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Home My WebLink About11004-zFORM NO. 4 TOWN OF SOUTHOLD BUIt. DING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.~.'l.q~65 .......... Date ..... ~ a..n .u.a.v.y....2.9 .................198.~. THIS CERTIFIES that the. building ................................................ '[0 Ships Drive Location of Property . .~ .1.6.q ........... g.o..r'.~}l..R. 9,a.cI' .t,.9' .B.y.a..v.ip.!q.... Southo!d House No. Street Horn/et County Tax Map No. 1000 Section . .0. 79 ....... Block . .q 3. ........... Lot . .0.1. ? ............ Subdivision ...~ .................... ! .......Filed Map No, ,X, ... :..Lot No..X ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ·. p.o,.qo.r.a.b.e.~...1 .8 ...... ,19 .~0.. pursuant to which Building Permit No. 1100"~ 7_, dated ... p.o.c, q .m!~.e.v...2 fl ............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 ......... ....... ~a..p.v. ~,y.a.~.~. p.n.q-: .f.amt. 1. y' gy.e..1.!.t, qg: ..................................... The certificate is issued to I"redevlok C. and Helen P. Fahy {owner~l~ ~r-'te'rmtrt) of the aforesaid bnilding. Suffolk County Department of Health Approval .~.0..-~p.-.9. '.o ~..~. ~. ./ .1.3 /. 8. ! ,.......... P, obe ri; .~.... ~i/..la ,... . UNDERWRITERS CERTIFICATE NO N 5 Building Inspector Rev. 1/81 TOWN oF ~ BuiLDING TOWN HA L ~i , souT,O-O, N~ 'r.I BUILDIt~G' ~E~IT (THIS PERMIT MUST-BE KEPT ON TH.i~ PRE/~,IS~S uNTIL COMPLETION OF THE woRK AUTHOR!.~ED) Permission is hereby granted to: at premises located at · ~;. ....................................... Cou~ Ta~ ~ap No. 1000 Section pursuant t~ application .... ;, 19 .; and approved by the Building I~spector. ............. Rev. i6/30~80 . , 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 submit'ted 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 disposaI-(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 ail property lines, streets, buildings and unusum 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, 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 o. New Building .... ~ ..... Old or Pre-existing Building(Z): .... ~_.... =/Vacant Land - ,,. , · ocation of Pro,~rty ................. W..~ .,~..~.. ~ ~.~:~,... ~. ~ ~ ..... House No, ,_ ~ q ~ Street0 '~ Ham/et o~. o. o~.~, o~ ,~o~.rt~ ... : ~ ~ ~ ~'?. .~.~ . . . ~ ~ ~ ..................... County Tax MapNo. 1000 Section ..... ~.~... Block .... ~.~ ...... Lot..~ ....... Subdivision ................................. Filed Map No ........... Lot No .............. ,.,~,~,o./~ ~. . ---- .... . ...... ~ ....... ~.~ Health Dept. Approval.. Z.~/~ .b ......... Labor D.pt. Appro~.l ...................... ,.. Und.~,.rsA,,.o~,..W//.2. ~ ..... ,,...~n,,o~d App~o~, .................. ,.-, Request for Temporary Certificate Final Certific~t~ * Fee Submitted $ .... - ........................ ~ / ~ // ~ ~ ~ Construction on above described,building and p all ap nd ohs. Applicant ~~~_.. Rev. 10-10-78 ~ C,O. z IO~ ,/~/~ ~ ~ G. ~ ~"o-'.~ ~ ~,~ ~., THE NEW YORK BOARD OF Fi;RE UNDERWRITERS i~ BUREAU OF ELECTRIOITY THIS CERTIFIE~ THAT only the electrical equipment as ~scrlbed below and introduced by the applicant tm~d on ~he above application number in the premises of in tke following locatlon; [] Basemen£ [] 1st Fl. [] 2nd FI. Section Block Lot wa~ exa,.i.ed on Ap;tit ~0 ~, ~9~i[ and found to be in compliance with tke requirernents of this Board. FIXTURE OUTLETS DRYERS SWITCHES 2~ FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS NCANDESCENT FLUORESCENT 3O TiME CLOCKS SYSTEMS NO. OF FEET E OTHER APPARATUS: ~D~or/s ~ E R V I C NO OF CC COHD A W.G. NO. OF HI-LEG A.W. G NO OF~EU]RALSJ] A W.O. PER ,~' OF CC. COND. OF HI-LEG OF NEUTRAL t 1/0 2 Box 143~ Mat~t:ltuc~, N~Y. 11952 lie. 242-E This certificate must not be altered in any manner; return to the office of the Board if inc&rrect. Inspectors may be identified ~1 COP~f, ~OR BU~IID!NG DEPARTMENT. THIS COPY OF CERtifiCATE ~T NOT BE~;ALTERED IN ANY MANNER. COMMENTS FIELD INSPECT,ION FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME& PLUMBING INSULATION PER N.Y. STATE ENERGY COpE FINAL [ONAL COMMENTS Lu'O,B,M NO, 1 TOWN OF SOUTHOLD IUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Permit No. -' ^pp.cation .......... APPLICATION FOR BUILDING PERMIT Date ................. .~...~....~...:..)....~. ....... , ,9 .