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Home My WebLink About10555-z FORM NO.4 TOWN OF SOUTHOLD BUilDING DEPARTMENT T own Clerk's Office Southold, N.Y. Certificate Of Occupancy Z10005 Date .. , .. .. J)ll;:>: . ~, .. .. .. .. , , , .. .. .., 19 ,89 No................. . THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' ..............,'. . LocationofProperty "... .1199. .':\'1;.r~.~ .i:l?:t.~I:'I;!.j:..,!:\rjf?............. .Q:r:i?!1.1;, .N..X.,.. House No. Street Hamlet County Tax Map No. 1000 Section ,." 9,1.~ . . . .Block ., .Q? . . . . . . . . .Lot . . . . . . 9, 1. I? . . . . .. . Subdivision .Qr:i?p.1<-: l;JY:-.i<4~7'9.~q. . . . . . . . .Filed Map No. ....... .Lot No. ,.. Y? . . . , . . . conforms substantially to the Application for Buildmg Permit heretofore filed in this office dated . . . .J.1J.1'.l1,.li'.J:Y.. ?9, . . , .. ,19 .E!Qpursuant to which Building Permit No. .... .1.Q,?:;5:>.Z. .. . .. . . . . dated .. .;r.R)1'q.<JTY, ,29, ' . . . . , . . , , . . . 19 !2\Q , 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 . . . . . . . . . ..In~grQund.Ppo1 w~tn,D~G~,RdditiQn.?!1.d f?p~~.~~~Q~1,.I~~......,.."". The certificate is issued to ......... J?r::i,1):p. 8,!?<J" p'~J,9!'~.~ .I:t~~.~~~. , . . . , . . . . . . . . . . . . (owner,le's1'8If~ of the aforesaid buildmg. Suffolk County Department of Health Approval ........... ~!.~ . . . . . . . . . . , . . . . . . . , . . . . . . . . UNDERWRITERS CERTIFICATE NO, . . . . . . . . . . . . , . . . . . ~~?~~?? . . . . . . . . . . . . . . . . . . . . . kAH~~ Building Inspector Rev 4/79 i " i , ~.;U ,,"<I; , Ii, ~ FORM NO. 2 TOWN OF SOUTH OLD BUILDING DEPARTMENT 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<! 10555 Z Date .J;M...l.I./.~.fZ.'1"'''Z..{.......... , 19;'>0 Permission is hereby granted to: ......t11d.i...-/..,.2G{/t;&~;?..;JC.U.h(4 ;J ../ ./..it. r:J..... T/./tfca;.. tl.<t;:;JZ;/Cf,....!,..o(.!.....E..,' .....()f(;;~.e/.f.;I....,.."I..J..Y.j. .........., ..".., . .. , to ....<.:.d..&<~Z/.L"c:..7,...A3.Q.k.;;.".F7K(7G-./~..,.Sc;..U""J-/.).4./.,..'j,.:/K;;j(:<'.L- ..... .ll/./..J.)C;:c L.., .,.(J.j{J.C?/.. 7/..0,f.V.. tjf .,... ~~.2if:.~&.C.E.... .$;..4A;;k6.f(; t;;.J/t{..,;;;;.... ,..,' , at premises located at 1/..9.0'........7../..././"E ....t&4t!iJ;i<0~...'.atf.<C;......... ..,..,........... ....... ................:.:::;........::.:.:.::..........;,::.::............. ";'~' ....,.........~~Z.~~..k..{,:;..,...... ...." 0;;-- / L b, II.I.E.' < f., ~ Ib I ..:.....It:::..&I.......'-d..y...... .;;;....<DJc:/J.........~c,7'ft(...(................, ~...... .c.... .. .-:'........ . pursuant to application dated ..,:E/.(.J... ..2."!.,.. ........ ............, j9?a, and approved by the Building Inspector. Fee $./..;'$...~.~... ~........... ,_ ,J. ~,/t, , it FORM NO.6 TOWN OF SOUTHOI..D Building Department Tawn Hall South old, N.Y. 11971 APPUCATlON 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 fallowing; for new buildings or new use: 1. Final survey of property with accurate lacation of all buildings, property lines, streets, and unusual natural ar tapagraphic features. 2. Final appraval of Health Dept. af water supply and sewerage dispasal-(S-9 form ar equal). 3. Approval ,af electrical installation from Board of Fire UnderWriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tians, a certificate of Cade compliance fram the Architect ar Engineer responsible for the building. 5. Submit Planning Baard approval of campleted 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 peaperty showing all property lines, streets, buildings and unusual natural ar topagraph ic features. 