The URL can be used to link to this page

Home My WebLink About10889-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ................................................ Location of Property ...... ~ .~ .0. .-~..W. ?. 0.M. '~;r~ ~ ~t k'- ~ R6E t~.~ .~. O.'l.~"l .... House No. ' .......... 'S'ti;e~[ ...... J' ' ' Flamlet County Tax Map No, 1000 Section ....... ,~, ,~.Block ............ l- ,Lot .... Subdivision.. ,,~0tJ?R.~tt.l~..~Hr, i~-.,~ ...... Filed Map No..J.~.5~,~Lot No ..... '~'7' ...... conforms substantially to the Application for Budding Permit heretofore filed ~n this office dated ............ .~..E?.'[....~, 19..~. [~ursuant to which Building Permit No .... t. 0. ~.. ~-..~. ....... dated .................. .~.~..~.7....~.~19 . .~.O, 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 ......... ..... .... ..... ...................... The certihcate is ~ssued to ~'~P~ktt~F,, Ixl I~t~k~-Ik-~ ................. ;"' ?o¥o'o;,'f~;i&~ ...................... of the aforesaid building. Suffolk County Department of Health Approval )/~ - .SD- ~ ~ q~.2..~./.~..2.~. UNDERWRITERS CERTIFICATE NO .... .~...5'..~..~. 0..0..~. ............................... Building Inspector Rev 4;79 (THIS PER/~ COMPLETION FOII,~ NO. ~ TOWN OF ~OUTI~OI~D Town HALL SOUT~O~D, N,. ~.~ BUILDING P, ERMIT JT MUST BE KEPT ON THE PREAhlS£S UNTIL FULL OF THE WORK AUTHORIZED) Permission m hereby grarited to: WILHELM ..........................................~, ~, . ~ ~ ~ , ........ , -.~....:~ ............... ~. ~. ~6~') BgI~ A PR~A~ 0~ to ................................... ~ ............................................................ '~ ................. 830 TARPON DR~E ut premises locoted at ... .................................................. ~ .......... ~ .......................................... .................. ~ ..................... ~...? .........~: ...................................... ' : ~:' ~ ~Lot No. 9. . Coun~ Tax Map No. 1~00 Section........,.........~..,.. ..................................................... , the pursuont to application ;, d~ted Building Inspector. R*¥.: 6/30/80 'Buildirig Inspector FORM NO, 6 TOWN OF SOUTHOLD Building Department Towil'~all Southold, N,Y, 11971 APFLICATION FOR CERTI, FICATE OF OCCUPANCY instructions This application must be fdled in typewriter OF{ ink, and submitted in d~piicate to the Bu[Iding inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of alt buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of HeaJth Dept. of water supply and sew?rage disposa~(S.9 form or equal). 3. Approval of electricaJ installation from Board of Fire Upderwriters. 4. Commercial buildings, industrial buiMings, Multiple Residences ~nd'similar buildings and installa- tions, a certificate of Code c6mpliance from the Architect Or Engineer- resl~onsibl~ 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 showJflg all property lines, streets, buildings and unusual natural or topograph ~c featu res. 2. Sworn statement ~f owner or previous ortner as 1~o qse; oc,qgp~ a[Icy. ~n~ condition of'buildings. 3. Date of any housing code' or s~f~'~y inspection 8f buIIdings, or"p'remises, ,or ct,her pertinent informa- tion required to prepare ~ c~rtifica'te.'" , ";~, ' ~, ' , , Fees: 1. Certificate of occupancy ' 2. Certificate of occupancy on pr, e-existin~ dwelling (~r land ,u'se $'51'00 ' ' 3. Copy of certifica'te of o,ccupancy $ I'.00 Date ,. New Building .... Old or Pre-ex'istin¢ Building('Zi. ..... ,, , - ...... ~ Vacant Land ............ Location., of Property . ................... ........ Hou~,No. ',, , . , Street ~ H~mlet ~7 ' '~' ' County Tax Map No. 1000 ~eotion Block .. F, ......... ......... ,.. Unde~riters Approval ~Z. ~ ~%~Z0.~.2[. ,Planning Board Req st for Temporary Certificate...~ ........... Final Certificate, ,, .....~. , ......- ......'¢/~ ,.¢u~ .................. Fee Submitted$. ~.%; ~ Construction on above described building and, p,~, ~,~e~ts all ap;p.~~d reguJations~ ' ,'I THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICIT~ 85 JOHN STREET, NEW YORK, NEW ~ORK 10038 THIS CERTIFIES THAT ~n~y th~ electri~al e~uipment as described bel~ and ~ntr~d~d b~ ~te~aPplic~nt n~med ~n ~he ab~ve a lication number in in ~he /ollowing location; [] Basement ~.~ ¢~a.~i.