~... ...... INSTRUCTIONS a. Thts apphcahon must be completely hlled tn by typewriter or in ink and submitted in triplicate to the Building Inspector, ~vith 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 a detailed description of layout ofproperty must be drawn 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 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, os 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. ....... i~i'~l'~'~¥~'; ~ ' ~ ~c' '~'l~'l~ii~ o n t i '~ ;' ';~a';n'e~' 'i~' '~' ' ~'; 'l~;~;i~ ~'i ........ ......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. a~corporate, signa.t~ 9('duJy. author'~e'd gfficer. If / (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No /~.Z:..~..../~..,......~...~..,..~,~7~ Electrician's License No .... Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: J ....................................... Lot No ......................... Street and Number .~./.~...~.~...~..~'~..~..~.~,..~...~.., .~J~.~ .i:.~ ............. .~....Lg...'~...~.~.:l..~.4.(d.:~.; ....... ' ...... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occu anc ~/./..,.? Cio/uT--' ....~..-~./-~ I b. Intended use and occupancy ......... ; ;..~...~. 3. Nature of work (check whichlapplicable): New Buildirig.. ...... .~......,.. Addition .................. Alteration ................. Repair .................. Removal ............... ... ~emoht~on:....: ............... Other Work ................................................. ..,. ~ ~ O ~ ' ',~ r ';:'.'~,,g¥~ ~c~' (Description) 4. Estimated Cost ...~.....~q, ...................... .:'......:....'.....':.~:F~e'...i~..:/...~ ................................................................. ' (to be paid on filing this application) 5. Jf dwelling, number of dwelling_ units ...... ~..~...~'... ........Number of dwelling units on each floor ........................... If ga?age, number of cars ..... t-~./4g"~:2 ........................... , ...................................................................................... 6. If business, commercial or p~ixed 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 ................................ Height. ............................ ,~,tNumber of Stories ................................ 8. Dimensions of entire new construction: Front ....... ~ ......... ~.. ............Rear .....~..~.,......~. .......... Depth ...~...~. ............... Height ...... ~ ............. Number of Stories .......... (~).~...~ ............................................................................................... 9. Size of lot: Front ...... J...~lL:.....~ ...................................... Rear t ~ ')'~,). ............ Depth .,.f..6.,~.,~..:..~....~... ....... 10. Date of Purchase ...~.0...d.:....LJ.~,.~,.°.. ...........................Name of Former Owner ........................................................ I 1. Zone or use district in which premises are situated ............ . ......................................................................................... ]2. Does proposed construction viloJate any zoning law, ordinance or regulation: ........................................................ Will at be regroded .......Lt....~..i.~ ........... Will excess fill be removed from premises: ( ) Yes., _ (i-~o 13. . ''~t--; ..... v~ ~.--, ' ~b~"/~ 14. Name of Owner of premises .-tll..~g..¥~...~....C.'..~,~..~.'.¥:.~'fl~.,% ....... Address .....~..~. ....... )....?/. ;~. Phone INa ........... ;. Name of Arch,tect ..~....~.~.] .~.~ .......[(,.0...~......~...,. ............ Address .......... Nome of Contractor ....lJ. .......... kt. ....... ?. ......... ~.! .................... Address ............................... Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and indicate all set-baek dimensions from property lines. Give street and blqck number or description according to deed, and show ~treet names and indic0~t~e whether inferior or corner lot. T ST^T OF ,V K. X% s that he is the .................. ('lqJame of individual signing contract) ' above named. ( ~---;ZZ~fC~agent, corporate officer, etc.) , of said owner or owners, and is~uJy author zed to perform or have performed the said work and to make and file this app cat on; that all state~nje,~?~,~co~n~t~ained in this application ore true to the best of his knowJedg~and belief; and that the work will be performed in fha manner set forth in the application~4j~d therewith. Swam to before me this ~ / / - // ~ / £LIZABEi'H ANN NEVILLE , 'NOTARY PUBLIC, State of New York : : No. 52-8125850, Suffolk County Term Expires March 30, :9 N