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Home My WebLink About11383-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin~ Inspector Town Hall Southold, N.Y. Certificate Of Occupency No..~.1. I. 0.2.0. ...... Date ......... ~.qBe. 4...... ............. 19~:~. Tills CERTIFIES that the building ............................................. ,... Location of Property . ?.0.5. ............ :.4.a.p.]:e.. ~.a.~.e. ................... .H.a.~ .:.:L.t,.u.c.~ .... House No. ,,Ctreet Nam/et County Tax Map No. 1000 Section . .1.q7. ....... Block .... 0.2. .......... Lot . .'..0.1.2. .......... Subdivision....X. ......................... iF/led Map No...X ..... ..Lot No. conforms substantially to the Application for Build/ng Permit heretofore fried in this office dated · .3..e p.~.e.m..b.e?.. ! .0 ..... ,19 .8.1. pursuant to which Building Permit No .... 1. 1..~.8.3...Z .......... dated ..... .3.e.E ~. ~ .~.b.e.~...2.2 ......... 198..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 ......... a.n..a.cc.e.s..s.o.r.~ ~ara&e. The certificate is issued to Alfred E. & Claire M. Bouffard (owner, ~ of the aforesaid building. Suffolk County Department of Health Approval ..... n./..a .................................. UNDERWRITERS CERTIFICATE NO .............................................. Building Inspector R~w. 1/81 N? ~1383 z TOWN BUILDIN~ TOWN ~H~rL sOuTHOLD, N~ Y BUILDING FER~iT (THIS PERMIT MUST BT KEPT ON' THE pI~EMIS~S UNT!L COMPL~ION OF THE WORK AUTHORIZED) / .~.,. ......... tLot No. ~,, I~.'. ~..i, 19~ .~.~.~., and ~pproved by the 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, 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. 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 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 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ..... New Building ............. Old or Pre-existing Building(X) ......... ~/Vacant Land '~ ........... Location of Property /c~,O.~-,~.-. ~ ........... ~i~r~. ~5' .... ~ ............... Hamlet House No. · Owner or Owners of Property . ~..~. ~ ~...~.~drJ~...'J~.(~.O.~'-~i~ ................. County Tax Map No. 1000 Section .... ~O. ?. ...... Block. .... ~ ?~-, ..... Lot...~. ?..~ ....... Subdivision ..... ~ ........................... Filed Map No ........ ~.ot No .............. Permit No./.~'~.~..~.. Date of Permit .Applicant...~...~.., .~..~'. ...... Hea~th Dept. Approval ........................ Labor Dept. Approval ...................... Underwriters Approval ,/~...??.. ~..~'...~. ....... Planning Board Approval .................. Request for Temporary Certificate ..................... Final Certificate ................ Fee Subm'itted $ ............................. Construction on above described building and permV~mee~s all app~cabie~code~ and regulations. THE NEW YORK BOARD OF FIRE UNDERWRITERS P~' BUREAU OF ELECTRICITY ~-- 85 JOHN STREET, NEW YORK, NEW YORK '10038 THIS CERTIFIES THAT only the electrical eou!~ment as described belo~v and i~troduced b~ the ap~gllcant named on the above application number i~ the premises of · ~ed *% l~a~£a~d, ~p~e Lane, [~o. Kd. (27A) & M~i Rd., l~at:t::Ll::~c~, in thefollowing location; [] Basement [] 1st FI. [~ad FI. g~e Section ~O~lock 02 Lot was examined on ~- ~-9 , ~.9~ and found to be in compliance with the rdquirements of this Board. FIXTURE FIXTURES RANGES OOOKINGDECKS OVENS DISH WASHERS EXHAUST FAPIS 9 ].5 7 1 8 [' SYSTEMS/ SERVICE DISCONNECT NO. OF S E R V I C E Pmaelboard/8:1-4cir. lOOamp. Alfred ~. Bouffaru IV'~ple Lane, ~ox ~,0:," [v~C£~' N°Y' llg~2,'.ust not be a,tered in i~P This any manner~ return to the office of the Board f ~ncotrect Inspecto may y mr credent als ~ BUIL. O~ING DEPARTMENT. THIS COPY OF d~ERTIFIC'AT'~i~:M~m'~g~u~?, -~ ~'~-.,",. ,~' ........... FIELD INSPE~CTIO~ FOUNDATION (~st) FOUNDATION (gnd) 2. COMMENTS ROUGH FRAME & FLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765'1802 Examin~d · .'~.~ ~ ~7~ .......... Approveci ~-~ ~ .......... , .. ........... Disapproved a/c ......... (Building Inspector) APPLICATION FOR BUH.DING 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 Buildi Inspector, with 3 sets of plan.s, 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 stre~ or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apt: cation. ~. The work covered by this application may not be connnenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such pern shall be kept on the premises available for inspection throughout the work. e. No building shall be occnpied or used in whole or in part for any purpose whatever until a Certificate of Occupan 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 t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describ~ The applicant agrees to comply with all applicable laws, ordinances, building code, housing;code, and regulations, and admit authorized inspectors on premises and in buildings for necessary ins. pections. ~ ~ r~ (Signature of applicaig,~r name,\if a c~rporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, arcllitect, engineer, general contractor, electrician, plumber or buitd~ N~e of owner of premises .. ~q . . .~., 5. ~9. ~. .................................... (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 work will be done. l!lo~J;.h. 8:l. liO..O;f; Mat}~¢..La... EaSg. 0'fi .Cr:r-anxt .Ave o Hous~ Number Street ' ttamlet County Tax it{ap NS. 1000 Section .../..~..~. .......... Block ..... ,~..'.~. ........ Lot ................. ~' Filed Map No Lot Subdivision ........................................................... (Nmne) 2. State existing ui~ and occupancy of premises and intended use and occupancy of proposed construction: a Existing use and occupancy . · · b. Intended use and occupan6y 2. .0.a~ .C,..a.:??.~. .......................... 5. Nature of work (check which applicable): New Building . .~ ..... Addition .......... Alteration .......... Repair Removal ' Demolition Other Work .,. · eS~ ~.~.. ripti.o (Desc n) $4 .0.0 ~. Estimated Cost. · ~ 9.0.0. .. .... Fe ........................ (to be paid on filing this application) L If dwelling, number of dwelling units ............... Number of dwelling units 0n each floor ............... If garage, number of cars .... 2 .................................................................. ~. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... ?. Dimensions of existing structures, if any: Front ............... Rear .............. Depth .............. Height ............... Number of Stories ....................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth ...................... Height ...................... Number of Stories ...................... ~ ~ 0~ 3. Dimensions of. entire new construction: Front .... ~- ......... Rear . .2/[ ........... Depth . .~5 ........... Height .J~ ~1~ .~.e. qOlru be of Stori '1 t m r es ......... : ......................... 3. Sizeoflot: Front .... .I.QQ .............. Rear ...... '100 ............. Depth ~ ................... 1. DateofPurchase .7~/7J. ....................... Na~ne of Former Owner ..t~lg ..................... · i. Zone or use district in which premises are situated ..................................................... L Does proposed construction violate any zoning law, ordinance, or regulation .NO ............................. l. Will lot be regraded .. N.o. ....................... Will ~xcess fill be removed from premises: Yes NoX L Name of Owner of premises .139.u.f..f..gl['f:l.~..A.,..E.,.&.. Address .lyl~...1~.1..e...I.~..? ....... Phone No.2~90.-55t7.~ ...... Claire Address Phone No Name of Architect .................................................. . .. Nmnc of Contractor ............................ Address .... . ............... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from .-2.10 ,. O Ioo-lg tow street names and indicate whether IRATE OF NEW YORK. .~ ~/ ~ ~ OUNTY OF .~ .../?..,~..f'~. f.. ~...~.:...,~O.e). ~-~ .~.~.. :/? ........ being duly sworn, deposes and says that (Name of individual signing contract) 5ove named. he is the applicant ie is the .............. : .......................................................................... (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication; that all statements contained in this application are true to thb best of his l~owledge and belief; and that the 'ork will be performed in the manner set forth in the application filed therewith. worn to before me this .~~...day of .... /.~..~ ........ 19~../. '. JOYc~ M 5KWA , ..~.. . ~ . Ov ~o. 52'466349 ~ff~ °f'pR1X"""" C~rn . ~u~ed m SUffolk C^ m,s~,on ~Xpires Mqrek~ 765d~,~ 9 AM TO 4 PM FOR THE \, 1, FOEJ~,-'~-~N - -P, NO REQU RED ,.... . . ,~:~ CONCRETE ~. pOIJ~t-~ c~AM]NG & PLUMBING ALL C ,'-~,, ~-:-' ....... SHALl ME~ ~"' ~*~ - OF THE S~A~E CONSTRUCTION & ENERGY eO~S. NOT RESPONSIBLE D[~%N O~ CONSTEUCTION E~O~,. r%,oo.9/. N '0 IL~ O.C. RaFTE F%uH DHTIOH. Y IzOOT