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Home My WebLink About10256-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Sou~thold, N.Y. Certificate Of Occupancy No.7~t/~ 32.6. .......... Date ...A~r.J-.:L..~0 ..................... 19 .8.6. THIS CERTIFIES that the building ... F 97.~1~. ~.d. cl$ .t; ~.o.q ............................ Location of Property ....... ~.QQ..L.i. gh...~. ~ouse Road Southold Ho~,se No. ' ......... 'S'de~i ....................... h~iel County Tax Map No. 1000 Section .. 5.0 ........ Block ...... 2. ........ Lot...1 .............. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..~.i~ C.5-.Z..~ .......... 197.9. pursuant to which Building Permit No...1.0.2..5.~.g. ............ dated ...J. une..7. .................. 197. 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 ......... ...P,d cl..afl, wB.h~ O.t:.e.c[. pg?.ql~..~.o..a.. PD.q..fp.m.~ Z. y..d. we 1.]_fi_.n. g ...................... The certificate is issued to D 9¥~,a.],cl. ~p,c~. ~t.n.q y..A.ccur d to ~,,;e;., ~ '~k ..................... of the aforesaid building. Suffolk County Department of Health Approval ........... i~/. g ............................ UNDERWRITERS CERTIFICATE NO. # ~/524151 Rev. 1/81 FORN~ NO, 2 TOW~ OF SOUTHOLD BUILDING DEPARTMENT TOWN CL£RK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10256 Z Date ........................................................ , ........ Permission is hereby granted .................................................................. L~L~'~ ......... Z";Z'~'=/' ....... Fi'~"~' ...... Ye'~'~'~ ............ at premises located at ................................................ L~'~g~"f'T~'/'"g ........... 'XT.'"? .............................. pursuant to application dated ........................................................ , 19~, and approved by the Building Inspector. Fee $ ........................ Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y, 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted m~ 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-conformin9 uses, or buiidings and "pre-existing" land uses: 1. Accurate survey of p~operty 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 $15.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5.Updated C.O. $15.00 Date ..~.~..~?..~.. New Building . .'~, ........ Old or Pre-existing Building ............Vacant Land ............. Location of Property . .' . . . . ,Vo. ' ..................... . .¢.. Owner or Owners of Property ,~..~.~.~.~. ~[~., ~ .r~d .~..~. .. . ~/~.C~ ~7.~ ............... County Tax Map No. 1000 Section '.~O ~ - 2.-- -~ Block Lot.. Subdivision ................................. Filed Map No ........... Lot No .............. Not ~...~. ~. ~.:~)ate of Permit &'.~.'7.: ."~ ~ .Applicant~,~.l~..~....~..~?. ~ ~:~. ~..~.~ ~ ~ Permit Health Dept. Approval ........................ Labor Dept. Approval ........................ U nde~riters Approval. ~. ~F. ~, ,~.~ ...... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...~ ................. Fee Submitted $ ............................. Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICMT~ Date Apl)licatiort No. on file N5 ;~ ~ ,;' ~'~' ~ ~ ~'. '~, THIS CERTIFIES THAT only the electrical equipment a~ descF~bqd~?elow~artd introduce~, by th~. aPl~lifar~t oar~¢d Olk the above application number ir~ the premises of FIXTURE FIXTURES [] 2r~d FI. Section Block Lot and found to be i:t compliai~ce with the require:nents of this Board. RANGES OVENS DISH WASHERS EXHAUST FANS DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SERVICE DISCONNECT NO OF CC, COND 1 ~W G~O,~ NO OF HI LEG This certificate must not be altered in an 1177,~ manner; to the office ~OP~,FOR BUIL~ING DEPARt[ME,To THIS, COPY OF GENEI~AL may be identified by their t . IN ANY MANNER. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, N. Y. 11971 TEL. 765-1802 November 12, 1980 Donald and Nancy Arcuri 60 E. 4th Street Patchogue, New York 11772 Dear Sir: This is to notify you that Building Permit No. 10256Z issued Ju~ne ~, 1979 .... to add unheated pgrch _. will expire on If more time is required to complete the job and obtain a Certificate of Occupancy, you may apply, ~y ~etter, 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 peEnit. GEORGE H. FISHER Sr. Building Inspector Memorandum from .... BUILDING INSPECTOR'S OFFICE TOWN OF SOUTHOLD TOWN HALL, SOUT~OLV, N. Y. 11971 765-1802 /f?'?2 ..... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1803 1~:.. .~4~plication No.. Examined ...... / . ~. , / / :' 19' d.. Permit No.//.-:.'.,,,'. ~ .~.- Approved'...,. ?: ..... /.., ........................... .......... ,/.../ ...... ?. . . . i ."i . .'. (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 co~te~-~and regulatious, and to admit authorized inspectors on premises and in buildings for necessa~7'~pectio~ ~ ~ ,~ -'~x.~ ~' .. ........... (Signature of ~pplicant, or name, if a corporation) (Mailing address of at¥1icant) ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ,,5 ................................................... Name of owner of premises ..~. ?. {:. )5.k. {>.. }~.. ?...~3. ~} .~."~.. ~..¢!~., . .~.'~.Q .Q. )~.) ....................... (as on t/cie 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 .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. '. soo .X. .................................. House Number Street ' Hamlet County Tax Map No. 1000 Section ....... .~...0. ...... Block Lot 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 ...... , .............................................................. b. Intended use and occupancy .................................................................. 3. Nature of work (check which applicable): New Building .......... Addition .~. ........ Alteration .. ......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost . .~'.-S.c.} .0.,. p. 9 .................. ........ Fee .. ., .o. ~ ............................. (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 ........................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ........... , .......... 7. Dimensions of existing structures, if any: Front·...~,-I..~ ........ Rear . .~ } ......... Depth, '3~_ ,0,' .......... Height ............... Number of Stories .... .~ ................................................. Dimensions of same structure with alterations qr additions: Front ,, .1~)~ ............ Rear ..2,~ ............... Depth . . .~.~ ................ Height . . .\~ .... . ............ Number of Stories . .\~ .................. 8. Dimensions of entire new construction: Front ....~..~ ......... Rear .~ .~ ........... Depth ...~ ........... Height .. ~.\ ....... ~.. Number of Stories ....~ .................................... _~ .............. 9. Size of lot: Front . 2~-~_~. ................ Rear ... Z~ ................ Depth .l ......... .~ 0 ........ 10. Date of Purchase .... [~'~ '.-I...~7. ................... Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ... ~.{ ...................... Will excess fill~be removed ~rom premises~ Yes 14. Nme of Owner of premises~)~. ¢.,. B[~.~ .... Address ~g. *~ ~P.~ .~g~r. Phone NoS~lq T ~,~: Name of Architect ........................... Address ................... Phone No ................ Nme 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 number or description according to deed, and show street names and indicate whether interior or corner lot. OF NEW COUNTY OF s.s .. ~. ~ ~... ~.. ~.~.~.~ ............... being duly sworn, deposes ~d says that he is the applicant (Name of individual signing contract) abow~ named. · .- -- He is the .................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or ownem, ~d is duly authori&ed to perform or have perfomed ~e s~d work and to m~e ~d file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~ner set forth in the application filed therewith. Sworn to before me this ............. ~..,...4ay of...: .~Z./. ~ ........ 19.Zff