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Home My WebLink About10515-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin~ Impector Town Hall Southold, N.Y. THIS CERTIFIES that the building ........................................... ..... ~fou~ No. . S/r~t County Tax Map No. 1000 Section .. 0~-~ ..... ,Block..0:l ........... Lot... 0.1.0 .......... Subdivision..S~v&tmo~'a .Es~tes ......... Filed Map No3'~23 ..... Lot No...5 .......... conforms substantially to the Application for BuUdip4 Pm-mit heretofore filed in tiffs office dated 3 ,?pUrmaattow hS Udins . rmitNo' 05 5Z dated .. p.e.q, pp. hq V. J.3. ........... 19.7. ~, wss issued, and conforms to alJ of the requbeme~ts of the applicable provisions of the law. The occupsncy for w~ch this certificate is issued is ......... The certificate is i, ued to ...... Chvt&l~o. a~d. lt.AZ®~. D~vhl~,t,d~! ....... · .............. of the aforesaid buildins. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO .......................................... Building Imp,ctor Rm.l~l FORI~ NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHOR]ZED) N? 10515 Z Permission is hereby granted to' ~ ~ t' ,~/~ ~ .,.Z~)/q 7-~2/-/'/~' Z)~, ~ ~ ........... ~zz~..... ~.~.~.~ ............ .~.y.~ ....... ~;~:~z:Zr.~.~....~ ................. .... ~'"~'~'"'~C~:~"~72z~/~z'''z~' Z 7 ~ '" pursuant to application dated .,&,~.'.~.......-~.. ................................... , 197...c~.~., and approved by the Building Inspector. Fee $l.~..:.~: ...... FORM NO. 6 TOWN OF $OUTHOLD 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 mstallation 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 buddings (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 or land use 3. Copy of certificate of occupancy $1.00 $5,00 Date .A.P. P,. [.L.. 9.,. ! 9.8.1 ............ New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property STRATMORS ROAD , EAST MARTON, L, !:, N, Y. House No. Street Hamlet CHRISTO & HE. LEN D,AP.H.N.]~I~ Owner or Owners of Property ................................................... County Tax Map No, 1000 Section ~ ~ ~'~-~ Block Lot. :.~, · Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ attached Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate . .f.o.~ .qd.d.l:t;l:qQ/.~l.~ctr.~cal work Fee Submitted $ 5.00 Construction on above described building a,~Pl~e~it meet~reU.applicabJe codes,al~ reggl, ations... ~ THE NEW YORK BOARD OF FI RE UNDERWRITERS BUREAU OF ELECTRICITY~ 85 JOHN STREET, NEW YORK NE,~v ~ORK 10038 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicator nalt~6d on the above application number in the pren*ises of Daj~'s~de~l, PriYate ]Road off Ro~ Point: Roa4, 'P'-~St Marion, N. ¥. in the following Iocation~ [] Basement [~ 1st lq w.~ ex.,,,i.ed o. Nove~er 10, 1980 FIXTURE OUTLETS JECEPTACLES 4 SWITCHES FIXTURES FLUORESCENT DRYERS [] 2nd Fl. Section Block and found to be in complian?e with the requirements of this Board. OVENS DISH WASH SYSTEMS NO. OF FEET Lot OTHER APPARATUS: S E R V I C NO OF CC COND A W O J A W g NO OF NEUTRALS OF NEUTRA[ ~This any ~anner, return to the office of the Board i~ect, Inspectors may be ~dentifled by therr credentials J~'~'~,l~'~,'~',~z~z~.~'~'~.'~'rv,~A'is~;,~cert~ficate must not be altered irJ m~ credent, als. FIELD INSPECTI0~ COMMENTS FOUNDATION FOUNDATION 2. ROUGH FRAME & PLUMBING ? INSULATION PER N.Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 E×amine' ...... 1,7. Approve~..%.../..~. ....,197. TP¢~mit No./0..--57./.0.-7. Disapproved a/c ........ 22.2.' ' '----~ ...................... APPLICATION FOR BUILDING PERMIT Application No. ~..~..~.-./..'~.. 7 ...... Date ................. ,19 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to th~B~ilding Inspector, w~th 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of build,ngs 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 s{~all be kept on the premises available for inspection throughout the work. ¢. 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 co, de,/Bp/d~egulations, and to admit authorized inspectors on premises and in buildings for necessary inspectior~:~ -,-~/;//" / ~o~//~ ~:;?