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Home My WebLink About11515-z FORM NO. 4 TOWN OF SOU~-HOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...Z1.10.43 ..... Date June 23 .82 .................................... 19.. THIS CERTIFIES that the. building ............................................. Location of Property ...45.5 .......... .S.t, QDy..S. bg?.e..D..v.iy.e. .......... Southold House No. Street ........... County Tax Map No. 1000 Section . ., 05.~ ..... Block . . .0.~ ........... Lot ,..q~.~ ........... Subdivision .... S~horec.r. esi; ............... Filed Map No. , .5..5.8.4..Lot No.. 4 . conforms substantially to the Application for Bu!lding Penuit heretofore filed in this office dated ..... De.oombe,t'..8 .... , 19.. 81}ursuant to which Building Permit No. 11515 Z dated ...... De.cerabe.n. 16 ......... 19..g3~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 ......... d.w.e 1 ling ..... a..pri.v.ate, o~e-. f~Y ......... ,, ....................................... The certificate is issued to ..... A~k~.:[ .K..a.l.e.~.d. 9.r'.i.a.n..& .~.',a.d.u.~. KliJi. an fowner, les~e.~-te¢~'~)~.~ ................... of the aforesaid building. Suffolk County Department of Health Approval ... JJ..~..-.1.3fi. ~ 6/16/82 ~ UNDERWRITERS CERTIFICATE NO .... Iq 565336 ..... %.-~.. ,'~4/b4.-.q~... ?. .... f,. ~'~' ~ Building Inspector Rev. l/S1 BUILDING PERMITi , (THIS PERMIT MUST BE KEPT ON-T:H,E PRE IS~S UNTIL ~UL coMpLETION OF THE WORK AUTHORIZED) ii }, i · , ~.~,. &../ Per~issiod is hereby granted to: ','. ~ } ....... ~....~,....E~,~..~,~ ~o ..~.~~....,~.~xc¢..~~...~ ........... ; .......................... ...... ; ......... ~.~ ..... ~ ~..~s~ ~ ...... , ......... ~ .................................. ~ ~ ~ ~' ; .~~~~....:..~ ........ , ...... ~4~....~..,....?., .......... ~ ........................... ' C~un~ T~x ~op Uo. I000 S~chon ...~.~...., *lockl?~..,..,....~kot No. ~2~ .......... pursuant to appl cat on dated .~ ~ ......... ~ ............. ;,...a....., 19 .., and ~pprov~ by the 8uil(Jlng I~spector. : e¥. &/30~80 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, 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. 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 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 2o 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(Z) ........... ~/Vacant Land i ........... Location of Property ~ O~ ~ u ~ Hou~ No. Street Ham/et Owner or Owners of Property ~ ~¢ ~'/ ~ ~ ~ CountvTax Map No, 1000Section .. ~,~:.~ ..... B,ock ...~ .......... Lot...~. ....... ~~~ No ~ ~.~ kot ~o~ ~ .. HeathDe t A nrova /¢'~O P · P, · .......... , .~ .~¢ .~..,~ .¢Labor Dept. Approval ......... ~ ............... Unde~riters Approval .%~ ......... Planning Board Approval ........ Request for Temporary Certificate ~ .... Final Certificate Fee Submitted $ ....................... Construction on above described building and per,~it~m, ee~s all a~able~co.de~ and regulations, /. ~ / , - , FIELD IN~ P EC~iON DATE COMMENTS FOUNDATION (1st) , FOUNDATION (2nd) __ FLUMBING INSULATION PER N. Y. ~ STATE ENERGY CODE ADDITIONAL COMMENTS: ~000805 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITy 85 JOHN STREET, NEW YORK, NEW YORK 10038 v.t. June 15, 1982 Appl,~.t,.n No. o, S.e 1608 '].-82 N 5 6 5 3 3 THIS CERTIFIES THAT only the electrical equiptnent as described below and introduced by the applicant named on the above application number itt the pre.rises of T.G,M. Const~ion, N/E/C Stony Shore D~Ive, & Wild Cherry Way, Southold, N.Y. in the following location; ~ Basement [~ st FI. ,~,,sexa,n~.edon J~ 3, 1982 FIXTURE OUTLETS 2O RECEPTACLE~ 39 SWITCHES 23 20 [] 2nd FI. Section Block Lot and found to be in compliance u~ith the requirements of this Board. FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS FLUORESCENT DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI.OUTLET DIN~N[ERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R V I C E OTHER APPARATUS: 1-Sm~e De~ec~or A. W G NO OF NEUTRALS A W, G. OF HI.LEG OF NEUTRAL 4 WarremSeott Ele~. Co. Inc., Box 907, Lake Ronk~, N.Y. 1,1779 [,:Lc: 498E COPY FOR ANY MANNER. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved/~.~:C.,..../..~ ..................... , ]9 .. permit No.././....~....../..~.. ................. Application No. /..~...~..~..~.~... ............... Disapproved a/c .................... ...~..i...i~.-~.. .......................... ......~, ....................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o¢ i~ 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 fo adjoining premises or public streets or areas, and giving a det(~iled description of layout ofproperty must be drawn on the diagram which is port of this application. 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 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 oil 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 name, if a corporation) ........................................................................... L.~..'CF~..¢ ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........... ....................................................................................................................................................... Name of owner of pram ses ........ ...... ........................... If applicant is a corporate, signature of duly authorized officer. (Name an~l"~Tt'l'~'~'Fo'~:l~orate officer) Builder's License No ..................................................... Plumber's License No ............................................... Electrician's License No..~/..(.~.....& .......................... Other Trade's License No ............................................... Location of land on which groposed work wdl be done ..... u ,~ ~/~..~...~ · · ~ ..............Lot No. ~g,~.~. .......... Street and Number ....~...6~.?.] ......... ~.:~...~..~..~. ...... ~.j.~...o....~.~ ....... ~)..~.~.~7 .............................. ..~..9..?.:.~.:~.~.?..~....~...: ..... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .....~.~...~....C-~...~.....~......~T~.. ........... ..L:..,.~...~...~j~ ........................................................ i .............. b. Intended use and occupancy ~k, I ~ ~ ~ ~ '~'~ 3. Nature of work (check whichiapplicable): New Building,. ........... Addition .................. Alteration ................. Repdir .................. Removal, ..... Demolition .................... Other Work ................................................ .... J [ ~ (Description) cot .................................................... ee .................................................................. 4. Estimated 000~ ' F ' ~ ~ , (to be paid on filing this application) 5. If dwelling, number of dwellilng units .....~, .~...~.~.. ........... Number of dwelling units on each floor ............................ If garage, number of cars ..... ]~..1~,...~."~. ............................................................................................................................ 6. If business, commercial or ~mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structqres, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ , / ...... ~'~..~. ............... Depth .....'~.....0.. ............. 8. Dimensions of entire new construction: Front ....... ~"/¢. ..................... Rear , Height ....,~.,.~?-r.f. ..... Numbe~ of Stories ...... ~.. ,1~,..~.,....,' ............................................................................................. 9. Size of lot: Front ............... ~ ...................................................................................... t- .......................... 10. Date of Purchase .... L~....~...li ....................................... Name of Former Owner ....... .~...~...~.J(.Eh..(~..J~,. ............................ 12. Does proposed construction violate any zoning law, ordinance or regulahon: ...... ~ .................... .....~ ................ 13. Will 'lot be regraded' .......~...'~" .............. Will excess fill be removed from~._~remises: ( ) ,V, es (,,V) No Name of Architect ...~.~,..~..~'~.. ................................... Address .'~./~.~.i. k4~.¢.~..... Phone PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-b~ck dimensions from property lines. Give street and bl~ck number or description according to deed, and show street names and indicate whether interior or corner lot, ' STATE O~ NEW Y(ORI(,-- .cz' i ~ e , (No me of indi~/idu~JJ~gning contracO : ' above named, j~r He s the ........ lJ ................. ~..'~ ................................ ; .............................................................. :" ~k.Cont, roct..~agent, corporate off, car, 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 be performed inlthe monne, r set forth in the application filed therewith. 14o. 5~-8125850, Suffolk Co~..__ Term I~xpires March O, 19~ unty ....~..s ............................. · 4~ .:~.~.~' ............................. (Sign~re~pplicant) ~,BETH ANN NEVILLE -" UBLIC, State ~f New York ~ , ,/