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Home My WebLink About10173-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. Z 10147 Date September 15, 19 80 THIS CERTIFIES that the building ................................................ House No. Street Hamlet County Tax Map No. 1000 Sectzon ....1~. ..... Block ..1..'1 ........... Lot .0.0..~ ............. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Budding Permzt heretofore filed in this office dated dated .... A.A..~i.1..~..6 ............... 19..T. ?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 ......... Addition to Private one family dwelling. The certificate is issued to William E. Granneman of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO. N 4487?9 Rev 4/79 FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTJ~4ENT TOWN CLERK~'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 10173 Z pursuant to application dated ............... ...~......~'...../.~.. ................. 197...~.~ and approved by the 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. Fina~ approval of Hea~th 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 con. dition 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 or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date...'?. 7..~...~. . .~..<~. ......... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Locat.on of Property ~.i.~.O~.....~--~M.(~. ~ ?~ff'~'~ .~ ........ House No. Street * Hamle~ Owner or Owners of Property ..... ~r~.~,~51' ~,. ~.~,T~.e[~,T~ ............................... County Tax Map No. 1000 Section . Z ~ .~. · ........ Block .../.(. .......... Lot...O..O..~. ........ Subdivision ......... 7 ..... : ................. Fded Map No ........... Lot No .............. Permit No. ,/~../Z~.. ~Date of Permit ~/.~?./~.~.~.Applicant ~.:...~,¢~.~.~..~.~..~..4~; .~'.~..". ..... Health Dept Approval ------ Labor Dept Approval -- Underwriters Approval ...................... Planning Board Approval ...................... Flequest for Temporary Certificate ..................... Final Certificate . .a~., .................. Fee Submitted $...5 · D.Q ..................... Construction on above described building and permit meets all applicable codes and regulations. Applicant~.... ~ ' . .......................... Rev, 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICrTY ~ ES JOHN STREET, NEW YORK, NEW YORK 1OO3~ THIS CERTIFIES THAT o~ly the electric~l eq.qlpme.t as descri~e~ ~elow ~nd i~troduced 6y t. he appi'~.~c_ant name~..oE ~ a~ appllca~on ~mber in t~he prem~es ~o~ '~'m, ~. Granneman, s/s Peeonte ~ay ~lVd.s ~UU W/O ~P&y Ave** ~a~re~ in the following location; [] Basement [] 1st FI. [] 2nd Fl. Section Block Lot ,~o~..o.~i..~o. ~eptembe~ 7, 1979 and found to be in complian~e with the requirements of this Board. EXHAUST FANS 1 DIMMERS OF NEUTRAL COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY ~tM~ll~t1~',' 765-1802 BUILDING DEPT, INSPECTION FOUNDATION 1ST [ I ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [~FRAMING ~ ] FINAL REMARKS: E×amined '-d'-- / (' ., 197.c FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Application No...~.~.~ ./..~.. f~. ...... /~Approved %/ - [ ( ., 1! Permit No / Disapproved a/c ..... ~_.~~ .... / ..... .// APPLICATION FOR BUILDING PERMIT DateA/p2.,./. ......... /.4., 197.5'. 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 Penuit 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 herem described. The applicant agrees to comply w~th all applicable laws, ordinances, building, code, housin~',ode, and regulations, and to admit authorized inspectors on premises and in buildings for necessary ins~c~'~ ~/~,~,.~/r~ ~f~/ ...... ~./~4~. ~. · .< c/..c~4~.:..--~. ............ (Sigr~ture of applicant, or name, ~f a corporation) (Mmhng address of apphcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.~ (J c~., *u ~... ~ ..................... J Nameofownerofpremises /?/,~ /~'11~$ t,d, 1/, .,.~., (:.