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Home My WebLink About10780-zI:ORNI NO. ~ TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N.Y. Certificate Of Occupancy No....g.!42..02 ........ Date .......... .~.e.b.r..u.a.r.y....5 ......... , 19.86.. THIS CERTIFIES that the bmlding Addition & Alteration Location of Property .5.0. Q .............. .G. qo..s.~..C.r..e.e.k..L..a.n.e. ........ .S.o.u.~..h.o.i.d. ....... House No. Street Hamlet County Tax Map I'4o. ] 000 Section ...0. 7..~ ...... Block .... 0..~ ......... Lot...0. 0..4 ........... Subdivision ........ × .Filed Map No ....... Lot No. conforms substantially to the Apphcation for Building Permit heretofore filed in this office dated ...~.u.l.y.....1.5. ........ 19 $.0. pursuant to which Building Permit No .... .1.0.7.8. 0..g ........... dated .... .G.u.i.y.....~.6 ............... 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 ......... ·, ~ .-.-.-..~..~.cj~., .~.d.d.~.~..ig.n' .~...~.~.e.r..a~J:.o.n...s..~.n..Z.a.r.~.e...D.J:n.~..n.~..~.?.o.m..777.-.-.7 ...... The certificate is issued to ..... H..A.L.~,G..t~. F.,...R9.~.~.~.?. 9.-...~. ?.H.¥.~.~.I.~...~..... (owt~er, I~.~c~2~1~ of the aforesaid building. Suffolk County Department of Health Approval .............. .IxI/..R ........................ UNDERWRITERS CERTIFICATE NO ....................... ~ 5. $ .7.1.~ ? ................... Building Inspector Rev, 1/81 ~0~ NO. ~ TO~N OF SOUTHOLD TOWN CLERK'S OFFICE SOUTHOLD, H, Y, BUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ...~...~../.~/. ~' N? 10780 Z Dote ............. t..~. ....................... , 19..~.' Permission is hereby granted to: ... ..~.c~...~,~_.(...r~... ¼,~..~. ............ ...Jo.~.r~.~.~_ .~...=...~...:.~..y. ...................... to ...... C~,.x.,.~7.z,' c~ ~.....~.z~.c...4~....,~q~..,~ ~..zT.Z~.,~.......~.....~..a..7,~..~. .................. ..... z=~r.~......:2.,.;,,.~.~.r~......~cG.~.J~.., ................................................................. ......................................................................................................... ~.~.~a~.=~..:~.,... the Building 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 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, s~reets, 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 reqmred 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 ..... ~.~?.~..~ ............ New Building ............. Old or Pre-existing Building Z/ Vacant Land Location of Property .. ,?~.?,...~.~: :/L.r.~.. ,d: ./Z/.~..~.,~'... :4./~.~.~F ...... .~...~.~././,/..z~.~..~]. .... ~,-. c./,/..., ....... House No. Street Ham/et Owner or Owners of Property .../.~.d~-EFE~.'...~.. ?...~/.~, ./'. z.~.~.~../?. .... ./.?? ,7)/.z.-.~. ,/7~'~-. ......... County Tax Map No. 1000 Section ./~.~¢~., ?.~.... Block ....... /. ....... Lot ..... ~ ......... Subdivision ....... ~ ......................... Filed Map No.. -- .Lot No. -- Permit No./.~. ~.~.~,... Date of Permit ?~,/.~/~,?..Applicant. -~/.~.~..~....'~.~...."?~.-.~.'~/.~.~,'.... Health Dept. Approval ........................ Labor Dept. Approval ........................ UnderwritersApproval lt,?: ~ -~' ' , ' ! .... : ~. ...... . ~:, .~:¢ ......... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ,9 ~ . ................ Construction on above described building and pern~m~ets all applicable codes and regulations. e~ ~'~ Applicant ...... 7.~..~. ~..~. .~., (~ ~ .... ~ ....................... Rev. 10-10-78 , THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITy~ ~¢~.p~llb~g~ ~tO~ ~5 JOHN STREET, NEW YORK, NEW YORK 100~8 THIS CERTIFIES THAT only the electrJcaJ equipment as described belo~ and introduced by the applicant ~ame~ o~ the above application nu ~ber ~ the premises of w~ts examined on ~*~/'~i~ ~ 2{}, {,sJ~ and fottnd to be in comphance with the requirements of this Board. RXTURE ~ FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT DRYERS SYSTEMS NO OF FEET E OTHER APPARATUS E I C NO OF CC COND PER ,8 NO OF HI-LEG AWG OF HI LEG This cerhficote must not be aJtered in cmy monner, return to the office of the Board if lic~ 137-E GEN EI~.AL MANAGER Inspectors may be ~dentified by their credentials IN ANY MANNER. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southo[d, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcation must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec* tor w~th the following; for new buddings 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 Planmng 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. Fees: 1. Certificate of occupancy $§.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ......... ~ ............ New Budding ............. Old or Pre-ex~sting Building ............ Vacant Land ............. Location of Property ...~..~?¢~,.. ,~;.~. ~.~...~,..~. ,/Z..z~.~./~....~..'¢. ,¢~.~7. ..... .-~..~.~?. ,//,A~..~. .... ,¢~. ,/~, ,, ....... House No Street Hem/et Owner or Owners of Property ...~.~.~..~..:..~....~'...~?.~...~"..~.....~. .... . ..~..'~./.~..~.~..~.,~. .......... County lax Map No. 1000 Section .Z'~?.~.. 7.~.... Block ....... / ....... lot ..... .~. ......... Subdivision. '~' .Fded Map No. ~ .Lot No. -- Permit No./.~. 2.4? .... Data of Perm,t . .Applicant ...~/d:C~ .~...c.'..../.d..~/:~.~..~?T..~~. .... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval .~...~.?, 7. /.~. ?.~. ........ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ~'~- Fee Submitted $ '-~-~ // Rev 10-10-78 Construction on above described building and perm, it'm--'eets all applicable codes and regulations. App,cant ................. ........ 