The URL can be used to link to this page

Home My WebLink About10185-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No....Z'~0.156 ....... Date ... Sapte~her. 2.3, .............. 19 ~0 THIS CERTIFIES that the building ................................................ ...... .12~. DJqrt~n. Roed~ .......... i~mt~.4 .... Location of Property I-Iou~ No. '~t~ ..... County Tax Map No. 1000 Section .... 7~ ...... Block ....... .~ ....... Lot ....... ]5~...~... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Apblication for Building Permit heretofore f'ded in this office d~ted · .J~PlP;L],..17 .......... ,19.7~pursuant to which Building Permit No...'~0~8~ .Z ........ '*... dated .... AI~iI · 2.~r ............. 19.7~, 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 ......... Suffolk County Department of Health Approval .......................................... RWR '.RS RTIFI AT ...... ........ i'"/ ............. Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CL£RK'S OFFICE SOUTHOLD, N~ Y. jBUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10185 z Permission is hereby granted to: ........ ~......~.:~..;~.;.;~.;.~; ....... ~.~-;~:.;~ ........................................................................... at premises located at /~ D~ )'~b~ ~[,~ ~ ~ ....................................................................... ~u'~;~'~';D ................. ~"~'~ .............................. ........................................................ , 19~. ,., ~nd ~pproved by the Building Inspector. Fee /~o~-- 7/- 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. 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 New Building ............. Old or Pre-exi~ing Building . ~...~_~...... Vaca . . ............ Location of Property· ~ .~.~.~?...~..~..;.~.~ ...... ~¢~ ~ ............ Owner or Owners of Property·. ~.~. Subdivision ..... :...: ..... ,~ ................~/ /." ~[,M~ap No .......f/--~/7"'" .... Lot 1~.~..;1 ........... Permit No.,~ O.l~';~ ~ Date of Permit .f//.~.~/i~.Applici~nt! ~/~../.C..,~..~?.-.~. ,.~.~. ~,~...-.~..:. ~,:.~ .... Health Dept. Approval ........................ Labor Dept. Approval .... .~./H .~./... ........... · N 442056 · U.derwrlters Approval ........................ Planmng Board Approva~ .~ ............... Request for Temp~rar,v/~ertificate ..................... Final Certificate .[~/ ..................... Fee Submitted $ .? i ........................ Construction on above described building and pe~'kt,:~megts all a~l~iicabi~.,codes add regulations. App,,cant. .................. ,,~. ,,-,0-Ta Receipt ~17648 9/2~0/40 #Z~0~56 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~-- Ob 85 JOHN STREET. NEW YORK, NEW YORK 10038 o,.. July 18, 1979 ~t~,plic. t~o.~Vo.o, fl. 0260~1 N 4420 : THIS CE~IFIES THAT only the ~t~M ~nt m ~scH~ ~ ~ int~ by t~ ~l~on ~ a~ ~ numar in t~ p~m~s of in the following location; [] Basement [] 1st FI. [] 2nd FI. S~ction Block Lot ~i.~do. July 16E 1979 and found to be in compliance wl~h the requir~ments of this Board. DRYERS iFURNACE MOTORS FUTURE APPUANC$ FEEDERS A~T. K.W. OIL H,P. GAS · H.P. AMT. NO. A.W.G. SERVICE DISCONNECT NO. 01~ S I 200 "eh: METER X RANGES ~PECIAL REt'PT R NO. Of CC. COND. PER ~' COOKING DECKS OVENS DISH WASHERS 1 IA~M~E. CLOC~Kp~~ TRI~AN~$. ~ V I C OF CC. COND. EXHAUST FANE DIMMERS 2/O Joseph ~', Fr'ohr~xoef'e~' Maln Rd, Southold, I'I.Y. 11971 Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. TOWN ,OF $OUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, N. Y. 11971 TEL. 765-1802 William J. Jacobs Depot Lane Cutchogue, New York Dear Sir: This is to notify you that Building Permit No. I0185Z issued ~23/79 to John B. Fallen will ex,'ire on 10/23~80 If more time is required to complete the job and obtain a Certificate of Occupancy, you may apply, FY letter, for a six (6) month extension. If the work is not completed and the Certificate of Occupancy not issued after the six (6) month extension period, you are than required to apply for a new building permit. Very truly yours, GEORGE H. FISHER Sr. Building Inspector TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFI¢! SOUTHOLD, N. Y. Examined ",~' ~ .......................... ~.,.:.....-~., 19 ..... Application No, .,Z..: ...................... ............................. /t. :':: .... , 19..,?(:~/ Permit No ...... ~proved Disapproved a/c ................. '~ ~,. ........................................................................ ............................. ~,~' ':f%' "';~; ......... : ,' ......................... V APPLICATION FOR BUILDING FER~IT ............................................ , , ~.....,..~ ~ INSTRUCTIONS a. This application must be completely filled in by typewriter o¢ in ink and submitted in triplicate to the Buildin~ Inspector, with 3 sets of plans, accurate plot plan to ~ale, Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout of property must be drawn on the diagram which is pa~ 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 a Building Permit to the applicant. Such permit shall be kept on the premises ~vailable for inspection throughout the work. e. No building shall be occupied or used Jn whole or in part for any purpose whatever until a Ce~ificate of Occupancy shall have been granted by the Building Inspector, APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o 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 a~terotions, 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 inspect ons (Signature of ¢ ' ,ir (Address of apl State whether applicant is owner, lessee, agent, architect, engineer, gene~ral contractor, electrician, plumber or builder. ............................................................... .......... ......... .................... .......... ';"i": ...... i ................ :;:',, ..................... If applicant is a corporate, signature of duly authorized officer, l./,~,'~ f,,~,.,~ ~:~,.~,~ ~ r'oo ,~./ (Name and title of co~orate officer) Builder's License No ..................................................... "-----~ Plumber's License No ................................................. Electrician's License No r-'ocgO" -7/- /- ~ Other Trade s License No ............................................... Location of land on which propo_sed work will be done~: /~ap No._'~..~.~.,~....~...~....~...~.?...f.~'-.~'/Lot No ......................... Street and Number .~..~.>....[~.~l...m.~.....~} ........ ~,dO.~:~.~.....,....~,.~ ............................. ' ' / Municipali? State existing use and occupancy of premises and intended use and occupancy of proposed construction: b Intended use end occuponcy ................... 3. Nature of work (check which[ applicable)· New Building'. ................. Addition .................. Alteration ................ Repair ................ ~,,, Removal] .................. Demolition .................... Other Work ................................................... - ~ .~, ~¢1! /.~ (Description) 4. Estimated Cost ............................................................ Fee .......................................................................................... i (to be paid on filing this application) 5. If dwelling, number of dwelling uo:~s ............................ Number of dwelling units on each floor ........................... if garage, number of cars ............................................................................................................................................. 6. If bus.ness, commercial or [mixed occupancy, s,~l'~f~ature and exte~tKof each type of use 7. Dimensioqs 9( existing structures, if any: Eront~....?..%.¢¢... ............. Rear ................................ Depth Height ........................ Number, of Stories ........................................ ,~.':'.~'~ ../. .......................... ......... L.~,~,,~,~,. ................... Dimensio~ c~, same structur~ with olt~,ra.,t~ons or additions: Front ............. 7 ................... Rear ............................ Depth ................................ Height .....'...i ........... ~¢~..Number of Stories ...... ~/../~ ................. 8. Dimensiot~of entire new cogstruction: Fror~t .................................... Rear ............................ Depth ........................ Nc,u~ ~ of Stories Height F~ ~ ~'~ /,' ? Z 9. Size of lot: Front ......... ~ ..................................... Rear ...................................... .. Depth ................................ 10. Date of Purchase ................. , ...................................... /Hame of ~Focrmer,Owner ........................................................ · 1 1. Zone or use district in which [premises are situated .............................................. ~4~:~ .............................................. 12. Does proposed construct elate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded, . ......... 4.'...> ...... ~.. Wil~exc~ss fill be removed ~r~ p/~r&~.~cYes ( 14. Name of Owner of promises ....; ............................................... Address ................................ Phone No ....................... Name of Architect ...... ,~..,...¢¢ .......... ~...~ ......... .~..¢,: ................ Address ,,.,...,,¢..z ............... Phone Name of Contractor ............ ' ............................................... Address ...~... ........................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed and indicate all set-back d mens OhS from . property lines. Give street and bl6ck number or descriphon according to deed, and show street names and indicate whether interior or corner lot STAT£ OF NEW YORK, t¢ S' COU/qTYI a~. ..,,. ...... ',.'. ................. Cf~...~,...~...(..t~'Z~.........~..~....4.~..~.l.~..~¢ ............. being duly sworn, deposes and says that he is the applicam (Name of individual sig;nin~ 9oQtra~) abovenamed, i~ ' ' ' He ~s the ..................... ~./ ,~ ................................................................................................................................ , (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all stete~ents contained in this application are"¢rue to the best of his knowledge and belief and thor the wo~ill be~erfor¢~in ~he manner set foffh in the application filed therewith. Sworn d_sposal and water supply by this department ~d' found Chief of ~eneral Engineering Services ~v~e~ "~ L,c~,~e~ ® 4O ? ~pp~OVED ~$ 765-2660 9~ ~o 4PbA FOR R~QU~R- ED INSFECTIObiS: 1. BEFORE BACKFiLLiNG 3. ~EFOR~ COV~R~;G P~FZS OF ANY NOY RcSPON~ ~.E~':~ ' OR CONSTRUCTION ~ '~ MUST MEET 5. ALL CONS~Ru .... ~;~ C~c"~S C~ ~-Y- sTATE CODE t=-'y: s/'ff~ 3 W~LU~,~ J. Jsco~s BUll. DER DEPOT lANE CUTCHOGIJE, NEW YORK 1193~ 734-5815 / JOB No,~_ ;