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Home My WebLink About10456-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 budding .., .O.n.~...f.a.m.J: .1¥..d.w..e.l.l.5:.n, ? ...................... Location of Property . ~..Q, .Iq....o..f.f..S../~..R. qgt.1' .ko...E.afi. L., .E.n.d, ~'ishers I s land House No. Street ................... /J~r~/'oi County Tax Map No. 1000 Section .. ,8, ........ Block . .1 ............. Lot .6...4. ............. Subdivision ............................... Filed Map No ......... Lot No ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... Oc.t.,. 25 .......... 19 7,0. pursuant to which Building Permit No. 1.0. 4..5.6.g. .............. dated .O. qt ,..2.5. ................... 19 7.9. , 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 ......... .... ~cl$ ~:£.o.n. t:o..one..£ami~l.y, dwa]. 1 ~,ru7 ...................................... 'Ii~e certificate is issued toAllerton & R5 ta Cushman ..................... [o~n'o;, 'l~do'dr't~t;a'o'tJ ...................... of the aforesaid building. Suffolk Comity Department of Health Approval ........... 15!//k ........................... UNDERWRITERS CERTIFICATE NO ............... ~.5.Z 1.013.0. .......................... Rw. Building Inspector THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITy ~ 85 JOHN STREET, NEW YORK, NEW yORK 10038 Date ~kVy 22, i9~1 ~o.~o.o.y~ 052232-~9 N ~ ~* THIS CERTIFIES THAT only the electrical equipment ~ &scribed below and introduced ~ t~ applicant no.ed on the above application number in the premises of ~.~ ~,.i.od o,, May 19,1981 ~,,a found to be i,~ compliance with the requirements of th,s Board. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS 7 zO 5 6 1 DRYERS FURNACE MOTORS ~IME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO OF FEET SERVICE DISCONNECT S E R V I C E AW OTHER APPARATUS. Pt~lboard./s~ 1-42cir. 200map 4-~Sanp (~CI. Racpt. i ~ke ~tec~or 1 AWE OF HI LEG AWE 3/u Wall P&H ~a~ro !alaad, N. Y~ 06390 Th,s cerhficate must not be altered in any manner; return to the of the Board (Op¥ FOR BUILDING D~PAR.~MENTo THIS ~OPY Li~ ~ ~455 GENG~A'. MANAGER Per !t __ may be ~denti{ied by their credentiols. IN ANY MANNER. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRIC~IT~ ~ 88 JOHN STREET, NEW YORK, NEW ~ORK 10038 THIS CERTIFIES THAT m~he/ollowmgloc, tion; ~ Base,,e,tt ~ ,stFl. ~ 2nd FlYfi g~,~ ~Zl~ Section Block Lot was exatnined on ~ ]~9~ .I.9~J~ and found to be in com~haaee with tke requirements of this Board. DRYERS FURNACE MOTORS FUTURE APPLIANCE EEEDERS UNIT HEATERS MULTI-OU1LET DIMMERS SYSTEMS NO. DF FEET SERVICE DISCONNECT S E R ,V I C E OTHER APPARATUS. ~ 1,OOamp NO OF Hi-LEG A W G A W G OF HI-LEG OF NEUTRAL ' 'Roiled% E. Wall Alpine Awm~ Fishers 06390 Thru certdtcate must not be o(tered in any manner; return to the office of the Board COPY>FOR BUILDING DEPARtMEnT. THIS COP~ OF GENERAL MANAGER , ,be ~dentifled by their credentials IN 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 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 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 s~te 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 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. Fees: 1, Certificate of occupancy $5.00 / Certificate of occupancy on pre-existing dwelling / land use 2. 3. Copy of certificate of occupancy $1,00 ~ --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 $.$ Date ........................ New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ...~..~..~. ....................................................... House No. ~-.__ / ~ ,, / Stree~,~ /~ Hamlet Owner or Owners of Property ~..'~..~.~. ~.. ~. · .~. · ................ County Tax Map No. 1000 Section .... ~ ........ Block ..... Z ........ Lot,., ~.~, .,~. ...... No,,~.~. ~, .~.~... Date of Permit~.¢~..Z-../.)~P,~pplicant Permit V Health Dept. Approval ........................ Labor Dept. Approval ........................ 57. I ooo Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $. ,~, r O.~. ...................... Construction on above described b ilding and permit meets al App ican ,,, d~¢~,., f.-T,< · ,'-?~, · ............... Rev. 10-10-78 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 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 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. C. - 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 --Pre-Existing C.0. $15.00 Vacant land C.O. $ 5.00 Date .......................... New Building ............. Old or Pre~e~xistin~_ Building ............ Vacant Land ............. Location of ProperW ............................. · ........ .~ ............................ House No. ~"~ ~ ~ ~- ~d t~ ,,/-- Stme~'/~ ~ Ham/et Owner or Owners of ProperW .......... ~ ..................................... ~ .... ~ ...... / ............. ......... ..... ....... ....... ~ ................................. ~ ~ ~ ........... ~ ~. ~ ....... ~ .... ~ermir ~o ........... Dato of ~erm[t .......... gpplieant .............. ~.. ................ Health Dept. Approval ........................ Labor Dopt. Approval ........................ Unde~riters Approval. W ~'~ t ~ O~. . .Planning Board Approval Request for Tempora~ Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. described buildin an5 p~rm[t ~eets all a~lic~ codes~n~re9ulat[ons. pp ma ,~. v R~. 10-10-78 FORM NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×om ned ........................... ..... App,cat on No. Approved /~'/~'~-~' I~' PermitNo. /~)(I~ ~ -- ................................................ :::::::::::::::::::::::::::::::::::: ..... APPLICATION FOR BUILDING PERMIT Date ................................................. 19...~.~. ..... INSTRUCTIONS a. This application must be completely filled in by typewriter o~ 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 Iocatior~ of lot and of buildings on premises, relqtionship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. 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 o 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 port 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 code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ...................... (Signature of~tdplicant, or name, if a corporation) ..... (Address of applicoJ'ft) State whether applicant is owner, lessee, agent, arc~ect,z/~ineer, general contractor, electrician, plumber or builder. .................................................... If applicant ~s a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .............. ../...~..~.... .......................... Plumber's License No ........ ...~....~..~.~...77,,?. ................... Electrician's License No....~...~..~.-~',Z~ ................... Other Trade's License No ............................................... 1. Location of land on which proposed work will be d~t~e. Mop No.: ..... ~ ................................. Lot No. %~ ...................... Street and Number ....................................... Municipality 2. State existing use and occupancy of premises and intended usean~ occupancy of proposed construction: a Exislting' use and occupancy ....... .,<~--=~...~:~..~..~,.~..,.~:.. d..~'~....~/~.:"~/~" .............................................................. b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which[ applJcaNe): New Building .................. Addition..................~ Alteration Repair .................. Removal J .................. Demolmon .................... Other Work .................................................. I (Description) ' (to be paid on filing this application) 5. If dwelling, number of dwel lng units ....... ../. .................. Number of dwelling umts on each floor ........... ; .............. If garage, number of cars ..................................................................................................................................... 6. If business, commercial or Imixed occupancy, specify nature and extent of each type of use ........................... 7. Dimiensions of existing struct4res, if any: Front ....~,~.'~.. ............... Rear ...~...%'.'.~.. ................... Depth ..b..-'~,.. ........... Height .../.,,.~.[. ............. Number of Stories ........ ./. ...................................................................................................... Dimensions of same structur~ with alterations or additions: Front ....... ...~...;};Z ................... Rear ...~...~...~. ............... ............................ Number of Stories ................................ 8. Dimensions of entire new construction Front ....... .~.~.. ................... Rear ...,...~,....~.. .............. Depth ...../....'~. ............. Height ...~.....-~... ....... Numbe~ of Stories ....... ~ ........................................................................................................... 9. Size of lot: Front ~ Rear .................................................................................................. D~pt/h ................................ 10. Date of Purchase ....... ../...~...¢..~... ................................. Name of Former Ownery~.../...a~C:~r~..~ .................. 11. Zone or use district in whichlpremises are situated ....... ~.: ............................................................................ ~2 Doe~ proposed construction violate any zoning law, ordinance or regulation: ,,~,; ....................................... 13. Wdl lot be regraded ...~ ............ ~. WHI excess fill be removed from p~n~ses: ( ) Yes 14. Name of Owner of premises ~ ............ ~ .......... Address ......~.....~..: ................ Phone No ....................... Name of Architect .............~",~Z~'~"~' ............... Address .............................. Phone No ....................... ~' i PLOT DIAGRAM L, ocate clearly and distinctly o I buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed and show street names and indicate whether interior or corner at, STATE OF NEW'YORK, ^~ ~'S S COUNTY OF ..,;;~,m~L~.L% ......... ~' ' ,, , ~ ,x~ ................................. .~?.~.:.~.¥X~~eing duly deposes and says that he is the applicon, ,: (Name of individual signing 4tpntrac~) sworn, above nar&ed. , He is the ....... ...,...............! ......................................................................................................................................... ' (Contractor, agent, corporate officer, etc.) of said owner or owners, end is duly authorized to perform or have performed the said work and to make and file tMs application; that all statements contained in this application are true to the best of his knowledge and belief; and thor the workwill be performed in the manner set forth in the application filed therewith. Sworn to before me this ~ .......... .............. , ,, / / ....... Coun .... ................. ~ ~ ~ ~ignature of applicant) ~UC~' J. AHMAN ~ Notary Pqblic, ~oter~' ~ublio, State of New Yo~k No. 52-0028880 (~ualified in ~u[folk Te[m expires Ma[ch 30, ~9 ~3 l