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Home My WebLink About10505-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of t.he Building Inspector Town Hal! $outhold, N.Y. Certificate Of Occupancy No .... g..1.0.6.2.3. ...... Date ...... ~u. g.u.~.t~. 7 .................. 193.1.. THIS CERTIFIES that the building ................................................ Location of Propert' 7845 Skunk Lane, Cutchogue, New York Y h~s'e ~id ....................... 's'tle~i ....................... County Tax Map No. 1000 Section ... 1. .0.4 ...... Block .0.4 ............. Lot . .2.5. ............. Subdivision .N.a?. e..a.u..~..~.~.m?. ................ Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... l'l.o.v..e.~.b.e.~..2.3 19 79 pursuant to wkich Building Permit No. 1.0505 Z dated . .D..e.c.o.m.b..e?. fi. .............. 19 79. , 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 ......... Addition to Dw~.~l..i~g The certificate is issued to ...4a..m.e.a..R. ~.1.o. ........................................... {owner, of the aforesaid building. Suffolk County Department of Itealth Approval .... hi/R UNDERWRITERS CERTIFICATE NO. N483813 Building Inspector Rev. 1/81 FORM NO. 2 TOWN OF SOUTHOLD 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) No. 10505 Z pursuant to application dated /~/~'.6,/~C~/.~'~T./~... ~-'~ ...... , 194.~, and approved by the Building Inspector. / 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 alt 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 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 New Building ............. Old or Pre-existing Building ............ Vacant Land ............. House No. Street Hamlet Owner or Owners of Property . .~.~ ...... ~.~ ~-- ................................. County Tax Map No. 1000 Section ... !~.r~ ....... Block ..... ~..~. ..... Lot .... ~J:~ ...... S ..... ~Z~ ~ ~J ..... F,led Map No ........... Lot No .............. Permit No. ~.(')~Z~ Date of Permit /.~/~7~ ,Applicant .................................. Health Dept. Approval ........................ Labor Dept, Approval .................... ~.,, Unde~riters Approval .... '~,~ ............... Planning Board Approval ................ ?'~ ..... Request for Temporary Certf cate ............ F nal Cert f cate .~, .......... ~'. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ i~[ E5 JOHN STREET, NEW YORK, NETM YORK 100381 Date · ~ ~ Application No. on file T.,s CERT~=~ ~ ~S0 0~S~9 N 4 8 3 813 only the electrical equipment as ~scribed below and ir~t~duced by the applicant ~m~d on the above application number in the premises of ~2 1179 in tbefollowlng location; ~aseme.~ ~ 1.~ Fl. ~ 2nd Fl, Section Bloc~ Lot ~. ~x.,ni.~d o. J~;~a Z3, ]~.980 and yound to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS EWITCHES FLUORESCENT 7 7 DRYERS MULTI-OUTLET SYSTEMS NO OF FEET OTHEE APPARATUS. 2-Poat 'L~t:es E R V I C E NO OF HI-LEG NO OF NEUTRAL! AWG OF NEUTRAL 1/o ~lb bluish .Su. b~mordai~, t'~.I/. 1.1553 must not in any ~ COpY FOR IN ANY FIELD I~SPE~T ION COMMENTS FOUNDATION FOUNDATION 2. ROUGH FRAME& PLUMBING INSULATION PER N.Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: .... 7~5:1-~9 'AM-TO 4 PM ~0R TH~ -' ~ .... .. .... FOU Q'~JNG IN,S, ECT O _ RED ..... :..1. FoQNDAi'I~N '- FVIO R~QLII 'FO~- 2OUt~'D' CONCRETE? ~.2.. ROU. GH_: .FB&MING & PL~MBI~ 3. INSU~TION '~ ~~ . BE COMPLEYE FOR C 0.~ . THE R~UIR~M,..NTS OF T~E N Y~ ~ .......... STAT~ CONSTRUCTION & ~NERGY "'-V-C', , ' ¢ '::, '&,~,~- -, : %~'-":' ' : ' '' FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 Examlned~...~. ..... , 19... _ ,,b Application No. A~Troved .~..J~. · · ~· ...... 1_9_,? ~. Permit No. L~..~.' .~..~.(~..~. 'U D' pproved a/ .... - ............... ................................ (Building Inspector) , APPLICATION FOR BUILDING PERMITDate ............ t~/~. ~ , 19 27 / 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 ichedule. 