HomeMy WebLinkAbout10986-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No... Z .10.531 ........ Date ...... Ju.ne, 22 ................... 19.. 81
THIS CERTIFIES that the building /
........ ;-53.~3. ~q.~y~.~¢.t..qv.,. l~.o. oql, ........ qUI~¢AOgU~.,..150~. Xork.
Location of Property House No. Street Ham/et
County Tax Map No. 1000 Section .... 1.1.1 .....Block .... 9.7. ........ Lot .. 00,7 ............
Subdivision~l.a~ ~a.u .? g....Club..~.~?o¢ ......... Filed Map No ......... Lot No. , .379 ........
conforms substantially to the Application for Building Permit heretofore Fried in this office dated
· ~ovembop · 26 ........ 19 .g0pursuant to which Building Permit No ...... 1098.6 · g ........
dated .... B~¢em.bo~,..1.~ ............ 19 -$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 .........
.... Aco~.so ~7..G~mage .a~d .Add.£ ~ion..of. D. eck..t.o .~x.i.at tn~ .Dwelling .......
The certificate is issued to ......... ~.~ f~.r.* 10..¥t~ .t.e.EtJ .................................
(owner, le~.er..tenat~t~..-
of the aforesaid building.
Suffolk County Department of Health Approval ~I/R
UNDERWRITERS CERTIFICATE NO ....... N-q. 1799.7. ..................................
/?'
Building Inspector
Rev. 1/81
1:0986 7
TOWN OF SOUT.O[
BUILDING DEp~RT,~
TOWN
SOuTHOLD,
BUILDING
(THIS P~RMIT MUST BE KEPT ON TH,~
COMPLETION OF THE woRK AUTRORIZED)
Permission is hereby granted to: / ~'~" i: -~/ :
to ..i~.~/.~.. x.~.4;.~...~.. .....
at pi'emises located at
..... : ........... ~, ................... ~ .... I .~ ........... ;~~'.7'C~''-'~' c/'-
~.:~.~....2¢,.~.., ........ ~......~ ................ l?Zo.,.~....~.~z ................
County Ta~< Map No. 1000 Section ..../.~, .~, ....... ;.,. BIocE i!..~,f..TJ ........ i:Lo, No...(,~.1~..7 ........
pursuant to application dated ...~..(~.;~-~,~g~-~......i:'~'~., lC)'..~
, and approved by the'~'
Building Inspector.
/
~ B~ildlng 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 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.
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
3. Copy of certificate of occupancy $1.00
$5.OO
Date..,~I,,P~'NE~. q.~
New Building ............. Old or Pre-existing Building ....~. ...... Vacant Land .............
Location of Property . .~'~"~ /-t~.'-~ i,',J~T-~,~ .~ ........... ~U~.~O~.
Hou~ No, Street Hamlet
Owner or Owners of Property ..............................................
CounW Tax Map No. lO00Section ~:~':.~ ...... Block ............... Lot. ,~.~.~. ........
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No../.~---/~.~¢.. Date of Permit/.~.J'/.~....Applicant. ~,'~O~tT[~.~....C~.~..~'~,.o./~.'. .CO~
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .... ~ ...............
Fee Submitted $...~.'..~ ......................
Construction on above described building an[l, per~it meets al~plicable codes and regulations,
Applicant..~....LI~,~ . . . .~..~ ...................
Rev. 10-10-78 .~~:::J~/ /~¢~¢~_~0
FORM NO. 3
ToWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N.Y.
NOTICE OF DISAPPROVAL
PLEASE TAKE NOTICE that your application dated .... ~:....~. ......... ,19 .~.~/...
for permi~to'~o,nstrttct,...~Q?.~z~-~.~'~.~./('~'~.~- · · ~).~". '(~- ~ '~(~'~ ~x~ '~ ..... ~/ .......... at
Location of Property ..o~.~,~.....ZZ-.~.c~.~Z/i .~.~r'~?:. ~(~.,~7..~'. ...... .~..~.~.~././~--
t?ouse ND~ / b'treet ' ,/~-Iamlet
County Tax Map No. lO00 Section ... ~/./. ...... Block ....~..~. ....... Lot .~).~.~. ........
Subdivision ./(~{~,~..(/.~/.* ..... Filed Map No ................. Lot No, .. ~. l~. · .......
............ .... .........
