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Home My WebLink About10550-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the bmlding ................................................ Location of Property ..... 3.8.~9. ?.~.n.e.. ~.e.e..R..~.o.a..c3 ................~..o.u.~.h.o..1.d.,...~:.Y..... House No. Street Ham/et County Tax Map No. 1000 Section ...0.7.0 ...... Block .... 99 ......... Lot ....... .0.~.~. ...... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .D. 99.e.m.b..°?..~.? ......., 19.7.9. pursuant to which Building Permit No .... .1.O.~.~..0.Z ........... dated .. ~.a.rl.~.~..ry. ?.]: .............. 19.8.0., was issued, and conforms to an of the requirements of the applicable prowsions of the law. The occupancy for which this certificate is issued is ......... ........... ~.e. ?.,.~.~..or~' .q .~r.a?. 9.t~u. ?.~.u.~.?..tm .~..?.n).. ¥.~a?. .................... The certificate is issued to Sol Berg ..................... ?o¥,'d'. '~it~.~tt~4t~Y,~ ' .................... of the aforesaid building. Suffolk County Department of Health Approval ........... .N./?. .......................... UNDERWRITERS CERTIFICATE NO .................. .lq. ??.9.37. ...................... Building Inspector Rev 4/79 * Board of Appeals No. January 17, 1980 2659 I~OF, M NO. ~ TOWN OF SOUTHOLD., BUILDING DEPARTMENt'''~ TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT ~, ('r~s PERMrr MUS'~ (.gPT ON THE P~E~£S UN'r,. FULL COMPLETION OF THE WOEK ^UTHORI~ED) N°. 10550 Z Dote .~~.y...~/ .............. 19~. Permission is hereby granted to~... ...... .;~..~.~.c~.....~,,r~..-...~.,.~- ~ ...... ,,~z......~ .............................. '. to .~.o,~/c,l'.~ ~.......,~..c~....~ c~c~....~ ~...~ c ~o,¢~ ............. ..... ~.~......~-~.o,~..~..:,o,,,~......-.....~/~....~..~r~.~.......-,....z,.~ _,-,,. ,-, ~.~...~./..~.~,_ ................ pursuant to application Building Inspector, Fee $.../..(~..~... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE oF OCCUPANCY Instructions A. 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 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 Commerc a 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 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 features. 2. Sworn statement of owner or previous owner as to use, obcupancy 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 3. Copy of certificate of occupancy $1.00 New Building .... ~.'. ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property.. b~.. House No, Street Owner or Owners of Property .. ,~../~, .... ~..~-:./~J-~ ................................ County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. /~.~..:~.~-.DDate of Permit ~.:'.~./.'?..~.Applicant..~.O., ./~.....~..~./~Z./.. Health Dept. Approval ...................... Lab Dept. Approval ................... Unde~riters Approval ................... Planning Board Approval ....... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ...... ~.~ ................ THE NEW YORK BOARD OF FIRE UNDERWRITERS ~rt BUREAU OF ELECTRICITY ~ 86 JOHN ,STREET, NEW YORK, NEW ¥~ORK 10038 ..re ~.~l ~ ~0 ~p~li~,o.~o.o.~ile 02~9 N474037 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the gl~pllcant hammed on the above qppllcatlon number in the l~remises of Soi Berg, n/~ Pine ~4eck Rd., 300'" W/O NOrth Bayvfew, N~uLb,old, in the followlng locatlon; [] Basement [] 1st FI. ~.se~.,.i,,edo,~ &przx 7, l~d0 FIXTURE OUTLETS DRYERS [] ~td FL Section Block a,~d fouud to be in cotnpliat~ce with the requtrements of this Board. Lot FIXTURES RANGES OVENS EXHAUST 33 S E OTHER APPARATUS, Elec. Room Heater~:l-3.0KW,2-1.SKW Panelboar¢l/s: 1-24cir. 200amp., 1-19tlr. R AWG, OF CC COND ~/0 125amp. .o o, .,-~ ~ w ~ I } ~/~ OF HI LEO NO OF NEUTRALS O~A N~U~RAL Rula~ld ~lec. Co. P.O. ~ox 143 Magt£guc~, N.Y. Li¢.242 g Th,s cerhflcate must not be altered in any ~manner return to the office of the Board if FOR THIS FI ~E~_D ~SPECTION FOUNDATION (~s~) COMMENTS FOUNDATION 2. ROUGH FRAME & PLUMBING (a~a) INSULATION PER N.Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENT~: FOEM NO. 3 TOWN Or SOUTI4OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Iq. Y. NOTICE OF DISAPPROVAL PLEASE TAKE NOTICE that your application dated ..~..~.~...C.. ......... ..Z:....~.. ....................... , 19...7...?. for permit to construct ,..