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Home My WebLink About10473-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No...Z. 909.8. ......... Date ....~.8..~9.h..!~ .................. , 19 THIS CERTIFIES that the building ................................................ Location of Property .... ~.0.~. ~.O.l~.~;tl..C.l?.O~t..R.q.8.1t. ............~.~..~9.h.O.g¢..e.~..I~. ~ .Y.o ..... House No. Street Hamlet County Tax Map No. 1000 Section ....1.'1.0. ..... Block .... ~ .......... ]Lot ..... .2,9.. ......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·. ~.e. lcl;¢l~.b.e..z'. ~.1. .... , 197.9.. pursuant to which Building Permit No....~.0.~?..~..Z ............ dated .... .I~o.¥.e.llljb. e.l'...'l.~ .......... 19.7..9., 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 .e, ?. ................................. The certificate is issued to .......... $.~ll~l'.'l;. ~klb0~ .................................. (owner~~E/~ of the aforesaid building. Suffolk County Department of Health Approval ...9..'.~.0.~! .0.~ .... .2 ./ .2.~. /. .~ .0 .... .R:..~..~.. y~.~.l..~. UNDERWRITERS CERTIFICATE NO ............ p.e.rl.~.~.r)g. ............................. Rev 4/79 Building Ins[~6ctor FORM NO. 2 TOWN OF SOUTH,OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10~73 Z Permission is hereby granted to:~. ~ __ ..... /..~:..L(~?Z~...C.....-~z.:.~....Z~.~ . . . ...... z~.,~.~.-~ .~,.cZc....-.....~.....~: ..... to ....... .C c~.,~. ..~ z:. zcc,. cr. . . . . . . .~ ~.~ . . . .,=~ .~.,. .~. ~/. . . ~,,,~. / z z. ,~. ~ ..................... at premises located at ..~..'-0..~..'].. ...... ,,,~.~.Z~ ...C,g~.<:~...~.~:~/~. ................................. ...4:~ ....... , 19.~..~.., and approved by the Building Inspector. Z ~Y J~uitding Inspector 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 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" 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 cdndition 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-ex~sting dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.O0 New Building ............. Old or Pre-existing Building ............ Vacant Land ............. ~ocatlon of Property . .~/ .............................................................. Ho~ise No. Street Ham/et Owner or Owners of Property ,..~'..'...~)..U..~..o..~. .......................................... County Tax Map No. 1000 Section .... /.L .O. ....... Block .. ~ .......... Lot...~..~. .......... Subdivision ................................. Fded Map No ........... Lot No .............. Permit No. ~..~..'~.?.~..'.Z'Date of Permit ./.~.~./,~//¢.?~¢.Applicant . ./¢.'..~. ,~../.z".~...¢'. ~..'.~.'~'..J.'. ........ Health Dept. App o a .,. / ................... Labor Dept, Approval ........................ Underwriters Approval .~..~'. ~. ~ .~ .~.~./ ............ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ~ Fee Submitted $ ..... .~....o..0 .................. Construction on above described building and permit meets all applicable codes and regulations. FIELD I~SPE~TION COMMENTS FOUNDAT~0N FOUNDATION (2nd) ROUGH FRAME& PLUMBING INSULATION PER N.Y. STATE ENERGY cope 4. FINAL ADDITIONAL COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS ~' BUREAU OF ELECTRiCiTY ~- 85 JOHN STREET, NEW YORK, NEW Y~0RK 1OO:38 ..t~ ~,'~h~-~, l~0 ~pp'ca.o,,No. on~.e 0~33~ N471450 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant r~ant&d on the abo~e application number in the ~remlses of S~warL ~ ~/s Soutt~n~a Cro~s t~1., 600' ~/o PeClUa~h in the followlng locaoon; [] Basement w~ e~,,..~do.Maz.;h 1.>, 1980 FIXTURE OUTLETS RECEPTACLES ~z SWITCHES 24 21 [] 1st Fl. FIXTURES [~ 2nd FI. Section Block Lot artd found to be in compliat~ce wtth the requirements of this B~ard. DRYERS FURNACE MOTORS FUTURE TIME C~OCKS MULTI-OUTLET SYSTEMS NO OF FEET EXHAUST FANS DIMMERS SERVICE DISCONNECT S E R -~ V' I ' C ~ E OTHER APPARATUS- NO OF CC COND PER ~ AW G, OF CC COND NO OF HI-LEG AWG OF HI LEG NO~NEUTRALS A W G OE NEUTRAL Joseph lB. liizmini 227 Waverly Av~. l~df. ord, N,Y. 11763 This certificate must not be in IN ANY FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined..'~t~..../.,~.., 19Z7 Approved .:~'--~.... ~r..~...:, 1~97. ~. Permit N~..~...~...~ , Disapproved a/c ........ T: ............... .(~ ...... 2. / ................. ~ ...... ...~..~...~.../ APPLICATION FOR BUILDING PERMIT Application No .................. INSTRUCTIONS a. Th~s application must be completely filled in by typewriter or in ~nk 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 ~ssuance 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 inspections. · .. 