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Home My WebLink About12779-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .................. Date October 29 19.8.4 Z12943 ................................ , . THIS CERTIFIES that the building ...z..ng?.qu..n.d..s.w. $.m.m.~.n.g. ~p.qo. $ ................... Location of Property ..... W..~.n.t.h.r..o p..D.r..iy.e ...................... .F.i.s.h..e .v~..3:~ .1.a.n.c]... House No. Street Ham/et County Tax Map Ho. 1000 Section . 09 ......... Block ... 09 .......... Lot ..... 1.7. .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated ..... .0 9.t'.... ! .2 ......... 198. 3.. pursuant to which Building Permit No.. J .2.7. 7. ~ .Z ............. dated ..... I) ? ¢.... 2 ................ 1 ¢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 ......... Ingrqund swimming pool. The certificate is issued to William & Patricia Faulkner of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO ................. t~ ~I.6.5. ~ (3 9.1 ........................ Building Inspector Rev. 1/81 TOWN OF SOUTHOLD r Building Department Town Hall Southold, N.Y. 11971 I ~__.._~.L.D~. DEPT. 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 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 Enginee~~ responsible for the building. 5. Submit Planning Board approval of completed site plan requirements 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. Fees: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date,..-~.~..-~..~.~J... ......... New Building ............. Old or Pre-existing Building ............ ,~,ae~c-E¢~5~../~..~.?..Z.~.,. Location of Property ................................................................... House No. Street Hamlet Owner or Owners of Property .,(.~.~/.~ .~././~//'.,., ~../~'~. ~'~? ./~..~/.'/~.....~.~. ~¢./.Z..x~j~//.~/.~ r,. ......... County Tax Map No, 1000 Section ,.. ~, .......... Block ,..~. .......... Lot.../..~. ......... Subdivision ................................. Filed Map No ........... Lot No.~/~'c/,?./~.~..'-Z.'-. ~'~ .... ?F~:.~.Applicant ~¢~;~. Permit No./'.'~).'?:?;~.. ~' ~ ~ Date of Permit Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificat~e ..................... Final Certificate ...................... Fee Submitted $....~..~ .~'~ ~). ................... Construction on above described building and permit meets all applicable~od, es and regulations. A p p I ica n t .~.'¢ .~./~,~.~ ~-.¢/./. ' .~.~..-¥ ./~.~. ¢~.~.' ..................... Rev. I0-10-78 BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CE~IFiES TMAT only t~ e~t~ equip~nt ~ ~cdbed be~ a~ i.t~ by t~ appNca~f na~d on the a~e application numar in ~ premises of ~n the followin~ location; ~ Basement ~ 1st Fl. ~ 2nd Fl. ~i~ Section Block FIXTURE OUTLETS ~ECEPTACLES SWITCHES DRYPR$ 14, 1984 RX?OEE$ and found to be in compliance with the requirements of this Board. RANGES OVENS SYSTEMS S E R V I C E NO O~E~C, ECOND A.W O A.W G, NO OF NEUTRAl A.W.O, OF CC, COND NO-OF HI-LEO OF HI-LEO OF NEUTRAL OTHER APPARATUS: 1--G.P.G.i. l~ Nia~ic River Rd. Waterford, Cf'. 08385 Li¢#$160 ~HE~L ~NAGER,~ This c~rf~fic~fe musl nor be ~lf~r~ ia ~ny monn~r~ return ~o th~ off~ce o~ the ~rd i~ incorrect Inspectors moy be iden6fi~d by their COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. TOWN 0{: SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHO~D, N. Y. Approved Disapproved a/c Application No ............................... ! '>~ ,( ui ding Inspector) APPLICATION FOR BUILDING PERMIT Dote ..... ..................... , INSTRUCTIONS o. This application must be completely filled in by typewriter or~ in ink and submitted in triplicate to the Buildin Inspector, with 3 set~ 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 p emises or pub ic streets c( areas, and giving o detailed description of layout ofproperty must be drawn on the diagram which is part of this opplicatior 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 issue a Building Permit to the applicant. Such perm 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 o Certificate of Occupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for lhe issuance of o Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describec~.~ The applicant agrees to comply with oil applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and ir~ buildings for necessary inspections. (Signotur~b/of applicant, or nome, if a corporation) (Address of ppplicq~) State whetber/;_) applicant is owner, lessee, agent, architect, engineer, general, contractor, electrician, plumber or builde, ..... ~.~/-~,:~. ,-~.:.f.4,,' Nome of owner of premises ................................................................................................................................................... If~ applicant is a corporate, signature of duly authorized officer, (Name and title of corporate officer) Builder's License No ........ ./..~.'.~.'. ................................. Plumber's License No..~..~....~....:..~.. ........................ Electrician's License No ........................................... Other Trade's License No ................................................ . ,. ..... . Location of land on which proposed work will be done. >Agp No.: ................ Lot No. Street and Number (.,~/,L~.t'.~.L(~-~.~,~...~,.~}~n.~,.......['~.~:X~'~,Vz~..c~:.~.~.,~fZ. .................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ,.~,~4~;R~.~ ............................................................................................. -- ,.:.,~,., ~ .......... ~'"'~'""'"'/ ,, ' . b. Intended use and occupancy .~,l~/~4f...) ..... ~ . ~..~.- 3. Nature of work (check which applicable): New Building .................. Addition ............ ; ..... AI.teratior~ ~ Repair .................. Removal .................. Demolition ................. ~ Other Work 4~/,.,Z/~.~2~'./L..~..'~x.~. .......... ~, '~ '~ ~- i (D~scription) 4. Estimated Cost' ..... .~.~/.~ ........................................ Fee .................. (.-~. ......... L ........................................................ (to be paid om filing this application) 5. If dwelling, number of dwelling units ............................ 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 ............ L ................... 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 ................. , ........................................... , ......................................................... 9. Size of Iota Front ........ ..~,.r~.~.~. ................................... Rear .......... ,~.~...~. ......... ] ............. Depth ..~-...~../. ................ . . e e ................ I0. Date of Purchase ..~.~.c~..;../..~.../..,,~'..x~-.... ................... Nam of Former Own r, 11. Zone or use d strict n wh 'ch premises ares tuated .~X/.~.~;~.~r~"~.. ...... r:~i/, .................................... i ................ 12. Does proposed construction violate any zoning law, ordinance or regulation:: ....~..~..~.: .......................................... 13. Wdl lot be regraded . .................... ~ ...... Will excess fill be removed from premises. (~") Ye,s ( ) No 14. Name of Owner of premises ~..¢~. ......... Address ..~. ono No.~.4~:2~/..:,7.~ Name of Architect .................. /,! .......................................... Address ............ /.'...: ................ Phone No. :/' Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorr property lines, Give street and block number or description according to deed, and show street names and Indicat~ whether interior or corner lot. STATE OF NEW .,Y-ORK, ~ ~z ~ c ¢ i...~... ................... ..~/~ .............. ~ ................................. being duly sworn, deposes and soys that he is the applicon (NamdYof individual signing contracf) above named. He is the .......~.....~f(A~T..~ ..................................... ~ ................................................................................................ (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 fih this application; that all statements contained in th s application are true to the best of his knowledge and belief; an~ thor the work will be performed,in the manner set forth in the application filed therewith. Sworn..,,~ -~;~-t° before me this C~)~0 ~-~''~'~ ,/~_~/.//-,/ Nota p bl,c,. ................ Coun ...... ....................... (S, tureofapp',cant) ,