12. Dobs proposed construction violate any zoning law, ordinance or regulation: .. ~..~. .......................... 13. Will lot be regraded .... ?~.d. ..................... Will excess fill be removed from premises: Yes No~ 14. Name of Owner o f premises-iq .~...~.//t../~../tY .t'Y.~.rY. Address ~/~.Y'.~./.~',~.'x~T~hone No. ~ q~ ~ - - · Name of Architect ........................... Address ................... Phone No ................ Name of Contractor ~n ~.e~..~.~..~.~. ~ A/~.~,'.~ / .~.~. Address~..~.,g'..~/J.q..d.~. Phone No. ~.~..'..~..~'..~-~./... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, an4 indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~qK~, ~ /..~ ~q · ~ CO NTLOF,' Z- 2--;r, ..... ~ I.~. ,o~C~. ~..0...~ .... ,. ........ being duly sworn, deposes and says that he is the applicant (Name of individual signing c~'~'lrtmct) ' above named. He is the ................... .iTt'...~..~.~..4 .~.c,..'~..a.~.. ................................................... (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 Nota Public ............... County ~ ~' Nol~ PO~L)~, State of Hew Verl~ (Signature oI applicant) NT~;m Ex~ires MarchSuff°lk30. C~,g~.952-8125850. ~ Fl "~-E fqO, T~?~E~!-2590 D/MFU .~ F(~J~. EFLI~"V'ATI~MS O7 If copper tubing is used for water distributing system~ piping shall be of types K or L only AP;?::C _;) AS NOTED NO~I~01LD[NG DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGN ~ FRAMING & pLUmBING 4. FIN41 - CQN'STRUCTION MUST ALL CQNqTR'JCTION SHALL MEET THE RFO~UREMENTS OF THE N Y STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS,