HomeMy WebLinkAbout10621-z
FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
" ",.,,,,~, Southold, N.Y.
Certificate Of Occupancy
No. . . . Z.1.01~:? . . , , . , Date. . . . . . S.e.p.1;~:gJp,eI: . ~ .1. . . . , . . . . . . ., 19 . ~~
THIS CERTIFIES that the building , . . ..........................,................ .
Location of Property ,. .565, .Aqu8:1r,iew. R.oa.d,. . . . . . . . . . . . . . .Ee$:t, .M:e.:riQ'Q., . N..,Y, . . . .
House No. Street Hamlet
County Tax Map No. 1000 Section .. ,Q~1. . . . . .Block .. P.~ . . . . . . . . . .Lot . . . .qO!?~ .1. . . ... .
Subdivision. . . . . . . . . . . . . , . . . , , , , . , . . . . . . . .Filed Map No. ...,... .Lot No. .............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
. . .Apr.il. 7. . . . . . . . . , , 19 . 8qmrsuant to which Building Permit No. .... ~P.6.21. (:, . . . . . . . .
dated .. ,April. 7. . , . , . . , . , . . . , . . . 19 .80, was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for wluch this certificate is issued is . . . . . . . . .
. . , . , . . , . . OnEJ.,.j<'arnily, Dw<;'.'J.Hnll. .(Aci<l;1.:t.:!,QJ:l). . , . , . . . ........................ .
The certificate is issued to ... .W!J.l.:!.QIIl. Q.~t;'Q!3!i. . . . . . . . . . . . . . . , . . . . . . . . , . , . . . . . . . . . . . .
(owner, ~JeJW1jfj=
of the aforesaid building.
Suffolk County Department of Health Approval ........... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
UNDERWRITERS CERTIFICATE NO. . ., . , . .. N '/+1390'41 . . . ,. . .. . . .. . . . . ., .., . .. ., . . .. .
/L ~A::/
...............................,....... .
Building Inspector
Rev 4/79
f , .d , J. < & ~--
FORIII NO. 2
TOWN OF SOUTH OLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTH'OLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE pREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N~ 10621 Z Date 4~r..?"..:.......7........................, 1 exPO.
Permission is hereby granted ~-
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to ............... .. .'KM.~t.,.......~.......~....r/,.l;?a..5......... .' .~~...Q.&!.......,.........., ..
.......e7..f.~7/..~j.....Q."...m#!.I..?2...~II~...-:-4......(t;.e;,..o/u.q,f.4 .'
at premises located anf..ds..........J4y'-':4v.::f1....... ..-::1((;,&/2....:.........,... ...........,..,..
................................................................................ ...,........f6%,/......I::rf.q~l.Q.~...Li...~.. '..
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Building Inspector.
I~
Fee $........................
.__!. 1i .
FORM NO.6
TOWN OF SOUTHOLD
Bu ilding Department
Tawn Hall
South old, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted in duplicate ta 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 ta April 1957), Non.canforming 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. aecupancy and candition of buildings.
3. Date of any housing code or safety inspection of bu ildings or premises, or ather pertinent informa-
tion requ ired to prepare a certificate.
C. ires:
n' .Certificate af accupancy $5.00
2. Certificate of occupancy an pre-existing dwelling or land use $5.00
3. Copy of certificate of occupancy $1.00
n (; V }tie;" / Date .. '!~ .fet. !! . ; . .I.? ~f ~~ .. .
N B'ld' !\!JV' (/!Y[\ Old P .. B'ld' V L d
ew UI Ing............. or re-exlstlng UI Ing ............ acant an .............
. I. (i.. ".. .. ;") 0 D j!'/i '> r /11 //-A"; ?UiJ
Location af Property .... . . . . . .. /. y;-..{.,.-tif...v;lP.;t.-v. . . .1=. .0;<:\. . . . . . . . . . . . . . . . . . . . . . . . . .
House No. Street Hamlet
Owner or Owners of Property .... V.l!.;:'((f. <,\'01. . . Q e./p. D, <)'.;r. . . . . . . . . . . . . . . . . . . . . . . . . . . .
. 021 02 ~o'"
County Tax Map No. 1000 Section ............... Block............... Lot.., ~. 00.5. j
Subdivision. . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . .Fiied Map No. 5'k' :5 L t N
.......... 0 o. ........... .,
Permit No. If}. h)./. . Date of Permit. .4/1'/8Q.Applicant .. . .. .. .. .. . .. . .. . ... . . . .. . ... .. . .
Health Dept. Approval . . . . . . . . . . . . . . . . . . . . . . . . Labor Dept. Approval ........................
Underwriters Appraval . . .l'f . ~!3.Qq'f:1. . . . . . . . . . . .Planning Board Approval . . . . . . . . . . . . . . . . . . . . . .
Request for Temporary Certificate. . . . . . . . . . . . . . . . . . . . .Final Certificate. . . .. . . . . . . . . . . . . . . . . . .
r (7()
Fee Submitted $.. ..),~~-:-:...................
Canstructian on above described building and permit meets all applicable codes and regulations.
(/') 'b/ fL /.~ ;t;:c,- fJ.J
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pp Icant . ../ rJl" ,1-.tc.... . . .. . . . . . ,/.. ............. ..f. . . . . . .. . -II
.. (. 0 I
Rev. 10.10.78 111 10
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--_..._------~
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
l,pin 85 JOHN STREET. NEW YORK. NEW YORK 10038
Da'e AugU>it lip. 1980 Applwation No. onj,le 079432 N 4 8 ~ 0 I!, 1
THIS CERTIFI~~T7 1980 . . .
only the electrical c.quipment :::'8 described b~'ow and introduced bl. t~ app,licant named on tlJp apove ,!pplicati?n ?,:"mber In the p,remises of
WJ.ll:i.w1 Ge:rosa. ,;s{oo V:k!t~ Lane, l<OCRy Po:!.nt:.Rd. & (;edat' ur.. East. Mm:J.,on, N.Y.
in the following location; D Ba'icment 0 1st Fl. CX2nd Fl. Section Blof.-k Lot
was exammed on Augt.rot 4 z 1980 andJound to be in comphan('c wlth the requirements of thlS Board.
FIXTURE R FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTlETS ECEPTACLES SWITCHES INCANDESCENT FLUORESCENT M~~~gr AMT K W AMT K W AMT K W AMT K W AMT H P
2 6 4 2 I
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIALREC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
' SYSTEMS
AMT K W OIL H P GAS H P AMT NO A W G AMT AMP AMT AMPS TRANS AMT H P NO OF FEET AMT WATTS
SERVICE DISCONNECT NO OF S E R V ICE
METER NO OF CC COND AWG AWG AWG
AMT AMP TYPE EQUIP. 1.J!2W IH3W 3H3W 3J!4W PERH OF CC COND NO OF HHEG OF HI-LEG NO OF NEUTRALS OF NEUTRAL
OTHER APPARATUS
l-Sm:)Ke ))el:ec1:or
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U P/ /;> f)..7f?~!/(.
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Paul Bt:u:t1.9
'I'uwn lJarbor. ~ GENER ANAGE ?~:::-
Southold, N. Y, 11971 Lio.282 E n..
p"
This certificate must not be altered In any manner, return to the office of th~ Board If i~cortec,t. Inspectors may be identified by th}\r credentials.
COPY FOR BUILDING DEPARrME\"T. THIS COpy OF C~TlP~t~E~~ ~OT BI!I~;rER~ IN, ANY MAN -,'
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FOUNDATION (1st) i3
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FOUT\TDATION (2nd) ~
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INSULATION PER N.Y. <+6\
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FORM NO.1
TOWN OF S()UTHOLD
BUILDING D~PARTMENT
TOWI\I'HALl
SOUTHOLD, N.Y. 11971
TEL.: 765.1802
Examine? 14 .t. . 7. . . " 199 . Application No./06.?-/. . . . . . . .
APprove4';3t.. , .7.. . ~.~ lcJi). Pennit No. IcY. (7:-f.i!:-
D;''''~'d*... .....___.............;(......... .
,~
0',.................... ......,...
(Building Inspector)
APPLICATION FOR BUILDING PERMIT ~
Date*~/.(...... .;. . . ., 19Q~
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 whkh is part of this appli-
cation.
c, The work covered by this application may not be commenced before issuance of Building Pennit.
d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such penn it
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 Pennit 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 neces~ inspections. ,--,-
fJ,~ . ,. .'.... .~~~.(?~.~.,........
(Si ature of applicant, or name, if a corporation)
BD~( ?~'. .JA:t:~.(.n:. .~r. .~, J1~.~.....
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
{3 , 'i/c.e
...~',..~...,.......,.".........,..,....,..".,.........,.'.........,......,...........
Name of owner of premises ,.~:..~ " c.G..~f.{.Q.~.-:"!)...,.....,,......,.............
(as on the tax roll or latest deed)
If appJicant is a corporation, signature of duly authorized officer.
............ ............,. -....,... ,...,....
(Name and title of corporate officer)
Builder's License No. . I ~ . ' . . . . . ' . . . . . , , . . . . .