-~,'~ 4.,~,/~., ....... ~ ,~' . .~.~ (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.T.~t-,~,.' .95 .[ ~..~Jf.~J.,(.~.~t~/[.. Plumber's License No .... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done...&~: :,.t.~. :..: ::.(.~.~.. ~.~- ............................. ..... .............. .............. House 7 ' ' Street Hamlet County Tax Map No. 1000 Section .../.~.~. ....... Block ....... ~! .......... Lot ..... ff. ............ Subdivision ..................................... Filed Map No...~ ~. ......... Lot. ~ .O..O..~.. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ./.' ..~./.~. b. Intended use and occupancy ./,../., .'.; .... 3. Nature of work (check which a~plicable): New Building , ..~ ....... Addition ....... Alteration .......... Repair .............. RemOval .............. Demolition .' ............ Other Work ............... 4. Estimated Cost . ./~,~ i (Description) · ~..°.'..~r* ......................... Fee .................................... . (to be paid on filing this applieatiqn) 5. If dwelling, number of dwellinglunits .... /. .......... Number of dwelling units on each floor.,, ./ ............ If garage, number of cars .... q ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front .¢?. ~ .......... Rear ?. ~. i ......... Depth .*./?.: ......... Height ./.f.v. .......... Nun~ber of Stories ../. .................................................... Dimensions of same structure with alterations or additions: Front .~/./.' .............. Rear .~.f.: ............ Depth . ,/Z ~. ............... !.. Height ../..F.~ ................. Number of Stories . ,/ ................... 8. Dimensions of entire new construction: Front ./3 :/~.". ........ Rear ./.~.'/. ~/2 ........ Depth /.~:~?/;: Height ../.4 J .......... Number of Stories . ./. .................................................... 9. Size of lot: Front ........... [ ........... Rear ...................... Depth ..................... 10. Date of Purchase ........... I .................. Name of Former Owner ............................ 1 I. Zone or use district in which prdmises are situated .................................................... 12, Does proposed construction violhte any zoning law, ordinance or regulation: . ~/.o. .......................... 13. Will lot be regraded ......... i ................... Will excess fill be removed from premises: ~7~s,~ No 14. Name of Owner of premises ~,~<4,*~ t~/,.G,-~ ~.,~?,.~-;, ~.,~Address t.~.,~?:~:~.~/t.s~?..~.'~.~.'.~.(.. Phone No.a.~.Cr.n .~.~'A/. ..... Name of Architect /~,,~/.,,, ~,, r~_. w. ~. (~/.~: (( ....... Address (~,. ~.~.,~.~:,'e~T~..../~f~... Phone lqn~; Name of Contractor /.~.: ~. ~ T.t,/ ~.,,,,~ .~. ..... ,~,'~ ' ~ /< ' - ..... Address g.. ~-~ ~' ........ ,~r,~. Phone No. ~?.c.: ./~..{ $ ..... PLOT DIAGRAM Locate clearly and distinctly all ,:buildings, whether existing or proposed, and, indicate all set-back dimensions from property lin~s. Give street and block number or description according to deed, and show street names and indicate whether interior or c0rn~lpt. 'i .~ .... ~ O TATE OF NEW Y RK, ~ ...... ..... ~5~.. ,.~,..~ ~')~.~. ............... being duly sworn, deposes and says that he is the applicant (Name of indMdual signing contract)' above named. He is the ............................................ ' ........................... (Contractor, agent, corporate officer, etc.) of s~d owner or owne~, md is duly authorized to perform or have perfo~ed the said work and to m~e and file ~is application; that ~1 statements containbd ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~ner s~t forth ~ the application filed therewith· Sworn to before me this ................... day of..~ ........ , 19. ~ B~u,7~ c. co>moY ~ ....... ( ' u ¢ of a licit) Sultolk Cotm[y Commis~on Expfro~ ; 'I I I NOTIFY BUILDING D:PAR~TMENT AT TION OR STAr:T ERAkUNG ' ' , 3, ANY KIND; REQUIREM~N'r50~ N.Y. STATE CODE r AND TOWN HOU~IN~ CODE& ZONJ[4G ' ~ , 'r,, ,'~, ,, "l