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Home My WebLink About10605-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No... ZIOO.'IB ....... Date ..... .July..3 ................... ,19 80 THIS CERTIFIES that the building ............................................... Location of Property ...865..gecolld. 8.~.ee~ ........................ l~e'~. 8llffo~.l~..1~1,~'o House No. Street HamTet County Tax Map No. 1000 Section ...117 ...... Block ...08 .......... Lot ...... 0.~0 ....... Subdivision ............................. Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permxt heretofore filed in this office dated ..... l~Ita~'¢l~ .2/* ...... , 19 80 pursuant to which Building Permit No ...... ~O60~Z ......... dated .... Ma~.¢I~. 2.7. .............. 19 80., was issued, and conforms to all of the requkements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ........... P~.lvate. One .Femt~y. I~elling .w/AdditAon ....................... The certificate is issued to ........ I31%. arid .[tt~s ~ .[4.. l~otlssall ....................... (owner, ~ of the aforesaid building. Suffolk County Department of Health Approval ............. Iff./lt ........................ UNDERWRITERS CERTIFICATE NO ...................... I~..1479.~.7./~ .................. Rev 4/79 Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE Pi~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? J0605 Z Permission is hereby granted to: ...... :..../.~: ...... ~..F~,~:~ ...... .../.~.~.....~.r..7.. .................... : ....... ~( ...... .... , . ~ ~ ~ ~ Z~.~ c ~ .. ~/~e~.~ ~. ~...~.... ~/~.~ C ....... ~ ....... ZL ............................................................................................................................... :: prem:~e: :o:md :~.~ .... ~CO.~.~ ....~Z ............................................ ............................................................ pursuant to application dated 4~.~........~-.....~... ................. , 19~.., and approved by the Building Inspector. m ,LZ.....~ .... Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, ~nd 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 F~re Underwriters. 4. Commercial buildings, Industrial buildings, Mutt~ple Residences and similar buiMings and installa- tions, a certificate of Code comphance 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 prewous 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 dwelhng or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ..~:.. New Building ~ Old or Pre-existing Building Vacant Land Location of Property..~..{~;.'5'.... ~.'~.~'.~..~... ...... .~,..~/'.,, J~f .~O.l./.~'~,...r~....~ ......... House No Street ~ ~ ' Hamlet Owner or Owners of Property . ~J)~.~... ~...~1<,.~..~.... ~ ~L.¢~?~ ..................... County Tax Map No. lO00Section ..!.l.? ........ Block ...... ~ ........ Lot .... I.~. ......... Subdivision ................................. Fded Map No .......... Lot No .............. Permit No...~..O.6.~)~. :ZE)ate of Permit ~'O' ." .~. 7.'.~.~Applicant... ~--JJ... ~I~'.C~ ~"~?. ........... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate . ,~N ................... Fee Submitted $ .... .~.'"~ .'? .................... Rev. 10-10-78 Construction on above described building and permit meets all applicable codes and regulations. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRIC:ITY~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 in the following location; ~ Basement FIXTURE RECEPTACLE~1 SWITCHES OUTLETS DRYERS ~ 1st FI [] 2nd FI. Section Block Lot and fouud to be in compliance with the requtrements of this Board. FIXTURES OVENS EXHAUST FANS SYSTEMS NO OF FEET OTHER APPARATUS R · I C AWO' OF CC COND AWG OF HI-LEG NO OF NEUTRALS AWG OF NEUTRAL Alexal~d~r G. Habbard Dox Aquebogue, N.Y. llbf31 Lie,304 E Th~s certificate must act be altered in uny ~anner, relurn to the offKe of the Board ~f incorrect, inspectors may be identified by cop~ ~OR S~LmNe ~N ~ credenhaJs FIELD !i~SPECTIbN CO}~ 116_, PS , FOUNDATION (Ist) FOUNDATION (2nd) 2. ROUGHFRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY COpE 4. FINAL ADDITIONAL COMMENTS: [iF NOTIFY BUILDING DEPARTMENT AT 755-~8,,']2 9 AM TO ,~ PM FOR THE '=OL! '", ''~' ? ]. FOU"-A:I,~N - T\¥O REQUIRED 2 DOU~'q - FRAMING & PLUMBING 3. IN~ULZ~-IDN 4. FINAL C2?;~U~'rION MUST BE CC;s'OLETE FOP, C O. ALL CO~,S~RUCTiON SHALL MEET THE REQU:RE,%~NTS OF THE N.Y. ~ATE CONSTRUCTION & ENERGY CODES. NOT RESPONS(BLE FOR DESIGN OR CONSTRUCTION ERRORS. i FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TELx 765-180;~ Disapproved a/c ..... ~ ................. .