'TELD I~S~ECTION !. FOUNDATION C OIv~VlENT~ FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FOBM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~ , Approved ...~.Z.~. ......../..~.. ............ , ! .~...~... Permit No ............... ................. ................................. ................... D~sapproved ale ........... ........ .... (Building Inspector) Application No. /.~.?..Z..~...(~.. ............ APPLICATION FOR BUILDING PERMIT Date .......... .~/./.~..~,. ..................... , INSTRUCTIONS o. This application must be completely filled in by typewriter o~.in ink and s, ubmitted 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 al areas, and giving o 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, end 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, bgJJ~ling code, housing code, and regulations, and to admit authorized inspectors on premises and ir~ buildings for necess~y i~spections. ....... ........................... (Signature of applicant, or namer. ~r,a corporation) ...... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................ .............................................................................................................................................. Name of owneE of premises ...~/.~'./.~.~....,~.......C-~....~.........~..../.x~..~.~:..~ ........... .~.......y~...~:....~....~.~ .~....~x________~.....~.. ..................... If apphcant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......... ..~.....~..~. ............................. Plumber's License No ................................................. Electrician's License No. ~.ZX~f.(,,,.,,.~ .............. Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.' .L.~....~..~......~.,~.. ..............Lot No ......................... Street and Number ....~....x~......~..~..~......~¢~.~./.~......~. ~ ............ ~.~..~...~.. ...... ~,~.~...., ......................... Municipality State existing use and occupancy of premises and inCended use and occupancy of proposed construction: a Exisiting use and occupancy ........ ~...~.~...'-[~..~.~.%~...~.~. ................................................ ~'"7~ __ --'* ...................................... b. Intended use and occupancy ........ ../~...~..~.d'.../~....~.../k(..(: .~........' "~"/.....~.~...~w.. ....... .~.~....~.,~..,~,,¢,4..~ ........................... 3. Nature of work (check whichi applicable): New Building, · ................. Addition .................. Alteration ................ Repair .................. Removal, .................. Demolihon .................... Other Work .................................................. t~.....~.. (Description) 4. Estimated Cos ....... .~.?..~..~,.~ .................................... 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, commercml or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimens,ons of existing structHres, if any: Front .....,,,~.~...~ ............. Rear ,,~,~ ......................... Depth ~.,,~..../. ........ Height ...... ~.../. .......... Number of Stories ........../ .................................................................................................... Dimensions of same structure with alterations or additions' Front ..... ~...~.. ....................... Rear .5~..~.. ................. Depth ......~ .~... ................ Height ...~/~..f. ................ Number of Stories ..........~. ................... 8. Dimensions of enttre new construction: Front ......... ,'(.. ........................ Rear ....~..~.[ ................. Depth Height ...... /...~../, ...... Number of Stories ..... ./Z. .......................................................................................................... 9. Size of lot. Front ........... ~..~.'~.../. .................................. Rear ~/~/ Depth 2.%2-c~ 10., Date of Purchase .............. ./...~.. .................................. Name of Former Owner ~.z~..~..~...~4........~....4~./'.~,.~- .............. 11. Zone or use district in which]premises are situated ...... .~....~'.M'.,.'¢.~..,~/..'.~.(,~..¢,-¢......'..,~.. ................................................. 12. Does proposed construchon violate any zoning law, ordinance or regulation: , .¢~....~ ............................................. 13. Will lot be regraded ......j[~...¢ ............ Will excess fill be removed from premises: ( ) Yes 14. Name of Owner of premises ...~4¢.Z-.~...¢~....~.¢.~.~f.~....../~./~/~¢fJ~es~'.~......'~....~.~....~Phone No. Name of Architect ........... .~¢../,-JF~ ................................... 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 in.n_t, erj~or or comer lot : ,.~/~¢F~........~...../0f~..~¢4¢~'~ .............................. be.ng duly sworn, deposes and says that he ~s the applicam (Name'~of individual' signing contract) '.' above named He is the ............... ...~ .~'....________________/~,.,~ .................................................................................................................................. (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and is duly authorized to perform or have p'erformed the said work and to make and file this application; that all statements contained in this apphcation are true to the best of his knowledge and belief; end thor the work will be performed in 'the manner set forth in the applica,~,o'd"fT~jd therewith, ELIZAI~ETH ANN NEVILLE NOiARY PUBLIC,~tate of New York T~m I[xp~es ~rch 30,