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Home My WebLink About10430-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No Zl1230 Date October 4 ................................................... 19 82 THIS CERTIFIES that the building ................................................ L ..... 3965 Soundvie,~ A,v. en ue Pecontc ocauon oi rroper~y ........................................... House No, Street .............. ~l~r~/e~ County Tax Map No. 1000 Section . .0.6.8. ....... Block ...0.1 ........... Lot .. 9.1.5.: .0.0.1 ....... Subdivision X .Filed Map No. × .... Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated October 3 979 ..................... ,1 ... pursuant to which Building Permit No. 10630 Z dated October 5 198.2.. 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 ......... ...~..~. ?.d.a..~.~p.o?...~.o. ?., .~..?.~. ?.~.~.~.~. ¢??.~..~.~.~.~ .. .................................. The certificate is issued to Glo,ia E. Fultz (owner, of the aforesaid building. Suffolk County Department of Health Approval n/a UNDERWRITERS CERTIFICATE NO. N 577515 Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) No. 10430 Z Permission is hereby granted to: ....... ~c~...~....~.r~ ........... ..~.~......~.~C ............................................... ........ i.~~?...~.?~.,%.., ........ ~o ..... .~.~..c...z.~-~L~..~.~/..~./~..~./~z~z~.~....~u.~-././.`~.. ........................................................... ~......~ ...................................... : ..................................... : ....... et premises located at ..-?~.......e..~....~'.'........~)... ...... ~..~...~'.;../~.~.-~.~-~/-~......~..~.-~.~ ....... ~..~.~-~,~t..~L,2 'y Building Inspector, Fee $.../.....~.....~..'~..~.. ..... 1000378 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY~ · SD JOHN STREET, NEW YORK NEW ~ORK 10038 D,.e September 2%1982 *.p,catio..No.o../ile 095~:['8a N 577515 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant oamed on the above application nu tuber in the premises of Earl Fukz, Soundview Ave., Peconie,N.¥, in the following locatwn; ~ Basement ~ 1st FI. ~.sexami,,ed,,~ept. 16,1982 rot OUTLETS RECEPTACLES 30 DRYERS FURNACE MOTORS FIXTURES FLUORESCENT 1~' 2nd FI. Section Block and found to be in compliance with the requirements of this Board. RANGES OVENS FUTURE APPLIANCE FEEDEES EXHAUST FANS UNIT HEATERS MULTI-OUTLET SYSTEMS NO OF FEET DIMMERS SERVICE DISCONNECT S E R V I NO OF CC COND A W G , OF HI LEG 1 3/0 OTHER APPARATUS Elco. room heaters: l-2.0kw. 1 GFCI, Hot weCe~ heater: C E A W G NO O~EUTRA/$ OF HI LEG 1-4.5k~,. - AWG OF NEUTRAL 3/0 Chq~les M. Hall Elec.,Inc. 760 Long Creek Dr. ~outhold,N.Y,11971 lic.657 ER This cerhfkate must not be aJtered in an COPY return to th THIS COPY off,ce e Board if may be ~denh ANY MANNER. FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buiMings 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 disposaI-(S-9 form or equal). 3. Approval of electrical ~nstaIIation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buiJdings 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. 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 Date .. O.~-~¢",~,~I I~[T/ , .. New ~Idh-,~ . .~:]~.~. ;... Old or Pre-existing Building(X) .. ....... ~/Vacant Land ............ Loo.t on of Property ........ .... ..... ' .... House No. Street Ham/et Owner or Owners of Property ..... . ,~..~ O ~__ !'~.~-.~. , .~:-~'. ~. ~...c/~'.'~. ,/~. .......................... County Tax Map No, 1000 Section .... ~i ?. ....... Block ..... ,(~)J ....... Lot.. ~ ./.~:; .~..c).l . Subdivision ..... .~. .......................... Filed Map No ........... Lot No .............. Permit No./.~.~.~.'? .... Date of Permit...!.~.¢....Applicant ...~./..O..~.,: ./9...~.~..~.~.T..~-. .......... Health Dept. Approval ...... .~..¢ ............. Labor Dept. Approval ......................... Underwriters Approval. ~ .~.. 9.~...~..I. ~~', ...... Planning Board Approval .................. Request for Temporary Certificate ..................... Final Certificate ........ - ......... - Fee Submitted $ ......................... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 76§-1803 Examined .