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Home My WebLink About11381-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall 5outhold, N.Y. Certificate Of Occupancy No..Z.1.4.2..8.8 .......... Date HaPch 1 9 ., 198.6. THIS CERTIFIES that the building .. ~.r~ ~ ~.o.a.e.d.. p.a.b. $. 9 ............................. Location of Property ...... 6.8. 0.. ;.R.U.~ .g.~.~.. P, ~.T.FI. ................. R,~ .8?..~.~ .~.?. ........ House No. Street Hamlet County Tax Map No. 1000 Section . .C~ $ .1 ....... Block .... .0.1 .~ ........ Lot 0 0 2 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated · ~ fi 1~.t. ·...8 ..........., 19.8. ]. pursuant to which Building Permit No. , 1. .1 .~.~. 1. .Z ............. dated ....... ~ 9 p,~.....2.1 ............ 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 ......... · En. ol oae..ex ~-a.t ~-~g..pa t ~-.o. .................................................... The certificate is issued to ... fl.0. H..~..~.~D...E.T.H.E..L..H.~.L..L.~.G.~.~ ............................ (owner, ~e~d~ Y~Y~]~ of the aforesaid building. Suffolk County Department of Health Approval ....... N./.~, ............................... UNDERWRITERS CERTIFICATE NO ............... N.~3 9 9.0.8 .......................... Rev. 1/81 Building Inspector (THIS PERMIT COMPLETION OF THE WORK AUTH~RIZEpi TOWN OF ~OUTI~UD~ TOWN'HALL SOUTHO~, BUILDING~ PEP~IT MUST BE KEPT ON ~HE PAEAIs~S UNTIL ~ULL N°. 11381 "Z Vote Permission is hereby granted to: premises Iocoted at County Tdx Mop No 1000 Section :...(.~...,?...(..:;.,~[;. Blo~:k Oursuant io appl[c~Hon~ doted .... :.. BU Idlng I~spector. ~ ...... , 1 .., end approved by the Inspector Rev. 6/30~80 ~ ~ ~ ~ FORM NO. 6 TOWN OF SOUTHOLD Building Departmen~ Town Hall Southold, N.Y. 11977 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and subr~itted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Final sunJey of property with accurate location of all buildings, property lines, streets, and unusual natural or toaograohic 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 building~ and installa- tions, a certificate of Code compliance from the Architect Ur Engineer responsible for the buiiding. 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 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. / 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 New-i~./~e-~., ..... Old or Pre-existing Building(:~) .. ........ =/Vacant Land - . ........ Location of Property. ,~.~',0 ........... .~.~. ~ .¢)~,ft,~... P¢~. ....... House N,2. S~ree~ Ham/et O~vner or Owners of Property .... /,O ~/' I~- ). County Tax Map No.,1000 Section . ,0.~L / ........ Bloo, .... ./7 ........ Lot.. One. ....... Subdiwsion... ~( ............................. Filed Map No ........... Lot No .............. P rm,tNo. OateofPermit .... ......... : ........... Health Dept. Approval .. ~ .................... Labor Dept. Approval . · ,"'. .................. ,.. Underwriters Approval ./~.. ~. ~."~. [ .d~'~ ......... P lanning Board Approval .................. Request for Temporary Certificate ..................... Final Certificat~ .... Fee Submitted $ ............................. Construction on above described building le~codes and regulations· FIELD INS?F,CTIO~ 1. "DATE COMMENTS (1st) . FINAL ADDITIONAL COMMENTS: FOUNDATION FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY qODE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY THIS CERTIFIES THAT only the electrical equipment ~ described below and introduced by the applicant named on ~he able a~plicatlon ~umber in the pre~nlses of in tbe.followlng location; ~ Basetnert~ ~ 1st ~. ~ 2nd Fl. Section BIoc~ Lot ~o~..~i,~do,, Oc~ 19~ ,1,98t and found to be iu compliat,ce wlth the requirements of tbis Board. FIXTURE FIXTURES RANGES COOKINGDRCKS OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT DRYERS OTHER APPARATUS; S E R OF CC. COND I C E NO OF HI.LEG A W, O, NO OF NEUTRALS A W.G. OF HI-LEG OF NEUTRAL 42-D ~m~ll La. Per i . This cerfificote mos* no* be ol~ered in any monner; retvrn *o the office o} *he Boord [[ incorrect, Inspecto[s m~y be identified br *he,r ~credent~als. COPy ~OR B I~OiNG DEPARI'it~IENT. THIS ,COPY.OF~ CER,THqCATE MU~T NOT BE~,LTERED,~IN ANY MANNER. TEL. 765-1802 OFFICE OF BUILDING INSPECTOR Box 728 TOWN HALL SOUTHOLD, N.Y. 11971 To Whom This May C ncern, We are unable~to complete your Certificate of Occupancy because ~of the following reasons. /Z/ An application for Certificate of Occupancy is not on file. /~/ No Underwriters Certificate on file. /~/ The check is(outdated/not on file.) ~°--° /~/ No Health Dept. Approval on file. /5/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. Building Dept. No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because.of the following reasons. /Z/ An application for Certificate of Occupancy is not on file. /5/ No Underwriters Certificate on file. /~/ The check is(outdated/not on file.) ~ /5/ No Health Dept. Approval on file. /Z/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. Building Permit ~ [ [ ~ ~ I Z ~ Building Dept. ***/5/ No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 76.5-1802 sappro¥0 e ....... '. .... :- ........................ /' APPLICATION FOR BUILDING PERMIT Date ................... 19~¢/ INSTRUCTIONS a. This application must be completely filled in'by typewriter or in ink and submitted in triplicate to the Buildi Inspector, with 3 sets of plans, acct~rate plot plan to scale. Fee according to schedule. b. Plot plan showing location o1' lot and of buildings on premises, r~lationship to adjoining premises or public strer or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this ap[ 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 porn shall be kept on the premises avaihtble for inspection tl'.roughout the work. e. No building shall be occupied or nsed in whole or in part for any purpose whatever until a Certificate of Occupan shall have been granted by the Building Inspector. APPLICATION 1S tIEREBY MADE to the Building Department for the issuance ora BuildingPermit pursuant to t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, fo~ the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and aehnit authorized iuspcctors on premises and in buildings for necessary inspecti9.n~ __//~7/// (Sig~'~u~e/~4/_ ~ /~OY ~-¢~r::~¢~ .¢ ~/°f applicant~J:~r n gms6, if a corporation) . . .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bnild. : (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 L'cense No..-.~."?..J~. ................. Plumber's License No ......................... Electrician's License No. Other Tratke's License No ...................... 1. Locati~Sn of land on which proposed work will be done ................................................ House Nmnber Street Hamlet County Tax Ivlap No. I000 Section ...~.. ~ / ........ Block ...... /..~. ........ Lot ..... ~...~. 2 ..... Subdivision ..................................... Filed Map No ............... Lot .............. (Name) 2. State existing use and occupancy of premises and intended usc and occupancy of proposed construction: a. Existing use and occupancy ~..~/(...~_ gt~"~_.~./_/~./. ~¢////¢,..¢:~.,~ . , !. Nature of work (checkwbicl, applicable): New Building .......... Addition......t"/ .... Alteration ......~1... Repair .............. Removal .............. Demolition .............. Other Work ............... ~.~_~_. ~ ('-/ (Description) Esti;natcd Cost ...~...,,r~...,-'~.. ......................... Fee .../?. .............................. - (to be paid on filing this appIication) If dwelling, number of dv.'elling units ............... Number of dwelling units on each floor ................ If:m,a:~c, ,111 .... r o cars ................... , ..................................................... If business, commercial or mixed occupancy, spe6il~y ~ature and extent of ca'ch type of use ..................... I)i:uension~ o1 ex;sting slmctures, if any: Front ............... Rear .............. Depth ............... I leighl ............... Number of Stories .... d'O.-~, ............................................... Dimensions cf same sm~cture with alterations or additions: Front ................. Rear .................. Depth ...................... Ileight ...................... Nmnber of Stories ...................... ,. Dimensie::s of entire new construction: Frant ...: .,...,, .... ~.,.',., Rear ............... Depth ............... I Ieight ............... Number of Stories ........................................................ h Sizcoflot: Front ...................... Rear ............... · ....... Depth ...................... ). Date of Purchase ............................. Name of Former Owner ............................. I. Zone or use district in which premises are situated ................................... : .................. 2. Does proposed construction violate any zoning la;v, ordinance or regula,on. .... L Will lot be rq_.a,..d ............................ Will excess fill be removed from premises: Yes No !. Name ofO,.vner ofpre:ni?.'s .................... Address ................... Phone No ................ Nam: of Architect ........................ :..Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAG RA.M Iocate clearly and distinctly nlI otmdmgs, whether ex:sting or proposed, and indicate all set-back dim~.nsions from :opcrty l/nos. Give strzzt and block number or description according to deed, and show street names and indicate whether Iclior or corner lot. 'FATE OF NEXUr~RK~, / OUNT, sis , ....... being duly sworn, deposes and says that heis' t,l~'" appll~..nt'^~ e is the ontractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed tho said work and to make and file this >plication; that all statcmc;us comaincd in this application are tru,: to the best of his knowledge and belief; and tlmt the ork will be performed in °.he manner set forth in the application filed therewith. worn to before me this .............. ~ NOTARY PUBLIC, Stq~ of New YOfI~ ( ' ~ (S'' 'i~mature ~o. 52-8125850, Suffolk Coujll~.~ Imm Ex~ires March 30, 1~.~...~ 4