The URL can be used to link to this page

Home My WebLink About11517-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Sou(hold, N.Y. Certificate Of Occupancy No... gJ.1.7.5~ ........ Date . .d.u..n.e..2.6. ....................... 19 .8.3. THIS CERTIFIES that the building .c la ~r~ne y ....................................... Location of Property., 5.0.605 .................... I~ ~ $ .n..~ d., S o u t h o 1 d rtouse No. Street ...................... ~t~r~l'e~: County Tax Map No. 1000 Section . . .0.7.0 ...... Block ....0.1 .......... Lot ....0.0.~. .......... - Subdivision ........ x ...................... Filed Map No...x ...... Lot No ...... .x. ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated · .I~ecemher..1.~ ....... 195.1. pursuant to which Building Permit No .... 1. l .5.q.7. g. ........... dated . J).e g 9 ra.b.e v...1.6 .............. 19~3 ~., 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 .c.h. ~..m.n.e.y.. · .on. e~5.~ l,.t~g, d~.e. 1 $ ~ng ...................................................... The certificate is issued to ........ ~.t~ e p h.e.n, d ....P. e r r &C ~ ~ ~ ........................... (owner, ~e~Sto~ ~e!~e,(~) of the aforesaid building· Suffolk County Department of Health Approval ...... ~ o.g..~, e q~.~P. ~ ct ...................... UNDERWRITERS CERTIFICATE NO .............. ~ ~).g..v. e ~1 ~.~. e ~ ...................... Rev. 1/81 Building Inspector ~o~ NO! ~ ~ BUILDING DEP.~ SOUTHOLD, N~. Y. BUILDING, P, ERMITi~ (THIS PERMIT MUST BE KEPT ON TH, PR IS S UNTIL L COMPLETION OF THE WORK AUTHORIZED) i · ~ 11517 Z Permissiorl is hereby granted to: .. .,, . . ............... ?...~ ................ ~'. .................... ~ ..... .,, .......... !.:.:~,~ .......... ~ ........ ~ .......................... ~t Prem ses mcatea a~ ........................ ; ...... , .... .... ~' "./" '" ....... """~ ......................... ...... , ......... ~ ................................................................ ~ .............. ?.,.;~ .............. CounW Tax Map No 1000 Section ................... BI~E ~. ..... '..-.~ ........................ pukshant {o application dated .. ;....(.~......~....:..:...~...: ...... 1 .,, and ~pprov~ by tho 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" ~and uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusua! 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 I 2. Certificate of occupancy on pre-existing dwelling ~r land 3. Copy of certificate of occupancy $1.00 use $/s"//$5.00 Date ....... New Building ............. Old or Pre-existing Building(Z) . _.~ _~/Vacant Land'i, ............ i Location of Property ..... ~'~,-~,~..~.Or~.. ....~ ./~..... ........... ~.~.~.. ...... Hous~No. I~/ ~ .Street Hamlet CountOWner or Owners of PropertYTax Ma No 1000 Sectlon~~"'~- l~.~.~ · ............................. Y P · ' ...0 ........... Block .... (~../. ,...'i, . Lot.. J~..~..~.. ..... Subdivision ............... /~'~. ................ Filed Map ~ ~' , No...~ ..... ..Lot No..;': .......... Permit No. [¢'~-./..~.."~-Date of Permit · .~,~'/.¢-/~,Applicant ~ ~~: ................. Health Dept. Approval " ~ .Labor Dept. Approval o,. Underwriters Approval ........................ Planning Board Approval .. ,-; .............. . , .~ · Request for Temporary Certificate ..................... Final Certificate ................ Fee Submittod $ ...... ,,,~c~...~ Rev. 10-10-78 TO~VN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 i,~o ?~T iON FIELD COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY QODE FINAL ADDITIONAL 1000129 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY~ ~ ~kCu~t 24, 1982 ss JOHN STREET, NEW YORK, p ,i tion o. Si, N 573952 THIS CERTIFIES THAT only the electrical equipment as dezcribed below and introduced by the applicant ~amed on the above applica~ior~ number in the premises of Steve Perr~c~e, 48775 t,~a~ ~d., Southold, N.Y. in was exatnined on and found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES OVENS OUTLETS SWITCHES FLUORESCENT EXHAUST FANS DRYERS SYSTEMS E OTHER APPARATUS: E R V I C NO OF CC, CONO PER ~' OF CC COND. AWE OF HI-LEG NO OF N~UTRAES l~Liddle Island, N.Y. 11953 Lie. 1858g ANY MANNER. FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined~...../..~...., 19 .o-~../. .... , l .Permi, No../. Disapproved a/c ................................... ,'/ ' / v_ (Bffil~'ing Inspector) APPLICATION FOR BUILDING PERMIT Application No..~./?.~.~.//.: ........ Date ...... /~.~¢ ...... 19 ?..( 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 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 pa~t 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 cod~, housing 9qde, and regulations, and to admit authorized inspectors on premises and in buildings for necessary insp~c~)~ns/~ ~/{~ ff~# ~,~ ,///~'~J ', ..... .......... (Signatute of appl~an?], or n~tme, if~ a cor. p/ora,ti57n) (Mailing address of applicant) ' -; State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... ............ ............................................................. Name of owner of premises ...... ,,/,t-.4~, ~.. ~ ........................................................ (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 ....................... Other Trade's License No ...................... 1. Location of land on which proposed wo~rk will be do, de .................. ~ .....,v. · .2 t~ ..................... House Number Street Hamlet Oo County Tax Map No. 1000 Section .... ~ ~:. Block ..... -~.t. Lot. ~.. ........... Subdivision ........ :'..: ......................... 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 · ................................ ............. .. J b. Intended use and occupancy ~..~..~. ~_....~///..,.,',.~ 'Y-d,/~ ~..~.~,~..~C~.. ' 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteratiqn t0~ ~...~ Repair .............. Remqvai ........ ...... Demolition .............. Other Work '.C~ .~. :.. i i (Descrila~6n) 4. Estimated Cost ............. '~'.~.t~.. R..~. ............. Fee ...................................... i : (to be paid on filing this application) 5. If dwelling, number of dwelling Cnits ............... Number of 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 existing structures, if any: Front ............... Rear .............. Depth ............... . Number of-Stories ........................................................ Height .............. Dimensions of same structure w!th alterations or additions: Front ................. Rear .................. Depth. ................... i. · Height ...................... Number of Stories ...................... 8. DimenSions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... N~l:14b e r of Stories ............... 1.-~ ........................ ............. 10. Date of Purchase ...... [[./..~. [.~ .............. Name of Former Owner . ;~.. ~.~2~z ............ 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction vinhte anti ~z~ning law, ordinance or regulation: ...... /~. (~? ..................... 13. Will lot be regraded ....... ~.i~Y~f.. j.~..../]., a .... Will excess fill.be remov~ed fro~ premises: ,- ~es No Name of Architect ........................... Address ................... Phone No ................ Name Of Contractor ......... i ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block umber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ·...>.ct./~.W~ .x~..... OF COUNTY --~'.~.C~..~..~[2. ~ . .~..~..Z.~..~'~... being duly sworn, deposes (Name of individual signing contract) above named. and says that he is the applicant He is the ...................... i ................................................................... , (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 conthined 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 . ......... .I. ........... .c . ..... , . . . . ...................... ~O'rAF~y PUB£1C, State of ~ew Yort{ Q t,lo. 52172, 771