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Home My WebLink About10499-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. Z1011 ~ Date AuSul~ 26 80 THIS CERTIFIES that the building ................................................ Lo ..... ~00 Beebe Dzd. ve Outebo~..e., ~,~'. cazlon OI rropeny .. .... : .................................................. ..., :: County Tax Map No. 1000 Section ....0.~.7. ..... Block ....07 .......... Lot....0.(~.. .......... Subdivision .... .N.o.o.~.?..0.o.v.? ............... Filed Map No..~..~.~.0...Lot No..~.0. .......... conforms, substantially to the Application for Building Permit heretofore filed in this office dated Nov®mb®l* R8 197..9.. pursuant to which Building Permit No. 10~gZ dated .. l~ovlbel' 30 19.7..~, 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 ......... The certificate is ~sued to iUlell ed ~lo~l& ~ll~ ... ~, .......... ..................... io'~.9,'~I~1~/' ' ': .... of the aforesaid bufldin$. Suffolk C~unty Department of Health Approval 9.,80-111 Au&~et~ 13~ 1980 UNDERWRITERS CERTIFICATE NO ....... l[ 11.80999 Building Inspector Rev FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING P, ER/~AiT (THIS PERMIT MUST BE KEPT ON THE PJ~E/VdSES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10499 Z Permission ,s hereby granted to.~_ o .~o...G~.~./~ ....................... ..... ~,.~ & ~. ::r:..~. ~. .......... ~ .... , ~o ~.o~.:~x~.~.~...~4x~.~....¢~.....~.~.~..~;'Zz~.~ ............. at premises located ~f ,.....~.~r~ ...... ~ ....... ~/~ ~t'~'~ · c- ~ ~ ~ ~ Z.5 ~ ............... ~..:~.~.~ ..................... ~7~*~ ~.... ~ ............................... ' opprovod by t~e Buildin~ Inspector. Fee $./00....~ .......... 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-(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. 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 topograph i c 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 or land use $5.00 3. Copy of certificate of occupancy $1.00 New Building ...~..... .... Old or Pre-existing Building ._ .... ~ ...... Vacant Land ............. House No, Street Owner or Owners of Property ~~..~. · .~~. · .~..~ ............ County Tax Map No. I000 Section . .~??. ~. ........ Block ....O..7. ....... Lot..O.(~.~j.. ....... Subdivision ~.~'?, .'~.~....~.~,. · ./-~. ........... Filed Map No,'~..~..?'..~...Lot No. , .~..? ....... Permit Uo~/~., .~. ?.~. Date of Permi .t~.°.~.?.°..7,~pplicant ............... ~. .......... Health Dept, Approval . .~..~..~. ,~. 7./'.// ........ :. Labor Dept. Approval ........................ Underwriters Approval<~...~/, ,~.~..?.~...~. ........ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..... Fee Submitted $ . . i, . .~. ,~'...'~.~:~. ........... Construction on above described building and perr~it meets all applicable codes and regulations. Y_ THE NEW YORK BOARD OF FIRE UNDERWRITERS ~- ~[3J'~ BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038~ THIS CERTIFIES THAT only the alee trlcal equipment as described below and i~ttroduced by the applicant named on the above application number in the premises of R~ssell Hilhnan~ n/s P~be Dr., 200' w/o Dee~foot Path, Cu~cbogue~ u, the following location; ~ Basement []~lst FI. [~ 2nd FI. Section Block Lot was examined on J~ ~ ~ ~.9~0 attd found to be in compliance with the reqUirernents of tbis Board. FIXTUEE SWITCHES FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS 16 FLUORESCENT OTHER APPARATUS: 1-~-r~k~ Deteci~or E R I C E NO OF CC COND ,~/j~A W O NO A W G NO~ N A W O PER ~' OF CC COND OF HI-L~G OF EUTRALS OF HI-LEG OF NEUTRAL 1 1/0 P~O. ~ox 143 Mat:cituck ~ N~Y. be 11952 THIS office Lie. 242 E Board ~ ,.coO:ect FT~,D INSPECTI~0N FOUNDATZON (~s2) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY CODE FZNAL DATECOMMENTS ~o~ co~s: ~J ~ '~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180~ Examined {~ .~.. e~.~'~...., t9 ? ? Approved ./ff..V'?...~:. &..., 19Z~Pe~it No. ~e.¢~7~ Disapproved a/c ................ ~ .... ~ ......... ./. V APPLICATION FOR BUILDING PERMIT Date ................. , 19 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~m~p, ections. , .... ....... (Signature of applicant, or na~,~ if a corporate) ......... (M aili~ · '"' '~ i~ ~dd r"~';'ss~ ~ ~71i~ ~r~) ....... , .... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or.pull,der. Name of owner of premises . .'~.~.~.I..~. [!. ?...~..I.o..~ .~....~. [ ! { ,t~..~..