2. Sworn statement af owner or previous owner as to use, occupancy and conditian of buildings. 3. Date of any housing code or safety inspectian af buildings ar premises, or other pertinent infarma- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate af accupancy an pre-existing dwelling or land use $5.00 3. Copy af certificate of occupancy $1.00 Date.... ..7p/rs:.\'J....... New Building .,..,........ Old or Pre-existing Building ........,... Vacant I..and ......'....... I..ocation of Property, . ,U. 9. t?.. . -:-: T.4(~Y;.t:;~.. 0<:-!.~~JI;.s. . f.: t:'J..v,\ .c;. ~ ,. . (!.~ ! .~.(';~ House No. ,..,,', Street <CoO Hamlet Owner or Owners of Property .. yk: !.i;.. .~~. J)~.19.v!-.~c.?... .K.f.~. !-:-.'::'. :-:-;-.-.. O/~ . , Q/~ Caunty Tax Map No. 1000 Section ... ,..c....... Block .. .0. . . . . . . . . .. I..ot... ............ SubdivIsion. , . o~.\.e;;(<...1~ . "0'~. .~ . ~o/ , . . .Filed Map No. ~~ ~ ./. .lot No. .. (f.. . . . . . . . Permit No. !..<: :~7~Zoate af Permit .L.( ?:t)1(O.APPlicant 70:-! .1.1' 7\ ~;~.~ ;";<;-;'. . . . . . . . Health Dept. Approval . . . . . . . . . . . . . . . . . . . . . . . . Labor Dept. Appraval ........................ Underwriters Approval. .'1 '7 .~. .'I. ? .L . . . . .Planning Board Approval ........ . . . . . . . . . . . . . . Request for Temporary Certifieate . . . . , . . . . . , . . . . . . . . . .Final Certificate. . . . . . . . . . . . . . . . . . . . . . . ~?!Jh/ Fee Submitted $ . . . . . . . . . : . . . . . . . . . . . . . . . . . , . C"""m",'"""" .b~' d=,ib,d ",,,'di", '7~.t~bI' ood.. ,"d .'0''''""' _.."" A",<,",.. 7~'~.. i{)i~;;'6~. 7/;/YO 4~7li-J7~1 I . ,..,t, jV 4 \".u ,,~ .,j L ' i,.e,. .. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY r;r 85 JOHN STREET. NEW YORK. NEW YORK 10038 Date May 14, 1980 Applicafion No. aufile 072309 N 478435 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises oj Mr. RICJMJN,1l90 Three 'Iilater la, ,Odent,N.Y. in the following location; o Ba-;ement D'stFf. D 2nd Fl, outside Section Block Lot was exu,nlned l)n :Hay 17, 1980 andfound to be in compliance with the requirements of this Board. FIXTURE pr E FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS REeE AClES SWITCH 5 INCANDESCENT flUORESCENT MERCURY AMT KW AMT KW AMT KW AMT KW AMT H P VAPOR 1. 1 DRYERS FURNACE MOTORS FUTURE APPliANCE FEEDERS SPECIAL REC'PT TI,ME C;::LOCKS BELL UNIT HEATERS MUl TI.QUTlET DIMMERS KW OIL H P AMT TRANS. SYSTEMS AMT H P GAS AMT NO AWG AMT AMP AMPS AMT H P NO. OF FEET AMT WATTS 1 .l.O SERVICE DISCONNECT NO,OF S E R "V I C E METER 1,H2W l,if3W 3H3W 3j!4W NO O~E~~COND AWG AWG AWG AMT AMP TYPE EQUIP OF CC CONi) NO OF HI lEG OF HI lEG NO OF NEUTRALS OF NEUTRAL OTHER APPARATUS: 1-GFJ.. Swilu:ni11g Pool: 'l.1:ri.s certificate covers ~11a1.1.ce at t~. date 0:6 ioopect1on only, Because of unusual amrlrCltJlUetlts it: is: advisab1:e to havEI frequent wsts ar;v;l/m:: repairs !IMIde by a qual:l.fied person. - , ~r-( i , Phil Gordon , 12 I>ean St. , Port. Jefferson Stat1.on,N.Y. 11776 GENeRAL MANA<iER, Lie ,1101 11 Pe-r.. This certifIcate must not be altered in any rpanner; return to the office of the Board if i~cor,rect. Jnspector;$ b:e IdentIfied : copy FOR B~IL I - , -- - - .-.. .. f_...___':-,; -__._. ___~._.._ ~ _.__. ..___ ,____...___.. 1:. .. _~ ,__ p" I I- 3'+- .. a'-- ...,~'I'"+ :t: '. ' ;,' . -N ' . '...'-, I' '''~~\..;ii~''~, ~,. ~ . Oer,N , .~. I ,IJ>, ''J;.''';'';' :\ ~ ' "'.t~' -,'.'1'."-,, r"" :... I) 111 ;".,...' ,. ~ ~J'~ ~ .. 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" ~ ~ ~ ~",. ~ ,--.J If'- tA :or: \:i '" ' :t' <> ::t "() I ,~ ", '\'"'" ....,....1:\ ~.....~ '\.I,' ~, f'- ! . ," . ,", ':f . ~;'" " " ^'...' to 1\ .,..~ .' ' ' '" () [" ,>" ...1'., ~. " ~ (\'. I,~~, ~'-\) () "", ,",,(). .....' Ji"t\ . .j"'''''- ~ ~,t~ <: ,,:-I~' ~a Y\; j\' ....-. ()') ~ 1. ";," )' ;";< J j ~ '\ . ~ ~ ~: '1'\ I\J ~ ~' ! {. <.! r (:l ~ ~:i ~ . ~ ~ ~ ~ VI 0 '0 '::Z () . r-- l .. "\ ~i'\ '\'~ :":r- 11''''- ;r (J 'f\J . II" !II "11'", ~bi1"'" "~ C\;):' .... ,hi ="~ I :t ,- I .' ..... :::I :t 0 ,~ (h '" fh oJ ' ,0 fh' :>- Q, It ...:t. ~ \: i II, 1 '7<-. ~I\);-" ch' ~i~! '~ ~.... ~ ~ . ~ :t j.,' ~, 't <: 11\1 ti \" , :< '- <..0::: t:. 'j. oo~~ t:t (> 0 '" 1m.... ~ ... .... '<, r '\ It- -.J ~ f' \ I;~:I \J . . :< r. ,../).... ~ \-: '" -.J Q , :'t t::J Vj () t\j " o 'O! () I\! ~ ~. t>.:. . ~ ~\ ~ ! i~ (V IV ~ il C: "..... fl\ ~. . 1.$ t' ':h ......... il \J ,'i I <D c,,' II; ~. Jg 1"" 1......-< ..::j f\::r. f:< . ,~ ()- "' ;:-.... !(') , ....? I ~. '. ~ :t. ~ :-<:..,.. '" ... '. /'\ U I..... " ~ J . :S:," \.J!. " !). ;. ~'".'-;. "..,' '.' }' , ~ ", ' . . '1(: '.'.'.;. " ;;,:, ,>,..,,< ;,',;,,'0";'" ":';4' - ' '.;:,~, ";; ,:~f.?,;;,~ ' FIELD INSPECTION DATE COMMENTS", -~ , 'D - ~ 1, .:-' ;:~ ~ HI ~ -----,--- - --- >-3 FOUNDATION (1st) a QJ, --~--~-- . N --- FOUNDATION (2nd) ~~ - 7 r 2. " ROUGH FRAME & :z:..... ?tP PLUMBING ~ (D~ 3, c+ ~. - 'i ~ % ~ INSULATION PER N.Y. c+ Vi STATE ENERGY ~ , CODE " 4, 5f6) F!.i\\ - CD . <1' FINAL , 1J ~~ ~ ~ ADDITIONAL COMMENTS: 'i ~ ~ ~ --~. C . -- , ~ - B. ~ ~t'v c+"i) 1-" , 0 , ~~ i '::r: CD , A> .f-' c+ '" ~ t:! CD ~ . i J ';; l,,> .\.,.. "i ,.~, ><, ~ 4 ",-J'~ --'. FORM NO.1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ,.-,,-. ExaminedJ4!P.. .;;'.7.. ...,19 fJr Application No. ./Q.;r:S$~ . . . . . APprovedl(4'~. ,? '1,... " 19 ~ Permit NoJP:?~~.z "",,,'wOO.f'. ....... .~........ ~......... . .. ~.. ............,....... (Building Inspector) APPLICATION FOR BUILDING PERMIT .-- Date .J;Q4J... Z.7......, 19fo INSTRUCTIONS a. This application must be completely fined in by typewriter or in lllk 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 shan 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 buildlllgs, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with an applicable laws, ordinances, building code, housing ,ode, and regulations, and to admit authorized inspectors on premises and in buildings for necessary in io . 'r.. ........................ .. (Signatur of applicant, or name, if a corporation) . . .3. WN.b .!..~ t' P,~. .P-:!Y. . . . . . (Mailing address of applicant) 1('1 '>7 State whether applicant is owner, lessee, agent, architect, engllleer, general contractor, electrician, plumber or builder. ........ ......... ..,.. .:~~~~ ';.:;'~""" .;~.. '~-' ..~ ';e~~k;;~t)" ,............. ... Name of owner of premises ..".......,.." .-. . . ~. . v:e;.c'S. . . . . . , . . . . . . . . . . . . ., ..,...,'..,....... (as on the tax ron or latest deed) If applicant is a corporation, signature of duly authorized officer, . . . . . . . . . . .................. . .............. . (Name and title of c~orate officer) k=- - , , . -= -IE " Builder s License No. f.Q... ... .~,. .4t:iP. Plumber's License No. .,...,................., Electrician's License N~ ~, ...;::J;:t.~4o Other Trade's License No. ....."...........'.' l. Location of land on which proposed work will be done. ...........................,.........,........... .. Ilr ~ .. .. .. ....,. .71.~~. h;(rn<---!:. .,(R.l!wtC:..,."..,.,.. .@~(~~r.... House Number Street Hamlet County Tax Map No. 1000 Section ,..1'. (, ~ . . . . . . " Block ...