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Home My WebLink About10990-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ...... g. 104.36 ..... Date ..... &pti/1..6 .................. , 196. l. THIS CERTIFIES that the building ................................................ Location of Property .......... .t, 9.5.. I)o~l.p.h~-~..D.~. ~ .v.e., ....... fl. r.e.e.n.p. 9.p.t;.,' . .N :y.: ....... House No, Street Ham/et County Tax Map No. 1000 Section . . .Q56 ...... Block ....... .0.7. ..... Lot ....... .QI.'( ...... Subdivision .... Sou.t.b,o],¢..Shop.e.a. ......... Filed Map No..3.B. 5..3...Lot No....5.3. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ·. l:)e$orn lo er..3 ....... ,19..gq0ursuant to which Building Permit No ..... .1.(1Q 9 O..~ ........ dated ..... bo ¢ e m.t~o P. 3 ........... 19 8 D., 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 ......... ............ A. c..c.e.&~. 9 YY..Q .a .~ 9.F~e. ................................................. The certificate is issued to . ./~ndp. ew and Lucy. Ann Bart±lucca. ................. id~,~e'r,'l'~,~'~/.t~/d~: 2 ................... of the aforesaid building. Suffolk County Department of Health Approval ..... ~1/.~ ................................. UNDERWRITERS CERTIFICATE NO ...... N. ~ .~.4.6.. ] ? .................................... Rev. 1/81 Building Inspector TOWN O~ $OU~HOL~} TOWN HALL $OUTHOLD, ~ Y. BUILDING (THIS PERMIT MUST BE KEPT ON TH,E PRE~IS~S UNTIL FULL COMPLETION OF THE woRK AUTHORIZED) Permission is hereby granted to: Building Inspector. Rev, 6/30/80 ? InSPector 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 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- tion required to prepare a certificate. Fees: I. 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 ate ..... ......... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. House No. Street Ham/et Owner or Owners of Property ................................................ County Tax Map No. 1000 Section ...e.~.... .... Block ...~ .......... Lot../.q ........... .............. ~)~%~. ..... Filed Map No. ~.~ .... Lot No. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval N5 14 6 1 9 .... Planning Board Approval Request for Temporary Certificate ..................... Final Certificate Fee Submitted $ .... 5.0.0 ..................... Construction on above described building and~er~ me~all a~licable codes and regulations.JJ~- Rev, 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRI(D!T~ SS JOHN STREI~T, NEW YORK, NEW YORK 10038 .ate ~Cl~ a0. :~'~ ~pp,lc..on No. o.~i,, ii364~S - ~i N 5 J~-~ 6 ~, 9 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant r~amed on the above application number in the premises of A~c~'ew ~axtilucci, Dolph:i~ Dr.~ 500' $/i~t. in the following location; [] Basement [] 1st Fl. FIXTURE OUTLETS SWITCHES FIXTURES [] 2nd FI. C~i~r~ Section Block Lot and found to be in compliance with the requirements of this Board. RANGES OVENS DISH WASHERS EXHAUST FANS 4 3 3 DRYEES FURNACE ~o'roRs FUTURE APPLIANCE FEEDERS T~ME (;LOCKS UNIT HEATERS MULTI-OUTLET DIMMERS NO. OF FEET SERVICE DISCONNECT S E R I' C OTHER APPARATUS: NC'. NO OF HI-LEG AW.G. OF HI-LEG NO O? NEUTRALS A. WG OF NEUTRAL f'~brd, N.Y, 11763 1i0,2677-E eENJ~A~ MANAGER TMs certificate mus~ not be ~;~e~ed in ~n¥ man~e~; ~etum to ~he office of the Board if COPY ~OR [U?DING DEPARTMENT. THIS COPY OF IN ANY MANNER. F~EL~ ~NSPECTION COMMENTS FOUNDATION (Ist) FOUNDATION 2. ROUGH FRAME & PLUMBING (zn~) INSUIZTION PER N.Y. STATE ENERGY CODE % FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Exam~ne~ .......... ~' · ' ~ ~ .,19... Approve ~.~/:~Q--~. 7..%,...D ................... APPLICATION FOR BUILDING PERMIT Application No.. [ FO ~.~) ' 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 TR~egU2;t~icn2~ltf°;gJeh~s Ct°oncStormUC;~;~v~fh ba~ladi;ic~aabdledi[ia°wnsS' o°[d~lnteanracteis°,n~?l~ifn°; croe~TVhalo~d;?o°dliet, i°2'da;e~eu~aeit~odn~TCa~fi~etd(} State whether applicant is owner, lessee, agent, architect, engCn~general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If applicant is a corp~~ature of duly authorized officer. Builder's License No....-7-..-~.[~.(~ ............ Plumber's License No. -- Electrician's License No. 7 ..................... Other Trade's License No -- . .............. Lo ation of lan whic' i~s~ work will be done .~./~. 30L~..?f[~. ~t~ /~t ~/~ ~. ~o,~~~ ~ .... ,_ .... ........ ~..~.._:.: ....... r ..... ~. .~4 .~ ........ S.~ .~ ~ ~~..~.~ ~ ~ ....... ~ ...... House Number Street Hamlet County Tax Map No. 1000 Section 0~¢ Block ~ Lot 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 ... ] ............................................................~ [~ .... b. Intended use and occupancy ....~ ~.C ~ 0 ....... /...C ~ ~ .... ~ ~ ................. 3. Nature of work (check which applicable): New Building .......... Addition .......... Altemtinn .......... Repair .............. Remo:val .............. Demolition .............. Other Work ./. (~./~. o00 ; (Description) 4. Estimated Cost ..... Fe ............................. (to be paid on filing this application) 5.If' Swelling, 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 ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure wiih alterations or additions: Front ................. Rear .................. Depth ..... ' ................. Height ........ [ ............. Number of S!~o~ies ............ , t ........ 8. Dimensions of wtire nc';; constrBction: Front.. l .~. .......... Rear ....~... [.~. ..... Depth . .~..tr. ......... Height ... ~.. Number of Stories ....'. ................................................. 9. Size ofilot: Front ........... ~ ........... Rear ...................... 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: ............................ 1 3. Will lot be regraded ......... ................... Will excess fill be removed from premises: Yes 14. Name of Owner of premises ...: ................. Address ................... Phone No ................ Name of Architect . ~ ....... i ...., ............ Address ................. ~. Phone No. Name of Contractor ](~4~J)fi:~.)~...]~ .I;.~..Ct7 ....... Address/.2.'7..~%,~. ga . ./~one No, PLOT DIAGRAM Locate Clearly and distinctly allI 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, COUNTY OF . . ., .......... Fg.. IS'S ......... ! .... ~, .]. ~ ~. · · I'~. ~fl~.).~. d~.. · · .~w~.. ....... being duly sworn, deposes and says that he is the applicant (Nam'6 of individual signing contract) above named. He is the ............. : ....... .. \ ((:ontractc~, 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 b~ performed in the manner set forth in the application filed therewith. Sworn to before me this ..- ..................... dayo ... ,19. NOTARY PUBLIC, State of New York ~o, 52,4524771 ................................. QUchficd in ~;tJffolk County nature of applicant) I Oumml~on ~xp~re~ March