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Home My WebLink About10742-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTM E~i'~*~ Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. Date AUgllS~ 95~ 19 80 THIS CERTIFIES that the building ................................................ 300 Rebbit L~e, EsSt; M~t'ion, New York Location of Property ht4~s~ )V'o: ....................... ~r'e~t' ....................... County Tax Map No. 1000 Section 03~ .Block ~8 . .Lot 007 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ... ,.T..l~..~...1./*., .......... 19..8.0pursuant to which Building Permit No. '10762 Z dated . .J.l:ln~. ? .9 ................ 19 .8.0., 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 ......... Addition to existing dwelling. The certificate is issued to ..... Melchior..&. B. arbar, a ._M.~O_O._~ ........................... (owner, le~ of the aforesaid building. Suffolk County Department of Health Approval ...... .lq./.R. ................................ UNDERWRITERS CERTIFICATE NO. 1%1 ~8509 Building Inspector Rev 4/79 FORM NO, 2 TOWN OF SOUTHOLD BUILDING DEPARTMElqT TOWN CLERK'S OFFICE SOUTHOLD, Iq. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP~EMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) 10742 Z Date .................... ..--... ........... ,...'... ............. Permission is hereby granted to '~- · .~ /~. /Y"C~,,,~,~/d, . ....... ~4~...., ........................ ~ ........... ~ ...... ~...~./..~(..o...~..z....~.:~.: ............... .................................................. at nremises locate t · · · pursuant to application dated ..... .V'..~..~..'......./.,...~... .................... , 1 .9~.....K~.., and approved by the Building inspector. Fee $..l...~...~°~- ..... / Bd~lding Inspector 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. 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 (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 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- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $I.00 .... ..... New Building ............. Old or Pre-existing Building ............ Vacant Land ........... '.. Location of Property .... .~. Q.0. ............ ,~..~../.'~Z. ~W~.~/'.~--~.~ House No. St~ ~ ~ ~ Hamlet Owner or Owners of Property ~ ~.~..~<~~. ~~ .......... County Tax Map No. 1000 Section ...~./ ...... Block ...... /. ~. .... Lot... ~ ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No, Z~~ate of Permit .......... ~pplicant ~ .. Health Dept. Approval ........................ Labor Dept. Approval ........................ Unde~riters Approval .~~.~, ~ ...... Planning Board Approval .... . ..... Request for Temporary Certificate ....... ~ .......... ~..Final Certificate ....~. ......... Construction on abovo doscribed buildin~ a~ me,ts all ap~hcablo THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRIGITy ~%l~jIJ~t 4, ~_9~ 85 JOHN STREET, NEW YORK, N~ET~K 10038 in the following Ioc¢tti~n; ~ .~s~[~ent [] 1st FI. wasex..*,nedo. JUAy 3 FIXTURE SWITCHES FIXTURES [~ 2nd FI. Section Block and found to be in compliance with the requirements of this Board. Lot RANGES OVENS EXHAUST FANS OUTLETS 2 SYSTEMS NO OF FEET OTHER APPARATUS' !-R~ke Detector S E E V I C CC COND OF H~ LEG NO OF NEUTRAl AWG OF NEUTRAL Paul. B~cns T~m~ }{arbor Lane Lic. 282 E This certificate must not be altered in any manner; return to the office of the Board If ( ._~_~ F I~.EIjD~I~NS PEC T I 0N 2. FOLqIYDATION ( FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION PER STATE ENERGY COpE FINAL DATE COMMENTS lsd) nd) I ADDITIONAL C0~ENTS: tRAP OP' I. AN,O' BORE'S 'd, FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ~ TEL.: 765-1803 Examined .J~ .X~.27.../. ~...., 19 .~..(~ ~ ~ . . . Permit No. Approved .~(,~ ./~.. .... /.~...., 19 Disapproved a/c ..... .~... i. ......................... ............. ......... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 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, building code, housing code, and/l~)ations, and to admit authorized inspectors on premises and in buildings for necessary insl~ctions. / / ... ......... '' ~g~l~[~re of applicant, or n~me, if a~orporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................. ................................................................. Name of owner of premises ..... ~ . .~_.. ~..t~.~.. L.O./7'...~: .~..~..~..~..~..~r3~...~...~.~.O~ ~ ........................ (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 .... .,~...d~. ................ Plumber's License No ......................... Electrician's License No.../.~..~'.~....~..i~L.~'~~ Other Trade's License No ...................... 1, Location of land on whichprop(Cs~ ~orkwill be done.' ' '~'~)~/~"~ ~'~.,~..~.~..d).~ .~/.~.'..~ ........ , ...... ...... q.o. ............................. i ....................................... .... House Number Street Hamlet County Tax Map No. 1000 Section ~ ~' { Block ,~ / ~v Lot... ff 6' 7 Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupm~cy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......................... , ................... b. Intended use and occupancy .~...~5~2.. ~ ........ j ...... property lines. Give street and block :number olde*~cription according 3. Nature of work (check which applicable): New Building .......... Addition .. Alteration .......... ~ Other Work R'epair .............. Remoyal .............. Demolition ............................. (Description) 4 Estimated Cos .... ; ............ 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 ..... i .... ,~.(Z'.O~. ¢'.-< ............................................. 6.. If bus~ness, commercml or rmxed occupancy, specify nature and extent of each type of se ............ .... 29 7.i Dmtens~ons of ex~mn, g structure~, ff any: Front ........... Rear ..... .~. ....... Depth .. ~.~ ........ Height ...... /. ~ ...... Number of Stones . ./. ............................................. Dimensions of same structure wiih alterations or additlgns: Front ...,~.. ~- .......... Rear .. ~'~g, ........... Depth ......... c;~. ~. ....... i.. Height ..... /...~. ............ Number of Stories .... / ................. Dimensions of entire,new construction: Front .... /.q'~- ....... Rear .... /.~ ....... Depth ...~...~. ........ 8. Height ...... ./."ff. ..... Num.ber of Stories .................. /. ............... ' ......./. ............. 9. Size of.lot: Front ..... ~.,5~. ........... Rear ....... ~r.~.. ........... De~th . .~..~./.~-~ ........... 10. Date of Purchase ........... ! ..... '. '. ........... Name of Former Owner . ~./.7~.o'./. ~_~. ............ 11. Zone or use district in which pr~mises are situated. · -'~---~..~. '-ff .Z'///~.~· / cd?~'. .... ,'~.,/,/~, ...................... 12. Does proposed construction violate any zoning law, ordinance or regulation: . .rff,..~. ....................... 13. Will lot be regraded ......... i...~, ................ Will exce,~'fill l~9,remove~ from premises: 14, Name of Owner ofpremises...,,~,('.~.<9. ·~. ...... ~...Address ..~..~../P'./~/.O.. .~. .... Phone No. .?./. ./. .-~°.. ."?.r. · · · Name of Architect .......... '..., ............. Address ~ ............... Phone No ........ ~.~ ...... Name of Contractor . . ~'~?..~',~,rTf/'.~ ........ Address q:~.~d-~. ...... Phone No.. ~. ~.~q~... ~. ~'~.. PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, and. indicate all set-back dimensions from to deed, and show street names and indicate whether interior or corner lot, STATE OF NEW~K/~ ~',,d, ,, ,, COUNTY OF ?'a · ........ sworn, deposes and says that he is the applicant .............. being duly (Name of individual signing contract) above named. (Contractor, agent, corporate officer, etc.) of smd owner or owners, and ~s duly authorized to perform or have performed the smd work and to make and file thi application; that all statements con{ained in [his application are true to the best of his knowledge and bailer; a,g~a'c~e work will be performed in the mann'er set forth in the application filed therewith. /' ) Sworn to before me this i /// Notary Pub i , · ¢., · ......... i.,:~-frT, gtfZM[tl4 t[~l.~l~kt[n ~" .//,/ / ~' , )to, ,~2.81258§D~ Suflol~.~nu~lty ............................................. l~m £x~res [larch 30~I~"-- (Signature of applicant)'