~ ......./ / (Building'Inspector) APPLICATION FOR BUILDING PERMIT /2-.F. Date . . ~. .............. , /cCc ;;- Application No .................. 19 .~. ? INSTRUCTIONS a. This application must be completely filled m 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 wluch is part of this appli- cation. c The work covered by this applicabon 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 avadable 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 iaws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessaw inspections. State whether apphcant is owner, lessee, agent, architect, engineer, g__enerat contractor, electrician, plumber or builder. Nmne of ow er ofprenuses . . / ........ :'. ............................................................ (as on the tax roll or latest deed) If apphcant is a corporation, signatnre of duly authorized officer. (Name and title of corporate officer) Builder's License No .... .~....~.~.. ........... Plumber's License No ....................... Electrician's License No .... ~..t/.). .~. ............ Other Trade's License No ..................... 1. Location of land on which proposed work will be done .................................................. .............. ......................................................... House Number Street Hamlet County Tax Map No. 1000 Sectmn ..' '~"/'7 .......... Block...~...~: ........... Lot..O./, .O .............. Subd~wsion .................................... Filed 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 ..... .~.../7..~.....-/7..e..~7. :~.....fi"~ ~f ~'~e * · -e b. Intended use and occupancy .C?// -~ '-~t~ ,,,%..~. ~--/ ~,~r t/~ ,t c~ ~ .~.. ............ 3. Nature of work (check which applicable): New Building .......... Addition .: ........ Alteration .......... Repair .............. Rem6vall .............. Demolition .............. ~ ~er~Work ............... (Description) 4. F, stimated Cost ....... ~xG/.~, .......................... Fee .... /.~t..~..~. ......................... i (to be paid on filing this application) 5. I f dwelling, number of dwelling Cnits ............... Number o f dwelling units on each floor ................ If garage, number of cars ..... ~ ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of e.xi, st~ng structurels, if any: Front ..... .~. ~. ...... Rear .... ~....~TT. .....Depth . . .~. ~. ......... Height ...... l.~ ....... NuN. bet of Stories .......... ! ............................................. Dimensions of same structure wlth alterations or additions: Front ..... .~.~Z~ ........ Rear ... ~....~T. .... Depth ..... 3. ~ ............ ~.. Height ...... It(... ,e .......... Numbel: o~Stories .... /. ................ 8. Dimensions of en. tire~ew construction: Front ..... ~.~,. ...... Rear ...'.~.'l~.. ...... Depth .. ] ~ ........ 14eight, . ..... J..~. ..... Num.b0r o~ Stories ........ ! ....... ,..~ ..................... ].,,../ ........... 9. Size o~lot: Front ......... .~.~. ....... Rear ....... ~.~/ ............ Depth .... /....~' .............. 10. Date of Purchase ........... i.. ].f.7~. ......... Name of Former Owner ............................. 11. Zone or use district in which promises are situated ..................................................... 12. Does proposed construction violate{ny zoning law, ordinance or regulation: ............................. 13. Will lot be regraded ......... ; ................... Will excess f~ll be removed fro, m l~remises: ~ Yes . ~Fo 14. Name of Owner of premises ~Q. [.~. ~ P..~. tl ./~f.~.u.(4~.~Address ~ .~.'~-..~..~./~.~-.~.~f?. r.~[~ne No.. ~ ~ff.'777. '.7 ..~... Name of Architect .. ~.' i~ P-4/(~7' . Address ................... Phone No. Name of Contractor. i.~.i i-'"" 't' · ' · ' ·" · ................. . Address~.~ .~...)~..7../.~..~.~¢./~one No. Locate clearly and dist property lines. Give street a interior or corner lot. PLOT DIAGRAM ~ctl.v all. buildings, whether existing or proposed~ and, indicate all set-bacl d block ~ ,ujnbe~0r description according to deed, and show street names dimensions from indicate whether STATE OF NEW YORK, .... ~'~c ~ COUNTY OF..~~ '~i:~'~'~I/'"~-'~1~ ~o ~' (Name df i~divid~al signing contracf) / above named, i He is e .................. (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 application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will b~ performed in the manner set forth in the application filed therewith. Sworn to before me this i ......... ,. .... lc, State of' New York L/ ' NO, 82.8125850, SuffotJ( County I Term E×01rea March 30,. 19.~.~