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Home My WebLink About10568-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy ZlOa30 No .................. Date ...... ~.r.¢h..3,1, ............... ,198g. THIS CERTIFIES that the building ................................................ Location of Property .. ;I.l.~ 0..0.~ q ~ ~ F.cl. ~ .t, l'.e~q t, · ......... 0..z, .ig.q .t, ,..Ii., ~, .............. House No. Street Ham/et County Tax Map No. 1000 Section .. 2.7 ........ Block .... ~, ......... Lot .. 3.,.1 ............ Subdivision .Beau~ .JoLaJ, s. Ac~.es .......... Filed Map No.. 63.7.3..Lot No...1 .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .F?.b.r.~.a.r.y.. 2..6 ........ ,198.0.. pursuant to which Building Permit No. 10568 Z dated .... F..i bl~M.&r.¥. 2.(i ........... 19 .~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 ......... ...l.dd~ion ~o Dw~lltq& The certificate is issued to Fredica L. Washber~er ..................... ..................... of the aforesaid building. Suffolk County Department of Health Approval ..... l{/. B ................................. UNDERWRITERS CERTIFICATE NO ..... 11.4.9.q ? 51~ ..................................... Building Inspector I~,u'M NO. ~ TOWN OF SO~TMOLD BUILDING DEPARTMENT TOWN CLERK'S OFfiCE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON TH.E-PJ~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10568 Permission is hereby granted to: r/~ ~-* D lc/~ J~ ~l//'4-~JaI, ~ ~: 7'~ ~ ~ 9~. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apptication 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 supplv 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. 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 $5.00 Date...///.~. :~...~.~..C.O, .......... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property 2'/~ ~ ~rJ.~'~ 'J -~'~' ~"P~"-"~- House No. Street Hamlet Owner or Owners of Property ............................................................. County Tax Map No. 1000 Section o ~- ~ . Block ~;~ ~ Lot ~ ~ -~// Subdivision ~t~-d.°.~)~°/~/~ //~'~'~''~ .... ~ / ............................. ~uea Map No ........... Lot No .............. Permit No.~..~.'~..~..'~ ~-~ z~/.;.'~..~.°...Applicant ~:2~/./'~ /z~-,.~- '~ /~/~'~_~. · Date of Permit ................................... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval N494 ? 52 ..... Planning Board Approval Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $.. 5 · 00 Construction on above described building andj~ermjt meet~ all ~plica, ble codes and regulations· Applicant. ............. Rev, 1040-78 THE NEW YORK BOARD OF FiRE UNDERWRITERS ]~1[I[ BUREAU OF ELECTRIC~ITY 85 ,JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIEB THAT only the electrical equi, ment as described belotv and introduced by the applicattt tiat~ed on the above application number in the premises of in the following location; [~ Basement [] 1st FI. ~ 2nd Fl. Section Block Lot ~a~ ~.,n~ned on~te't~'~' 22, 19~ and found to be in compliance with tbe requirements of this Board. FIXEURE FIXTURES RANGES OVENS DiSH WASHERS EXHAUST FANS OUTLETS FLUORESCENT DRYERS SYSTEMS NO. OF FEET OTHER APPARATUS. E R ~ I C %~m La~e (~ree~tr~, N.Y. GENERAL MANAGER Per ~ Th s cert'fcate must not be altered ~n any manner, return to the office of the Board J ~ncog'ect Inspector;s may be ~denhfled by their credentials. COPY FOR BUILDINf.~DIEPAR~rMENT. THIS COPY OF ~K~!'IF!C~.T~,,~,U,~T ~OT ~BE~ALTERED IN ANY MANNER, FIELD INSPE~TI0~ COMMENTS FOUNnATION (~s~) FOUNDATION (2nd) 2. ROUGH FRAME& PLUMBING INSULATION PER N.Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: .... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ~7..~7~'~.,. ?. ~'..., 19 ~ Approved~...~.(..., 19~ ee~it No.~ ............................. '7. APPLICATIO~ FO~ BUILDING PERMIT Application No../~..~.7 .)(~.. ?>.. ..... 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 drown on the diagram which is part of this appli- cation. c. The work covered by th~s 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 ~nspection throughout the work. e. No budding 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 w~th all applicable laws, ordinances, building code, housing code, and regulations, and ~ admit authorized inspectors on prennses and in buddings for nece~..