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Home My WebLink About10994-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town' Clerk's Office Southold, N.Y.. Certificate Of Occupancy THIS CERTIFIES that the building ................................................ Location of Property ~3&~ 3~9'0 ...... .V.J..2..i. 8..g.e..L..~..~., .............. QT$.e. IT¢. ~. ;bl...¥, ..... Street Hamlet County Tax Map No. 1000 Section ..... 02/~,..Block .... ~ .......... Lot ...'1/~ ............ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·. No.v, erabe~.. ~ 7, .... ,19 BD pursuant to whZch Building Permit No .... 7k09.c2/~. Z .......... dated ....I)?.qe.m..b.e~.. J .0 ............ 19 .8.0., was issued, and conforms to alt of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ............ ?..dd:L~:J. on..~o. D~.e:l.:l. J. ng ............................................ The certificate is issued to ..... .ff.a.~.e. ~. p.,..Ie.~.'L.h.a. Ig' .................................... (owner, lJ~;I~x~t~,ll~ of the aforesaid building. Suffolk County Department of Health Approval ...... ]bi/jR ................................ UNDERWRITERS CERTIFICATE NO .... ~ .505B27 .................................... Building Inspector Rev 4/79 No. 1,0994 z BUILDING P,ERN~IT!/i (THIS PERMIT MUST BE KEPT ON' THE PRE~IS~S UNTIL ULL COMPLETION OF THE WORK AUTHORIZED) i' ' Dote ~ ~....../.:g ........... , 19.. Permission is hereby granted ..... ....... ; at pi, emises located at ' . ...... ~ ......... ~ ............................................................................... ~',,'~ .......t'~ ....... ' · County Tax· Mop No, lO00 Section ...~..~'..~..~_~ ...... ,. Block li~,: ~ ~"t"',"~°t' No, ,0/-..~.. ............ pursuant to application dated ~..~...~.r~.~..~.,; ...... ~.~...~....., 19.~,~ ' , ~ i ~ ~ ; ' .i and approved by the Building Ihspector. i~ i:' ,~ Fe~ $. ............. ~ Rey. 6/30/80 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 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 $5.00 3. Copy of certificate of occupancy $1.00 Date .......................... ~ BU;~'~ Vacant Land New Building ............. Old or Pr g ,, . ......................... L cati f P perty ,/~.~P. M'//--.~..~..C~..-- ~¢, . ....... o on o ro ........................................ House No. Street Hamlet Owner or Owners of Property ......~'~..z~.., .~7~.. ...... .~.,. .......~...7~....-/~... .................. County Tax Map No. 1000 Section ...~..Z~ ........ Block ..... .~. ........ Lot /~// Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. /~).~.~..~..~. Date of Permit f..~./~.¢/~.~.~..Applicant.. ~.~ .~...,..~..-... · .~. · · .'~7.. · .-z~)~. · ·. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval.,~'.~,~ .~..~ ........... Planning Board Approval . . . -~y ................ Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ...... .-~-~,~ ................ Construction on above described building and perm~ meets all applicable co~s ~d r~ations. FIELB IN~ECTION COMMENTS FOUNDATION (~st) FOUNDATION 2. ROUGHFRAME & PLUMBING (2nd) INSULATION PER N.Y. STATE ENERGY cope FINAL ADDITIONAL COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS [~ BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NE~W~Y~O~R~I( 10038~ ~ Pe~e~ 17~ 1980 THIS CERTIFIES THAT only the elec t~cal e~uiDtn~nt as dega~b~ belomartd.i~tr~d b~ t~oolic~t ~d on the above application number in the premises of fIXTURE OUTLETS IECEPTAC£ES SWITCHES FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS NCANDE$CENT FLUORESCENT DRYERS SYSTEMS NO. OF FEET E OTHER APPARATUS: E R V I C AW.G OF HI,LEG NO OF NEUTRALS AW, G OF NEUTRAL Paul Burns Tow~ l-[m:~ Lam ~,ut::'h~]A, N.Y. 11971 L~c, 282 E This certificate must not be altered in any manner; return to the office of the Board if Inspectors may be identified credentials. COPY ~OR BUILDING DEPARTMENT. THIS COPT OF ~ CER?FJC~I' ~U~T ~T BE~ALTERED IN ANY MANNER. h,~ ~:~ AT 9'AM 3'h ~ PA4 FOR THE ..... ~ ~' FLDNS: TWQ REQUIRED FRAM]Hi ,% PLUMBING ........ ~,. ¢ t 9N MUST. FOR C. O. FIDN' S~;IAI..L MEET RESPONSIBLE FOR ERRORS. FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1B03 Disapproved a/c ...... i:. ~:... i ...................... / (Buildiffg Inspector) APPLICATION FOR BUILDING PERMIT / Date ..... !.| . .I.~. .......19~P. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. fl. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit auth°rized inspect°rs °n premises and in buildings f°r necessi~'~ ~ ~$i~nature of applicant, or name, if a corporation) ..... ...................... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, enl~neer, general contractor, electrician, plumber or builder. Name of owner of premises .. >..E~..~1. ?f.~... ?., .... . .~..~ ........................................... (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 . . . .~04.4.4.4.4.4:~.. ~ ~?a~,L ~ r~/~/-~ Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. ........................... ~ir~ .................. h&~n'l;~ ........................ House Number County Tax Map No. 1000 Section ..... O..2-.t{ ......... Block ...... ~ .......... Lot ..... /(.~ ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 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 ........... ~.: · · ~ '? ~," .... ~ ,~ .~,' ~o;~ .............................. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ......... Repair .............. Removal ...... Demolition .......... ' Other Work ............... ,i ', .--- (Description) 4 Estimated Cost .~.~..~>.,..op. i . (to be paid on filing this application) 5. If dwelling, number of dwelling iunits ....... [...; .... 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 t;~l~e of use .:. .................. 7. Dimensions of existi~ng structures, if any: Front ~1 Rear . ~-- Depth ~2r'/ . Dimensions of same structure with alterations or additioos: Front ..... ~.q .......... Rear .... '.'/~-.~. ........... Depth.. ..... ~.~ .......... ~.. Height ....... .%?.. i ......... Number of Stories .... 2-. ................ 8. Dimensions of ' ' . .............. entire new construction Front .. 4('.. · i Rear ............... Depth ......... Height ............... Nuinber of St(~ries ....... '. · .' ...... ~ .......................... e ............. 9. Size of lot: Front .... ~.q ....: ........... Rear ...... ~'.o .............. Depth ,,~..f.y. o~ ............ 11. Zone or use district in which promises are situated ...... : ............................................. 12. I)oes proposed construction vioiate any zoning law, ordinance or regulation: . . . ~. .o .......................... 13. Will lot be regraded ...... /~.p .......... , ......... Will excess fill be removed from premises: Yes Name of Architect .......... . ................. Address ................... Phone No. Name of Contractor ~ Address Phone No 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, cOUNTY ................. is's .~3-A:PI~-~ ~9.. ,...]~..~ ........ being duly sworn, deposes and says that he is the applicant (Name of individual sign!ny 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· Sworn to b~fore m~.th~s ·.., ................. day of. Notary Public, . ..... ~.L)..[: ............. , ...... County /~