The URL can be used to link to this page

Home My WebLink About12503-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13123 Date ............. J~a.., , 10 ... 198..5. THIS CERTIFIES that the building ....... .P.o.o..1 .................................... Location of PropertyHouse'' 1..59No.,5 ................ .P.a.r.k. w. .a ~.street .................. S. o. .u ?.h.o. 1.Ham'd' ' ' ie; County Tax Map No. 1000 Section ... Q 7.0 ...... Block . ..1. 1. .......... Lot . .. 0..1.7 ........... Subdivision .... S.c..u.t.h...W.o.o.d. ............... Filed Map No.. ~2..1.4.1..Lot No...5.1. ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated June 20 19 83 pursuant to which Building Permit No. 12503Z dated ...... .J.u..ly .... .2 .3 ........... 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 ......... Round Inground Pool The certificate is issued to ................ C.~.b.~.°.~.~.?.~.. ~.b.D.~..~.F.~. .................... (owner, I~ee~a~ of the aforesaid building. Suffolk County Department of Health Approval .......... IxJ../.~ ............................. UNDERWRITERS CERTIFICATE NO .................. IxJ.~ .5,5.9.Q .5 ........................ Building Inspector Rev. 1/81 FOF, M NO. ~ TOKYO1 OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12503 Z Permission is hereby granted toL ,~ /.~..~-.........~...g~.~...~ ......................... ..~.~~.~.. ......... .~.....~. .................... ~ to ...... i at premises located at ..... .J...~'.~'-.~...~.....~...~....~......--~.....-,.~. ....... ,~.~; ..~...-. .................... Map No. 1000 Section ...... ..(~.....~....Q ..... Block ... i.I. Lot No (;~,.~. County Tax ......................................... pursuant to application dated ........ .~.l, drnC~.....~'~.~. ................... , 19..~.~.., approved by the ~j Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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. Approva~ 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. Su bm it P lan n in g Board approval of comp leted site p lan requirements where appticable. 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 g'r land use 5/5-/ $5.00 3. Copy of certificate of occupancy $1.00 ~ New-B~:fi/ltj~: ..... ~... O~d or Pre-existing Building ............ Vacant Land ............. Location of Property .I.~-.O. ~-.~ ...... ~.~...~..¢~.~.. ~.)..~.? ............... % .~. ~;. '.T. 'F~ ~b ~_ .t) ....... House No. Street Hamlet Owner or Owners of Property . .~.1~..~,~.~..~..~..-~' .~...V~.( ..... )~ ~,~i ~ t~-~. ~ ~ ~ .............. County Tax Map No. 1000 Section ,.. {5.~...~. ...... Block ..... I1.1 ......... Lot ..... (~ ~.'~ ....... ~- c -~ -¥ ~, .~.' c .~:~. ~ ~'.~... Subdivision...~ ......................... Filed MapNo..~)~...LotNo ......... Permit No. ~5'O } .'~. Date of Permit . ~14~/~-).Applicant .~')~T.'~. ~.'. ~ A~ ~5'~R,~ Health Dept. Approval . .~.~ ................. Labor Dept. Approval .................... Unde~rit~rs App~r~l . .Plannln ............ equest fo Temp y ............ Construct~o~n above described budding and ~ermi~ets all apphcable~,~R~[~ FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CpDE FINAL DATE COMMENTS ~l~ ~ , ADDITIONAL COMMENTS: 7GS-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND £ ] INSULATION [ ] FRAMING ~] FINAL REMARKS: - ~q , ~ ~ , INSPECTOR ~/. (~-,~- THE NEW, YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY I~l~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~.te ~'~ ~-, l~ ~,,pli~..o.~o.o.~ile ~llZ/,~ N 655905 THIS CERTIFIES THAT o~y the electrical equiptnent as ~scrlbed belo~ and introduced by the applicant named on the ~bove application number in the premises of in the followlng location; ~ Basetae,¢t ~ Ist Ft. ~ 2nd FI. ~Si~ Section Block Lot ~1 was examined on and found to be in compli~,~ce with the requiren~ents of this Board. FIXTURE OUTLETS DRYERS FIXTURES RANGES OVENS EXHAUST FANS SYSTEMS NO. OF ~EET E R C OTHER APPARATUS: ~IING P(XJL,: This c~r~tfica%e cover~ coa~lia~ce st the da~e o£~ in~eotlon only. b-f--~}[~ironmants it i~ advisable to have frequeat tes~ and/or rep~i~-s nk~te by a q~%lif led persom 1~ P~'~ ~'tay (ii.D// 1 ~oathold, N.Y.. 11~71 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspector_s may be COpY FOR B~J!LDING DEPARTMENT. THIS COPY OE ~l ANY MANNER. