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Home My WebLink About12127-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of OccuPancy No...Z.I.I.8.7..0 ......... Date August 24 1983. THIS CERTIFIES that the building . .addition..to .existing..dwelling ............ Location of Property 30 Pvt. Rd. %4 Dogwood Lane East Marion ~&~'~ '~'o: ....................... 's'tle~i ............................ · Hamlet County Tax Map No. 1000 Section . ...3.7 ....... Block I . .Lot . 5 S,,~;visio~ G~rdiners Bav Estates · 275 I00 & I0I .................................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..J..anuar. y.. 7 ........ ,19~3. pursuant to which Building Permit No.. I2X. 27~ ............. dated January 2 5 198.3 , was issued, and conforms to aH of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Addition to existing dwelling. The certificate is issued to GEORGE W, & EVELTEN F. CLARK .................... ?ol4,,'o;,'~e',;~'t~Mn't~ ...................... of the aforesaid building· Suffolk County Department of Health Approval ...N./.R. UNDERWRITERS CERTIFICATE NO. · N612190 Building Inspector Rev. 1/81 {THIS PERMIT MUST BE KEpT ON THE COMPLETION OF THE WOR~ AUTH~)RjZE~) Z ~t. to. ....... ,......~4~; ..... at p~mise's located at ................................................. and bpproved by the 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 typewriter 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 featu res. 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" ~and 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 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 Building ............. Old or Pre-existing Building .... /. .... Vacant Land ............. Location of Property .... .'~...~. ............. .~r,/m~... ~,r~d ~. ~.... ~, ,/_z J...~. ~?.~. ~~ House No. Street Hem/et Owner or Owners of Property ~. ~ .~..~,~ .~, ~~ .................. County Tax Map No. 1000 Section .. ~. "~7 ..... Block ,,, ~/ ........ Lot .... ~.~,.. Subdivision ~/~. ~ .~ ~..F i~ap~ .~. ~ot No../~ Z~/. Permit No. ~.~/.~... Date of Permit. (/~/~Applicant ~..~~..~,. ~ Health Dept. Approval .~ .~/~..Labor Dept. Approval ... ~/~ ............... Unde~riters Approval. ~. ~. (~ ........... Planning Board Approval... ~/~ .............. Request for Temporary Certificate ..................... Final Certificate .................. Fee Submitted $ .... .~. ~ .~ ................ Construction on above described budding and perm~ me~ts all apphcable codes and regulations. 10010'/1 THE NEW YORK BOARD OF F!R!E UNDERWRITERS BUREAU OF ELECTRlelT~ .ate ~,,.,ic,,tion No. o.,/i,e N 6121.90 THISCERTIFIES THAT only the electrical equipo~ent as described below and introduced by the applicant v~a~ed on the above application mu tuber in the premises of Clvx'k, DO6~vood [~e off Old Orchard~ in the fottotvlng Iocatio~t~ [~ Base~nent ~ 1st FI. was examined on A~J~t 1~ 1983 FIXTURE FIXTURES OUTLETS SWITCHES FLUORESCENT i5 17 ~ 2nd FL Section Block Lot and found to be in co.t~li~nce w th the requlretnents of this Board. RANGES OVENS DISH WASHERS EXHAUST FANS DRYERS SYSTEMS NO. OF FEET E E NO OF CC, COND PER 1 OTHER APPARATUS: :Electric m heaters; 1-2,.Ol~w, 1-1.75k~, 1-S~oke Detector. R I C OF HI-LEG 2/0 & S Electric ~ · . . Per This cerh6co,e ~usf not be olterecl In any manner, return 'o the off,ce of ,~e Board, i'~inc~r[ec, Inspectors moy b~8-b~("eir ~"~'~'ia's. ~l~l GUF7 eM8 ~UILOI~ DEPARTMENT, ~HIS COPY OF qER~ F{OATE M~N~ B~ A~TER~m ~ ~ ~ ....... '" .......... ~ 76S-1802 BUILDING DEPT* , INSPECTION [ ] FOUNDATION 1ST [ ] RO~JG" PLUG.' ? ~ [ ] FRAMING REMARKS; DATE · ~-~ iNsPECTOR · FIELD .[~SPF~TION COMMENTS FOUNDATfON (~st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING ]I~SULATION PER N. STATE ENERGY C,ODE 4. FINAL ADDITIONAL COMM_E__NTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .~7 .(;2-A-A~.....~..~7. .... , 19 .~'.~. (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No.../.~: ./..