~-~,~_ ... s.~..~c..~.~?~~s: ~i~ .......... - .... /(J?ignature 9f applicant, o~h~ttne, if a corporatmn) ...................................... ~ ._,(Mailing add,tess of agplicanO. ~ . ,./. State whether 0~plicant is ow,,ner, lessee, a~nt, architect, engineer, general contractor, electrician, plumber 9r builder ....... .................. , ......... _ ...... , .......... ................. g (as on thdtax mtl or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License ~o. ~'~" /~4/t~/~Fd~/.g~- ~ian's U~>~ ............... O~Ti~'~icense No ...................... t. Location of land on which proposed work will be done .................................................. House Number ~ ~O Street Hamlet County Tax Map No 1000 Section .... ~.~Z ....... Block .. ¢~ ............ Lot.: :~(.Q. ~ .... ' ...... Subdiwsion .~ ~0J~..~~ ........ Filed Map No.. '}-~. 7~ .~. Lot...-~.7 .... '},... (Name) 2. State existing use and occupancy of premises and intended use and occBpancy of proposed construction: .... .................. b. Intended use and occupancy /.*~g~... ~ 5... ~(//~O~} i*,, ~- ............. ~, ..... ...................... 3. Nature ~o~ork (check which a~plicable): New Building .......... Addition., ,X .... Alteration .......... Repair i..; ..... :. ..... RemoVal .............. Demolition .............. Other Work ............... timated Cost ~ ~g(fl [ F -- 4. Es ..................................... ee ...................................... x.(to be p~d on filing this application) . 5. If dwelling, number of dwelhng umts ............ Number of dwelling units on each floor ............. If garage, number of cars ..... ~ .................................................................. 6. If business, commercial or mixed' occupancy, speck~ nature and extent of each ty¢e of use .................... 7. D~mensmnsofex~stmgstmcture~,ffany: Front .... ~'.~ ........ Rear . .~ ....... Depth .... ~ ....... Height .... /~ f ........ Number. of Stories ..... ~ .................. t ................... ~ ........ of same structure with alterations or additions: Front ..... ~ ........ Rear ... ~ ~ ......... D~ensions D~nfh ~ ;, Heit (~ ............. Number of Stofies ...... [ ............. 8. D[~i~ons of entire new construct~on~ront . . ~ .......... Rear ..... ¢X~ ....... Depth . ~{.~ ....... HeiSt .... // ......... Smber of Stories .......... ~ ...................... ~ ......... 9. Sizeoflot:Front .... ~/~ .... ~ ........... Rear..~.'.~7 ............. Dep~ ~ ......... 10. Date of Purchase I Name of Fomer Owner .................... 11. Zone ~r use district in which premises are situated ..................................................... 12. Does proposed Construction violate any zoning law, ordinance or re~lation: ................................ 13. Will lot~be regraded .... ?Sq'.~ff~ ................... Will excess fill be removed from promises:__..._ Yes ~ No 14. NmeofOwner ofprem~ses .. ~'[v([~:[ ~/~(~ddress.SY~ .......... Phone No. ~/~ PLOT DIAGRAM Locate clearly and distinctly Ml~build~gs, whether existing or proposed, and, indi~te M1 set-back ~enMons from ~dperty Hnes. Give street ~d block Oumber or desc~ption according to deed, and show street nines and indicate whether yint~fior or corner lot. STATE OF N~O~tK, , counTY s.s ............... ~.'~.~.. ~.!...~.../...,~"../~.. ~¢~.'. being duly sworn, deposes and says that he is the applicant (Name of individual sigaing con~raCt) ab6ve name'd. ' ' ' ~ ~ ' '~ , ~ ...... Heqsthe ~'" (Contractor, agent', corporate officer, etc,) of smd owner or owners, ~d ~s duly authorized to perform or have perfo~ed the said work ~d to m~e ~d file ~is appliCation; that work w~l be gerfomed in the m~nOr set forth ~ the application filed ~gyewith. , Sworn to befo~ me this ' .'~ ' - . ".' ' ................. /L . , Nota[y Public . · ~ ~~ - .: ... ~ ~ a , , , ~mission E~lrea ,,I t ( DATE: B P FEE: ........... r.,.~._ _ ~.-~ ..... , .... ?~ MUST . ',~L MEET STATE r~ ~o~ .... CODES. N3T RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORs