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Home My WebLink About11510-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..z.1.1.4.8..~ .......... Date February 1 ? 1983 THIS CERTIFIES that the building add±tion Location of Property . .5./~.8.9.5. Main [toad Southold House No. Street Hamlet County Tax Map No. I000 Section . .0.6..2 ....... Block ...0..1 .......... Lot 004 Subdivision X X ............................... Filed Map No ......... Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... D.e. 9.e.m.b. 9 ¥' .4 .... , 19 .8.1. pursuant to which Building Permit No.. 1. .1 ~.I.Q..Z ............ dated .............. Decembep. .............. 11 19.8.1., 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 ......... an addition to building for storage--clothing shop. The certificate is issued to J.H.R. EDZARD VAN HOLTHE ..................... [oYn'~;, '~'d~' drZ~bb'~'d ..................... of the aforesaid building. Suffolk County Department of Health Approval n / a UNDERWRITERS CERTIFICATE NO. N 552705. . . Rev. 1/81 FO~ NOo ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 11.510 Z Permission is hereby granted to: ....... ~.:..~.,:z¢.~.......-2~......~-.:~,..~ ....... ~.~z~.....~..~..~ . ....... ........ to ........ ,~.~.z~.~..~4~.~.,...,.~.~zc?.~...../..~. ....... ./..-<~c~......~..~..........~..¢~....,.,~,~ ..... ........................... ~.....~.../.Y.-....~....~-.~.~...~&~.~...~..~ ....................... at premises located at ...~.,,,~.,.~,,,~.,,~,,, ........... X~. ,,e~,Zx~......~....' ................................................... ..................................................................................................... .~,~/**-.~.~...=~..~ ,~*** ....... County Tax Map No, 1000 Section ...~..~.....~... ........ Block ....(~.../. ............ Lot No..(~.~......~/. .......... pursuant to application dated ..~..~.. ....... ~ ........................... , 19 ........ , and approved by the Building Inspector. Budding Inspector Rev. 6/30/80 ')=ORM 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. 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 buildi'ngs 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, 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 ..... New Building .. ,~&,~.&.o,~,.. Old or Pre-existing Building(X) ........ ~. fVacant Land -i ........... Location of Property ..5..,h:.8.9,5, ...... ~l~J.~t.n.. ~.&. ..................... .8p~.t.b..o.l,,et~. ~.e.~,~.9.r.t~; ...... House No. Street Ham/et Owner or Owners of Property ...0'. ~ .R..~.(tzar(l...V[~.n._.Ro..]..the ................................. County Tax Map No. 1000 Section .... 0~2, ........ Block .,. p;l, .......... LOt.. ¢¢.b,~ .......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No..I.;I ,¢.~.[.?. , . Date of Permit . !~j.'!~'f...Applicant. G.e¢..v~;,e. ~. ~8~tlz¢;c ................... Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval ........................ Planning Board Approval .................. ~ ,., Request for Temporary Certificate ..................... Final Certificat~ .. ;[.;...- ......... ................ · "-'" i ' ~,'~/~ ' i~: :' ~' J. OUUT?iTHE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 o.,. March 3, 1982 THIS CERTIFIES THAT only the electrical equipmeoJ~tls described.~elow and.il~tl&oil~c~d bx.t~e ap~f~t ltall~ed_on the abq~ve applic~tion.nu~er il~ t~ premises of w.~ .~,ni..d o. March 1, 1982 .x~u.~ .x~ua~s OUTLETS FLUORESCENT 3 [] 2nd FI. Section Block Lot and found to be in compliance w~th the requirements of this Board. RANGES EXHAUST FANC~ DRYERS OTHER APPARATUS: SYSTEMS S E R V I C E NO, O~ERCC~COND. OF Acc,WcoND.G' NO. OF HI-LEG oFA Hi.tEGW G. NO OF NEUTRALS A, WG OF NEUTRAL - P.O. l~ox 143, [~, Th~s cerhflc~te must ~ot be ~lte~ed i~ ~ monner; return to t~e office of the Board ~&~D~N~ .~EPAETMENT~ THIS CO~Y 0~ CE,T~CAT~ M~ NO~.~. ~[~EE,.D [~. AN~:~MA~NE~, FIELD INS P~ECT I/~N COMMENTS · FOUNDATION (1st) FOUNDATION (2nd) FRAME & PLUMBING ROUGH INSULATION PER N. STATE ENERGY C~DE FINAL ADDITIONAL COMMENTS: O'OOg 'dDOD 9;wc/?~l t M,,Oc,O_qo 0 N ¼4 "~ " FORM NO, 1 ~, TOWN OF SOUTHOLD ,. BUILDING DEPARTMENT TOWN HALL SOUTHOLD, FLY. 11971 TEL.: 765-1802 E x a m i n e d ~_~_./-....-..~.0 ..... 19~../. Al~plication N o/.t/.~.~/.~. ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to thc Bv~Jd Inspector, with 3 sets of plans, accurate plot plan to scale. Fde accoi-dino~ to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stre or areas, and giwng a detailed description of layout of property must be drawn oll the diagram which is part of this ap: cation. c. The work c-overed by this application may not be commenced before issuance of Building Permit. d. Upon apprc.'al of this application, tile Building Inspector will issue a Building Permit to the applicant. Such per~ shall be kept on the premises available for inspection throughout the work. e. No building shall be o~cupied or nsed in whole or in part for any purpose ia, hatever until a Certificate ~f Occupar shall have been granted by the Buikling Inspector. APPLICATION IS HEREBY MADE, to the Building Department for t~, ;uance ora Building Permit pursua~.~ to ~ Building Zone Ordinance of the Town of Southold, Suffolk Co~inty, New x" <, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or ~!t4rations, or fo(removal or demolition, as herein descfib The applicant agrees to comply with ~i1 applicable laws, ordinances,~ilding code, ho~sing code and regulations, and ~----~~e ot"~plicant, or name, i} a corpo;ation) (Mailing address of applicant) - State whether applicant is owner, lessee, agent, architect, engineert/~'a-fffir~a'F'contract--'-"~'-~ electrician, plumber or build (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 Licens: No ........................ Electrician's License No.' . ,/..,-.. :.<.~..~'ff~/'~ . Other Trade's License No ...................... House Nrumber ............. Street Hamlet County Tax lVlap No. iO00Section ...O.~.c~ ....... Block .../. .............. Lot PC,~.,..¢ .... Subdivision Filed Map No Lot (Name) State existing use and occupancy of premises and intended usc and occupancy of proposed construction: a. Existing use and occnpancy ........ O ..... · .......................... Repair .............. Rc~inoval .............. Demolklon .............. Other Work .............. (Description) ' (to be paid on filing this application) {. If dwelling, number of dwellihg units ............... Number of dwelling units on each floor ............... Ifgarage, number of cars ...' .................................................................... ~. If business, commercial or mixed occupancy, specify hature and extent of each type of use .................. L Dimensions of existing stmctt{res, if any: Front .......... ' ..... Rear .............. Depth ............ Height ................ Nthnber of Stories ..................................................... Dimensions of same structure iwith alterations or additions: Front ................. Rear ............... Depth .................. ~ ....Height ...................... Number of Stories ................... ~. Dimensions of entire new con~truc/ion: Front ...... '. ........ Rear ............... Depth ............ Height ............... Nt[mber of Stories ..................................................... }. Size of lot: Front ............. '.' .......... Rear ...................... Depth .................... ). Date df Purchase ........ , .................... Na'me of Former Owner .......... ~ ................ 1. Zone or use district in which kemises are situated ................................... :; ............... 1. Does proposed construction v olate any zoning law, ordinance or regulation: .............................. ~. Will lot be regraded .......... ' .................. ~ill excess fill )e removed from premises: _ Yes L Name of Ov,'ner of premises~ ~..~.~ddress .. ~O~ ..... Phone No.~--. Name of Architect ................. . ......... Address . "~'~ '~' . Phone No ........... '.. N~ne of Contractor .S.. Address ~ ~f Phone No pLO$:~I~GRAM Locate clearly ~d distinctly ~uildings, whe'~her existing'b?~Ofbposed, and, indicate ~1 set-back d~ensions fron roper? Unes. Give street and gl~mber or description according to ~d show~eet.names and indicate whethe T^TE OFNEW,YORK, OUNTY OF.. .EW. s.s .... .5'.:... 4t¢,~ ................ being duly sworn, depos.es and says that he is the applican ,~' (Nanie of indMd.ual signing contract) (Gbntractor, agent, corporate officer, etc.) said owner or owners, mid is d!dy authorized to perform or have performed the said work and to ~/i~/¢ke and file till ~pli,cation}~th,at all statements co'ntained in this application are' true t6 the best of his knowledge and be~j. gf;.and that th 'gr~k~fll 'be perfortned in the mdnper set forth 'a~ the application filed therewith. ~$m to before hie this · ~ .day ~f....~...-~.. ?.'.~..~.~..~..., 19 .?. [ ~o 52 4524771