<? if. . . . . . , . . .. Lot..O t. If. . . . . . . , . . . Subdivision (O/Z/.E.~'/~I'. .~. . ~r.? . . Filed Map No. ........,.,... Lot. .1 (, . . . . . . . . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . 7?'!".I. , . . .O/v,'4-. . .r.4Md., 7 . . .~ ;1/.1)...)1' . . . . . .~ . : . . . . b.Intendeduseandoccupancy . ::::~...o4 iE.... V. .~a?.<<.. ~~. _X~/!(j.I-?... i , 1 i I I 3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition. . . . . . . . .. Alteration .......... Repair .............. Removal. . . . . . . . . . . . .. Demolition .............. Other work?',d,!: 19~J.:if.(j'4-'" , :!$! __ .- (Description) 4. Estimated Cost . .. . .. . ..7-/ij:. t!!. ~ .. . . .. .. . .. . .. .. . . . Fee . I:i: . -:-:-:. . .. . .. . .. .. .. .. . .. .. .. .. . .. : (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 .....,................................................................... 6. If business, commercial or mixed oecupancy, specify nature and ex,tent of each type of use . . . . . . . . . . . . . . . . . . . . . 7. Dimensions of existing structures, if any: Front. . . . . . . . . . . . . . . Rear .............. Depth............... Height, ............... NU111ber of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure wjth alterations or additions: Front ................. Rear . . . . . . . . . . . . . . . . . . Depth. . . . . . . . . . . . . . . . . . . .:. . Height. . . . . . . . . . . . . . . . . . . . . . Number of Stories. . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new constt}iction: Front. . . . . . . . . . . . . .. Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Height ............... N~r of)tories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size ofJot: Front y-~. ,.te.v.~ ~ Rear...................... Depth ...................... 10. Date of Purchase ...........:....... .......... Name.)?Fonner Owner ............................. II. Zone or use district in which pr~mises are situated. . , . ..-:-: . .:-:-................ /.J' . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: ......... ...Q.:............... 13. Willlo~ be regraded ........ .;.. ... .. . ... . ... .. . . Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . . .j. . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Architect.. . . . . . . . .;. .. . ... . . . . . . ... . Address.. .. . . ... .. . .. .. . . . Phone No. .. . .... .. . .. .. . Name of Contractor . . .. ., . . .;. .. .. .. . . . . .. .. . . Address.. .... ... .. . .. . .... Phane 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 )lUmber or description according to deed, and show street names and indicate whether interior or corner lot. I A ISo ~ 9R"~ cdU,o ~/~~;,u,. ~OCl'------ '-xf J-;?~czE 7!.r6C kSo/LL V 'ZEc"-. :.------- ..... €XTk4Ito;U STATE OF NEW YORK, SS COUNTY OF . .,s:W; F'?.'-J'.. . " . . . . . . . . . . . .I:.fI:!~fI'. . . .~JC:If/l/J:tV. . . . . . . . . . . . . . .. being duly sworn, deposes and says that he is the applieant (Name of individual signing contract) above named. He is the. . . . . . . . . . . . . . . . . . . . . .!. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) , of said owner or owners, and is duly' autharized 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 perfonned in the manner set forth in the applicatian filed therewith. Sworn to before me this ~~adJ2~HH~H'19,qA ' t PublIc, .................:.......44.. County ~ A LINDA F. KOWALSKI \ Z . 1 NOTARY rUBLlC, Stata : , of "ow York . . . . . . . . . .. .................................. No.52.4524771 ' (S' t f r t) Qualified r S If I Igna ure 0 app Ican fI u ol( County Commrs~lon ExpIres March 30, 1980