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Home My WebLink About10402-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building Addition Location of Property 130 . . .T.a. sk, .~.r..I~.a. ,n9 ............ .G.r.~..~D~.o.¥.t ...... 121~S~ 'gl'of .............. Street Hamlet County Tax Map No, 1000 Section .... 9.3.3. .... Block ...... 9.4. ...... Lot ·..0..4.5 ........... Subdivision ......... X. ..................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated ·..S.o.p.~.: ......1.3 ....... 19.8.4. pursuant to which Building Permit No ...... 1.0. 4. .0.2.Z .......... dated ....... Q.c .tp.b.~..r ........3 .....19 .7.9., was issued, and conforms to ail of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ...... A..d.d.i.t.%9.n...gO. ~;J~.'c;i,ng. 9P~e.. F~t.m.J,.~y. p.W~.l.i.~g ......................... The certificate is issued to ................ t~E~IqlgT~t ...... ~R3;$trlE ....................... (owner, la&e~ nr-tatlantl of the aforesaid building. Suffolk County Department of Health Approval N/A N488084 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 7/81 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 submitte~jp~cctc to the Building Inspec- tor with the following; for new buildings or new use: I. 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 topographic featu res. 2. Sworn statement of owner or previous owne~ 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 / land use 3. Copy of certificate of occupancy $1.00 z --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 o /0- ate .. . . New Building ............. Old or Pre-existing Building .....'~. ..... Vacant Land ............. /"louse No. ' .................................. Owner or Owners of Property ,.. ~.'¥,., .'~Q .~...~. ........ ~.~..%~. ........................... County Tax Map No. 1000 Section ..... ~ ,~. ...... Block ............... Lot ....... Subdivision .............. Filed Map No ........... Lot N~o~. ~.. ~,~ .... Perm it No/z2 ~..~.~..'~... Date of Permit .......... Applicant..~...~ Health Dept. Approval ........ ~..'~ · -.Labor. · · · · ·.. Dept.~~ - -' 'Approval ........................ Underwriters Approval ...... ../~...~.. ............ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $..~.~. ..................... Construction on above described building and permit meets all applicable, codes and regulations. ~l¢- ~-~ Applicant .~l~r~¢~-~,, . ~ ..... ...................... Rev, 10-I0-78 THE NEW YORK BOARD ~F FIRE UNDERWRITERS J~JUREAItJ (~)F ELECTRICITY [~]C 85 JOHN STREET, NEW YORK, NEW YORK 10038 Bat~ au:Ly 30.. ~ao ~,~..on~o.o.~.~ 0~774~ N THIS CE~IFIES THAT only the elec trlcal equipment as described below and introduced by the applicant ~m~d o~ the able application number in the premises of in thefotlowln~ b,c,,tlo~; ~ B.sement ~f 1st FL ~ 2nd FI. Section Block Lot was examined on ~y ~ , ~ ~ {~ and found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES ~LUORfSCENT DRYERS SYSTEMS NO OF FEET E R V I C NO OF CC COND pER ~' OTHER APPARATUS ~"~:,c~~'~ )o~ h~.~a~:ers:l-2.0kw,2-1o 25kw NO OF HI lEO AWG OF HI LEG NO OF NEUTRALS AWG OF NEUTRAL ~'~.~cq)~)O~Tt ~ ~,~, ~.]~. GENERAl. MANAGER 1L This certificate must not be altered in any~manner; return to the office of the Board ifhnc~rrect Inspectors may be ~denhfled by their creden.als. ~OL~ ~ H Ff'~AI',"~F---- 4~ .5 F'i r.J ,,~ I 0~o c ' o o L ~' ~ .' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examifled ....... , Disapproved a/c .......... ~ .................... APPLICATION FOIl BUILDING P~IT Application No ....... : .......... 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 ~ving 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 Depar[ment 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 inspections. ~' J (Signature of applicant, or name, if a corporation) (Mailing address of apl~licant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... ~...~:>'..~/:.:;:,-- ~ ~:.:. A...~ ......... ~' ......................................................... Name of owner of premises /(.: ,,, 9,,.-. :/.7-, ./. ~,t.[////~ .[.~.)/../.. ~}:/.'e.. ~.',~ ./. }./:'LQ~ ........................... /(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. Plumber's License No Electrician's License No .................. ~ ..... Other Trade's License No ...................... 1. Location of land on which proposed work will be done. ,2.. ~... .;..I~,! .~1~ .lc: .,..,.:~. ............... Z: .o ......... ,,.....;-: A.' .............(,..,2.¥.c'..,. ....................... House Number Street Hamlet ~ "' . ......... 'ZZ/.. Lot ..... '~5." .' ~:. ....... County Tax Map No. 1000 Section ......... ~. ,J~ ..... Block ..... Subdivision ..w. ~.,..~ '>. ~ ~ . ~-~,. z .}..~, .~.~ ....... Filed Map No ............... Lot ..... ¢. ~. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construcfion. /:/::.,,.,.,.,../;,. //. a. Existing use and occupancy ................ ~ ..M. ~....eL ....................... b. Intended use and occupancy ...... /?. ;:. x./..~:.~,' .~.~. }:PD...~..~.. 7~.d~. · .%'. F) ............................. V 3. Nature of work (check which applicable): New Building .......... Addition.../X,,.... Alteration .......... ' RemoVal Demolition Other Work Repair ........................................... .~'1" ! .:~ (Description) 4. Estimated Cost ....... ': ................... Fee ....... ,..~..':O. .................... (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 nature, and extent of each type of use .............. ~. ..... 7. Dimensions of ex~st~ng structureS, ~f any: Front...-D'~. ~...~.... Rear .,~ .7' ''~' ..... Depth ...C~ .~.~ ....... Height .. .............. Number of Stories ...... c~ ............................................... Dtmens~ons of same structure w~th alterations or ad&tmns: Front . .~:~. 7.. ~ ....... Rear ...~-~. ~. · ~ ...... Depth ...... .~/f..,~. .......... Height ...................... Number of Stones ..... Z ............... 8. Dimensions of entire new construction: Front ..... ~. ~ ...... Rear .... & .-~. .......Depth ...j.-¢'. ........ Height ............... Number of Stories .......... .~. ............................................ 9. Size of lot: Front ........... . ........... Rear ...................... Depth ...................... 10. Date of Purchase ........... : .................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violtite any zoning law, ordinance or regulation: .... ,~.O ........................ 13. Will lot be regraded ..... j~.O.. ....;./~ ....... ~ Will excess fill be removed from premises: C~ -, N,o 14. Nam e of Owner o f premises[('~ ~ ~/. e. ~. j~).L ~ Ad dress~f~o m .~.~..~} v .c .0~h ~/~. Phone No. ,f/..Z' ~..; ./. !, ~'o. ~.. Name of Architect , Address'.. Phone No Name of Contractor ........................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all ibuildings, 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. COUNTY OF ~4' ' ,;~,;a , .............. ; ........ I ...... .~ ..... being duly sworn, deposes and says that lle is the applicant ~ gn!ng above named, ,; nt, r, etc.) of said owner or owners, ~d is duly authorized to perform or have perfomed the said work and to m~e ~d file ~is 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 m~n{r set forth ~ the application filed therewith. Sworn to before me this ~O.,~-~258~D, Suffolk Coun~ , te~"~fres March 30, 19~ ,