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved . .~, ~ .~.~..., 19~.,~. Permit No. ]..~. ,~. ,O..~..~ Disapproved a/c (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No.. ~, ,~: .~'..0..~. ~ .... INSTRUCTIONS a. Tlds appilcation must be completely filled in by typewtiter 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 apph- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Bnilding 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 necessaw i~pp~pions. ~ (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 ~~~w~w~-.~.. ............................. (as on the tax roll or latest deed) ~,~ If applicant is a corporation, signature of duly authorized officer. }'~ ¢"/'"~ .............................................. ' (Name and fitle of co~orate officer) ~'~ ~ ~.~ Builder's License No...~. ~..~ ....... ~ [ ~ ~ Plumber s License No ......................... ~ }~ Electrician's,License No ....................... Other Trades License No ...................... /.>~7~ tlon of land on which proposed work wxll be done ....... ....: .... ' ' Street ' ~ ................. Hous~Num her Hamlet 0 Section ...... ~.~ .O. .... Block .(.( Lot County Tax Map N9. 1 ~ .................. ............ ..... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed constrhction: a. Existing use and occupancy ... ~ ...... ~..~~ ........... b. Intended use and occupancy .... '~'~'-~" '~''t' ~ "~ ........... 3. Nature of work (cheek which applicable): New Building .......... Addition .......... Alteration ........... Repair .............. Rem6val .............. Demolition .............. Other Work.. ~ ..... ~'Description) { (to be paid on filing this application) 5. If dwelling, number of dwelling Units ............. Number of dweiling 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 &existing structureS, if any: Front ............... Rear .............. 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: F~qyrrt~.. ,~,~k. ........ Rear ............. Depth ............... Height ............... Number of Stories....d?.°7. ~ .............. ii ......... 9 Size of lot: Front . Rear Depth 10 Date of Purchase ~ Name of Former Owner I 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction wolate any zoning law, ordinance or regulation: .... 13. Will lot be regraded ....... ;,'.,~' ~ '~i' ~' · ~ ........Will excess fill b,e removed from premises: (Ye~') No 14. Name of Owner of premises'~~,~og~-~4~. Addres~/~d~57. ~o~.~r,/... Phone No. ~../.~: ~..~7~,/2,~.] Name of Architect Address / ~: '- .... -' ' I .... ~: ................. . ...... Phone No ........ ~ ....... Name of Contractor, d~. ~... Address-ff...~/~ff../~/~ ,-,~_~hone No,57/d"~..Z~-.~. ~?. ~. PLOT DIAGRAM Locate clearly and distinctly all. buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block humber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~fOP)Y~ , / S S COUNTY OF 2~...~... i' CZ" ........ ~~,_'..5,;/,'2.2_','_'~'J2 ' .............. being duly sworn, deposes and says that he is the applicant (Name off-ndividuai sign!rig contract) above named. He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul;~ authorized to perform or have performed the said work and to make and file this application; that all statements contgined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manne? set forth in the application filed therewith. Sworn to before me this Notary Public, ~, .c~.~.} ~ ..~.~: County. Notary Public, State of New York .. ~~~.. Noi ~2-03~963 1Suffolk Coun~ ~ (Signature of applicant) ~mm[ssion [xpire~ March 30, 1~~