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Home My WebLink About10996-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .... Z. 1.0~69. ...... Date ..... JLo~. ~.1.24 .................. 19 .8.1. THIS CERTIFIES that the building ................................................ Location of Property t~s~7~o~.O.. Ind&an. N.eck./.~an e, 's'~/o~i ' P. econic, . N.,.Y ....... h~/~ County Tax Map No. ]000 Section ...Q86 ...... Block .... 07 ......... Lot .... t~.,(0..0.07 ..... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... Be~otabo~.. 5 ..... ,19. gL~pursuant to which Building Permit No ..... .113.9.96. Z. ........ dated . .Beco~r~er..1.1 .............. 19. ~t3, 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 ......... ..... P.v.:i. vaJ;.a .0n.c..~am£J. 7. I).*~ot.J. ~-nt; .......................................... The certificate is issued to .... Jama~t. and..lal~'.t.c:l.a..II~rs.o, tl ......................... (owner, I~q~.~ ~._. of the aforesaid building. Suffolk County Department of Health Approval . .10.-.~ 0.-.9.5. t~ p.b.~ v. I;..&,. It;t.~k3, g..P...~,..6./. ~. ~ / 81 UNDERWRITERS CERTIFICATE NO ...... gl 5 ~ t~99 .................................... Rev. 1/81 ...... ~ ..~~. ........ Building Inspector No. ror~ ~o~ ToWN O~ BUILDINO TOWN HALE,, SOUTH'OLD,: N~ BUILDING ~ PE~iT~ (THIS P[R~IT ~UST COMPC~TIO~ 10996 Z !S ONTiL I~ULL Date Perr~Jssion is hereby granted to: tO at p~emise~ located at .......7.~...~. ...... ............................................................................ ~.,~ ~ ~ ~,.: · .!:~,. ~. ~, ' ' j' ~. ~ ~ ot Coun~ Tax Map No 1000 Secton : B~k ~; ...~Lot No.: ..... ~Q7 pursuant ~o ~pplication dated .~~~.;.~...':., ] .; and appro y the oum,~,n~ ,us~ec.~r. .. ~ ;~ _ nspect0r Roy. 6/30 80 ~ ~' 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: I. Final survey of property with accurate location of all buildings, prQperty lines, streets, and unusual natu rat 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 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..../~..".. 1.~. · ,'T..~. · ! ...... New Building . ,.V.. ........ Old or Pre-existing Building ............ Vacant Land ............. Location of Property...~..~.~..0...~-t~ lkl.Pr/~...N.~,.~, .~-=., .~'4'4/_~. .......... ~,o )¥¢~. ........... House No, Street Hamlet Owner or Owners of Property .... ~J-/~.ht~5; .... t~./~to~o./J .................................... County Tax Map No. 1000 Section .... ~.t~ ........ Block .. ~ ........... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. {.0.9 .~.~. ,~. Date of Permit ~.~..'{/. ?~.O..Applicant ..... [J~.(~..~....~./~/~. ~_,,.-z,.~. ....... Health Dept. Approval ,.. ~,0.-~,~, ?~.'~, .......... Labor Dep:t. Approval ..., ..................... Underwriters Approval . .~.~.dd. ~.~ ........ Planning Board Approval ' Request for Temporary Certificate ..................... Final Certificate ..................... / Fee Submitted $...~."'~,Oo.~.~. ................... b Construction on above described building and permit meet~,all applicable codes and regulations. Applicant ..... ~J~t~.. · .~..^' ................. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~[~.. 85 JOHN STREET, NEW YORK, NEV~ YORK 10038 THIS CERTIFIES THAT only the electrical equipment as described below and ~ntroduced by the applicant na~ned on the above application number in the premises of ,J'~m O~o~, W/S ~ndl.an Ne&k Lmm. n/o :Pee~n:L~ B~y, Pe~vr~c., in the following location; [] Basement [] 1st FI. [] 2nd FI, Section Block Lot was examined on and found to be in covnpliart~e with the requirements of this Board. ,larch 26, 1981 FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT 4O 35 DRYERS SYSTEMS S E R OTHER APPARATUS: i,~m~re ~opliar~ce feeck~.r~: 1~2~14., 1-.,2#12., NO OF HI-LEG A W O. NO OF NEUTRALS A, W O OF HI-LEG OF NEUTRAL 1 2/0 G, Oo ~-' ' '' /~lectric i'.~dfo~J, N.Y. 1176~. THIS, FZE~D.I~PECTION COMMENTS FOUNDATION FOUNDATION 2. ROUGHFRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY COpE FINAL ADDI COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examine~.~.~..~.~ ..... , APPLICATION FOR BUILDING PERM IT 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 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 c~e, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections · (Signature of applicant, or ~ame, if/,b'corppllation) 7.. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer,~con~ electrician, plumber or builder. (as on the tax roll or latest deed Builder's License No .......................... Plumber's License No. ~7.. d~../~(~,~...~..../~..C Electrician's License No. ~., .O,.. ~_~. ~.~/'-~! Other Trade's License No.. '. ................... Location of land on which~proposed work will be done..~g~:.. ~..tJ..~.L/. ~. ................... J ...... · House Number Street Hamlet )./~ ~.. County Tax Map No. 1000 Section ..~.~ ............. 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...~J...~.~.~..~.~ .......................................... b. Intended use and occupancy .... ~.. ~.'~...~. ~. ...... .~...~.~5( .~../~...~.l./~.~. .......................... 3. Nature of work (check which agplicable): New Building..~..... .. Addition .......... Alteration .......... Repair .............. Removal .............. Demolition ............ Other Work .............. : "~. ~/ ~ (Description) 4. Estimated Cost ........................ Fee . ~/.~. .......................... (to be paid on filing this application) 5. If dwelling, number of dwelling nnits .............. 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 w~th alterations or additions: Front ................. Rear .................. Depth: .................... ~.. Height ...................... Number of Stories ........... ~, ......... 8. Dimensions ofel~tire new construction: Front.. ~. ......... Rear.. ~.~ ......... Depth., ,t;/h ......... Height...~D~-E2 ......... ~Number of Stories ... gL, ....... . ....................... ,./ ..... ~ ............. 9. Size of Itt: Front ...I.r~o. .... ........... Rear.. 1 ................ Depth . .~.~7.O. ............... 10. Date of Purchase ........... : .................. Name of Former Owner ............................. 1 1. Zone or use district in which pr~mises are situated. :- ................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: . ~/.~ ........................... 13. Will lot be regraded . .~ .... i ....~, .............. Will excess fill be removed,from premises: Yes (N(N(N{~) 14. Name bf Owner of premises~g. ~../~-..~!~/~t_~J4~ddress ~.~/~. ~-.~ /.~ Phone No ............. ~ Name 0f Architect ........... ! ................. Address ~,~ ~,a .Lg~. ~-~41q~A~hone No ................ Name 6f Contractor ......... i ................. Address ../~ l. ~ ............ 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 inumber or description according to deed, and show street names and indicate whether interior or dorner lot. STATE OF NEW ~YORK~ ~ COUNTY ......... .. r.i~ffm. ~.f[;~/~f'ifi~l.si~ ' ~t '"r~~ ,~ ,,,,,~ .¢.~7)~.. qL)~t z~ . ~^,~ j~.~. being duly sworn, deposes and says that he is the applicant t .... g ing 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;l that all statements cont0ined 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/,,/~.~.~(~,J~..~. ]h ~?~..' ' ' ~ '" LIND^ F. KOWALSK! NOTARY PUBLIC, State of New Yor~ No 52.4~2~771 .......... Commission Expires March 30, 198,."2~.-