~/. ..................................... (as on the tax roll or latest deed) If applicant isa corporation, ~lgnatDre/~f duly authoriz,e~P~fficer. · '~' .... ~a~ ~c'l 'title of corporate officer) Builder's License No .......................... Plumber's License No.. ~...~.. ?'..r~...~. (0..I~..~,..1~...~7~/~,X'"~ Electrician's License No.. ~o ~ ~ Other Trade's License No ...................... 1. Location of land on which proposed work will be done....~/..~.(..~..d?.'~..~.....~...~..~."..~..~.-7....fifl..~.: .......... · .Cc . ............................................... .4 ................ House Number Street Hamlet County Tax Map No. 1000 Section .... .(?..~.. ~. ...... Block . .(~..~, ............ Lot. ~ .C~....~. .... ~... Subdivision.. ~..~.Q .~..~'.. · ~ .d.~.~ ................ Filed Map No. ~..Z...~..~. ....... Lot.. 7..O. ..... .~.. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed constructi°n: a. Existing use and occupancy ....... .t~./O..~'..~../~. 7.d )'. ................................................ b. Intended use and occupancy ....~../d.~....~..~t:~..t.*./~ ...~..(~..~i ./4.x.,~.. ~ .............................. 3. Nature of work (check which applicable): New Building v'/ Addition .. Alteration Repair .............. RemoVal .............. Demolition .............. Other Work ............... ~ ~ (Description) 4. Estimated Cost ......... .~..~ .~. .... ,: ............ Fee .................................. (to be paid on filing this application) 5. If dwelling, number of dwelling finits ~ t~ M- Number of dwelling units on each floor If garage, number of cars ... ~-..r~,/'~ ~ .......................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure~, if any: Front ............... Rear .............. Depth ............... Height. ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... i. · Height ........... ~ .......... Number of Stories ............ t~"! ........ 8. Dimensions of entire new constrUction: Front .... .~..0: ...... Rear ...~.~.t ........ Depth ...~..~. ~ ........ Height ... ,~ 1.0 .t ....... Number of Stories ...... ~./4..~.. ............................. ; .............. 9, Size oflot: Front ..... '..~.~.,_, ........... Rear ................... 'a~ ~ ~.~.~./t ................. .~I!~ ~,?~.~.'~,'.~.~ 10, Date of Purchase . . . ].q..').~..~ .................. N o orme'r Owne 3. '~. 1 I, Zone or use district in which pre~nises are situated... ~ ................. ..~ ............................. 12. Does proposed construction violate any zoning law, ordinance or regulation: . F..O .......................... 13. Will lot be regraded .t,lt.~& I.. iM (~.~..~.,*~,.,~1~.,,,... Will excess fill be removed from premises: , Yes , (~) 14. Name of Owner of prem~ses/.~. $j~4! .~, ~& ~,~ ..... Address /~'tt.l.~.~.. ~/~.p,... Phone No.. g~ ............ Name of Architect .... ; ..... : .................. Address ........... r~ ....... Phone No lq,mar~e~'~ntr,~tr~r {/d~'ldt~Z I/Jl~t, I~d,'ln ,~ Aaa ~'~/~'~ ~* ,'t//~, Ph No ~_~d'"l~..~ . ................................. . ....... ~. ....... ~ ............. ,[~ ....... one ............. Locate clearly and distinctly [ill prope~y lines. Give street and block interior or corner lot. PLOT DIAGRAM buildings, whether existing or proposed, and, indicate all set-back dimensions from tumber or description according to deed, and show street names and indicate whether STATE OF 'NEW Y~_., ' ~ S COUNTY OF r,,. .......... . ~'..~..~...~.~.'~.. ~.'. ~.*~ ~.{] ........... being duly sworn, deposes and says that he is the applicant (Name of individual sig~ing contract) above named. Heis the ..... ~.~.~ ~J ................................................................... ~ (Contractor, agent, corporate officer, etc.) of'~id owner or ownem, ~d is duly au~ofized to perfom or have peffo~ed the said work and to m~e and file this applicationi that ~1 statements contained ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed in ~e m~n~r set fo~h ~ the application filed therewith. S~ru to before me this { ........... ay O ,. C,ill, , ,[ ..... ~ . Notary Pubhc, ............ ~..~ .... '~ q~./~'. County ,~UP'F, ~0. HEAl. TH Di[P~. APPROVAl,. · ? '/NAUTH OR/ZE~'T~TERA TIO N OR ro THIS SURVEY IS A VIOLATION:OF SECTION 7209~.~THE HEW ¥OII1~ STATI E~Ur..ATION LAW. MIA? o,~ Z. Or "A,d'OO,SE' COVE'" · 0,,.6,',,/~ co. ~'~h RODER~CK VAN TUY/ P. ¢. -':' v' MC. LAND I~Ul~¥1'¥O~ffi-~l~mk~lPOIIIT, N. ¥. NOTIFY BUILDING D~P,~RTMENT AT 765-180'2- 9 AM TO 4 PM FOR THE FOLLOWIHG INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FO~ POUR~D CONCRETE ROUGH - FRAMING & PLUMbiNG 3. INSULATION 4. FINAL - CnNSTR~ImTIqN MUST BE C~m~TE FOR C 0 't LJ CD