~ ./~. ~ .... INSTRUCTIONS a. This application must be completely titled 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 regulations, and to admit autkorized inspectors on premises and in building for necessary inspections. ..... ~/t'..~..~..r~rT...,~.t..~..o.~.c~.~-.~ ....... (SignatUre of applicant, or name, if a corporation) ....4q.~..,¥,.;.,~. ~0./. . .~..o ~.~ ~. ,~. : .~.~. : ..... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... Z~t~t ~.~. ~ ............ ~... ..................... ..................................... Name of owner of premises . .~. &~.~.~..~.. ,~..~2~' .~M.... ~ .................................. (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 ..... /.~ ~/ ................. Electrician's License No..~.. Other Trade's License No ..... .~.l~ ............. 1. Location of land on which proposed work will be done ............. ..................................... · ...... ............ ............ House Number Street Hamlet County Tax Map No. 1000 Section ~ ~'7 Block ~/ Lot Subdivision .Y.~0. ~o...~/~.~att.~te,,~t~..~fle~q..~77.,~"~.$. Filed Map No. .. ~,??...~. ..... Lot ~.O~. ~t.z'. O.Z .... (Name) 2. State existing use and ~ccupancy ~f premises and intended use and ~¢cupancy ~f pr~p~sed c~nstructi~n: a. Existing use and occupancy .... ~)./4..~....~.,~..,q(?..~....~. (/~. ~..~. .................................. b. Intended use and occupancy .. ~13.~....~R .~./..~...~9t, q~t.:ie/'~ .................................... 3.Nature of work (check which apphcable): New Building .......... Addition .... ~g~ .... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) . . . . 4. Lst~mated Cost . .~'~P~.~.. ......................... Fee ............................... / (to be paid on filing this application) 5. If dwelling, number of dwelling hnits ............... 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. Danenslons of ex~st~ng structures, If any: Front .... ~. ; ... Rear ..... Depth... Height ... ~. ........ Number of Stones ........ .{. ~. ......................................... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ........... , Height Number of Stories .......... 8. Dimensions of entire new construction: Front ...... ~..~.: ..... Rear .... Z~: ....... Depth ... ~.f. ....... Height .... ~1~.t ....... Number of Stories ...... ~.'./.~. ............................................ 9. Size of lot: Front ..... /. ~. ~.! ........... Rear ..... ~.7 .............. Depth .../~.~. .............. 10. Date of Purchase ........... ! .................. Name of Former Owner ............................. 11. Zone or use district in which pr6mises are situated ..................................................... 12. Does proposed construction vioiate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ ~ ................ Will excess fill be removed from premises: Yes ~ No 14. Name of Owner of premises/4~j ~,~.~.. ~... Address 7.7. ~.t,t~.~ .~.~.. ~.~./.~Phone No.~.*.t.'.Z.~-~. ...... Name of Architect , . Address . Phone No. Name of Contractor ..~4~...~'e~n~./'.t~,.~/,,a~S~.,.. Address K~.~_~,~:~ng~.~or~ ..... Phone No. 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 number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YO~. ... ~S.S ......... ~ .................... being duly sworn, d?oses and says that he is the applicant (Name of individual signing contract) above named. He is the .... ~~ .... . ............................................................ ] (Contractor, agent, corporate Officer, etc.) of s~d owner or owners, ~d is dul~ authorized to perform or have perfo~ed the said work ~d to m~e and file this application; that all statements cont~ned ~ this application are true to the best of his ~owledge and belief; and that the work will be perfo~ed in the m~ne~ set forth in the application filed ~erewith. Sworn to before me this ................... day ............. ,19& Not~ Public ............... .... ~.. County ~ [U[~8 ...................... ~e, ~.812~850, 8ullal~ Cou~t~, (Signature of applicant) ~m ~plr~s ~arch 30, l - F ~R HEALTH - AT , ~,~,. ~ESIGN Ut~ ~ ~ , If cop~er tubing is used ater d stributing sy'~tem; pipin0 sh~a[l,ae ' ,/r of types 5 o~_L~o?~.y