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Home My WebLink About10763-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buiidin§ Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z.q..'].G.2. G. ...... Date April 18 ., 19. THIS CERTIFIES that the bmlding · &cces~ary. ................................ Location of Property /~-q?~5 F[air~ rd. ?eoon~_a House No, Street Ham/et County Tax Map No. 1000 Sectioi~ . .0.?.~ .......Block 05 .Lot 01q Subdivision .............................. Filed Map No ......... Lot No .............. conforms substantially to the Apphcation for Budding Permit heretofore fffled in this office dated April 19 19 .~.0. pursuant to which Building Permit No. ~10~6~Z dated... ...................... July 2 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 ......... a Food Cooler The certificate is issued to t~rime l~urveyers ................ ?o¥,Yr,'/~e'~;r't~e',*'t) ..................... of the aforesaid building. Suffolk County Department of Health Approval .. ?../..-¢ .................................... UNDERWRITERS CERTIFICATE NO.. N g9z[205 Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10763 Z Date ................................................... , 19 ....... Permission is hereby granted to: ~:'~/~ f-? ,~./)' , '' th pursuant to application dated ....................................................... , I9 ........ , and approved Dy e Building Inspector. Fee $ ........................ Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcat~on must be filled in typewriter OR ink, and subn~itted in duplicate to the Building Inspec- tor with the following; for new bui[d~ngs 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 disposa~-(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 Aprd 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 topograph ic 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 inspection of buddings or premises, or other pertinent informa- tion required to prepare a certificate. '~ Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copv of certificate of occupancy $1.00 $5.00 New Building ............. Old or Pre-existing Building(X) . _.~, -- ~ ZVacant Land ............ Location of Pro.erty.... . ........ .... Hou~ No, Street ..... Owner or Owners of Property. ..... '~)m~... ,.~.-~,~ U~. .~.~.~.,,,1~t .............. County Tax Map No, 1000 Section .... ~ .... Block ..... ~ ..... Lot Subd~ws[on .............. Filed Map No ........... Lot No .............. Permit No. ~.~ ~ .~,l. ~ Date of Permit ...... ,.. ]..Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval ........................ Planning Board Approval .................. ~ ,. ~ Request for Temporary Certificate ..................... Final Certificate ..... ~..~.'~... ..... * Fee Submitted $ ................... Construction on above described building and permit'meets all apP~cable~,codes and regulations. .... ............... Rev, THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ BUREAU OF ELECTRICITY [~ '8S JOHN STREET, NEW YORK, NEW YbRK 10038 THIS CERTIFIES THAT only the electrical equipment as described belotv and introduced by the aJ~pllcartt _named on the above application number in the premises of t%-~ne Pur,~:~:'s Ir~. ~ ~4eJ.~ Rd., Peooni~, N~ Y. in the following Iocatio~t; [] Basement [~lst FI. [] 2nd ~'l. Section Block Lot was examined onSeptea~r 18~ 1980 and found to be in compliance w th the requirements of tbis Board. FIXTURE OUTLETS 3 DRYERS RECEPTACLES SWITCHES FIXTURES RANGES OVENS DISH WASHERS EXHAUST INCANDESCENT FLUORESCENT SYSTEMS E OTHER APPARATUS, E NO OF CC COND 1 R V I C AWG OF CC COND 2 NO OF H~-LEG AWG Of HI lEG AWG OF NEUTRAL Sott~ho ~.d, N~ Y. 11971 Li.e. ~ 47 E GENSRAL MANAGER This certificate must not be altered in any manner; return to the off ce of the Board ;f ih~n~/-~* · / ...... COPY FOR BUILDING DIiPARJ'~MENT. tal$ COPY OF ~.I[,FIC~]~ itJJU~J!i' NOt BE JlLT~R~I) IN ANY MANNER. FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 (BuSlding Inspector) APPLICATION FOR BUILDING PERMIT Applicahon No. Date .................. 9 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 regulations, and to admit authorized inspectors on premises and in buildings for necessary ins~ctions. /9 ......z//~../"~.~..-~... .... '-~'~i ............ (Si~nature of applicant, o#name, if a corporation) .... ./:. ~.,../~..., .~,. ~./-.: .~./~..~... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... .0..~. F. 3. ~.: ................................................................................ Name of owner of premises .~..~.;..~fY.¢...9.¢r...~ .ID .~.~[ {3...~.-.~ ............................................ (as on the tax roll or latest deed) If appl/,cant is a corporation, signature of d~y authorized officer. (Name and title of corporate officer) Builder's License No .... I..~/.~ ................. Plumber's License No ......................... Electrician's License No ...................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ............................................ · ....... ...~..I.q..o,5 .................... ~.~i ~. . . .~. .~.~. L ............. ~.~o.~. i ~. ' ~ ' House Number Street Hamlet County Tax Map No. 1000 Section .... .~5...~..~ ....... Block ...~..~. ........... Lot...~. I I ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of p~oposed construction: a. Existing use,and occupancy . .~...~A%. ~..<~Ld. ~...~.~..~~0.. ' b. Intended use and occupancy .~~. ~O O ~. ~/~.F~tr,~5~c 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ........ Repair .............. Rem~vai .............. Demolition .............. Other Work .O~_~ ..... (Description) 4. Estimated Cost ....... .~. 0~..:..0~. ..................... Fee 1 5', o'D (to be paid on filing this application) 5. If dwelling, number of dwelling ¢nits ............... Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ . 6. If business, commerciai 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 ~ ' ' Rear Dimensions. of same structure with alterations or addztions: Front ............................... Depth .................... :.. Height ........ ..,.. ........... Numbe~/f Stories .............. ,~ ....... 8. Dimensions of entire new constrUction: Front .... }~.t ........ Rear .... l ~.~ ........ Depth ... ,:~/'/~ ......... Height .... ~/ .......... Number of Stones ........................................................ 9. Size of lot: Front ........... ~'. .......... Rear ...................... Depth ...................... 1 1. Zone or use district in which prgmises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded .............................. Will excess fill be removed from premises: Yes No Name bf Architect .......... i ................. Address .. Y.v. IPf'Ct .CT...t?~A-..~... Phone No ................ Name of Contractor ......... I ................. Address ................... 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--~__ __YO~RK .... ........... ./.(-,~:~... ~g A.~P?. {... :~{ c .~-f~ 5T~. 5 ~ .~ ~ ~. being duly sworn, deposes and says that he is the applicant (Name of individual sig~ing contract) above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is d~ly authorized to perform or have perfomed the said work and to m~e ~d file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work will be performed in the m~her set forth ~ the application filed therewith. Sworn to before me this ~ ~ ~, ~ ~ ~,~ (Signature of applic~t)