~, ins~)e~ctions. ~...~. / ,_ ~,Z/.~' ...... ..... &q .... ~ (Signature of applicant, or name, if a corporation) . . . ..................... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, enginee~ ~o~racto~r electrician, plumber or builder· .................................. .i¢--/~.~-~,/. .C.,~. .~~2_fi~.'~.~...~.... t / -: ~ ~ . ......... Name of owner of premises ./~,, .... ~Z~3.t~- .............. n~ ~.~.~.?..d~.~ ......................... (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 ..... ~/~..~ .......... Plumber's License No ......................... Electrician's License No. '~.Z. Other Trade's License No ...................... Location of land on which proposed work will be done .... ~..1-.(7-./~. ~.....~.~./... ~../~.[.~(U~// ......... ............. ................ .r c ........... House Number Street Hamlet County Tax Map No. 1000 Section ...C)..~.~..~. ......... Block .... .~..'.'~. ......... Lot..~..~..~.. ,~ ,~. ........ Subdivision ~ ~ .~..C2.'..~..~.../.~..~..C7..C.~..?.. Filed Map No... ~..~..7.~. .... Lot..~..~. ......... (Name) State existing use and occupancy of premises and intended use aCd occupancy of,proposed const,ruction: · - a. Ex,st, ng use and occupancy .... ~ ..... //(..~ .......... .~ ..... ~ .... ~ ....... ~ .... , ........ b. Intended use and occupancy ...~. (~¢~../~:'T.. ...... ~ ~..O.m..7...~...?~?.~1 . .~.~C~'..'~.. ,~. ~4~'I~.~.Z.~. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. RemoYal .............. Demolition .............. Other Work ............... 4. Estimated Cost ...... /~..~...~fi.~. t?..*~.. ........ .~...p .... Fee .......... ' I (to be paid on filing this applic~ttion) 5. If dwelling, number of dwelling Cnits ............... Number of dwelling units on each floor ...... t.. ........ If garage, number of cars ..... i ................................................................... 6. If business, commercial 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 ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... ;.. Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of. lot: Front ........... i ........... Rear ...................... Depth ...................... 10. Date of Purchase ........... [ .................. Name of Former Owner ............................. 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 ............................. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ..................... Address ................... Phone No ................ Name of Architect ....... Name of Contractor .. ~. ~*~' ~¢~t"~?~t~'~'~ ..... Address ................... Phone No ................ ............... g,:,/'/ ldress .... ....... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, an& indicate all set-back dimensions from property lines· Give street and block gumber or description according to deed, and show street names and indicate whether interior or corner lot.~ I STATE OF, NEW YORK, !S.S COUNTY OF ,$k.f ...... b .................... 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 du!y~ authorized to perform or have performed the said work and to make and file this apphcatmn; that all statements contained m th~s apphcatmn are true to the best ofh~s knowledge and behef and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........................ day o~.. :,~.~.c..(,.~.. NOTARy PUBLIC, State of No '~ ' ~'~ '~' ...... ~t~ [. ~°~[S ti '~ ' ' rof p ) -e'-' ap-li6~t' : · '"' '" ,: ' t .I ' I. ~ ~ ' :.~' ; · 'i:., ~ '! . .. ~.,.' t ~" ~ ~x~ .~?~..~'.-,.'~x~',~.~.,./~. ~ ~,~ t~ ~ ~,~ ~ .~ /~ ~ ~ ~f~ ~~ '" ~ .... ' ~'"~'~ ..... .... "~ ........ ~ ~ ~"~'...~. f,~,'~ '~.." '. ~" ~'~ "t~ '-~'l.I ........ ~ "~' ~'' ~ ~ ~ ' l~ ' ~. '}'~ ~""'i ....· O~ZI.. I.~r : . ~ .' ' ~'" ' ~ ': · ~ · ~' .~ ' ' .. · J · ' ' . ~/x~ ",.z.J ~ :'"~? :".~'~4. ~ .~"':' ~ ,~'" ~''~ '. '.~"? '~ ~" ""'~'~'.. ] '!'-' "..~ .... . 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