1~.: ..~.~.2..'-.~f.':..~.i ?.~:~.~ .... /..w..~., .... '(Signature of applicant, or name, if a corporation) , ~ . ............. . ./n...~. m..~.;../~.//. ........... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name ~f ,~wner of premises ..... .~:.~..~...~..~...T~'. .... ~..V.(as onB'the ~tax '~roll ...................................... o~ latest deed) If applicant is a corporation, signature of duly authorized officer. .......... .... (Name and title of co.orate officer) Plumber's License No .............. Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ........... .,5:./.~.. .J.:p..o.-.Ffl....C:.~.o..~.~....~.~ ............ ·..-f/.~.0..5-. ................................................ 9. ~..~.~ ~ ~ :~ ?..~ .... .~.'/.. .... House Number Street Hamlet County Tax M~p No. 1000 Section .... ~../.~. ......... Block Lot...c~..~. ............. Subdivision .................................... Fried Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occui~ancy of proposed construction: a. Existing use and occupancy ..................................................................... b. Intended use and occupancy ...~....~...~. ~ .~.~./ ...... .~../~.. :.~..~:. ?. ~ .~: ..................... 3. Nature of work (check which applicable): New Buil~ling .... .1,,'~. · ·. Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ! (Description) 4. Estimated Cost ............ ~ ...... o .o · · · Fee ................................ ~ (to be paid on filing this application) 5, If dwe~ing, number of dwelling~units ............... Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ 6. If business commercla or mixed occupancy, specify nature and extent of each type of use ........ ~., ........... 7. D~ensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ D~eusious of same structure ~ia alterations or additions: Front ................. Rear .................. Depth ................... .... Height ...................... Number of Stories ...................... 8. Dimensions of entire new constgtction: Front ..... ~.~..' .... Rear ............... Depth ~.~ ........... Height ............... Number of Sto~es ......... ~ ............................................... 9. Size of lot: Front ..... ~.~...'. ........... Rear .... ~.~,. 6.9 ........... Depth I ~.). m./.~.7 ......... 10. Date of Purchase .......... . ................... Name of Fomer Owner ............................. 1 1'.Zone or use district in which premises, are situated..~ ................................................... I2. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ l .................... Will excess fill be removed from premises: Yes ~ 14. Nme of Owner of premises ~..~.~. ~. ~.~ ...... Address ~.~ ~ c.lq.~.d ~ ~ .... Phone No ................ Name of Architect ......... ~ .................. Address ................... Phone No ................ ' PLOT DIAGRAM Locate cle~ly and distinctly a21 bufld~gs, whether existing or proposed, and, indicate all set-back d~ensions from prope~y lines· Give street and block number or description according to deed, and show street nines and indicate whether inte~or or corner lot. ~ S uey STATE OF NEW YORK, ~ S.S COUNTY OF ................. ......... ,~.0 ~ .n',J~ ~./ti. 'i" ~' '~" ~'~' '/' '~' .~/,,~/being duly sworn, deposes and says that he is the applicant (Name of lndividual signing contract) above named. , " He is thefi~ ................... '. .................................................. ' ' , ' (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dhly authorized to perform or have performed the said work and to make and file this application; that all statements cofitained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manfier set forth in the application filed therewith. Sworn to before me this ..................... day f ..... .t'.., 19 I ~£~B~U ANN NgV~tt! (Signature ~'f applicant) NOTARY PUBlIC, State of ,New YI~ No 52-8125850, Suffolk! Counl~"C,~ I Term E~ppres March 30,I 19__ % ,/ 0 ® ,_T TU/) DUE~ OAf VALUE "l.,r"o~,"l'),' AP, L~ P, Tu H ~×~Mu~ ~LLoW~L~- ~TV~ ¥/?~' TOTAL ..... F_TTC' L .T ........................ . W' A ~ i,O 5'. AF~'~'~E~ ~s ~¢o~'~ IDAT~: !~B~I~. ~~ NOTIFY l~O I~_i~lRl~ D~p/~I~TMENT AT 765-1802 g A~'~O 4 PM FOR TH~ FOLLOWING INSP~TIONS'. 1. FOUNDATION' '- TWO R~Q FOR PO0~)D C"~NCRETE 2. ROUGH - (~Xh~tNG 8 FLUMD[NG ~. INSOLA'~ ~N' 4, F~NAL - CO~STRLJCTION MUST BE CO~ILETE FbR C O ALL CO~'STR~JCTI~ S~ tALL MEET · HE RE~'f~EM5~,I~ OF THE ~ATE ~N'ST~UC$1ON & ENE~G~ ~[~, NOT R~PONSIBLE FOR RE. NO. z~ ~r- j / UP T