RV 1/80
THE NEW YORK BOARD OF FIRE UNDERWRITERS
[)~ BUREAU OF/ELECTRICITY
~ .~Ci]~ 27~ ].98]. 85 JOHN STREET, NEW YORK, NEW YORK 10038
THIS OERTIFIES THAT
only the electrical equipment as described below and introduced by t~ applicant ~alned on ~he above appl[cation number in the prem~ses of
H.E. W~nters, Z395 t~a~rs P~.d~ ~~
in the following location; ~ Basement ~ 1st FI.
wasexa,ni,e¢lou April 23, ].981
FIXTURE
OUTLETS
11
8 5
[] 2nd Fl. ~(~ Section Block
and found to be in compliance with the requirements of this Board.
Lot
FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS
11
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS
UNIT HEATERS MULTI-OUTLET
SYSTEMS
NO. OF FEET
DIMMERS
SERVICE DISCONNECT S E R
OTHER APPARATUS:
I C
O~C~ ~ W'O' NO.OF HI-LEG A
J~O CON~ O~ %C. COND, OF Hi-LEG OF NEUTRAL
Oettr~r Elec. Co.,
P.O, Bo~ 482,
Riwrhe~,~::[, N.Y. 1190].
lic0643-E
11
MANA~GEE
This certificate must not be altered in any manner; return to the office of the Board if ~incqrrect Inspectoys may be identified ~, thei~ credentials.
COPY FoR BUILDING DEPARTMENT. TH~IS,C~ ~OPY MUST NO~ ~BE ALT~EEED EH ANY MANNER,
.5
· NJ. '¥'. '~ -r-Za
//
.I
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
Examine . .... .....
^pprove . Z .... ......
APPLICATION FOR BUILDING PERMIT
Application No../.(.?~..~.. ........
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 mnst 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 alt applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in buildings for necessary inspections.
.... "
· .C ......
(Signature of applicant, or name, if a corpor.ation)
... ..............
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises . ~O¢-.~....~..~.x ~O.T.W .f~...~. ........................................
(as on the fix roll or latest deed)
If aPl~icaqt is a corporation, signature of duly authorized officer.
............
(Name a~ title of corporate officer)
Builder's License No ....... .~. .................
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
1. Locati6n of land on which proposed work will be done ..................................................
House Number Street Hamlet
County Tax Map No. 1000 Section . .\~. S.S'..~..--.'~ ..... Block .................. Lot....~..r)..C~. ..........
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy . . .C~..v~. ,~.... ? . ~. ..... ~ . .x.~. ............................
b. Intended use and occupancy ....................................................................
/
3. Nature of work (check which applicable): New Building . ......... Addition.. [,'5.. .... Alteration ..........
Repair .............. RemO?al ............. Demolition .............. Other Work .............
.~..~.,~--- .e~. (Description)
4. Estimated Cost.'~-'~..~,q<''~.~ I~ O ............. . ......... Fee ..................................
(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, commerciai or mixed occupancy, specify 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 .................... i · Height ...................... Number of Stories ......................
8. Dimens!ons of entire new construction: Front .... ~..~ ....... Rear ...aZ..'r(. ........ Depth .. ~.'Ir. ........
Height ................ Number of Stories ........................................................
Size of tot: Front ..... [.lO. kg.. ! ........... Rear ...... L~.L~.. ........... Depth ...~.O.~. .............
Date of Purchase ........... ' .................. Name of Former Owner .............................
Zone or use district in which premises are situated .....................................................
Does proposed construction violate any zoning law, ordinance or regulation: ................................
Will lot be regraded ........ ,i .......... ~ ....... Will excess fill be removed from premises: Yes No
Name of Owner of premises . ~.l?~.~.qk4%....~a.hKreqkddress ................... Phone No ................
Name of Architect .......................... Address ................... Phone No ................
Name of Contractor ~.O .~.xT0~.....(~.q .~.~..x...(.e-9..c.~q~)ddress ................... Phone No.
PLOT DIAGRAM
Locate clearly and distinctly all ibuildings, whether existing or proposed, and. indicate all set-back dimensions from
dumber or description according to deed, and show street nsm, es and indicate whether
10.
11.
12.
13.
14.
property lines. Give street and block
interior or corner lot.
STATE OF NEW YORK, . ,iS
COUNTY '
S
......... (--~..~..~.~. .... ~c'~.O~l~o~ ................. being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is 'the O--0 I0
(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 con~ained in this application am true to the best of his knowledge and belief; and that the
work will be performed in the manner set forth in the application ~ed therewith.
Sworn to before me this
....... . .~..~.. · .~. ....... day o'f....~..0..~· ............. 19.~
LrNOA' F. KOWALSKI k. T'-" ]
No. 52-4524771
Qu:hfieO in Suffolk County (~ (Signature of applicant)
Commission Expires March 30,