~...~...O..-.'. .... ,197.? Approved-~....c~-..~. . .~..- ....... 197.?. Permit No. ZO.~..."~.q ''~ Disapproved a/c ....... (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No./~.~..~..'~....O. ...... 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 detaded description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by th~s 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 inspect]on throughout the work. e. No bmld~ng 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 apphcable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necess~s~ection, s. ....... f('$1gnature of applicant, or name, if a cordon) (Mailihg address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bmlder. · ............................................................................. Nameofownerofpremises .. G,~- Ol.~ f4-../~..,...C · . . ....................................... (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 ..... ./. ?.....2~....~..~..c: .'~_.~ Electrician's License No ...... Other Trade s License No ...................... Location of land on which proposed work will be done... O.q//9. i>. g.I...~.... ~/.6. House Number Street Hamlet County Tax Map No. 1000 Section .... o..~..~'. ......... Block ....o..t ............ Lot...c9,/.~. :o. :q ( ........ Subdivision .................................... Filed Map No ............... Lot .............. (Name) 2. State existing use and occupancy of premises and intended use and 6ccupancy of proposed construction: a. Existing use and occupancy ...~..A~.,.~..'~.~...2-~. ~./7..c~.. ~'..~...~.t.: .¢.~..~. ................... ~. ................ b. Intended use and occupancy ... O..fy)..o,.~. .~.~..~./' ~.e ~[ ~-.~. ~/~-~ ~ 'of work (check which applicable): New Building .......... Addition .......... Alteration .......... i l~epairI y 1 D liti .............. Remo a .............. cmo on .............. Other Work ............... ~ I , (Description) ' 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 ..... i ................................................................... 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, . .............. Numlber of Stones ....................................................... Dimensions of same structure with alterations or additions: Front ................. Rear· ................ ~ Height Number of Stories Depth ................................................................. 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............. Height Number of Stories ' Rear ...................... Depth .... .. 9. Size of lot: Front ........... ~ ......................... 10. Date of Purchase~ . .......... i .................. Name ,of~o, rmer Owner ........................... 11. Zone Or use district in which premises are situated .......... ~ ....................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... t~,C~. ..................... 13. Will lot be regraded ....... , .i .~, Will excess fill be removed from premises: Yes No Phone No..'., ....... ~! .... 14. Name of Owner ofprem~ses'-:.,~...' ~ ^ Address';~'' ..;. ~.:;...-.,.. i; · ' ' · Name of Architect I[:..:.. ,~>.. )%.. ,, :. ....... Address: ~..'.'... :'... ~ ...... Phone No.; .... ' .......... Name of Contractor ......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all] buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block ihumber or description according to deed, and show street names and/indicate whether interior or corner lot. STATE OF NEWt,,Y)O R~,~~ ¢~' #~'/~ /Y/~-"~ ~ ~ COU~Y OF~... , ~ (Name of individual sig~ing confract) above n~ed. : ......... ........................................................ (Contractor, agent, corporate officer, etc.) of ~d owner or owners, ~d is duly author~ed to perform or have perfomed the said work and to m~e and ill'& ~i~ application; that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed in the m~n~r set fo~h ~ the application filed therewith. Sworn to before me this ,- ........ ~.~~ .... day o~...~.~..., 19~? ~ ~~ .... [L~ ~ ......... % ..................... ; ........ ~h ....... ~ ~ NOTA~ PUBLIC, State ~ New ~orF (Signature o appli ant) Term Expires ~tch 30, 19~ ~