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Home My WebLink About12540-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No Z1 JANUARY 3 84 2175 Date ., 19... THIS CERTIFIES that the building ADDITION Location of Property ..QI~I~E.~T.~L.-&.GLOAMING FISHERS ISLAND Ho~so No.' ................ 's'~/e~( ....................... h~l'o~ County Tax Map No. 1000 Section ...0tO ..... Block ..... .........10 .Lot .......5 ...... :. ~. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. J. LILY .............. 19.83 pursuant to which Building Permit No .... .1.2. ~ .4.0.Z. .......... dated ... g. lX3%IST. '4 ............... 19 4¢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 ......... ... ?.o.r., .a..v. ~..~.s.i.n.e..-.s.o.X..~.r..S.o..~.~.r.i.u..m..~.~..~.~.e.h.e.a., .%0...~.n..e.x..i.s.t.i.n. ?..o.n.?. ??.m. +.~.y. Dwelling The certificate is issued to ... RA.Y3IOND..&. WI1E. E. DD. YEkl ................................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ........................................ .. N~096,1.~ UNDERWRITERS CERTIFICATE NO ............................................. Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMEWT TOWN HALL SOUTHOLD, N. Y. (~.' ' BUILDING (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO 12540 Permission is hereby granted to: ,/'~,/ ~m,'~~ ' ,~,'1/,:....~. .... ~..~.:~...-. I0 ......... , ....... ....~... ............ ,......,L. ............. ..-~. ....... ~ .............. :.......' ......... -*...;...LL:.~ .................................. ~ ......................':...~"' ......................................... ~,,~,.~,~,.,~/r ...... ';; ....... ~., ¢~ ~.~;:-~ ,~/~..,.,,~.,~ . at premINs IocaTeG c~ ................................................................../ ........................... .~ ..................... , ..... Build~ng Inspector. Rev. 6130/80 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 Wpewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: I. 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. B. For existing buildings (prior to April 1957), Non-confqrming uses, or buildings and "pre4existing'~= 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 bu ildings. 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 / 3, Copy of certificate of occupancy $1.00 landuse--?re-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date ..~. z~./~./4~. ............ New Building~:~.~.~/~.. · Old or Pre~existing Building ............ Vacant Land ............. Location of Property ~o.u~No~ .~. · ~~/2~ .~ '.~?. :~. · ~~ Owner or Owners of Property' ,~ ~ . ,.~.-:' :~.~;Y~ .~..,~¢'-7~ . . County Tax Map No. 1000 Section ..... /~.' ...... Block ..... /~... ...... Lot...~..'~. ......... Subdivision ................................. Filed Map No ..... ...v..Lot No .............. PermitNo./.o/~.~.~,~DateofPermit~/~..~Z//~.~..Applicant ../~.~. ...... <~~ ............. Health Dept Approval Labor Dept Approval . Underwriters Approval ~-.~..¢~../..~. ...... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final C~rtificate .. ~ .............. Fee Submitted $ ............................. Construction on above described building and per, mit meets all app,~c ba,~c~es and~ regulations. , ............... ..................... Rev. 10-10-78 FO~ NO. 5 TOV/N OF SOUTHOLD BUILDING DEPARTMENT TO~VN CLERK'S OFFICE SOUTHOLD, N. Y. ORDER TO REMEDY VIOLATION (owner or authorized agent of owner) ...~..~ ............................. , .......... ,../.. ............ (address of owner or authorized agent of owner) PLEASE TAKE NOTICE there exists a violation of: Zoning Ordinance ..................... ~/'~'i,~'/~ ' ' ' ' ' '0' ~' Other Applicable Laws, Ordinances'or Regulations ............................................ at premises hereinafter described in that '~..~.~fi~.~...~.~....~.~.~_~.~ ..... (state character of violation) .A...~.~ L~Ek~.~......:~.~.~..~.~ .................................................................................................. (State section or p~ro~roph of opplicoble ~w, ordinance or regulation) YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the Iow ~nd to remedy the ~.~ o~ .................................... J.~.~ ...... , ~,..~ The premises to which this ORDER TO REMEDY VIOLATION refers are situated at Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law may constitute an offense punishable by fine or imprisonment or both. THE NEW YORK BOARD OF FIRE UNDERWRITERS P[~ BUREAU OF ELECTRIC!TY B8 JOHN STREET, NEW YORK, NEW Y~ORK 10038 ~ Feb~tw~-y i2, 1981 099149 ~ only the electrical equlp~e~t as ~escr~ed belo~ a~d introd~ by t~ qpp[icat~ t~m~ on ~he above application numar in the premises of FIXTURE OUTLETS ~ECEPTACLES SWITCHES FIXTURES INCANDESCENT FLUORESCENT [] 2nd FI. C~.