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Home My WebLink About10281-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No ....~- 10 5.1.1 ....... Date ....... ~/un.~. 3 ' ., 19 .~ 1 THIS CERTIFIES that the building ................................................ Location of Property . .52Q: .Snug..Havbo~ · Ro&d w .... _.. O~',,enpo~'.t w · li~w. Yol-,k ....... House Ho. b'treet Ham/et County Tax Map No. ! 000 Section ...3 ~ ....... Block ..... 5 ......... Lot ...... 3A. ........ Subdivision C~eavea .~o~.ot; · · Sac.. 3 ...... Flied Map No. A650...Lot No... 5.4. ........ conforms substantially to the Application for Building Permit heretofore t-tied ~ this office dated ·.. Jztr~e. 2~ v ........ , ! 9.7.9 pursuant to which But!ding Permit No .... ~ 0~81. ;[ .......... dated .. ,/u;14 · 2 ?.~ ................. ! 9 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 ......... ............ Ingi'.ound. ,~i~tt.,.m:Lng. l~.aol, amd. l~ilce .............................. The certificate is issued to .... Maac~el].. & .l~ut'.i~l. 3,imk:tla. ........................... (ownera.l~ ~r.~t~l~ __. of the aforesaid building· Suffolk County Department of Health Approval ....... R/.B ............................... UNDERWRITERS CERTIFICATE NO ...... N §.~.7.{18 ? .................................... Re,, 4/79 I~OEM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1O281 Z Permission is hereby granted to: FEu E .. ut p~mi~s {~ot~ at ............................................................................................................................ ..... L¢..~ ....... ~...~¢.~..~E.L~..&~.~',2 ......... ~¢.~z.....8~.¢.~ ...... ~.~ ~ ¢ ........................ pu~uant to application dat~ ................................. &~.~.....~.., 19.~, and approv~ by the Building Inspector. Fee $.....15. .............. Building Inspector FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TO~VN CLERK'S OFFICE SOUTHOLD, N~ Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°· 1028O Permission is hereby granted to: ........... ...,.~,~,.~.~..:~ ....... ~--,~.7,? .~.....~,,,,~,:~_~....~.~. ...... . ~.~~~.....~-...~,~....~.~,,~..~,~ at premiss ,~a,~ at ~.~r~--~ ........ ~:'~'"~Z"Y ...... ~~..~r~.' 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 wpewriter 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. 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- t/on 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 .... ~. ~.e..3,..1.9.~ 3 ........ New Building ............. Old or Pre-existing Building ..... .~ ......Vacant Land ............. Location of Property .... ~,2,0..3..~.u~ .H..a.~.b,o.~...R.o.a. d,: .......... G..~.e.e,~, p..o~.t,. ,...~.,.~... .......... House No. Street Ham/et Owner or Owners of Property ,...H.~.~.~..e .~.~. ,~.~..d..H.~. ~ .~.e.~...S~.m.~.~? ........................... County Tax Map No. 1000 Section . .3.5. ........... Block 5 Lot 34 Subdivision..C.Z.e..a¥.e.s.. ,~....S...e.c....3. ..........Filed Map No. 4650 .Lot No. 5/+ Permit No..1.0.2. 8..1..Z.. Date of Permit . .6./.2, 7../.7.9.Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval . . . ~.~.~ "{ .0.8.?. ............ Planning Board Approval ...................... Request for Temporary Certificate... Final Certificate Fee Submitted $. ~5..00 ....................... Construction on above described building and permit meets all applicable codes and regulations. Rev. 10-10-78 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1602 Examined ...... ..; :..../. i., 19... Apphcat~on No ............ LL.>' '1 Approved ..... ,;" ......../. .,19 :/.~'{PermitNo. /. .:. .'. .~. f. f.~' Disapproved a2c' ' ......... "~. ----- ~ ~ '~/~'~f/ .......................................... ;;:,, ..... ;/__ ', :~' i~ b~~,~ S: ........(BuildingZ(:'~' ~"' i~'~'' 'Inspector) .... : :' !" '~ ~¢~; ~t~ APPLICATION FOR BUILDING PERMIT Date ....... .~...:..~Z .