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Home My WebLink About10585-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No .... Z.~.0~ ....... Date ......... THIS CERTIFIES that the building ................................................ Location of Property .2.55. ~.o.r..t.h. Lene East Marion, N.Y, .... h&;de No. ' ............. 's'~i ......................h~mt*t County Tax Map No. 1000 Section .... ~fl. .....Block ...'/ ........... Lot ..... .q.q .......... Subdivision..O~--v'dJ~e~'& .BI~y. aT.~t&~e ..... Filed Map No...~0~.~ .Lot No...'lJ~ ........ conforms substantially to the Application for Building Permit heretofore fried in this office dated ... ~]R .q.} ........ ,19 .l~pursuant to which Building Permit No ........ '1..0~.~.5. Z. ....... dated .... ~8~O~ .'1} .............. 19 .~, 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..m,~$o.n..t..o...~.t.v..a.t.e..~.e..F..e~t. ly...~..e.~.~..tp.g....(!e..~..o.n..~. ) ...... The certificate is issued to ............ .~l:'g~ .~,. ~Q~ .............................. (own~r~mm3mm~ of the aforesaid building. Suffolk County Department of Health Approval ........... .N/.R. ........................... UNDERWRITERS CERTIFICATE NO... Building Inspector TOWN OF SOUTHOLD 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) No. 10585 Z Permission is hereby gmntecl to: to .................................................. : .................................... ~.. ~P~../~.I. J,...~. ............................... at p~mi~s I~ at ~ ~ LA ~ ~ pu~nt to Q~licQtion ~t~ ~ 1~ and a~r~ ~ the Building Inspector. ,,5-00 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 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. 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 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 3. Copy of certificate of occupancy $1.00 $5.00 New Building ............. Old or Pre-existing Building .... ~ ...... Vacant Land ............. Location of Property ................. 2_55 ............ [~.RT.H .L/~E ...... Eft, ST. t.~t~'f DJ~...N .¥. House No. Street Hamlet Owner or Owners of Property .. I~EOEGE. L.. 14Z1CH .......................................... County Tax Map No, 1000 Section ., .31 .......... Block .... ?. .......... Lot.,. II ........... Subdivision ................................ Filed Map No... 5D8.3 .... Lot No... ~.G8 ....... Permit No..[.0.5.8.5. .Z... Date of Permit . .5./~.D./.8.0..Applicant . ?,~.G.H.T..E.R. I~.O,H.E, .[.H.P.I~y,E?I.E~.T..C.O..... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval . . I~..h.7.7.6.7..~. ............. Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..... X. ................. Fee Submitted $...5., ~.O ...................... Construction on above described building and permit meets all applicable codes and regulations. Rev 10-10-78 Applicant .. EJ~.E. ST..F. ,I~IOH.T~,P~ ................................ RIGHTER HOME IMPROVEMENT CO., lNG. THE NEW YORK BOARD OF FiRE UNDERWRITERS BUREAU OF ELECTRICdTY 85 JOHN STREET, NEW YORK, NEW'~ORK 10038 oate }lay 8, 1980 Applicatio,.No. onyile 071393 THIS CERTIFIES THAT N z! 776?6 only the electrical equiprnent as described below and i~ttrod~tced bm the a I' n d n the ' , ~ · ~ ~ a reap ~cati~n ~u~ber in th r ises of tn the following location; [] Base.tent [~ Ist FL May 5, 1980 FIXTURE FIXTURES OUTLETS ~ECEPTACLES SWITCHES 4 6 3 4 DRYERS FURNACE [~ 2nd FI. Section Block Lot and found to be in compliance with the requirements of this Board. RANGES OVENS EXHAUST FANS SYSTEMS OTHER APPARATUS. E R OF CC COND C NO OF HI LEG A W O Town Itarboz' Lal S outhold ~l. Y~ 11971 OENERAL ~ANAOER ~l Tbs cerhflcate must not be altered in any manner; return to the office of the Board [f ~cor~ect nspectors ma be ~dentifled ' ~~~~~j~ ~ - ~ y by their credenhals., ~-~-'"'~ ....... , :- ~ ,~- ,~' ~ ~:, ,,v~, .~ .