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Home My WebLink About10331-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Cerlificate Of Occupancy THIS CERTIFIES that the building ............................................... Location of Property ... 69.0. .~.~.99.~.~..H.o.~.]..9~...~.a. Bg. ............. ~.O.~..'~q~..d.,..N. gw...Y..qx?.k House No. Street Hem/et County Tax Map No. 1000 Section ...0.7.8. ..... Block .... .0.~ ......... Lot ...q0..'l.,.0.Q9 ...... Subdivision.. ~leegy.. I-I0~].0~ ............. Filed Map No...{5~5.~..Lot No .... .7. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .ff..~.~}r..~.? ......... 19 .7.9. pursuant to which Building Permit No .... .1.0.~.~. ? .Z ........... dated . .0'¢.J-~.. ~ .~ .................. 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 ......... ................ ~.$V.~.~.. 0n.~ .F~tSJ, y. D~J~J~r~ ............................... The certificate is issued to ...... lt.a. StlllO18.d..8.18.1t..C..e0~.~_.~_.k..$ .................... (owner, ~ of the aforesaid building. Suffolk County Department of Health Approval . .1.~./.~..0/.'7.0. .... 9,,8..0.-.~.0....R.,.~. ~ .V.t..i.~.~. ...... UNDERWRITERS CERTIFICATE NO .................................................. Rev 4/79 Building Inspector TOWN OF 50UTHOLD 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? 10331 Z Permission is hereby granted t~ ....... ~....~.~.~...~..~p.~.~.:.:,. .... z~...~.~,~...~.o,~ .............................. ,o ....... c~.~.~z.~..,.-........o~..~.....~,:.~?....~.~.~.~.~ ...................... ............................................................ ~ ....... '2 .................. i ................................ Z ......... ~ ................... ~Z.~ ~/..y.~.././~. Z.~,...~.~.~.~./.~.~- at premises located at ...~. ~.. ~.:.~. ......... ~~./,~.~.. ............. ~.f..~....7.... .................................... pursuant to application dated ........ ~..~..~.y ........,~....~.. .............. , 19.?,..~.., and approved by the Building Inspector. Fee' $.Z~....~.....~ 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 approva~ 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 (pri.or to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peopert~ showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner br I~revious owner as to use, occupancy and condition of buildings. 3. Date of any housing code (~r safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a ce~'t, ificate. 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 .. ~.e.Q~.~.~'. ~..'19.~.9... New Building ..... }i ....... Old or Pre-existing Building ............ Vacant Land ............. Location of Property , , .6.9,0..S.l.e..el:)X .H.Q.l.l.q~...L.a.n,~ ................ S. QQ.t:;~Q~Q~. ATo¥ ....... House No. Street Hamlet Owner or Owners of Property ..... ]P~.y,~lO~d..&. ~2.~C eli~..~u.~.~l~± ......................... County Tax MaPo,~N°' 1000 Section...7/ ~// ....... .F. ~. .... Block .., ~./' ' ' '2.' ' ' ' Lot. O~../, .,. ~.~, .~... Subdivision. ~..~'¢~'~...Z/~. ~ .... F,led Map No. ~.~..~. }{...Lot No .... 7 ...... Permit No. 101~.~.'].;~.., Date of Permit . .7/~.'~./.~Z~pplicant ., .~.a~.~.o..ri.c1. ?~'~p~.i~:~ .............. Health Dept. Approval , .~..'~.~'. ~ .~ .~..~? ......... Labor Dept. Approval ........................ Under~vriters Approval .... ]}.e.n.d.i.n. ~; ............ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit p}eets all applicable codes and regulations. Applicant ....... THE NEW YORK BOARD OF FIRE UNDERWRITERS [3Bl BUREAU OF ELECTR}CI~¥ THIS CERTIFIES THAT only the electrical equipment ~ described below and introduced by the sppl[cant ~ed on t~ ab~e application number in tko premises of Lo:,~ l~ila~ vg0 $t,~epy l{oliow Rd., $ot~t~O'ld, in the followi,tg location; ~ Basement ~L lst FI. ~] 2nd FI, Section Block Lot was examined o~)'~ ~l~]r ~. ':/ ,~ ~ (~ / C~ attd fout~d to be in compliance with the requirements of this Board. FIXTURES RANGES OVENS FIXTURE OUTLETS SWITCHES FLUORESCENT DRYERS EXHAUST FANS E R V I OTHER APPARATUS. ~leC~ RO0~ ~ea~r~4~2,0KW,3~I~5i~,L~l,25tiW,2'i.0KW,5-175KW l~Smoke Detector E OF~NEUTRAL Rg t~ Box ibA~ Main kd. ~ Th~s certificate must oat be