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Home My WebLink About10913-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building InspeCtor Town Hall Southold, N.Y. Certificate Of Occupancy Z10374 February 2, 81 Date ................................. 19... THIS CERTIFIES that the building ................................................ 655 Smith Drive North~ Southold~ N.Y. Location of Property ........................................ House No. Stroot .................. County Tax Map No. 1000 Section ...0.7.6. ...... Block 01 .Lot 020 Subdivision .g .o.op.e.. ~ .e.c.R. .................. Filed Map No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 7..~.0p 10913 Z ·..O.c..~9.b.e..r' .7., ....... , 19 ursuant to which Building Permit No ...................... dated October 9, 19. 80 ............................... 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 certificate is issued to ..... ~.u?.~.e..1. ?.:..ap.cl..J..o.h.n..~ .,. ?.~.l..l? ...................... (owner, [es~t~J~:XX of the aforesaid building. 10-S0-64 1/29/81 Robert A. Villa Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO ...... Fend. lng .................................... Building Inspector Rev. 1/81 ~0~r ~ ~ BUILDING BUILDIHG PER/~'~ ii · ' ' (TH S PER/V~IT MUST BE KEPT OW} ~H,E P'R!~I$~S oNTiL lULL COMPLETIO~N OF THE WOR~ AUTHORIZED) ~ % N9 10913 ~Z *ate ~ .~......Z 19..~ Permission s hereby gra~ d to: ~ ¢~ · .......... , ........~ ................ ~ ......... ~.~. ~-~. ~....Z~,~ ........ ~: . . . ,.,..~.~.~Z~.._.~7. Of premises located .................................... · ' ...................................... '~ ........... "r"~'"":~ ........... Y ................................. ................ ..... ... .... ........ COun~ Tax Map No 1900 Sect on .~ 7 ~ ..... ;. ~lb~k ~..~Z ........... Lot NO ..... ~,~.~- ...... pursban, ,o application ~dated ~~....Z ....... .,.[....:~..:.., 19..~ and appro,~ by the Bu'ilding Inspector. FORM NO. 6 TOWN OF $OUTHOLD 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 (pr~or 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 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- t~on 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 New Building .. y~.~,~. .... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ~..~..~. ...... .~. '~.l;.~.. ~.~.,;;~....~..~.7~.~., ....... ~.';.~'..----~.../4~... House No. Street Hamlet Owner or Owners of Property ...~',~-Z ./~.. ~.. J.~.)l.~-...~.,..~. 1~./.~' ................... County Tax Map No. 1000 Section .... O...-).~ ..... Block ...(-~. ,Z ......... Lot .~...~. ~ ........ Subdivision ~'~..~.~, .~., .~.~ .Filed Map No. /~¢-~ ,Lot No, /.~. Permit No../.~.~./.~..Z. DateofPermit~.~.~..,.Applicant .~..~.~..~..~-.. J .... .'7~..~. ,~.~..~. ...... Health Dept. Approval .~../~.-~ ~.-.~.' .~. ........ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval Request for Tempj~orary Certificate ..................... Final Cert,ficate .i: i ~ i i i Fee Submitted $~..~.~ d/ ~' ......... Construction on above described building and permit m.eets all applicable codes and regulations. Applicant...~.~...~,..~.... ............ THE NEW YORK BOARD OF FI,RE UNDERWRITERS BUREAU OF ELECTRICITY~ 85 JOHN STREET, NEW YORK, NEW ~ORK 10038 o.t~ r~bn,a~.7 4, 19~,~:[ ~,ppiic..,,n No. onf.e 100~4 ' 80 N 5 0 8 ~ 0 2~ THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant ~amFd on the above application number itt the premises of Jo~ go Wills, 655 ~id~ Drive North, Sou~/~old, N.Y. in the following location; F~ Basement [] l st FI, ,~.~¢~am,,~e,l,,,~ Febr~w~:y 2~ 1981 Hx,U.E ~X~URES OUTLETS ~ECEPTACLES SWITCHES FLUORESCENT 23 33 23 23 DRYERS FURNACE MOTORS [~ 2nd FI. Section Block Lot and found to be ~n compliance with the r~quirements of this Board. RANGES ~(ING DECKS OVENS DISH WASHERS EXHAUST FANS FUTURE APPLIANCE FEEDERS T~ME CLOCKS ~NIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E OTHER APPARATUS= ~Dtor/sL I'G.F.I. 1-$~ Detector 1-15 Kw~ Elec. Furomce 215, Sou~bold, This e must not R V I C COND A W G, 1 3/0 AWG OF HI LEG NO OF NEUTRALS AWG OF NEUTRAL 3/O 11971 lico 578-g any manner; return to the office of the Board if Per 11 ma)' be identified by ILDING IN ANY MANNER. FIELD INSP ~CTI0~N FOUNDATION FOUNDATION 2. ROUGH FRAME& PLUMBING (end) INSULATION PER N.Y. STATE ENERGY CODE FINAL COMMENTS ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined~, .