HomeMy WebLinkAbout10798-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Buildin§ Inspector
Town Halt
Southold, N.Y.
Certificate Of Occupancy
No. Zl1353 Date December 13 1982
THIS CERTIFIES that tile bmlding .a. cl..d.i.t. 5:o. n .....................................
Location of Property .3.7. Q ................ u.$ .~.~3.a.m. f .b.u.P?.. ?.?..e ...... .S.o.u..t.h?.~.d. ....
House No. Street Ham/et
County Tax Map No. 1000 Sechon 078 .Block 05 .Lot 009
Subdivision . ...X .......................... Filed Map No. X .Lot No. X
conforms substantially to the Application for Bmldmg Permit heretofore filed in this office dated
.... .J.u.l.y...t 7 ........ , 198..0. pursuant to which Building Permit No..1.0.7.9..8..Z .............
dated ........ J.q 1 y..25. ........... 1980., was issued, and conforms to all of the requirements
of the apphcable provisions of the law. The occupancy for which this certificate is issued is .........
an addztion to existing dwelling.
The certificate is ~ssued to ....... .H, aP. jprze Ctust Stol. th
..... ?o¥,'~;, ¥~&~ '~4t; ......................
of the aforesaid buildzng.
Suffolk County Department of Health Approval ...N/.~ ....................................
UNDERWRITERS CERTIFICATE NO .......... .N..4. 9. .7 .5.2.9. ..............................
Rev. 1/81
Building Inspector
FOIL~ NO. 2,
TOW~ O~ SO'THOU)
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON 'THE PREMISES UNTIL PULL
COMPLETIO,N, OF THE WORK ^UTF'IORIZED)
N? 10798 Z
Permission is hereby granted to: /
.......... ..................................
........... L'7.~7.,- ~F.~"....-. :..o...,..c,Z. ..............
,o. g.~,~.~..z-~.~.~.'zs......~..~.z. ~..:/,~...._~..m~,~;.....~z~.,,(../../~ ......
......... / ~ x ~ tr// --- / /
.................. .'Z. cz. ~......Z~.,~ToY~:z ~.. ...... L,/~..o..~./. .................................................................
at premises located at .~..7...O.. .......... ./~.././Z/...~..~.~...~.~..,d~.~,.,...~.. .~...: .............................
pursuant to application dated .............. '/"7" ................. , 19..~...0., and approved by the
Building5~°~lnspect°r'
Fee $...[. ..................
...................... . g.; .........................
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. Fina~ 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 Aprd 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 $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(X) ........ ~/Vacant Land
LocationofProperty.... .".
...... ~.; .~ ·. ~. ~- ..........
Hou~ No, Street ~ Ham/et
Owner or Owners of Property ...~5.. I~,~(~ ,~ .........................
County Tax Map No. 1000 Section ...... Z~ ...... Block ...... ~ ...... Lot .... ?. ..........
Subdivision ................................. Filed Map No ........... Lot No ..............
.... ;'" .... I' . ...............
Health Dept, Approval ........................ Labor Dept. Approval ...................... ,..
Underwriters Approval Planning Board Approval '
Request for Temporary Certificate ..................... Final Certificate ........ - ......... -
Fee Submitted $.. ,~..' ...........
Construct[on on above described building and permit'meets all app~cal~co~es and regulations.
.......................
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW yORK 10038
o.t,. October 2], 1980 ~ppuc.t,on No o~ylt~ 0921~7
only the electrical equlptnent ~ ~scrlbed below and introduced by tko pppllca~t named on the able application number in the premlses o
i,~ the following location; [] Base.tent [~lst Fl.
wa~.,ni.~do,/3CtXfabr 16, 1980
FIXTURE
OUTLETS
~ECEPTACLES SWITCHES
FIXTURES
NCANDE$CENT FLUORESCENT
6 1 1
DRYERS
[] 2nd Fl. Section Block Lot
and found to be tn compliance with the requirements of this Board.
RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
SYSTEMS
NO OF FEET
OTHER APPARATUS:
E
R V I
AWG
OF CC COND
NO OF HI LEG
OF HILEG
NO OF NEUTRALS
AWG
OF NEUTRAL
JoN% Fo W~erka Jr.
This cerhflcote must not be altered in any r~anner; return to the office
L~c, 627 g
Board if Inspector
Al) DI~'IOI',.JAL_
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N.Y. 11971
TEL.: 765-1803
Examined .,~. z:~..j ........ ,
Approved . Jolt/. .... , l~... Permit No. X~.7. ·
Disapproved ajc .................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Application No./..~i~. 7..~..~.. ....