altered m any ~anner; return to the office of the Board if incorrect. Inspectors may be identified by thetr ~ t/ FOR AyPROVAI~ APPROVED FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 APPLICATION FOR BUILDING PERMIT/ Date...'7../~q .......... , 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 descriphon 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 Budding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Bui/ding 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. ..... ......... (Sig~iature 6f applicant, or name, if a corporation) ..... ............. (Mailing address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~'~¥/~ ~..~.~C-C~-~.J..~k.. ~[]LJ~.~.~ [ .................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No..~)C)....~i ./Ok. ............ Plumber's License No. /.~...t7¥...'~.AD I~..L ....... Electrician's License No. ~.~OC'.~... Other Trade's Li'cense No .................... 1. Locatmn of land on which proposed work will be done ............................................ .............................................. House Number 8treat Hamlet County Tax Map No 1000 Section ...~. 7~.. ........ Block . .~'?../.~ ............ Lot .~./....O. ~ .~. ...... Subdivision..~E~')g ./.7zL?//.O40 ................... Filed Map No. (O.~.S.' / ........ Lot'.&'.. ??. ......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... .~.,~. ~-/~,~-/fl. · · · · · ............................................ b. Intended use and occupancy .... .d[.J.).~[[lt'.'.'.L, ff .................................................... Nature of work (check which applicable): New Building ......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost .............................. Fee ........................... (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits ...... /. ....... Number of dwelling units on each floor If garage, number of cars ..... i ................................................................... 6. If business, commercial or mixed occupancy, specify ua. ture and extent of each type of use .../~.~. ............. 7. D~mensions of existing structure~, if any Front..~/]'Ttr. ........ Rear .............. Depth ............... Height ................ Number of Stories ........................................................ Dimensions of same structure wi'th alterations or additions: Front ................. Rear .................. Depth .................... i.. Height ........ :. ~ ........... Number of Stories ...................... 8. Dnnensmns of entire new constructmn. Front ...~.(aP. '/'c/ .... Rear .... ~/~ ....... Depth . c~2.~ .......... Height .............. .ANumlber of Stories ....... .r ?.eL. ............................................. 10. Date of Purchase . .~../..~..D.? ............... Name of. Former Owner ~ZID ./~.(,C)~,~/~q~/~/. ........ 11. Zone o:r use district in which pr{mises are situated .... ~.?(.J~O(C/ ..................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .~O ......................... 13. Will lot be regraded .... O.(~.I. ,. ~- ...... , ......... Will excess fill be removed from premises: Yes QNo~ 14. Name of Owner of premises . . .::. Fk F.O~.~P~ ~ ..... Address ~C¢:/1-~c~t ......... Phone No. Tl~4J. ~.[..{~. · Name of Architect .......... . ................. Address . ~ .......... ~ ..... Phone No ................ Name of Contractor . .~OL/..!~..I.(Z3,~ ........... Address Phone No..TA~l.~. B(~/.~ PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, and. indicate all set-back dimensions from prop?'ty lines. Give street and block humber or description according to deed, and show street names and indicate whetheL~ n oror o n r,o . o ,4--6,0 VC/cr STATE OF NEW YORK, iS.S COUNTY OF ................. ..................... ~. ................... being duly sworn, deposes and says that he is the applicant : (Name of individual sigdng contract) above named. , He is the ' (Contractor, agent, corporate officer, etc.) of said own&r or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true 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 ~UBLIC, Stale of New Yor~ [ ......... No, 52.4522026 . Suffolk Comm~sdon Exprr, e, March 30~ (Signature of applicant) d /,.