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Home My WebLink About12791-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13166 Date Jan. 23 ................................. 19 85 THIS CERTIFIES t tl Accessory tha ~e building ................................................ 2100 Jackson St. Location of Property 450 4th Street New Suffolk County Tax Map No. 1000 Section 117 .Block 10 ..... Lot 018 Subdivision ...... X. ........................ Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated Oct, 26 19 .8.3pursuant to which Building Permit No. 12791Z dated Dec. 8 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 ......... Accessory Storage ( Two Car Garage) The certificate is issued to WALTER GLASSER (o wrier, ~s~ ~ of the aforesaid building. Suffolk County Department of Health Approval N/A N671622 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 l~Ou~e' NO. ~ T~Y~ OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12791 Z Permission is hereby granted to: ......... ~4~.~z~....~... ~~ ... ...... ~. ....... -/~.~. ........................................ .... ~/~J.../.....~.~.~.~..=....~.....~.. ,o ......... z7. ~..~/..~......~~j~ ........... ~.~.~...~...~. ....... ..~.~.~......z~.~.. .............. . .~.~.~..~....: ............................................................................................................................. at prem,ses located at ....~..~..~.~. ........... .~........-~'....~....~/:...~/./.~.~......C.'~--~?~)~,...,~,~/., ........ County Tox Mop No. 1000 Section ...... /"/"]t ........ Block ..... /.~.. ......... Lot No...~../.~..[-~. ........ pursuant ,o application dated .... .~..CZ.~........~..~. ......... , 19~;-4 and approved by the Building Inspector. Build[rng 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 tilted in wpewriter OR ink, and submittedr--i~:d~[';cctc 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 Hea{th 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 19§7), 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 3remises, 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 --?re-E×±s t±ng C. 0. 3. Copy of certificate of occupancy $1.00 ~ Vacant land C.O. $15.00 $ 5.00 New Building ...,~..-. . or Pre-existing Building ............ Vacant Land ............. Locat on of Property-- /r o 4 e oo House No. Street Hamlet Owner or Owners of Property ............................................................ County Tax Map No. 1000 Section .. (I.~ .......... Block .../.~. .......... Lot. I Subdivision ................................. Filed Map ....................... Health Dept, Approval ........................ Labor Dept, Approval ........................ OnderwritersApproval.~..~.~'.~..~..~.~... ....... Planning Board Approval ...~ : Request for Temporary Certificate ..................... Final Certificate .............. Fee Submitted $ .~. .......................... Rev. I0-10-78 Construction on above described building and permit meets all applicable codes and regulations. 1000314 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ 85 JOHN STREET. NEW YORK, NEW YORK 10038 THI~ CE~IFIES THAT in the follow~ng location; ~ B~e~nent ~ 1st FI. ~ 2nd FI. ~0 ,Section Bilk was examined on D~ ~0 ~ ~ and found to be in compliance with the requirements of th& Board. RXTURE IR C~P FIXTURES RANGES OVENS EXHAUST FANS OUTLETS E TACI.ES SWITCHES $ DRYERS E R V I B~J. Elc~ct~¢ $~&illwa2~c Aven'o~ Cutoho~e,~ N~Y. t~gSo GENERAL MANAGER ~This certif ~'e~: , = COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANN_ER ...... ~IEL~ INSPECTION DATE COMMENTS FOUNDATION ( 1 st) FOUNDATION ( 2nd ) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ADDIT CO NTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined~.~. .~.~ ....... I9~? Approved 'i~..~. ...... , 't9?.4Permit No. Disapproved a/c ..................................... spector) 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 approvai 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 ~e~oval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building ~o~, h~fising code.=,a~d regulations, and to admit authorized inspectors on premises and in building for necessary inspections~,/~\ ~-~ ~-~(.ffX',/ ..... · ............ ....... (Signature of applicant, or name, if a corporation), ..... .... (Mailing address of applichnt) general contractor, electrician, plumber or builder. State whether applicant is owner, lessee, agent, architect, en~neer, *' (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Plumber's License NO ......................... Electrician's License No. Other Trade's License No ...................... ~. ~ ~,'~'1 tr~ t~ 1. Location of land on which proposed work will be done. ~ ~ '~am~ al(~- ~t.\~ £~ r~ House Number Street Hamlet County Tax Map No. 1000 Section t [ 7~ Block 1 0 Lot. ~C[ [ ~ Subdivision .................. ~. ~ ................. Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~fM~.. ~.~ ~...~//~ ........... - .......... b. anrended use and occupancy .... ~ ............. fi. )... ~ .~ i ......... ~'.~x ::~'~ ~ ..................... 3. Nature of work (check which applicable): New Building ....... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost ................................ ee ............................ (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 ..... .~.O ............................................................. 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 ............... Number of Stories Height ....................................................................... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ..................... i' ' Height ........... v .......... Numbe[ oft Stories .......... t .......... 8. Dimensions of entire new constrUction: Front .... .~./~ i, ..... Rear . .~. ~ ......... Depth~ . .~..~ ........... I-[eight ...~ .~.' ......... N,umber of Stories ... ~ ........ } ......... ~ ................ · .............. 11. Zone or use district in which pr~mises are situated ~e.J.~ .1%. ~t.~l ................... ~ .................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................... : .... 13. Will lot be regraded ..... 10.°. . ....... Will e~cess fill be removed, from premises: ~s No Name of Architect ~ Address Phone No Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM interi¢)r or 1 Locate clearly and distinctly all! buildings, 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 corner lot. STATE OF NEW YORK, i S.S ~ COUNTY OF .................. (Name of individual signing contract) being duly sworn, deposes and says that he is the applicant . above nara~ed, u,~, He is ihe~.~. · ........... ~ ................................................................... ~ (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 conthined in this application are true to the best of his kno~vledge and belief; and that the work will be performed in the mann6r set forth in the application filed therewith. Sworn to before me this ..... .C~..~..Q~ .......... day o i ...~)...~.7-..O...~..~..~. ..... 19 ~..-~ .~.. ~ ~~ , ....................................... - Ou..alffledl.n.Suff.~ ~a~y~[--' (Signature of applicant) ?* , lerm P. xplre~ Mar~h ~