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Home My WebLink About10482-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No ..... ZgBbr5 ....... Date ....~.I~ItlU]L.rq.Y. ~Z ................. 19.80 THIS CERTIFIES that the building ................................................ Location of Property ... ~.~15,,. ,,'~01,111~ .Avenue ................ 8OUP. a~OI~L~..I~l,Y.~tSr~/ei House No. Street County Tax Map No. 1000 Section .... .0.~.1 .... Block .... 0./*. ........ Lot .... 02/4 ......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated · ~O.v.~tltb.O,~..~, .1 ....... , 19.7.9 pursuant to which Building Permit No....10./~/~2Z ............ dated ... l~nxtembt!t~. 2.~ ............ 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 ......... ........ tL~ter~atton. ~o. E~sting .Office. Bllildl2ag .......................... The certificate is issued to ........... G~,OlPg.~ .1~,. ~Lt11~.~.811 ......................... (owner, ~ of the aforesaid building. Suffolk County Department of Health Approval ........ .I~/1'~ .............................. UNDERWRITERS CERTIFICATE NO ................ ~..~[~7 ........................ -t,'L-~'~,-~, ....... Building Inspector Rev 4/79 FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EM1SES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 018] Z pursuant to application dated ~.1~.~..~../-/~.~/..~'.......~.../.- ........., 19.7..~.., and approved by the Building Inspector. Fee $ ........................ Building 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 features. 2, Final approval of Health Dept. of water supply and sewerage disposal--($~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. 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 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~,~I&~.: , ,~. ) 1. ) ~ <,~Q .... New Building ............. Old or Pre-existing Building /~ Vacant Land · t 'c' ': , ,3 , Locat,on of Property ................. ~/0. ,L,I~. j~.../:~ .L).~.; ........... ~ [~ ~ ~. J. ~' ....... House No. ~. /,~ I Street Hamlet Owner or Owners of Property .. ~. ~C'.r,~. ~;.. IS.'..,.~L~I l J ~C~J:~ ........................... County Tax Map No. 1000 Section .~.~. ~ Block .... ~ ....... Lot...~;, .~. ....... Subdivision ........................ i ~ ........Fried Map No ........... Lot No .............. PermitNo..[g.t.[&¢.'¢. Date of Permit_, ,.I Health Dept. Approval ........................ Labor Dept. Approval ........................ Unde~riters Approval ........... Planning Boar roval ...................... Request for Tempo rary Certificate ..................... Final Certificate .. ~ ... Fee Submitted Construction on above described building and p.,ermit meets all applicable codes and regulations. Applicant , .'h'.[.¢'/~;(~.. ,~'~. ,/~¢('.~,~? .................. ¢ .......... Rev, 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ 85 JOHN NEW NEW YORK 10038 STREET, YORK, ..,. aan,,-~ ¢, zg~o .,,,,,,,..,,..~,..o./,,., o533o3 N 462957 THIS CERTIFIES THAT only the electrlca~ equipment o~ described Imlow and introduced by tim applicant named on l~e abo~e application number in the premises of ~eoz'ge Sullivan~ You~gs Ave.~ Maln Rd. & ~eohanles St., ~outhold~ in the following location; [] B~sernent ~ Ist FI. [] 2n~ Fl. Section Block Lot was exarnined on Eanuat~y 7~, ~0 and found to be ln compliance wlth the requirements of this ~oard. RXTURE / EFTA LE ~ WiT I FIXTURES I 2.,./".,!..cLo,!.s" L.L,,L.,,,,.! A~T. K.W, OIL H,P, GAS H.P. AMT. NO. RANGES ~FECIAL EEC'PI SERVICE DISCONNECT NO. OF AMT AMp METER SYSTEMS S. NO. OF FEET R I A. W, G, NO. OF HI-LEG A, W. G. CC. COND. Of HI-LEG EXHAUST FANS H.P. DIMMERS Paul BuPns TOWB Navbov La, 2ou2hold, N.Y, 11971 Llo.282~ Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credenhals. COPY IFOR BUILDING DEPARTMENT, THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. .IELD I~N_SP~ECTION COMMENTS FOUNDATION FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N.Y. STATE ENERGY COpE FINAL ADDIT__IONAL COMMEN~S: FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Exammed ~..0..~...'.~. ( .... , 19 7? Approved . .f~.?.?'.. ~ .... , 19~.~. Permit No.../.~...~.?..~. ~ Disapproved a/c ..... x.:-'::"-'7'" ,.,,. 