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Home My WebLink About12180-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ................. Date SeDtember 8 198.3 z 9o5 ................................. THIS CERTIFIES that the building Location of Property . 5~.Q.....g~..G..~.~,R.S...R.D ..................... G,~..~.e~.o.~.~ ............. House No. Street Hamlet County Tax Map No. 1000 Section ... ~.~. ...... Block .... ~ ......... Lot .... .0.'I.~. ..... ;..~ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ,..FI.o~c.c~ .~ .......... , 19~.3. pursuant to which Building Permit No...'1 ~J.~.Q.~ ............. dated . ~Oh..'].2 ................. 19~.3., was i~sued, and conforms to all of the requirements · of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... · ~..~?. ~n .ingmoun~l .swim~ing..DQO%..ar;4. ~.e.~O ................................ The certificate is issued to .. W~T~Z/L~ ,R.. P~7o~. ~..d ................ (owner, lessee or tenant} .................. of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO. N 602~89 Building Inspector lrOuM NO. It TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEP, NIIT MUST BE KEPT ON THE PRE/~ISES UNTIL FULL CONIPI. ETION OF THE WORK AUTHOI~IZED) N? 12180 Z Permission is hereby grant pursuant to appllcation dated .......... .............................................. , ........, app by Building Inspector. Building Insp~tor P~v. 6/30/80 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 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 buildin~gs, 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 o[ 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 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. C, Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling ~'r land use $/5'/$5.00 3. Copy of certificate of occupancy $1,00 Date..~¢.~...~....~. J ?.~ .~. '.~. ~ ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property .'~ .,~. O .... .~...~..~. / ~.'.~....~...~. .... House No. Street Ham/et Owner or Owners of Property . ~ ~ I? ... County Tax Map No. 1000 Section ..... .~..~. ...... Block ...... .~ ........ Lot....0.)..~ ........ Subdivision ................................. Filed Map No ........... Lot No. , ............. Permit No./..~/.~.0..~.... Date of Permit . .. ~.:~..Applicant ....~. ~).~..n?...~v. ..... .~.~! ............ Health Dept. Approval ........................ Labor Dept. Approval ...................... Underwriters Approval....~. b o ~.L/I <~ 9 .Planning Board Approval Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and pe,rmit meets all applicable cod~___a~d regulations. ' Rev. 10-10-78 FIELD INSPECTION; 1. FOUNDATION { 1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C~DE FINAL COMMENTS ADDITIONAL COMMENTS: looo663 THE NEW YORK BOARD OF FiRE UNDERWRITERS BUREAU OF ELECTRIClT~ ~. TtB 85 JOHN STREET, NEW YORK, NEW ~ORK 10038 THIS CE~IFIE5 THAT only the electrical equipment as ~scrlbed be~ and introduced by the appl~ant ~ed on the able applicotion number in the premises of and found to be in compliance with the requirements of this Board. RXTURE ~IXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS 1 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS UNIT HEATERS DIMMERS SYSTEMS OTHER APPARATUS: S E R ~ V I C NO, OF CC. COND NO, OF HI-LE~ AW.G. OF HI-LEG NO* OF HEUTRAL$ Glenn R. Bradley RFD 169 Horton Ave. Matgiauck~ N.Y,, 11952 ~LIE.#1227 ,ust not be aJtered in any manCer; return to the office of the Board if OF NEUTRAL m6y~ by ~heb credenfiaJs. FORM NO. 1 TOWN OF SOUTHOLD ,BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined..~.X./L2L../~2.~.., 19~.~ Approved ..~?~/. ~ .... 19t~.~.~ Permit No./. ~/~..~..~ . Application No../.~../. ~..~..~. .... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 issue 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 buildings for necessary igspections. .... g t.zAy. . .+. . .s.o. . . . . (Signature of applicant, or name, if a corporation) (Mailing address of applicant) If aptS~t is a corporation,,Aigni~re of duly authorized officer. ..... Builder's License No.. ,~r....~../.~. ·~ .... ~..~... o,~?~ Plumber's License No ......................... Electrician's License No .... ~..~.~..'~. ~/~.0...~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... .... c ..... _' .......................... P~i.2 ............. ~ ' ' '~ ........... Nme of owner of premises . ~ ~ .*.. ~ ...... .~ I ~1.~.~.. · ~. D~(~: .~. ?~./~.~ ·. · (as on the tax roll ~test aced) ~ . ~ ., 765-1802 9 AM TO 4 PM FOLLOWING fh'SPffCTIONS: l. FOUNDATION _ TWO R~O~JlPED FOR POURFD CONCRFT~ ,3. INSULATI~N 4. FINAL .. CONSTRU,-~ Bff C~Mp~ FT[ FOR C. O, ALL CONSTRUCTioN SHAL~ M~FT TH~ REQtI~R~M~NTS OF Other Trade's License No ...................... STATE CONSTRUCTION - ~DES. N~T .mE~O~ 1. Location of land on which proposed work will be done... .................... ..... County Tax Map No. 1000 Section ... ~ .......... 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. Existing use and occupancy ........................ .... :,~ ............................... b. Intended use and; occupancy .... ~' '~" ' '~-' ' ' ~ii~' ~' ........... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Rem'oval .............. Demolition .............. Other Work ,~..14t. t/~t~ ...... Fee .5. g..,,.C.r4.. 4. Estimated Cost ............ i .................................... (to be paid on filing this application) 5. If dwelling, number of dwellin~ units ............... Number of dwelling units on each floor ................ If garage, number of cars .... i .................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure ,~ith alterations or additions: Front ................. Rear .................. Depth ................... I. · · Height ...................... Number of Stories ...................... 8. Dimensions of entire new cons(ruction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Sizeoflot: Front .......... i ............ Rear ...................... Depth ...................... 10. Date of Purchase., ......... i ................... Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction,vi.~0!ate any zoning law, ordinance or regulation:~.~..~ ............................... 13. Will 10t be regraded ...... .r~.~. ................ Will excess fill be removed from premises: Yes 14. Name of Owner of premises . .i .................. Address ................... Phone No ................ Name of Architect ....... ,... .................. Address ................... Phone No.. Name of Contractor... ~..~.~.~..~,I.~ .~l(~.... Address..n~,K .~. 7.~~e No. ~. ~.~.~.~.' '~i PLOT DIAGRAM Locate clearly and distinctly ~1 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 NEItq'~ORI~ / ... -.~..).~'~.,..~~.. ~ ..... being duly sworn, deposes and says that he is the applicant / (Name of individual sign~g con~:f'af-g)~'''''' above named. He is the ..................... :...~ ..................................................... ! .... ( (Contract)r, agent, corporate officer, etc.) of said owner or owners, m~d is dtily autg/r,i'izcd ~erform or have performed the said work and to make and file this application; that all statements cohtained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ~ Public, NOTARY New Yofll No. 52, Suffoif( Coup// Term ~lres March SO~ 19..~r~ of applicant)