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Home My WebLink About10280-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No .... .Z.9.7..8.~ ........ Date ...... .D.!~00.~.B.~.I?. 7 .............. 19 7.9. THIS CERTIFIES that the building ................................................ Location of Property .... 5.8.'1.~...Us. R,. ~.7. ...................... .~.r. O01~ll~.O~:,. ~IoY,.. House No. Street Hamlet County Tax Map No, 1000 Section ...... 0./~.~. . .Block .... .2 ......... Lot ...... '~ 0 ......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... 0'.t~0..~ ...... , 197.9. pursuant to which Building Permit No ..... '~ 0~O. OZ .......... dated ..... ff!lYl. O. ~' ............... 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 ......... ............. P.r. iv~e. 0r~e..Family. D~.elling .................................. The certificate is issued to ............... .~.&O.I¢. 0/~o.~e),~-- --___--_--. of the aforesaid building. Suffolk County Department of Health Approval ... 9.~.0 .-~. .............................. UNDERWRITERS CERTIFICATE NO .................................................. Rev 4~79 Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON ,THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~o. 10380 Z Permission is hereby granted to: ........... ..~,..~..../.~. ~z..~ ...... .... z~.;/..~..~...z~ =...~~ at premises located at .~...~...~ '.~.../.~..,,¢/ ........... ~':' '~'~:~'""~";/~'""r ...... pursuant to application doted ....... ~.~<'~......a~. ....................... , 19/.~.~., and approved by the Building Inspector. / B,~i I dL~g Inspector FORM NO. 6 TOWN OF $OUTHOLD 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 dr Engineer responsible for the building. 5. Su bm it P lan ning Board approval of comp leted site p lan 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. 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.O. ,e .~.e.~, ?.~.,., !97~... New Building ...... .X ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property . .~.~.!~..~. .0. ,?.. .~ . .27. t .............................. .~?.e.~.l~.l~.O?.~.,. ~.,.~'. t. House No. Street Ham/et ~tcho:l. aS Dob. e~,~c~. Owner or Owners of Property .......................................................... County Tax Map No. 1000 Section ....07../+ ........ Block ...... ?, ....... Lot ...... 1.0. ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ! .o.~.q0.z..,. Date of Permit . .~../.2~/.?~pplicant..- .VA~q- .~.a~d.~..~.~.O. ............... Health Dept. Approval ¢,,S0-66 . Labor Dept. Approval Underwriters Approval N ~881~'i Planning Board Approval Request for Temporary Certificate ..................... Final Certificate .......... .Z ............ Fee Submitted $..~. '..0.0. ...................... Construction on above described building an~ ~erz~meets a lieableJ;)odes and regular OhS Applicant..~1~ /t A\. v, ; .~. y?. ..... ~. < THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY B8 JOHN STREET. NEW YORK. N YORK 10038 THIS CE~IFIES THAT ~ou~hOld, N.Y. was esami~ on NOV~ ~ ~ ~ ~~9~' and found to be in compliance with the ~quirements of th~ ~. RXTUBE LEPTA I I EXTURES OUTLETS r~EC cLEsi SWITCHES IiH~N=ESCmT[ FLUORESCENT I DRYERS FURNACE MOTORS RJTUBE AP~JANCE FEEDERS ,~. ~.w. o,~ "'" °~ "'"' '~1" ~' *' SERVICE DISCONNECT NO. Of S METER A~T. ~*~p. ~ EQUIP. I.e'2w 1~'3W 3~'3w 3~4w l~moke De~ectoP RANGEs ~P~CIAL REC'PT R COOKING DECKS OVENS DISH WASHERS AMT. K. W, A~T. K.W. ~W~T. K.W. TIMECLOCKS BELL UNIT HEATERS MULTI. OUTLET NO. OF CC. COND. A.W.G. ~ER ~ OF CC. CO~D. NO. O~ HI-LEG A. W, G. OF HI-lEG EXHAUST FANS DIM/ViERS NEUTRAL John T. Sapana~o 102 Oak Ave, Shi,ley, N.Y. 11967 LIo. 33 E This certificate must not be altered in any manner;, return to the office of the Board if incorrect. Inspectors may be identified COPY FOR BUILDING DEPARTMENT. THIS~COP~Y, O~F~C~TI~FICATi~M~II'~, NOT BE ALTIP~D~ IN ANY MANNER. Memorandum from.... BUILDING INSPECTORS OFFICE TOWN OF SOUTHOLD TOWN H~_r.r~, $OC~THO~.r,, N. Y. 11971 765-1802 .,,, TOWN DF .clDUTHnLDI '"'::' ~? ~;; !~3FFICE DF BLIILDI,NB INsPEBTEI~ · 3'~ ~, r q-- TOWN CLERK S OFFICE Cam rn (~sl on~'r/lo~ I:~llc~s Suffolk County Yaphank Ave., Yaphank, N. Y. Dear Sir: In accordance with Section 239K of the General Municipal Law of the consolidated Lows of the State of New York, this is to notify the Commis- sioner of Public Works of the County of Suffolk that has applied to the Town of Southold for a permit to construct a building as shown on the attached plat plan, submitted in triplicate, dated ................ ............................................ and titled ............................................................ We shall withhold further action on this application for ten days or as otherwise provided in the aforementioned Section 239K. Very truly yours, / /~ Building Inspector Town of Southold, N, Y, RM NO. 1 TOWN OF SOUTHOLD BUI LDINGDEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapprove4 a/c .................................... ~ ~ / ' ~ ~ INSTRUCTIO~~ or areas, ~d 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 Pe~it. d. Upon approv~ of this application, the Building Inspector will issue'a Building Pe~it to the applicant. Such pe~it shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in pa~ for any purpose whatever until a Certificate of Occupancy sh~l have been granted by the Building Inspector. ~PLICATION 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, ordi~c% ~d~ng code, h~ng code, and re~lafions, ~d to admit a~th°ffized inspect°rs °n premises a~d i~ b~ildi~gs f°'~es~ ~'q~ure of appl~~at'on) .... ............. ; ...... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or~ ame O (as on the t~x/oll or latest deed) If app~c~pt is a corp~ionasignature of du~ authorized officer. Builder's License No .......................... Plumber's License No. ~ ~ .~ ~ ~ ~[~ ..... Electrician's License No. ~...~.~... Other Trade's License No. ~ouse Number ~d~ Street ~~ Hamlet County Tax Map No. 1000 Section .... ~.~ ....... Block . ~ .............. Lot... t~ ............ Subdivision ..................................... Filed Map No. f:~ ............. Lot ............... 2. State exi~ing uae and occ ~.~ ~y, of premises and mtended use and ocdu'pan~ of propose{{ construction: b. Intended use and occup~~t~E~/~~~~}. ) .......... 3. Nature ofwork (check which applicable): New Building . .~....... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... .~..~. (Description) 4. Estimated Cost . ~ (O{~'O ......................... Fee ...................................... (to be paid on filing this application) 5. ] f dwelling, number of dweliing 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 ............... Rear .............. Depth ............... lteight ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ........... ~ ........... Number oftStories ........... .,., ......... 8. Dimensions of e~tire new construction: Front .... ~ .O. ........ Rear ...~ t~. ........ Depth . ~.,~..c/-., ......... lqeight- ... ]~ ..... ~.~ N/amber of Stories ........ '.~.. i ............................ ~., ............. 9. bizeTMof lot: Front ...,~.'..O~ ............... Rear . ..~.l ................. Depth . ]~...~. ............... 10. Date of Purchase ............................. 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 ... ~..~., ...... a .............. Will excess fill be removed from premises: Yes ' ' No 14.Name of Owner of premises ~!.~}{..~..o(~.. ~..~..... Address ................... Phone No ........ :., ...... g,5.2 ..... °. 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. STATE OF NEW YORK, ~ -- - S COUNTY OF, .......... '~' ~ "'~/'~t'~' }'k~.~' '°~'%~g~' ' ' being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) abow~ named. ~ (C~t~t~gent, corporate officer, etc.) of said owner or owners, ~d is duly auth~c~erfo~ or have perfo~ed the said work and to m~e and file this application; that all statements contained in 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 ~ the application filed therewith. Sworn to before me this ..... ~~ ....... day of.. ~~ County Nota~ Public ............. THIr W&'rlEN Iulqq~¥ ~ / / h ONLY ~O THE PELSON FO~ WHOM TH~ IS P~EPAP, ED, AND ON HIS BEHALF TO THE TUTION. GUARANT~ES ARE NOT TRANSFERABLE TO. ADDITIONAL INSTITUTIONS OR ~. JERVI~S. q~ , , ~ . ............. ~" FOR AI~iPRO~VAL O? CONffit~a~M N 0~' ; ~H~¢WA~~ SUPPLY AND ' ,¢~ H, ~. R~F. NO,= , , t, ~ ,; ~ STAN~RD~ OF ~UFFOLK CO. ~ ' OF ~LTH. . :~ . . ~. APPLICANT f h O~-E-% ' %- AP,~J ( ~ ~" s~A~) ~ ~ - RE=~.~, I~oT~ L APPROVED AS NOTED NOTIFY BUILDING DEPARTMENT AT 76S-2660 9AM to 4PM FOR REQUIR- ED INSPECTIONS: 1. BEFORE BACKFILLING FQUNDA- TION OR STAP. T FRAMING 2. FRAMING INSPECTION 3. I~EEOP. E COVERING PIPES OF ANY KIND 4. FINAL WHEN JOB COMPLETED NOT R~SPONSI~LE FOR DESIGN OR CONSTRUCTION ERRORS 5. ALL CONSTRUCTION MUST MEET REQUIREMENTS OF N.Y. STATE CODE AND TOWN HOUSING CODE & ZONING [, r 5'0 ~L .4~'7~ttAl ~ VTrL u£ 2_