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Home My WebLink About10158-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No ..... g9~.1./* ....... Date ... D. ece~b, er. D.1 ................. 19 THIS CERTIFIES that the building ................................................ Location of Property ....7.5.5..C.,.e.~?.~...A.v.e.~.t?.e ........................ .~.o.t.l .~.h.o.]:d.:. House No, Street Hamlet County Tax Map No. 1000 Section .... 97.8. .... Block .... .07 ......... Lot...0.~.7.-.0.~.8. ...... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated ...Ap?.~.~...'t.0' ......... , 19 .7.9. pursuant to which Building Permit No .... dated .... fi.y}V. ~.2...1.0 .............. 19 79., 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 ......... ............. ~..a.a.x.~..x.o.n..e..o. ?r.x.v.~.~.~.. 0. ~.o. ?..~..~, ~x..x.x.n~. w/~.0e,.~r.n~. D.e~. The certificate is issued to ..... .R.11~.t..~....Ig..tl.~l..~.~..O~.~.1~.O. [P..P.t~.O. ~ ....................... (owner, ~ of the aforesaid building. Suffolk County Department of Health Approval ........ .~./..t1. .............................. UNDERWRITERS CERTIFICATE NO ................ ~ .~.57.7..60. ........................ Building Inspector Rev 4/79 FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT 1'OWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 10158 Z Permission is hereby granted to:.// .~, __ ~..~/~.~..~...~~ ~,/z~o~ ..~~..~. ................................... ..... .~.~~...~:.~..~.. ......................... , ~ ....~.~.~%z~u. cz.....~Q~ez...~.~...z.~.....~~...~.~4....~.~...~... .... ~ziz~.~...~. .................. ;~ ..................................................................................... ; ............ ~, ~ ~,~ ~,...~.Se. ...... {~..~z.....~.~ ............................ : ............. ....................................................................................................... ~u~o~..=~,.~_.. ............ ..~.....~....~..~. ....................... , 19.~...~., and approved by the pursuant to application doted Building Inspector. Fee $..../..~...~.... ui ch'right nspector 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 featu res. 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 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 ...~.e.c..e.~.e.~...~.'1.,..~..9.~.9.... blew Building ............. Old or Pre-existing Building ............ Vacent Land ............. Location of Property .... ?.55. C. edar. Aven~te .................. So~,thold.,..~T,¥. ........... House No. /~treet Ham/et Owner or Owners of Property ./~.~.,...~ ~... ?z,.~...~., ?,,,~.. ~. t~,~.... ~_.4~_.~,. ............ County Tax Map No. 1000 Section ....0ff. 8 ........ Block ..... 0.~. ....... Lot..03.~,-.038 ...... Subdivision .... .~...;~ ............... ~..F~i?~ M,_~p No ........... Lot No .... 7 ' ........................... Perm it N o. 1.0. '1..~.8.~..~..'~ ~ate o f p ermi~? .~A~/p/p iicant .... //~/,?/~/- Health Dept. Approval ...~ ............ Labor Dept. Approval ........................ Underwriters Approval . . .1~. ~.~.~.~ ............ Planning Board Approval . ..................... Request for Temporary Certificate ..................... Final Certificate ..... ~ ................ Fee Submitted $..~ · 00 ....................... Construct,on ~~'~'~'-I~' ~/~"~' ~ .o n above described bu ,Id ing and p er~mit meets all ~pplicaJ~e, codes and regulations. Applican,~. ~,,~,.:g.~. ~ ...................... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CE~IFIES THAT ~Peck,Ce~r ~. ~Bay v~ew~ou~o~a,~.~. in the follmvlng location; [] B~ement [~ 1st Fl. ,~o~ex.mi.~do. Novemberl9, 1979 [] 2nd Fl. Section Block and foUnd to be in compliance ~vith the requirements of this Board. DRYERS FURNACE MOTORS FUTURE AF~JANCE FEEDERS AMT. K.W. aL H.P. GAS H.P. AMT. NO. A.W.G. A'~'T. MD. TYPE ~pR. 1~'2W 1~'3W 3~3W 3,~,4W I-GFCI RANGES iREaAL REC'PT R No. o~cckco~o. COOKING DECKS OVENS DISH WASHERS AN, T, K, W. AMT. K.W. U~T. K.W. TIMECLOCKS BELL UNIT HEATERS MULTI-OUTUET OF CC. COND. V I C NO. OF HI-LEG NO. OF NEUTRALS Lot EXHAUST FANS DIMMERS OF NEUTRAL P.O. Box 64 gait Marion,N.Y. 11939 L£c.617 Per 11 ~ ~ this certificate must not be ahered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by ~ cre~,d~htials. COPY FOR BUILDING DEPARTMENT. THIS COPY, OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. Memorandum from BUILDING INSPECTOR'S OFFICE TOWN OF SOUTHOLD TOW~ Ha[n, SouxuoLr~, N. Y. 11971 765-1802 TO~N O~ SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 T~L.: 765-180~ ..... ..... Disapproved ale ......... ;-~ · . . .