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Home My WebLink About12106-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building . .~.D..]).~.~.Q~ ..................................... Location of Property . ~25~.. Qr.8.~.4. ~y.e. ,. ~.q.~.SO. ~.o. Qqlo~-~,~:['. ~)y2,. ~I&~.'~ :i-~zlx~k ........ House No. Street Ham/et County Tax Map No. 1000 Section .... .q.O.~ .... Block .... 9~3 ......... Lot ..... 0.Q3 .... ; ... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated · ...~..o.¥.e1~.~.~7. J~. ..... 19 .~.~pursuant to which Building Permit No..q 23.0.~g ............. dated ....J.a~13¢~:'~.. ~J ~ ............. 19 B.~, 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 ......... Addition to an existing one £amily dwelling The certificate is issued to . . .AL.TALN. O,..DICK~R~OlXT..&. OH. fi2LLO~. D2[.C24~RSD~ ........ {owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO...31. ¢~] 2~2c) Building Inspector Rev. 1/81 (THIS PERMIT MUST BE KE~T ON' THE F~R*/~ !~, ~NT!L ~ULL ~r COMPLETION OF THEWoR~ AOTFt'C~Ri~;E~)i ~ i · 12106 Z bate .,.!~~::......:;,.; ............ , 19.~) Pen lissior~ is hereb, at p~mise~ located at and ~pproved by the BiJ 4lng I~spector. .... C~l~ty TaX Map No. 1000 Section ..~....~;~....~,~l~l~'~ pUCCini' ~'o opphco/mn aa~ ..... ,.~ ....... .~ ......... :...¢.,.; ...! THE NEW YORK BOARD OF FIiRE UNDERWRITERS BUREAU OF ELECTRIC~ITY~i ~b~LLO ~[[~ ~ [~ 85 JOHN STREET, NEW 10~38 YORK, NEW ~ORK THIS CERTIFIES THAT only the electrical equipment ~ described below a~ introduced by t~ applicant ha~d on the able application number ~n the pren~ises of in'the following location; ~ ~e.e,,,e.t ~ 1st FI. ~ 2nd FI. Section Block Lot was examined on ~ ~ ~ ~ mtd found to be in com~lia~ce wlth the requirements q this Board. FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS DRYERS FURNACE MOTORS APPLIANCE FEEDERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E I C OTHER APPARATUS: E iV NO OF HI-LEG OF HI-LEG NO. O~ NEUTRALS AWG NEUTRAL Ole~m 1~. Dra~ley This certificate must not be altered in any monneh return to the office (~f t[~e I~ard if DEPARTMENT. /GENE~L MANAGER may be identified by their credentials. MANNER. "FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~ODE COMMENTS FINAL ADDITIONAL COMMENTS: ~8o~ BUILDING DEPT INSPECTION FOUNDATION xsT [ ]~ROUG~ PLBG FOUNDATION 2ND [ ] INsU~ION 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- tot 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. 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 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 topograph ic 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. C. Fees: 1. Certificate of occupancy $5.00 ~ ~_/$ 2. Certificate of occupancy on pre-existing dwelling land use ~/ 5,00 3, Copy of certificate of occupancy $1,00 Date.. -N~;'; 9;~',~=..~g .... .~ ....... Old or Pre-existing Building ............ Vacant Land ............. Location ..... Hou~ No. Street Ham/et Owner or Owners of Property ...... ~ .. ~ ....... County Tax Map No. 1000 Section .... /. ~.'~. ...... Block .... ~ ....... Lot .... ~. ~ ...... Subdivision ................................. Filed Map No ........... Lot No .............. Hoalth Dept. ~proval ................... labor Dept. A~proval ........................ Request for Temporary Certificate ...... ' ' .Final Certificate .... .~ ............ Fee Submitted $. ~< .~ ................. .~ Construction on above described building and permitters all appli~bl~ codes and regulations. ...... ................. Rev. 10-10-78 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .~.~..c~%~..../..~.~..., 19 .~. ? Approved . .~..c~.....F.'?. .... , 1~..~. Permit No../..~..~.~. '.~..~- Disapproved a/c ......................... ....... .~ ......... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tkis 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 dl'awn 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//~tr for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, t/ui, lding code, housing code, and regulations, and to admit auth°rized inspect°rs °n premises and in building f°r necessary il~0i/~?