Date .h~q .... q ;~': ~(.~.., 19
INSTRUCTIONS
a. Th~s 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 th~s application may not be commenced before issuance of Building Permit.
d. Upon approval of this apphcation, 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 Budding Department for the issuance of a Building Permit pursuant to the
Budding 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 w~th all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in buildings for necessary inspections.
f.:!q: ............
(Signature of applicant, or name, if a corporation)
(Mailing address of apphcant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer) ? ~-~r. _~; k ~ I~ q O:' :'s ~ ,¢~c L o
Builder's License No.. . ~¥1 ...................
Plumber's L~cense No ........................
Electrician's License No. '- -
Other Trade's License No ....................
1. Location of land on which proposed work will be done. .' '.5.].]..iJ;.c,V,?Ol¥'¥5..(;:o.j.x(C, .......................
...... "://':77 . ',%.
House Number Street Hamlet
County Tax Map No. 1000 Section .... ~.. 7..~. ....... Block .... .~..5..'~. ........ Lot....C~..c?.? .........
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
2. State existing use and occupancy of premises and mtended use and occupancy of proposed construction:
a. Existing use and occupancy ....c!,:e? ? (~,:,~ .......................................................
b. Intended use and occupancy . .~ ,t.,cs~..,.c,~., .......................................................
3. Nature of work (check which applicable): New Building .......... Addition ..... X .... Alteration ...........
Repair .............. Removal .............. Demolition .............. Other Work ...............
/~'~ (Description)
4. Estimated Cost ~,;.¢000,D0. , ....................... Fee ......................................
~ (to be paid on filing this application)
5. If dwelling, number of dwelling pnits ....... ] ........ Number of dwelling units on each floor .... 3_ ...........
If garage, number of cars ..... i ...................................................................
6. If business, commercial or mixe~ occupancy, specify nature and extent of each type of use .......
7. Dimensions of existing structures, if any: Front .... L)9: ........ Rear ... Z.l'9.' ........ Depth ..............
Height :l.~ ' Number of Stories
Dimensions of same structure with alterations or additions: Front .. ¢9.' ............ Rear . .¢.~5 ~ .............
Depth ....... 20. .......... !.. Height ..... .:1,~ ! ............. Number of Stories.
8.' Dimensiq, ns of entire new construction: Front .... ~6.! ........ Rear ... Z..~.' ......... Depth . . .J-P/ ..........
- ,,,He.~ght :...~.~: ........ Number of Stones
9. Siz fot: Front .....t¢7.' .... ........... Rear .... 1.59: ..............Depth .....Zf.~. ~ .............
q0.. [)ate of,Purchase ........... , .................. N~me of Former Owner .............................
1 I. Zone or use district in which pr~mises are situated .....................................................
12. Does proposed constrffction violate any zoning law, ordinance or regulation: ../clO ...........................
13. Will lot be regraded .... ~qo.., ................... Will excess fill be removed from premises: XYes No
14. Name of Owner of premises .~eJL~er. ~$J~z ~h.,... Address . .~r:~_.qrc,~'p¼y:g..D.rBhone No. T.¢,~.-.~.~. ~./+. ..
Name of Architect ..................... Address ................... Phone No.. :z' ' ': .........
W~m~ ,,r c,~,,*~c*,,r C. '~h] ~rs BI dr, Inc. ~,~1~ ...C, .u~p.h.o.g.u.e.,..1.~: fPhone No. 75/*-5010
.......................... ' .: ...... - ................ ess ...............
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?umber or description according to deed, and show street names and indicate whether
interior or corner lot.
,65-1
STATE OF NEW YORK,
........ PO,.'[r,'q.i¢£~, /~h~_e:c~ .................... being duly sworn, deposes and says that he is the applicant
(Name of individual sigfiing contract)
above named.
He is the (J orrt:'ca¢:b, clz:
· .I . (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 before me t~,) L~,'
~ornmls~ .~ . n SUlfOlk Co
i.. e~pires M~ · Unty
OCCG?ANCY OR
USE IS UNLAWFUL
~ITD~T CERTIFICAT£'
OF OCCUPAfl,CY
rAppRGVED AS NOTED ',
~OT~ ~U~L~ DEP*.T~T
7&5-1802 9 A~ TO 4 P~ FOR ~HE, ,
FOLLOWING INSPECTIONS:
3 FOUNDATION- TWO REQU RED
FOR POURED CONCR~E ,
2. ROUGH ~ FRA~ING:& PLU~BING~
3. INSULATION '
4. FINAL ~ CONSTRU~TJDN MUST.:
BE C~MPLETE FO~ C~ O,
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF' THE
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR'
DESIGN OR CONSTRUCTION ERRORS.