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 dia~am 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 BuildingPermit 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 ~n part for a~ay 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 6f buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances,,,l~ildi~ code, ho~g~__c9de, and regulations, and to admit authorized inspectors on premises and in buildings for nece/~~ns/~ --?~6~" ' (~i'gna~r'e';~ ~¢l~am'e', if a~orpo-ration) · (Mailing address ;~'a~ii~ant~,-, State whether applicant ~s owner, lessee, agent, architect, en~n~neral contract~etectrician, plumber or builder. If applicant is a corporation, s~gnature of duly authorized officer. (Name and title of corporate officer) ) Builder's License N~....~../..~.(...'Z. Plumber's License No ............... ~ ....... Electrician s License No ............... =. ....... Other Trade's License No ..................... t. Location of land on which proposed work will be done .................................................. ............... .s'..z. ,q, ........ ................ House Number Street Hamlet County Tax Map No. 1000 Section ...... ! .O. ~ ....... Block ..... .O..(~., ...... Lot .... .~. '~ .'~. ........ Subdivision .... ..~.. Gr..5 $ .~-~.....~..q~'~ .~,~-.~, .... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premis,0~,and intended use and bccupancy of proposed construction: a. Existing use and occupancy ......... . .~..~ .-~..'~' .......................................... b. Intended use and occupancy .................... 3. Nature of work (check which applicable): New Building .......... Addi n .......... rati~ .......... Repair. Removal ...... Demolition .... Other Work ....... 4. Estimated Cost ............................. Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ 6. If business, commercial or mixed occupancy, specify ~ ~nd extent of each...ty~.~ of use ............ .~ ....... 7. Dimensions of existing structurels, if any: Front .... .~. ......... Rear ....~1, ........ Depth ... ~,,.~' ....... I-[eight ...... '~.../. ? .... Number of Stories ......... .~. .................................... u ....... Dimensions of same structure with alterations or additions: Front .....~..~. ......... Rear ...... .~.. ~ ....... Depth ...... 3..~ ......... 2" Height ....... .~...t'] ......... Number of Stol:Les ....... ~,~ .. .....,t~. ·. Dimensions of en i construction: Front ,~.~ Rear ~ C.c~.. Depth ... ,~q,q,q,q,q,q,q,q,q~ ... Height .... ~. ·/~,,L..~.' · · N. un'kber of Stories ....... .~. ~ ........................... ._ ~ ...... 9. Size of lot: Front ....... /.O .O.. .......... Rear ........... .q~ ....... Depth .... ~...~-. ........... 10. Date of Purchase ........... ! .................. Name of Fonpe, r Own_e!r .............................. 11. Zone or use district in.which prdmises are situated ........ ~.il~.. ~. ~...,~4~.~'...o~., ~ ........................ 12. Does proposed construction vioiate any zoning law, ordinance or regulation: ...... .[Q'~.(-~.. '.-'. .............. 13. Will lot be regraded .. 2.~ ................. Will excess fill be removed from premises: Y,e_s k i~o~ 14. Name of Owner of pre~s .,~. o,~, .~=~, .. ~.~.q,l?.~Address . .~.~.~..c.~p,pt~,,e...Phone No...'?r,~.~...,.,5.~."~.O Name of Architect ....... , ................ Address .................... Phone No ................ Name of Contractor .~.x.k'-'-)..,..'~ .~'.o .~-~..~.~v~.~.Uddress . .-~ ~ .(/~.. Phone No...r~fo.~'. PLOT DIAGRAM Locate .clearly and distinctly alll buildings, whether existing or proposed, and, indicate all set~back dimensions from property lines. Give street and block ~umber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEWiiORtC ~ . S S COUNTY OF ' ' ........... ...... (Name of individual sign'ing contract) above named, i ·. being duly sworn, deposes and says that he is the applicant (Contractor, agent, cori)orate officer, etc.) of said ow~ner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; tha~ all statements contained in this application are tfu~ 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 NOTARY PUBLIC, State of New Yor~ / ~ig~ture of a~licant) No, 52-8125850, Suffolk Co~ty~ T~rm ~pires Ma~ch 30. 19~~