Plumber's License No. .",.....,...."...,....
El t" 'L' N~(J'- ~ a.'S;:.
ec nClan s Icense o. ......" ~.),C"">-IY. . , . . .
Other Trade's License No. .... .".,........,..
I. Location of land on which proposed work will be done. .47r~.. .G3.~ , . . , , . , , . . , , , . . . . . . . . . . .
..... .-1!~....., ,'....." .ar~' ~.,........ .t!~.7?;:~~,......,...
House Number Street Hamlet
County Tax Map No. 1000 Section. , .Q ~ (. .. .. . . .. Block.. ,Q .~. . , .. . , .. Lot...Q. q .~". .I. .. .. . .
Subdivision, . . ' . , . . . . . . . . . . , , . . . . . . . ' . . . , . . , . . . , Filed Map No. ....,......... Lot.,.. . . . . . . . . . . .
(Name)
2. State existmg use and occupancy of premises and intended use and occupancy of proposed construction:
E . . d l:t '.-t: ~ci2.#~ .
a. ,xlstmg use an occupancy , . . . ~'C:~J:! ' : . . . . . . . . : .~.-.-O. . ~ . , . . . . . . . . . . . . . . . . . . . . . . . . .
b. Intended use and occupancy .,. r~. . . ~.~~. . . . . . . . . . . . . . . . , . . .. . .. . . . . ..
i
3. Natur~ of work (eheck which a~plicable): New Building. . . . . . . . . . Addition. . . . . . . . .. Alteration . .V: . . .
Repair .............. Removal . . . . . . . . . . . . .. Demolition .............. Other Work. . . . . . . . . . . . . . .
, -{{ __ (Description)
4. Estimated Cost. . .:2r~,'. .:-: .. . . . . .. . . . . . . .. . . .. . Fee.. . . .f:>' .~ . . . . . . . . . . . . . . . . . . . . . . . . .
, (to be paid on filing this application)
5. If dwelling, number of dwelling :units . . . r. . . . . . .. Number of dwelling units on each floor. .1. . . : . . . . . . . . .
If garage, number of ears .... ~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. If busiress, commercial or mixe~ occupancy, specify nature and extent of each type of use . . . . . . . . . . . . . . . . . . . . .
7. Dimensions of existing structur~s, if any: Front. . L . . . . . . . . . Rear .............. Depth. . . . . : . . . . . . . . .
Height ............... Nun)ber of Stories. .. . ..................................................
Dimensions of sam~structure with alterations or additions: Front ................. Rear . . . . . . . . . . . . . . . . . .
Depth. . . . . . . . . . . . . . . . . . . , . . Height. . . . . . . . . . . . . . . . . . . . . . Number of Stories. . . .~. . . . . . . . . . . . . . . .
,
8. Dimensions of entire new consttuetion: Front. . . . . . . . . . . . . .. Rear . . . . . . . . . . . . . . . Depth .. . . . . . . . . . . . . .
Height ............... Nun)ber of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. Size of lot: Front .. . . . . . . . . ; . . . . . . . . . .. Rear...................... ~Pth ......................
10. Date of Purchase ............................. Name of Fonner Owner. .... . ::??1:~ . . . . . . . . .
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 .. .......:................... Wille~s~vedfrompremises: Yes No
14. Name of Owner of premIses . ~"" .~Address ~... . ./.. .'YI..d.PhoneNo. ...............
. '" :;;7/'/ N
Name of Arehlteet ......... i . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phane 0................
Name of Contractor . .. ... ..: . .. .... ..... ... . . Address.... .. . . .. . ... '" . . Phone No. ., ., . . .. . .... ..
PLOT DIAGRAM
i
Loeate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and bloek'number or deseription according to deed, and show street names and indicate whether
interior or corner lot. '
7"r~= ~/CC~~V-iI- \
STATEOFNEWYO.f!h J SS
COUNTY OF . $u. ... J c;...... .
. . . .I<.f:j.in~./d. . . .W.>. . fe..:i(:r.~Q(I/. . . . . . . . . . . . .. being duly sworn, deposes and says that he is the applicant'
(Name 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 have perfonned 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 mann~r set forth in the application filed therewith.
Sworn to before me this ,
, ,
........;. .1:!:....... .day or. .!J.t~"I.~..........., 19~
~ - h'--K6. ~ .
N"OYP"W::,~:,.~.;;~::.. ~,HH Co=~tc;~H
No. 52.4024771 , (SIgnature af applicant)
, Qual!llcd In Sulfo1\\ C.)l:r>ty I
'C.ommlsslon ExpIres March JO, 193~