/'~ (Signature of applicant, or name, if a corporation) (Mailmg a dress of applicant)I State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................... ..................................................... mtane of owner of premises .... ~ ~,...4-.. : ~.-(. .... ¢..~.... f V ~.~..q'2~... (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..-.~.~.c y~)..~2.~..~~ Other Trade's License No ...................... ( 1. Location of land on which proposed work will be done ~t* ((~ ~', O~~ .~ (,g~'~[, ~' ~0~ House Number Street Hamlet O County Tax Map No. 1000 Section ~5 Block ~ Lot Subdivision ........... .~ ....................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. ~ti~g.use and occu~nc; ......... [ .~'~ ~ .(~)~. ....................... b.I,t~naeauseandoccu anc ........ ~..~[ ~r~,-,~g~ ~'~¢~',"~[;~ "~)~ '~'} ...... 3. Nature of work (check which applicable): New Building .......... Addition .~.. ..... Alteration ...' ..... ~. Repair .............. RemOVal .............. Demolition .............. Other Work ............... 4. Estimated Cost ................................ Fee .............................. (to be paid on fling this application) 5. If dwelling, number of dwelling Chits... ~f~. ....... Number of dwelling units on each floor.. 0.~.~. ......... If garage, number of cars ..... !.. ~ ............................................................... 6. If business commercial or mixed occupancy, specify nature and extent of each!ype of use . ~ ...... :~ .......... 7. Dimensions ofqxisting structures, ffany: Front .... 5~0. ........ Rear .... ~0 ........ Depth .... .0 .......... Height ... l~b. ......... Number of Stories ....... 0igc ........ ,-., ....................... , ............. Dimensions of same structure with alterations or additions: Front . ,k.0. ............. Rear . ~..Q .............. Depth....~.0 ~. ............ i.. Height . .I.~.I. . . Number of Stories .... q-lA~ .'~ .............. 8. Dimensions of e~ntire new constructmn: Front ...~.q ........ :. Rear .... ~.~' ........ Depth . l0 ............ }[eight ...~.Z. ......... Number of Stories... ~ ..... ~ ............................................ 9. Size of lot: Front ............... Rear ..... ]X..o .............. Depth .. ¢. ............ 10. Date of Purchase .......... ~.~ ~.~ ................ I~me o~ Fo~.~ Owner . [v~/i~eyg..{~ ./~.~ ............ 11. Zone or use district in which pr6mises are situated ...... l~,,~.q, tgg~t30rL .................................... 12. Does proposed construction viqlate any zoning law, ordinance or regulation: ..kX.0. ................. ~ ....... 13. Will lot be regraded .~0/~,....t~..~fee...~q~gq~,ll%{ ..... Will excess fill ~be rem. o~ed from premises: ~__Y_¢,)_ No 14. Name of Owner of premmes ~1~ .[.'. ~.C~¢t!~..o:~... Address ~ ~'~tt, t~.hqq. ~ !~{~it. Phone No. 2~.~.~.qrq.~.g ..... Name of Architect .......... .c-'~0~k~ ......... Address ...... ~.~ ...... Phone No ..... ~. 041.~.{ ..... Name of Contractor ......... .~.(~. ......... Address ....... g0.1/~q~ ...... Phone No ..... ~(,l,k~ .o.~ ..... Locate clearly and distinctly all~ bulldogs, whether existing or proposed, ~d, indicate ~1 set-back d~ensions from props:fly lines. Give street and block humber or description according to deed, and show street nmos and indicate whe~er interior or corner lot. ~ STATE OF NE{~Y()iRI~,I i,, o COUNTY OF. ~O)~1¢ ...... i a'a (Name of individual signing contract) being duly sworn, deposes and says that he is the applicant He is the . . .~.h¢ ............. . ............................... ~ (Contractor, agent, corporate o'f~'~;;,~ e't~.') 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 con}dined in this application are true to the best of his knowledge and belief; and that the work will be performed in the mann4r set forth in the application filed therewith. Sworn to before me this . ................. ,.,-.~...day Or... ......... i9.. Nora. Public~.~ ....... ~ [k,~. .... ~'~ ' ' '~ ...... County ...... ............. Ooallllsd In g~tfolgCo..No.~l~_~ (Signature of applicant) Commission F. xplre~ Mal~oh 30, 765A I-.,.', i' :~ pM FOP- ~c,-Tr-ToNS: L C,.,N'- e coo~S. ~2~o~s5RUCStO~ t~ DESIGN ~ ~ ' i J