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Home My WebLink About10845-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..g.~. q. 9.0.6. ......... Date ....... THIS CERTIFIES that the building .~.qc..e.~.s.~.~y ..................................... Location of Property . ? 73,5...~.e.~.~.D .t3.~.5.~...R.d.: ............. .E..~.~.~..i.~.u.c.k. .............. House No. Street Ham/et County Tax Map No. 1000 Section ...... ?+~...Block ....0.5 .......... Lot .... .0.0~. .....~... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... 4.ug.u.s.~. ~ 3. ..... ,19 .~.0. pnrsuant to which Building Permit No..~ .0.~./4:5.~. ............. dated .... ,gu. g~.~. 2~ ............. 19 .~.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 ......... ... )?.or. ~n. img~ou~d .swimming..Dool..and. ~.~nc~ .............................. ROBERT REYER The certificate is issued to ........................................ of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO. N &gq828 Building Inspector Rev. 1/81 FOILt~ ~0. ~ TOWN OF: BUILDING sOUTHOLD, N~ Y. i BUILDING~ P,ERM!Ti ~ (THIS PERMIT MUST BE KEPT ON ~HE PReEXIStS' UNTIL NULL COMPLETION OF THE WORK AUTHC~RIZED) !~ ~ 10845 Z Date ... Perm ss on s hereby granted to: ..... · ,,.* ~ ........... ," ...... to apphcahon dated ........ .-. .......... -.,..~ pur~uantBuilding Inspector. Fee $ ........ ,. ..... 19~... and approved by the FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, 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 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. B. 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 inspectign of buildings or premises, or other pertinent informa- tion required to prepare a certificate, Fees: 1. Certificate of occupancy $5.00 2. Certihcate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1,00 $5.00 Date.. (f~//O~,/oc~.2L ,. ...~..4~.. ...... Old or Pre-existing Building(X) ......... . 'Vacant Land ............ s New Building Hou~ No. Owner or Owners of Property ,, ,*.-~.,4 .............. cou,~ T,x ~, ,o. ~000 s,o,~o, ./¢/ ......... ,~ ..... ~ ......... m...,~ ......... Subdivision Filed Map No ~ Lot No ~ Permit No.. ~¢.~L Date of Permit .~¢~..Applicant. ~~ ...... ~ ............ Health Dept Approval ~ Labor Dept Approval '~ Underwriters Approval ........................ P~anning Board Approval '~- . ..... Request for Temporary Certificate... "- ...Final Certificate , Fee Submitted $.., ;, Construction on above described building and~e~able_,,co_des and regulations. .............................. THE NEW YORK BOARD OF FIRE UNDERWRITERS P~ BUREAU OF ELECTRICITY ~- BS JOH. STREET, ~EW ¥O.K. ~EW YORK ,ooae THIS CERTIFIES THAT ~,k'. I~y~ ~ 1735 ~m~l~lia ~. ~ ~t~, N.Y. " in the followlng location; [] Basement ~.sex.mi,~edonAtW,,tlSt 28, 1980 FIXTURE OUTLETS tECEPTACLES SWITCHES I [] 1st Fl. FIXTURES FLUORESCENT [~ 2nd Fl. 01;7~ Section Block Lot and found to be in compliance with the requirements of this Board. RANGES OVENS DISH WASHERS EXHAUST FANS DRYERS SYSTEMS OTHER APPARATUS. E NO Oi~ERCC~COND R V I C AWG OF CC COND NO OF HI-LEG AWG OF HI-LEG AWG OF NEUTRAL l~t~l C, orck~ 12 De~ ~ Port Jeff~.s~n Statio~ NoY~ 11776 L:[c. 1101 E ~n any return to the office of the Board by COPY FOR BUILDING THIS OF FIELD INSPECTION FOUNDATION (Ist) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY COpE FINAL COMMENTS ADDITIONAL COMMENTS: '5~~'°TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'$ OFFICE ~OUTHOLD, N. Y. Examined.. d,~/ ,j~ ' * No. ' ./.~...~....~..~ ."~. ............ ......................... , 19 ........ ~ Applfcatton Approved .~...¢;~./. ................ , 19 .~..... Permit No...~.~.~,..~...~.~..'~.."~.... ........ , ............................ ................... ~ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date August 13 80 ................................................. 19 ............ INSTRUCTIONS a. Th~s application must be completely filled in by typewriter o~ 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 Iocshon of lot and of buildings on premises, relationship to adjoining premises or public streets al areas, and giving a detailed description of layout ofproperty must be drawn on the d~agram which is part of this application. c. The work covered by this apphcation may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector wdl 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 authorized inspectors on premises and in, buildings for necessary inspections. (Signature of applic4~t, or'name, if a corporation) / (Address of applicant) State whether applicant ts owner, lessee, agent, architect, engineer, general contractor, eJectricmn, plumber or builder. Name of owner of premises .............. ~.o~.e.~'.~...]~e~.e.~. ............................................................................................................. Jf applicant ~s a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's bcense No 6Z Plumber's License No ............ ~A. ................................ Electrician's License No ....... ..L~D2~ ............................ Other Trade's License No ............................................... 1 Location of land on whmh proposed work will be done. Map No ...................................... Lot No ........................ Street and Number ..g,.~5~..W~,~.t,~,~,~,~,..~O.~,~ ........................................................ ~a,t~t~,'kg. e2~ ............................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o Exis~ting use and occupancy ................ .1.....i'..a.i~.~,~Sr...r..~,~.$.~.~¢.~ ........................................................................... b, Intended use and occupancy ................ ~OX.kO...'!I~!!.,iztg~ou~,d..s~$~m:Ln~.~oo:l..w':t.th..;fence...t~,.~ .......... 3. Natqre of work (check which applicable): New Building .................. Addition ....... ~ ........ Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................... ~.., ,.~,. ,_, (Description) 4. Estimated Cost ' ~ . . Fee .......00 ............................................................................................................... (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, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structdres, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. D~menslons of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Numbe[ of Stories ..................................................................................................................... 9. S~ze of lot: Front ....... ~.,.?;~.! ..................................... Rear ......... ~,00.! ..................... Depth .....~,,00.~. ............ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation: ............. .~ ...................................... 13. Will lot be regraded ..~1 ...................Will excess fill be removed from premises: (X) Yes ( ) No 14. Name of Owner of premises .~{3~l~'.~..[[t~llt3r~', .......................... Address ~e~t~cte. i,i~.,l~t~.... Phone No...P~.~.~,~]. .... Name of Architect ............................................................. Address ................................ Phone No ....................... Name of Contractor ...~r~m..K;~n~;..~'oo;ts ........................... Address ~t~te....~i~ ........... Phone No..:~'J~,~;~ .... PLOT DIAGRAM Locate dearly and distinctly all bui]dings, 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 Iot STATE OF NEVI~u~'f~ ~ S S COUNTY OF ............................... ~ ' ' ~.~.~...~....~.Zr~ ..................... be ng duly sworn, deposes and says that he is the applican~ (Nome of individual signing contract) above named. He is the ...................................... ~ .......................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this app cat on; that ail statemeqts contained in this application ore true to the best of his knowledge and belief; and that the work will be performed Jr~he manner set forth in the application filed therewith. Sworn ~o ~before me this ~'/ , - PETER (~. WILLSTI~IN Notary Publla. State of New York No. 52-46123~ 2 Ouehfled in Suf olk County Cornm ssmn Expires March 30.1 r o, WIM-KING POOLS, INC. UTE 25A ~Y POINT, NEW YORK 0 o A