15 ...... ......... (Bu APPLICATION FOR BUILDING PERMIT Date .. ~ ?. ?... '.~.~ ...... 19 '.7.9 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'lo 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 th~s appli- cation. c The work covered by this application may not be commenced before ~ssuance of Building Permit. d. Upon approval of thru 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 1S HEREBY MADE to the Building Department for the issuance of a Budding 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. ...... 4T~..t4.,4.../~.~,e .r-,~,~/...~.q: .re. ~,e.~cc. ..... (Signature of applicant, or name, if a corporation) .... ~ .~. ~6.c-.. · ~o~v. sM4a~.e:? ............. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .......... .~..~.~r-~.~.. Lt~...-~.q(./4 M4zc7 ...................................... (as on the tax roll or latest deed) If applicant is a corporation, mgnature of duly authorized officer. (Name and htle of corporate officer) Builder's License No ....... /.,.j9~. ............. Plumber's License No ..... .,~/~ ............. Electrician's License No.. ~.~.~. /~.. ¢~APff.&5: ...... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. ............ .... .............. ..... House Number Street Hamlet County Tax Map No. 1000 Section O Block t:Y .~. Lot. ~ ~ .~'.. --'"-~ Filed Map No Lot SubdMsion ................................................................. (Name) State ex~sting use and occupancy of premises and intended use and occupancy of proposed construction: a. Ex~sting use and occupancy ........ .~../{ ./T../. ~.. .... .~..4~ ......................................... / D b. Intended use and occupancy ........ f,X..~.r~.,< ,~-, .... z:;Stf~ff'...~ .* ................................. 3. Nature of work (check which applicable): New Building .......... Addition.. ~ ..... Alteration .......... Repair ............ Removal .............. Demolition .............. Other Work ............... 4. Est~nated Cost ..... Fe (to be paid on filing this application) 5. If dwelling, number of dwelling u~its ............... Number of dwelling units on each floor ................ If garage, number of cars ...... ~ ................................................................. 6. If business, commercial or mixed ~ccupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, lfany: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ..................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ....... ,~.l. ~.. Rear ............... Depth . .~. ~..~-~ ....... Height ............... Number of Stories ........................................................ 9 Size of lot: Front , . Rear Depth 10. Date of Purchase ............ i ................ Name of Former Owner ............................. , 11. Zone or se district in winch premises are s~tuated .......... .'- ! 12. Does proposed construction wolate any zomng law, ordinance or regulation: ............................ 13. Will lot be regraded ..... Jgo.. ~ ................. Will excess fill be removed from premises: Yes )<2 No 14. Name of Owner of premises ,~*o~. [¢..~o.~b~... Address ./~l~l~.~ .g~, u~_ ..... Phone No. 7~D".-'..[~Td~,... Name of Architect ........... ,i. ................ Address .... ~ ...... Phone No .... .~ .......... Name of Contractor ~[IO. ~-a~'~.. 6o,t,OOt ..~;,r~,Address . ~a~c,. ~,~. ........ Phone No..7.4'$.x .I.N'~.~... PLOT DIAGRAM Locate eleariy and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block ngmber or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW Y. J3'R~,,/.~ ~Z COUNTY OF .,/t7-'~~..q~''S . ~Name of individual signi ~g contract) above named. He is the ...... ~r-,AS-..~.~¢.ie~.. of said owner or owners, and is dui application; that all statements conta being duly sworn, deposes and says that he is the applicant (Contractor, agent, corporate officer, etc.) authorized to perform or have performed the said work and to make and file this ned 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 ofi ............... , Notary Public, .. .. ........... o ty JUDITH T. TERR~ ................... ~IO~SW public, State ~f ,New York [ (Signature of applicant) NO, $~.0544963 Suffo!k Count~/J Commission Expires Mar~h 30, lgg',/ ,! NOTIFY 765-]802 9 FOLLOWING 'l FOR 2. '3. INSI 4, F'INAI~ ~ APPROVEO BY