~.~... ~ ....... , 19 O~ Approved~.(. (Z.. ? ....... ,19~.:/3. Permit No../~). c/~../.~.. ,~ ................. .... (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No./..~.~ }/../.°~. ......... Date .......... 19'..?/. 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 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 Pen-nit. 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, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ................... (Signature of applicant, or name, if a corporation) ./ ~ ~. . .i-. ~ .~.~,,a/~. ~.'~.,z ~. / . . ~y ~, / //.~.> /2 7 J?.. . ~, (Mailing address of applicant) State whet,her applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . Name of owner of premises ....... .~. ~ .~./.'.4~/. t~.,...J('...Jo.~l./~...~.--: .dd~], ~///~. ........................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No..~-fi...o... ~. ~.-~.-.c-..~..~? {, Other Trade's License No.. '?... · ~. ............. 1. Locatmn of land on which proposed work will be done .................................................. .. . .:,. ,: :. ............ ........... ..... >/...Y, ......... House Number Street Hamlet County Tax Map No. 1000 Section . ~9.¢Q. j.~.~.~ .... Block ................. : Lot.../..~. ?. i .t_/. ...... e. ?.~.(~.:3.: . l.~>..z.~. ...... Subdivision...~..~.O.~. :~.. JO e.¢:~ . ~t,,..,.~,~.ff ~,,./<~. Filed Map No. C .... Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................... b. Intended use and occupancy . ~. ~,~.t~ .~..O. ~l'4~ / .............................................. 3. Nature ,of work (check which applicable): New Building ........ Addition .......... Alteration .......... Repair' RemoVal , .. Demolition Other Work ~y/~. $~ (Description) 4. E~timated Cost .................................... Fee .~(~. ~ ............................... I ' (to be paid on filing this application) 5.' If dwelling, number of dwelling ,units ....... i ...... Number of dwelling units on each floop,~. · ............ 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 structure~, if any: Front.. ~ ......... Rear .~. ............ Depth ............. Height ............... Number of Stories ........................................................ DimenSions of same structure wiih alterations or additions: Front ................. Rear .................. Depth .................... i. · Height ......... , ............ Number of Stories ............ : ......... 8. Dimensions of enti~re, new construction: Front . ~,.~'.r. ........ Rear . ~,. q~..~ ........ Depth .~.~.. ~. ......... Height ...... /.O..t ..... Number of Stories .(. ............. : ............................. ? ......... 10. Date of Purchase ...~.. (.~.."A, ................ Name o[ Former Owner ............................. 11. ' Zone or use district in which premises gte situated ......... '..~ ........~ .................................. 12. Does proposed constructai~n violate any zoning law, ordinance or regulation: . .~/O ................. ~ ....... 13. Will lot be regraded . .~. ¥ .0 ...................... Will excess fill be rem.oved fr~mpremises: ~ No Name of Architect ........................... Address ................... Phone No ................ Name of Contractor ......... : ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all ibuildmgs, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block humber or description according to deed, and show street names and indicate whether interior or corner lot. I STATE OF NEW Y~ COUNTYOF~~ ' ~ l 'e~'n being duly sworn, deposes ~d ~ays that he is the applicant above named. He is the ...................... ~ .....~ ................................................... ' ~ (Contractor,}gent, corporate officer, etc.) of s~d owner or owners, ~'d is du~y au~~orm or have perfo~ed the said work ~d to m~e and file this applieationi that all statements contained m this .... applieati' ~ 'on are true to the best of his knowledge and belief; ~d that the work w~l be perfo~ed in the manner set forth ~ the application filed therewith. Sworn to before me this ........ ......... day of 19 York (S~nature of applicant) o d O.