~d onMSZ~h 29~ 1982 FIXTURE OUTLETS ~ECEPTACLES SWITCHES 37 4Z 27 DRYERS FIXTURES FLUORESCENT [] 2nd FI. Section Block a~d found ~o be in compliance wi£h the requirements of this Board. DISH WASHER Lot SYSTEMS NO OF FEET E OTHER APPARATUS. S E AWG OF CC COND AWG OF HI LEG NO OF NEUTRALS AWG OF NEUTRAL t~a]and glec, Co., P.O. Eox 143, Mattim~k, N,Y. 11952 COPY FOR NG return to the office of the Board , THIS ANY FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined i i ~i i i~, '.o i,19 Disapproved a/c ...... .~.i. ,..'~. ...................... ...... ~ ~.~'..~../. X../..~.~. (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No ........ .~ ......... 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 promises 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, b.~ilding code, housi~~tions, and to admit authorized inspectors on premises and in buildings for necessaOt'~spqctions. / / // .............. (Signature of applicant, or name, if a corporation) ...7.sq...~.~.e.<.. kC...~ ?(~.Z~...~. ,.~, (Mailing address of applicant) //~ 3 / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... ~ .~¢~..x4~?. ................................................................................ Name of owner of premises . .~.....~/.. f.Z. ?..~.Z. ~ ..... ./~j./~../~. ?f.~..~...~/. ................................... (as on the tax roll or latest deed) If applicant is a corporation, stgnature of duly authorized officer. ................... ...................... (Name and title of corporate officer) Builder's License No ......................... Plumber's License No.. Electrician's License No..~.~ Other Trade's License No ...................... Location of land on which proposed work will be done...~.~(d'../,/f, ff..~..'~.....'51 ./~?../2...~ ....................... ......... 77..,¢'...¢?.v ./<-- ?. ~./V.~. ......................................... House Number Street Hamlet 3 ? OCJ C/ ~ ~-z . ..~../.. County Tax Map No. 1000 Section ........../. ...... Block ............ Lot.....--........,. .... Subdivision..~.~./'(..?~./4.~.~.~.. · . .~../-/.~, ./ff.~r.g. ............ Filed Map No..~.~,~..~. ? ...... Lot 3 ~.7 (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . .~'.'~ .C~...,,y..~. ...................................................... b, Intended use and occupancy /ff~ / ~ ,~..~ 4-." ,O. F..c~7.. 3. Nature of work (check which applicable): New Building .. ~ ..... Addition .......... Alteration ...; ....... Repair .............. Removal .............. Demolition .............. Other Work ............... . ,~..~. ~ (Description) 4. Estimated Cost..~. ......~.~ .~.q?.: ........................ 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, commercial or mixed occupancy , specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if 0nay: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ..................... i Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front...5. ~, .2 ....... Rear .... 3. :2.,. ~ ...... Depth .. zf.3.: ~. ....... Height .... ~ .W. ....... Number of Stories .... ~. ................................................... 9. Size of lot: Front I3~. ~O n~o~ /5-~, ~J~ Depth ././.~.~,.~..~...~../~..~.'.~. ?. eo .................... 10. DateofPurchase iii.iii'.~.iiiiiiiiii.~.'.~.~',ilNameofFormerOwner .l/.,.FZ..~.~.~..~. ................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..../k/..~. ......................... 13, Will lot be regraded .... .~. ~...5. ,. ................. Will excess fill be removed from premise~: , Yes 14. Name of Owner of premises .t~. ,. ~.~.~.~'..~..~.~ff. ..... Address .?.~7..~.~../~.'q.~4.z.~..~. . Phone No~../.2.~.47..s';~..~5~.~ Name o£ Architect . ~: . ./~.~...7~.~.~.../~.: .~. ,..~':.,~.. ,. Address ................... Phone No ................ Name of Contractor ~. ~. ,~. ~.77....~. q.~ ~..~...., Address .~..~?..7:~..~A ~ ...... 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 interior or corner lot. STATE OF NEW ~K.~ / A~ ,~ COUNTY OF. ~. ~'~ ..... ~:1.1.'~... being duly sworn, deposes and says that he is the applicant t amc o in ivi ua signing contract) above named. He is the ................. g~_,cz-.~.,~-~/~-~.. .......................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is du!y 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/n the application filed therewith. Sworu to before me this ........... .~. . ?~. rv ..... tlay o~ .... ~.., 19 .~45) ' ....:.:..',',,", /. , No. 52-11125850, Term £ap~r~s Ma ch 30, 19~°'~ '