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Home My WebLink About10966-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No... g.1.04. 9.6 ........ Date ..... .M?.)'.. 3.8. ..................... 19 81 THIS CERTIFIES that the building ................................................ Location of Property ..... ..6.5.5...F.a.c.%.°.?)t..[v. 9.n.u.e.I ....... I~ia~;{;~.~;uck~ ~I. X, House rye. Street Hamlet County Tax Map No. 1000 Section ... 1. 2. .2 ...... Block . 9.6. ........... Lot...0. 0..2., p.O. ! ...... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .O. qg9.b.e.v...3 .1 ......19 .8.0. pm'suant to which Building Permit No. 10966 ~. dated . .~gy.e.m.b..e.v..1.2. ............. 19 .8.0., 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 ......... · ,: .c.~.u. rc..h. ~..~.h..t.h..~..a.~.t.e.r.a.t.~..o.n' ?.n..~..a?.a..~.~.o.n. ,t ............................... The certificate is issued to ...... p. il ~..ry..B.a.p.t.~.~..t;..C.h.u. r'..c.h. ............................ (ownezde~,e. er-tonae, td. - - of the aforesaid building. Suffolk County Department of Health Approval I~/R UNDERWRITERS CERTIFICATE NO. N508370 Rev. 1/81 No. 1~o96~ Z (THIS PERMIT MUST BE KEPT ON THE P'RE~IS~S UNTIL F~ULL COMPLETION OF THE WORK AUTHORIZED)i: ~:~ l~'o~e ~ .......... ~ ......... .................. ............ 19.. Permission is hereby granted to: : ..~,.~:Y./.~....z'L.d,..,,~.i; ......... :;....i: ...... ~....:~..:. ~o ......~,...~.-~...~.~r...~.~..~..~.~.~.......~.,..~:~.~..~ia.~..,....~ ~,.,.~x~ ..... c~,~.. ~...~.~,.~. ......... . ~.....~,~,..~~.~~ :. , ,~ ~.~,~..~ ......................... ....... ; ......................................................................................... Coun~ ToX Mop No. 1000 Seot,o~...Z~ ........ ....~. BIo~ ~ ............ ~.. ~.~. o N . ~ ...................... Building ns~ector ' :- ~ ~ '- ~: I Fee ~ .~. ~ ............. FORM NO. 6 'TOWN OF SOUTHOLD 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 featu res. 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- 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 $5.00 Date . .~.P,Y..%$,~. ,.~9..~,l .......... New Building ............. Old or Pre-existing Building ...X~..~. ..... Vacant Land ............. Location of Property ..... .W/~. ~..a.~;1;Q,r~.. A¥.e.n.g¢ ....................... MAl;l;iCp. c,g ...... House No, Street Ham/et Owner or Owners of Property ....... ~pj.t;~. ]~pl;i~.t..C).~t~;b ............................. 122 06 002 *OO1 County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No..~.O.???....Z Date of Permit .Z~./.[..2~?.O. Applicant ... .Harold..R........ ....Re.e.v.e.. . ,&..........Sons, Inc. not requi ed ..... .-,ct Health Dept. Approval ........................ Laoor uept. Approval ................. · N 508370 'n I not required Under~;rlters Approval ........................ Plannl g Board Approva ...................... ~ Request for Temporary Certificate ..................... Final Certificate . .X. .................... ,%%' 5 O0 ~ attached~ ~ Fee Submitted $ ..... : .... \ .......... ] ......... ~\ \L~ Con struction o n above described bu ,Id lng and pen[n it ~t~ ~lc~ al;~pltp0,ble o/o]esand reclu lations. '~ ~. ~ /~ Jk ~ee~ & Son~, Inc. ~ ~/ ~ Applicant .... ~. ~.~. ~..~~ ......... 7.. ,~V / A~eS F, Reeve ~resident V Rev. 10-10-78 ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS ~[ BUREAU OF ELECTRICITY [~ 83 JOHN STREET, NEW YORK, NEW YOrK 10038 ..~. Febzuaxy 3, .L98:L ~p~U~tlon ~o,<,,,~'~ 098647 80 N 5 R '~ ? 0 THIS CERTIFIES THAT only the electrical eoulptnent as described below and introduced by the applicant named on the above application nu tnber in the pretnises of U/~iLs/ gapC:Lsc C,"m~-rch, w/~ Fac~ory Av~., Mat:~;:LCuck, i. a,~followi,,g locatio,~ [~CBa~e.~e~t [] I~t rt. [~ 2,d ri. Section BIoc~ rot was examined on J~tB~] ~ ' ~L98~ and found to be in compliance with the requirements of this Board. PiXIURE I SWITCHES FIXTURES OUTLETS V^~OR 29 12 6 DRYERS FURNACE MOTORS RANGES OVENS DISH WASHERS EXHAUST FANS TIMECLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT S E R V I C NO OF CC, COND. A W, G, NO OF HI-LEG A W.G. NO. OF NEUTRALS A W G. PER ~ OF CC COND. OF HI-LEG OF NEUTRAL OTHER APPARATUS: E,:Lec. Roam lt~acer/m2-1. Olgg P.O. Box 143 1%952 Lie. 242 g GEN~I~AL MANAGER Per This certificate must nos be ahered in any manner; return to the office of the Board if incof~'ect. Inspectors may be identified by their credentials. COPY F~OR BUILDING DEPARTMENT, 'I'BIS COPY OF ClER?IFICA?!L~'VtU~T NOT BIE~AI. TERED IN ANY MANNER, F~IELD'INSPECTION FOUNDATION (~st) FOUNDATION (2nd) 2. COY~ENTS ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY CODE % FINAL ADDITIONAL COMMENTS: TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWH CLERK'S OFFICE SOUTHOLD, N. Y, 19...~..~... Permit No.../.~..¢~.~.......~.. ........... Application No..~..~...~.,~..~... ................ Disapproved a/c ..................... :.;~ .......................... ~ .................. ' ......... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter ac in ink and submitted in triplicate to the Building Inspector, with 3 sere 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 o detailed description of layout of property must be drown on the diagram which is part 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 o Building Permit to Ohe 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 o Certificate of Occupancy shall hove been granted by the Building Inspector, APPLICATION S HEREBY MADE to the Building Deportment for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of $outhold, Suffolk County, New York, and other applicable Lows, 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. (Signature of applicant, or nome, if a corporation) .......... (AddOess of applicant) ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ... 0.~.&.~..~.....,~2x~.&.~....T-k.%T......~4~X~,,.(~J~ .................................................................... If applicant is a corporate, signature of duly authorized officer. (Nome 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 prop0~ed work will be done. M~ No.: ........................................ Lot No ......................... Street and Number ............ ~t.,~......~:.~.~-~-~.I~,.~...-~.~,I~.L~'~. ..................................... ~t/~,':'.~..L.T..~..~.l.~:,~ ........ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................... ~.~..~.~,[.~ ............................................................................................. b. Intended use and occupancy .... C~...t'~.t~-~-~ .................................... 3. Nature of work (check which opplicab e): New Building.. ................. Addition .................. Alteration Repair .................. RemovalI ................. Demolition .................... Other Work .~r',%-lJ.~./~4..¢~ .................., .... ~[ ,~ ~ ~, ~ ,'-- (Description) 4. Estimated Cost ........ '/,....,.t.¢~.....%~.~: .......................... rut .......................................................................................... :I (to be paid on filing this application) 5. If dwelling, number of dwellihg units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ...... t ...................................................................................................................................... 6. If bHsiness, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimelnsions of existing structures, jf any: Front ......'~.~ ................ Rear ....... .~...~. .................. Depth ....~.~ .......... Height ...... ,~C~ .......... Number of Stories .................. ¢~.t.~.. C% ................................................................................... Dimehsions of same structure,iwith alterations or additions: Front ......... ~,..~. .................... Rear ...... ~...~. ............... Depth ........ ~,¢.~.1. .............. H~ight .......~.~, ............ Number of Stories ........ ..~)..[.~,~ ........... 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number !of Stories ........ 9. Size qf lot: Front .................. ~ ...................................... Rear Depth ................................ 10. Date of Purchase .................. ,~ ..................................... Name of Former Owner ........................................................ 11, Zone or use district in which ~remises ore situated ..................................................................................................... 12, Does proposed construction violate any zoning law, ordinance or regulation: .... ~.~...~. .......................................... 13, Will lot be regroded' .....~,~.i ............ Will excess fill be removed from premises: ( } Yes ~ No 14, Name of Owner of premises ~,~.t,~.~ ..... ~.!5.~. Address' " ~ ~ ~,.~,.~..c~.~,-- ...... Phone No ....................... Name of Architect ................ ' .............................................. Address ................................ ,Phone No ....................... Nam~ of Contractor~'.,~..~.~.~-C.~G...l~,~J[.~'-'r~t,.lk, Address (~...'~...;.~i~,..[..d~..[.... Phone No..'~.°(..~;;'...~T.~.I~ PLOT DIAGRAM ~/~'~'r OAK.) ~ Locatel cleaHy and distinctly alii buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and blo~k number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, [ $ S COUNTY .OF ,~'..~.¢~g,~.~,.....=...~' ~' ............... ,~J~.l~;~....~..~....~l~?,~.-~ ............................. being duly sworn, deposes and says that he is the applicam (Name of individual signing contractO above nambd. He is the .: .......................................................... ..C-~.~.'['.t~.q~.%~::z~, .................................................................................. (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 . Sworn to before me this i / I .... .4pu ,,c,.day of ........... . ,,' . Nato,fy ........................... ~/.~.. County ................ .\.. L ..~ ..,..~:~... ~..., .......~~ ........... NOTARY PUBLIC, State of New York No. 52-8125S50, Suffolk CouAty T,rm I:xalre$ March 30, 19~,.~,