~:., 19 .Z~q~t a. This application must be completely filled in by typewriter or in ink and ~~cate to the Building0~) Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. ,~ v 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. ~-~ I '~ (Signature of apl~h'caut, or name, if a corporation) ..~ · ~O. T~~t o, )J (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or'builder. Name of owner of premises ................................................................. (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 ............... ~ ..... : ....... ~ --..~-~ Plumber's License No ......................... Electrician's License No ....................... O'ther Trade's License No ...................... 1. Location of land on which proposed work will be done .... ~i'.~. ¢~.?..~}~....~.~. ~.~..- .................... ....... ~ ~:~: ............ ~/.c. ~,~....~..~.~...~. ~<.~., .,~... ...... ~.~¢.P. ~.:.,'~ ............... House Number Street Hamlet County Ta~ ~ap No. 1000 Seetion ...... ~.~.'.-- ...... ~loek ..... --~.. .......... Lot..~::?. ............ Subdivision..C~,~ .~-.-e~'~.~. '3...~.g:~..~..~ Filed Map No. I~..~..0~. ....... Lot..~ ~.' ......... .... (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 .... :...' ............ ~.~, . .I. :. ................................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Altera~[ll3( g~r ....... Repair .............. Removal .............. Demolition .............. Other Work ............... . ~ . / (Description) 4. Estimated Cost Fee ..... [ ? ........................... ' ..... (to be paid on filing this application) 5. ] f dwelling, number of dwelling units ............... Number o f dwelling units on each floor ................ If garage, number of cars ........................................................................ 6. If business, commercial or mixed occupancy, specffy nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...... /.~' ............. Nff~(zer of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Dep~th ............... Height .............. ~. Number of Stories ....... /.(%.~ ...................... .~.~? .................... 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ...................... ¢,J~! ........................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ '....' .................... 13. Will lot be regraded ........ ? :,~' ~.":~ ~t"t.t.' ~.t~.l~. Will exce~sfllJJ~i-~,~.e~ft~m~,prem!s, es:/~,,/[.,{ Yt~s 14. Name of Owner of premises ...... ' .............. Address . .' ................. rnone ~o ................ Name of Architect ..... ? ~ '~I d ~.d / f.' · '~i.)'C."f ' Address . -. 'x-. No. ' Name of Contractor ........... '.; .........'. Address i. . ~. No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, an& 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, ~ ~ COUNTY OF. ....................................... .......... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is 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 statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworu to before me this ........ · ~' ~'r-x ........~ ~ .~. ~'~ k~.~\l ~, _ ,,, ~,. day °f ' "~' ' '~'O' '~' ' ¢' 'i ...... 19q~. ~c.~l kxpbes ~&~(h Jo. 19~ OWN[R: ~., General Engineerin$ ~ $UFF. ¢0. DI:FT. H. S. REF, NOn 7 I ~ APP~V~D: ii (S) THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ e= E5 JOHN STREET, NEW YORK, NE~Yf~o, OO3B ~ &ugust: 27, /979 THIS CE~IFIES THAT out;side 5~ in the folloxving locatiqn; [] Ba~e~ent. .~ lst FI. [] 2nd Fl. Section Block Lot ~vaz exarnlned on ~ ~ '~ ~ ~ ~*~ ~ ~ and found to be in compllance ~vlth the requlrementz of this Board. FIXTURE EXTURES RANGES OVENS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT FEEDERS SYSTEMS NO. OF FEET E R I C ~E~C~ A.W.O. NO: OF HI-L~G A.W.O. "0. OF NEUTRALS NO. O ¢OND. OF CC. CONO. OF HI-LEO OTHER AFPARATU$: (~g Pool.) This cerci£.icat:e covers comp]..iance a~: 1:he dat:e ag inapacr.:Lon onl, y, Because o:~ unusual anviroments -it: :La advio~ble co l'~ve freqtmuc t:est: and/o:r repai:s made by a qual.i~isd pe:cson. OF NEUTRAL P.O. Box 129 11795 Lic.2007 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by