~[~u I~ ANY MANNER. / '__ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802' Examined ...... Approved ...... Disapproved a/c .... L~' '~' ' · · · ' ~-z~,~ ............. (Building Inspector) APPLICATION FOR 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 ~ving 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 apphcahon, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for mspecbon 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 inspections. (Signature of applicant, or naame, ifa c{Sr°°ration, ' ~ p ' ) z ,~--7/~A yz/ ~_ ,- ~ / .... .~../..v ......... z.:. ~,.:~./.. (:~ .~ F%~?. .... ..:-- (Mailing address of applicant) State whether ap?licant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... .............................. Nme of owner of premises . ~ (as on the tax roil or~atest deed) If applicant is a corporation, smnature o~u]y authorized officer. (Name and title of co, orate officer) ...... ZZ . ......... Plumber's License No. ' ~.,~.d~ ~ ........... Electricmn's License No. . .~. ~ Other Trade's License No ...................... / r beane ~i.f~v'~t/tl't~¥~ /~' t'C~.) ~ 1. Location of land on which proposed wok will o ..... [ ................. : 7'..~/ .... '.. · .' .....~ ..... .................. ~. ~-~ ~.?~.,.....~.. House Number Street Hamlet 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ?..c.~ ~ ( ?.:'z./. :~.-..~ .... '.<-~.~.'74 .~ ................................. b. Intended use and occupancy ..... )'~.: .~"2/..2.d/.¥L k .... /¢~o..T~./. ~ .................................. 3. Nature of work (check which applicable): New Building .......... Addition /'// Alteration Repair .......... t,. · · Removal .............. Demolition .............. Other Work ............... ff , i ,--d~, (Description) · 7/0 D c.P ,-'-- /.5 4. Estimated Cost ........ d ...., ......................... 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 .... j ................................................................... 6. If business, commercial or mixea occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... tteight ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... i · · Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ................................... ii .'/.' .~. E i i i iii i ii 9. Size of lot: Front ....... /,~i.~9. ......... Rear .... /ff.~. ............. Depth . 10. !3ate of Purchase .......... ; .................. ~ame of/Forme!~ Ownl~r ............................. 11. Zone Or use district in which premises are situated... ~ .~ ?.r.q/.e· .q .h.Q/. ................................ 12. Does Proposed construction yio!at~ any zoning law, ordinance or regulation: ............................. 13. Will lot be regraded ...-~.Z~. ~..~./.~. ............ Will excess fill be removed from premises: Yes 14. Name of Owner of premises .:. .... 4 ............ Address ............... Phone No .............. 77 NameName of°f Architect .......... ~. ........ .~. :,.~ ......AddressAddress ' '~ ................. Phone No...,p.. ~.. Phone No. Y.. 2 ....... PLOT DIAGRAM Locate clearly and distinctly al1 buildings, whether existing or proposed, an& indicate all set-back dimensions from property lines. Give street and blocl~ number or description according to deed, and show street names and indicate whether interior or corner lot. , STATE OF NEW Y~tRK,4 ./. dZ S.S ............................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ............................................................... (Contract6r, agent, corporate officer, etc.) -' ,~ of said owner or owners, and is d~ly authorized to perform or have performed the said work and to make and file thisi application; that all statements contained in this application are true to the best of his knowledge and belief; and that the. work will be performed in the manner set forth in the application filed therewith, Sworn to before me this [ ......... ~...~.., ...... ,..daytf ...... ~....~f~. ~....,19~ Notary Public, .~... ~.~(<~..~ ... County JUDITH T, TERR'~ ,, . . . 1~"~ .';'% . ~%"~. ~ 7..~ .... Notary Public, State of New' YOfl~ No, 52-0344963 Suffolk Count¥~'/ 0ommlsslon Ex~ll'c~ ~arch 30~ 19,~/ ' ' (Signature of applicant) · ?~T~,~ \lie / i. KOCH-,OHNS~rON~ ^SSOC I^T ~ S, [ KJ INC. . · INTERIOR DESIGN & PLANNING I0 EAST 44th ST, N'EW YORK, N.Y. 10017 212-986-6170