$~ Section Block Lot and found to be in compliance with the requirements of this Board. RANGES OVENS DISH WASHERS EXHAUST FANS DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E OTHER APPARATUS: Par~iboard/s 1-.28e~r. ].50~p. R V I C NO. OF CC COND A, WG] P~R ~ OF CC COND. 1 2 NO. OF HI-LEG~ OF HI-LEG NO. OF~EUTRA[ 1 A. WG OF NEUTRAL 2 Montav~ Avo. F£~hers Island, N,Y, ~6390 Lie,g24 g This certificate must not be altered in any manner; return to the office of the Board if Inspecto( 11 may be identiHed by ~ N~ 4F ~,W~,.. 'w ~ ~ JUN. FORM NO. 1 . ~ ~' TOWN OF SOUTHOLD 'BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ..~./~ ,19..~. Approved ii i ~..,19..d~eermitNo..(.~....~...?.~. '~ Dzsapproved a/c ,. .... ~..........-..... · ........ (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No .................. Date ....... q ., ~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. 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 regulation~s~, and to admit authorized inspectors on premises and in building for necessary inspections· (gignature of applicant, o~ame, if a corporation) · (Mailing address of applicant) v State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises. ~ ~,.~..~.,. ~ .~....tzfi~ ......................................... (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 .......................... Plumber's License No ......................... Electrician's License No. Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. · ............. - .... House Number ...... .... /' ~;r;;; .... Hamlet / County Tax Map No. I000 Section Block ......... ---- pN ~" ..... Subdivision ..................................... Filed Ma o ............... Lot .... · ........... (Name) , 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .............................................. b. Intended use and occupancy ...~..~'~. · · -~.. · .~'~..~ ................................ 3. Nature of work (check which applicable): New Building .......... Addition . . . .t~. ..... Alteration Repa/r .............. RemOval ..... ~ ...... Demolition ............ 3/Other Work ............... '~/~z~'] i'~)- t9 (Description) 4. Estimated Cost .i .............. Fee ,- . ..... ! (to be paid on filing this application) 5. If dwelling, number of dwelling Bnits ............... Numbar o f 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 structurels, if any: Front... ,~, O. (... Rear . ~ ......... Depth../.~ · Height .~. / ' .... Num her o f Stories Dimensions of same structure w!th alterations or additions: Front .... ~2,a.' ......... Rear .... ~.o.t .......... Depth ....... /. ~'. ~. ......... !.. Height ....... 7. ~. ............ Number of Stories .../. ................. 8. Dimensions of entire new construction: Front ..... ..~.o.' Rear .aP.'.. Depth .4 .-4. '. Height: ..... 7: ........ Number of Stories .... ~. ................................................... 9. Size of lot: Front ~ ............... Rear ..... 4' .....~ .......... Depth .... ~,~.~: ............. 10. Date of Purchase . ./~"[..i .................. Name of Former Owner .,~,-~.. I 1. Zone or use district in which premises are situated .................................................... 12. Does proposed construction vioiatc any Zoii~ng law, vrdlu, ance or regulafiou: ...~.* ........................... 13. Will lot be regraded ...'7-t ,...i ................... Will excess fill be removed from premises: Yes 14. Name of Owner of premises/e..~.,g~o~..~..:¢~...~-~.... Address ~.-~-~.~...~.~.:~.,~l'h Phone No.~../f:g4:.~.'.7.~...~. Name of Architect .......... i ................. Address ................ .u.. Phone No ................ Name Of Contractor ,~,~,. ~ ............ Address/~*t,~-'~,i ~,. ..... Phone No.~ .~ .' .~.;~.4 .'~..~.~.. i PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block 'number interior or corner lot. r description according to deed, and show street names and indicate whether STATE OF NEW ,.Y..ORF,;,, C U ' o . .~ .o.~~: ;[?.~ ................ being duly'sworn, deposes and says that he is the applicant it (Name of individual sign~ing contract) above named, i ' He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, an.d .is,dulyauthorized to perform or have performed the said work and to make and file this apphcatmn; that all statement, s Cdat~med m th~s apphcat~on are true to the best of his knowledge and belief; and that the work will be performed [n,tkie'mannelr set forth in the application filed therewith. Sworn to before me this .................... ';day of ............. 19 .~..':3 t-to. 3/,9:7v~8~