~ ......... .~". ....... / / ................................ :; APPLICATION FOR BUILDING PE~IT 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 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 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 applicant, or nmne, if a corporation) ...... .~..~.~..~.....%~~... (Mailing address of applicant) State whether appligant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde}.~ .... ...... .................................. ) Name of owner of premises .... ~'~.~ .~.X.' '~1 '~'(as .... on'T'the '~'''tax roll' .~.~. rf~ .or latest'?" '~ ~' 'Q~/' '~' (~' '/~'deed, ............ ? If applicant is a corporation, signature of duly authorized officer. ' 2. (Name and title of corporate officer) Builder's License No .... ~.~..?..~..~..~.. ~..~. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... \ Location of land on which proposed work will be done ..... ~ .~,.~.~..~....D .~..~.0..~r. .................... ................... ......... ................ House Number Street Hamlet County Tax Map No. 1000 Section ...~.7..~. .......... Block ...0.7 ............ Lot....C~.'..~.-..O.~..~, ..... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... O.O. .~.~. ............ (~. &~. ..... /. ............. b. Intended use and occupancy ... 3. ~ature of work (check which applicable): New Building .......... Addition ......... terati .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ' ~ (Description) 4. Estimated Cost ..... (~ .c2..c>..~i ......................... Fee ........ /. >.'-.o..O. ....................... ~ (to be paid on filing this application) 5. If dwelling, number of dwellinglunits .... .(2 .v~..~:. ..... 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 ...... '.~ i i i ....... 7. l)imeas~ons of ex~stmg structures, ff any: Front .~. ~.. ........... Rear .. {~.~ .......... Depth .... Height . ~.O ........... Number of Stories ..... l. *f."~. ............................................... Dimensions of same structure w~th" alterations or additions: Front ...~. ~'- ............ Rear .. ~.~"' .............. Depth...'~. ................. Height ~ o Number of Stories... 8. Dimensions of entire new construction Front z~ o Rear ~ o Depth ! 2- . Height ../- .O. ........... Number of Stories .... '.. OYl ~ ............................ .~. ............... Rear .../~.0 .............. Depth ..................... 10. Date of Purchase .... J.~.'2~, .................. Name of Former Owner ...~..[~..~..g.°..~ .~'~C.. ............. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction vie!ate any zoning law, ordinance or regulation: .... t4A~. ......................... 13. Will lot be regraded ..... ~,~:~2 ................. Will excess fill be removed from premises: Yes Name of Contractor .... "~ ! ~.-~. ~t.~.l~L .......... Address .. 3) ....... ~. ( ...... Phone No. t.t ....... *.t ...... PLOT DIAGRAM Locate. clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property hnes. G~ve street and blocl~ number or description according to deed, and show street names and indicate whether interior or corner lot. STA.rE OF NEW YOJg.K~ S o COUNTY OF. ,.~,.~..o.~ ~, ' .~ ~ ~..._,},[~L:~''~ being duly sworn, deposes and says that he is the applicant above named. . He is the ................................................................... ~ J (Contractor, agent, corporate officer, etc.) of said owner or owners, ~ is d~ly autho~zed to perform or have perfomed the said work and to m~e and file ~is application; that ~1 statements con}ained ~ this application are true to the best of his knowledge and belief; ~d that the work will be perfomed in the m~ger set forth ~ the application filed therewith. Sworn to . .day ......... 19 ~ t ~cc~e: Z~O'z I' o ~' ~,YO,,~ ~3~f~~' MAP OF LAND -A~TUU~ ,~,. AF~,",~F~-.ST~':~. AT APPROVED AS NOTED FEE**''/~ -- BY: ~9~ - NOTIFY BUILDING DEPARTMENT AT 765-2560 9AM to 4PM FOR REQUIR- ED INSPECTIONS: 1. BEFORE BACKFILLING FOUND~ TION OR START FRAMING 2. FRAMING INSPECTION 3. BEFORE COVERING PIPES OF AN~ ~ND 4. FINAL WHEN JOB COMPLETED NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS 5. ALL CONSTRUCTION MUST MEET REQUIREMENTS OF N.Y. STATE CODE' AND TOWN HOUSING CODE & ZONING