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Home My WebLink About12100-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.. 22q.qG~9 ......... Date .............. ~ .2.L!- ............ 19 .83 THIS CERTIFIES that the building .. ,~,6clition .................................... Location of Property . .3~0 .... ~m:~se~c. Ida7 .......... _ ....... Sou.~old ............ .. ·:: House No. 5'treet ffamter County Tax Map No. 1000 Section . Og~. ....... Block .... O'l. ......... Lot ..... 00.~. ........ Subdivision CEllAR t3EACJ:t I~ARK . .Filed Map No. 90 .Lot No. ~ 6q conforms substantially to the Application for Building Permit heretofore filed in this office dated ... p.e?.? .~.b.e?.. 2.0 ....., 19 5.~. pursuant to which Building Permit No. A 2.~ ODT~ ............. dated . ?..a.~.~.~.~7...q.q. ............. 19 ~.~., 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...<~..~.¥¢.~.~..~. ??.~.~.~.~..~ .............................. The certificate is issued to g. lXl~H01~Y 1~1~I8~0 (owner, levee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ~/.~. ..................................... UNDERWRITERS CERTIFICATE NO...lXI~.~.~. 5.'] 7. ....................................... Building Inspector Rev. 1/81 BUILDII, CT'HIS 'pERMIT MU:qT BE KEPT-ON COMPLETION OF THE Pin niSsior~ is hereby g ~12100 Z , af:p~emise~ located at .......... and approved by the FORM NO. 6 TOWN OF SOUTHOLD : Building Department, Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. Tbis 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 d sposa -(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Undbrwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect dr 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-conforming uses, or buildings and "pre-existing" land uses: " 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topog;aphic 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. Fees: 1. 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 New Bu i[dJng ............. Old or Pre-existing Building(X) .._.~' ...... ~ ZVacant Land ............. Loeat;on of Property ......................... · .......... ' ..· ,.. ......... .. House No. Street Hem/et Owner or Owners of Property ....... t~.h/1-Ho _.~)/'~ ~C 0 County Tax Map No. 1000 Section ..... (~ .~.1 ......Block . .. .... 0 ~.. .... Lot ..... 0..O. '.7. .... Subdivision .... .~.[~ ~:'C....~4~11 Ch[.../~.t~.~./~,...Filed Map No .... ~.0 ..... Lot No.. J.(~ J ........ Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval./~/.-~".~'~.~j .~. Planning Boar royal .... ~ .~ ........... d App .............. . Request for Temporary Certificate ......... Final Certificat~ ~ Fee Submitted $....-~..~"~'- Construction on above described, building and permit'meets all app~cabl~coAtes and regulations. Rev. 10-10-78 THE NEW YORK BOARD OF FiRE UNDERWRITERS BUREAU OF ELECTRIGIT~ SS JOHN ETREET, NEW yORK NE~V ~ORK 10058 THiS CE~IFIES THAT ~ ~l~ny ~risco, 370 S~e¢ Wa~ ~u~ld, N.Y. i~ the following location; [] Basement ~ 1st FL w..ex.~in.do, april 11, 1983 FIXTURE / ~! SWITCHES OUTLETS RECEPTACLE. 12 '-"/t DRYERS [] 2nd FI. [ Section Block ~ot and found to be in corn~lla~ce with the requiremertts Dy th~s Board. FIXTURES OVENS DISH WASHERS EXHAUST FANS , FLUORESCENT SYSTEMS NO. OF FEET )THER APPARATUS: 1-~moke De~ecCor E R ~V I C NO OF CC, COND, pER ,~ 2/0 JNO OF HI-LEG AWG O~ HI-LEG NO OF NEUTRALS 1 OF NEUTRAL 2/o Pau[ ~m~m Town Har~r [~ae ~k)u~old, N.Y. , 11971 ~ENERAL MANAGER Per /'[~ COPY FOR ~UILDING DEPARTMENT, THIS:COPY 0F ~ERTIFIC~TEMUSTIN~E ~LTERtD IN ANy MANNER7 ~5 DAi~E COMMENT8 ,, "~ ~/~/ ~ >- ~~ F~/~ .~ FOUNDATION {1st) FOUNDATION {2nd 2. ROUGH FRAME & ?LUMBING 3. INSULATION PER N. Y. STATE ENERGY ~ODE 4. FINAL ADDITIONAL COMMENTS: 19.f..J Examined .J/c>~A-:?.. / r' ...... , .. Approved .~.~..~... t~ .... FORM NO. 1 TOWN OF SOUTHOLD ~i~IJILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Application No.../..~..~7...~. ....... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date D~F.C. ~.o 19 ~ 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 pwperty 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 pumuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Re4'ulatious, 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 inspector~ on premises and in building for necessary inspections. (Signat~ 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. .............. ........................................................................ ! (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 ...... ~ .~ .O. .............. 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 Street ~/ .............. Hamlet County Tax Map No. 1000 Section .... 0..~.~ ......... Block ...... OJ .......... Lot .... .O. ~. 7. ......... Subdivision...~....~....~.~,.. ~)~-~ ........... Filed Map No ..... ~.0. ....... Lot...~..~.. ]..~.~. ..... (Name) 2. State existing use and occupancy of premises and intended use and.occupancy of proposed construction: a. Existing use and °c?panc~( ..... . y .... b. Intended use and occupancy ....... ,~'~b~l~'....~.~.. .ClYI ......................... 3. Nature of work (check which ap licable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition.. .... ..... OtherWork ............... ' e~ I ~ -- (Description) 4. Estimated Cost ........... ~ ......... Fe .................................... (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 ..'. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............ ......... 7. Dimensions of .existing structure:s, if any: Front .... ~.~ .t T~. ~.t... Rear .............. Depth...~f.~ ........ Height ............... Number of Stories ....... (2..M.~."~. ........................................... 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 lot: Front I O(7 r ........................................................ ........... i ........... Rear ...................... Depth ../~..B../ .............. 10. Date of Purchase ........... ~ .................. Name of Former Owner ............................. 11. Zone or use district in which pr~mises are situated ........................... , ......................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ~.0 ..................... ~ 13. Will lot be regraded .......... i ................... Will exce~of~lt~e r?omuoved from premises: Yes (No) 14. Name of Owner of premises .~fff.T'b.h~,~/y ~./~ ~¢-O. Address t0.~e~.~.,~t~ ~ff~/~... Phone No. 7.~.'.Z:7/.~.7~ ..~. Name of Architect . ................. Address .............. t. ....Phone No ........ i . . i .... Name of Contractor . .~]~J(d..~0/~] ............ Address ................... Phone N0. ¢77..%/.0. ~t~.... Locate cleariy and distincfiy alF property lines. Give street and block interior or corner lot. PLOT DIAGRAM buildings, whether existing or proposed, and, indicate ail set-back dimensions from tumber or description according to deed, and show street names and indicate whether STATE OF NEW~O~,// ...... :.'.'..i.~ ..... being duly sworn, deposes and says that he is the applicant ~j' (Name ofindividuai signing contract) above named. He is the ...................... i'" ?~r-:-~ ................................................... i ,}~ (Contractor,'~gent, corporate officer, etc.) of said owner or owners, and is dul~ ~utho~rm 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 manne~ set forth in the application filed therewith. Sworn to before me this , ............ day of ..... 19 Notary Public, ................ i..~X~.. County /7 IE£1 AB~H )INN NEI?,~Llll ............. ~' NOffiRY PUBLI~, .State of~NeW ¥OT[/ (Signature of applicant) Term ExPirei March 30, 19~"-