~. CC.~.......~..~..~...~..~.:~ ...... at the premises located at ..'~.~.~.../.~ ................... Mo ~).~. ~......o...7....~... Block .......... ..~....~. ......................... Lot .............. ..0.....~_ .-~.. ...................... is returned herewith and disapproved on the follow;ng grounds ,,~cC:~o/C, c4 ~.~./.~G~..~..~'~ .~. . .~ ~ . . . . /u. ~.~. . . . . ~. ~ ~ .L ~ ~ ~. . . . ~. . .4 ~. . . . . . ~. .~ ~. ~ ?. . . . . .y~. ~c . .~. ~. ~ . .~ ~-~. . ................... .............. z/~. zc./ . . . . . .{.~. ......... .~5...~ . . : ...... ~ ~ .c_~. . . ................ .....-.........:...t... ........................... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Application No...~.~ ........ Disapproved a/c ~.c~~...~..A~.~...~.~..~.~...' ..... / v ~' (Buildigl'g Inspector) /~ ,~/~5/~t~/~ ~ Date. ~.. f.-~.7 ...... 197~. 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 Cerhficate 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) cz ..... ........... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... ............................................................................ Name of owner of premises ..... ./~. . .~/'<.. ~., ................................................ ~a}on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and htle of corporate officer) Builder's License No .... ./.o~. ~/ ................. Plumber's License No ..... .A?/.~ .............. .... e Electncmn s L~cens No ...... Other Trade's License No ..... g,~ ............. 1. Location of land on which proposed work will be done ....... .~.A~.~..,t,9.~.~. .... z~.~ .................... House Number Street Hamlet County Tax Map NO. 1000 Section . .O.~..O. ............ Block ..... ~7)~,~ ......... Lot ..... ~>. ~.'.~ ...... Subdiwsion ..................................... Fded Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ~... t/~/? ~.~'~...~4t~. '.~b]~..~.o.~ ......................... b. Intended use and occupancy .. ~AZ~... t,t~/~.'... J~~.. Z~6/t~...2~.~-,O~77e>t~ ............. '3. o o Nature of work (check which apphcable): New Building ....... Addition .......... Alteration .......... Estimated Cost ............... Fee .................................. (to be paid on filing this application) If dwelling, number of dwelling finits ............... Number of dwelling units on each floor ................. If'garage number of cars If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structure~, if any: Front .............. '. Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additiorls: Fiont ................. Rear .................. Depth .................... i. · Height ...................... Number of Stories c onstrcction:~ Front Dimensions nCen_~tle.}ire new ..... ~ ......... Rear ..... ....... Depth .. ......... Height , ~.N~u~nber of Stories ........ 10 Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed constru~c[~n violhte any zoning law,~ordinance or regulation: ......................... 11 lo re~rad~rl_. 13. Wi t be o ........ .~_.~..a. ............... Will ex~ess fill be removed from premises: Yes ~ No 14. Name of Owner of premises .'~...~....~fi'l~a.. '.1~. ........ AddressdA Plague No ................ Name of Architect .~,, ...... , .................. Address .................... Phone No ................ Name of ContraetorO?..~.'. . .~...~..:....~. · .~J~.~ Address .~.:.~8~.~.. ff~Si.~. Phone No.~.~..~I~. ~... 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 ~~ COUN~O~ .... ......~..ff... S.S · ,~l~J ~i~r~ i being duly sworn,, d~poses and says that he is the applicant (Name of individual signing contract) above named. He is ,he....~...~...~...~. ~.~....'" --~ -' '--- ~.~ ............................................... , ........... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this apphcatmn; that all statements contmned m' th~s apphcat~on are true to the best of his knowledge and belief; and that the work will be performsd ~n the manner set forth i,n the application ~ed therewith. Sworn to before me'tl/i~ ................ .~.7 .... day of....~..~..~..~..~...~....., 19~.~. No~~;,~, Eldolic ...... ~ .... -- :~ ' . . .'... County ',,..,,.~,~,~4' ~ ~f2' ~ ' /~ ~"~t~~ '-~ ~}Z^~t'T, ~I~lq ~twtta (Signature of applicant) ~OTARY PU~LIO stlae o~W Yor~ ,,; No 52.8125850, ;SufNBl~ounty