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Home My WebLink About11385-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupnncy THIS CERTIFIES that the building... ,A.d.d.i..t .i.o.n...a .n.d.. a..1 .tAr. ....................... L~n*;~nofPron~r~r R.O.W. off Pvt. Rd. # 1Goose C~eek Lane southold County Tax Map No. 1000 Section . 0 7 7 .Block 0 3 ..... Lot 0 16 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...8. e, p,t..,, ! ~5 .... [9..8.1 .... . pursuant to which Building Permit No..1.I. 3. 8..5.Z .............. dated ...S.c.p..t .... 2. 3. :.. 1, 9. 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 ......... Alterat±on and add 2nd stor7 and deck. The certificate is issued to ALICE J. HUSSIE ..................... ?o¥.'o;, ..................... of the aforesaid building. Suffolk County Department of Health Approval ......... .Iq./.4 ............................. UNDERWRITERS CERTIFICATE NO ................. ~.6.7. 0..7.3.4 ......................... PLUMBERS CERTIFICATION DATED: N/A Rev. 1/81 (THIS PERMIT MUST BE KEPT ON ,THEE P~,E/~IS~S UNTIL ~ULL COMPLETION OF THE WORK AUTHORIZED) 11385 Z Date Rev 6/30~80 · i i! Permissio~ is hereby granted to: .4 .... ............... ~ .................... "', ...... '~ ..................... 7"~7;~"77;'" · ................................... :",~. .................. 4' ........... '"'~ ........ ~ ........................ ' ' ' co.~ T~ Mop No. ~000 s.~,o. ...;. ~o~ :. ..~..~/ ~ No.,~ B~!l~lng I~pector. : uildlng}ln~ctor FORM NO. 6 TOWN OF $OUTHOLD 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" land uses: 1. Accurate survey of p~Operty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15 o 0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 Date .......................... New Building XX Old or Pre-existing Building Vacant Land Location of Property R.O.W. of~. Pvt~..Rd.. I Goose Creek Lane Southold House No. Street Hamlet 97' ALICE J, HUSSIE Owner or Owners of Property ...... County Tax Map No. 1000 Section 0 77 Block 0.3 Lot...16. Subdivision ................................. Filed Map No ........... Lot No .............. PermitNo. 1.1,3.85Z Date of Permit 9/81 .Applicant Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and I:~m~ meets all,applicable codes and regulations. Apphcant ~,_ ~ ...... Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS 10001~ BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW yORK 10038 .ate ~e;aa~e~' ~.0, ~.9~ A..~icatio. No.o.fi~ 30~/~ N 670734 THIS CERTIFIES THAT ordy the e/act r[cal equipme~tt as d~crlbed belair and introduced by the applicant named or~ the above application number in the premises of Alice IM~sey, Pvt. Road, ~/ ~yview, Opp. Hi~w~od, Southold, NoT. in tbe following location; [~ Basement [~ 1st FI. ~ 2nd Fl. '~o F]~. Section Block Lot was examined on Dfd~3C~II~A~ ~ ~ Z~ and found to be in compliance with the requirements of this Board. FIXTURE ~ OUTLETS EPTACLE.~ I SW TCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS FLUORESCENT SYSTEMS OTHER APPARATUS: i-=Slake )~t ec~r T£~k Li~ting E R V I C Paul Barns 'lbwn Ilarbor Lane 8out[~ld,N. Y. 11971 Lic. 282 This certificate must not be altered in any manner; return to the office of the Board if inco~Tect, laspecto[s m~y be COpY FOR BUILDING DEPARTMENT, THI~ their cr~dentia)s. ANY MANNER. FIEL~ IN~ECTION 1. FOUNDATION COMMENTS FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: Disapproved a/c ....... '. i .-~Z-.... ................... ../ · . APPLICATION FOR BUILDING PERMIT FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT · TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Application No ./?. q~. 77.~ '.~. ..... Date ................. ; 1 INSTRUCTIONS a. This application must be completely filled in"by typewriter or in inl~ and submitted in triplicate to the Buildi Inspector, with 3 sets of plans, accurate plot plan to scale. Fcc accordiug tc schedule. b. Plot plan showing location of lot and of bnildings on premises, relationship to adjoining premises or public stret or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apl: cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon apprcval of this application, thc Bulk!lng Inspector will issne a Building Permit to tile applicant. Such pern shall be kept on the premises available for inspection tllroughout the work. e. No building shall be occupied or osed in whole or in part for any purpose whatever nntil a ~ertificate of Occupan shall have been granted by the Building Inspector. APPLICATION 1S ItEP, EBY MADE to the Building Department for the issuance of a Building Permit pursuant to t Building Zone Ordinance of the Town of $outhold, Snffolk County, New York, and other applicable Laws, Ordinances Regulations, for 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, buil_.d, ing code, housi,ng code, and regulations, and Mnlit auth°rized inspect°rs °n prenlises and in buildings f°r necessal2/ in~.?.jkc~l°.~s~ ~'~g~ucex of apl~l~a~~po~atjon) ,. .... · [ ' ' (Mailinga&fr~s of applicant) Slate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, of owner prem so ............................................... O (aS on the tax roll or latest deed) If applicant is a corporation, signature f duly authorized officer. (Name and title of corporate officer) ¢ Builder's License No ......... .~.~.-.~'~. r.~.~... ?.~A'-...c~q' Plumber's Licens: No ......................... Electrician's License No.' ...................... Other Trade's License No ...................... of d on which prop sed ~ ork will b ne ............................................... House Number r Hanllet County Tax Map No, 1000 Section ...~ .t..t.~ ......... Block ................. Lot ................. Subdivision ........... Filed Map No .... Lot ..: .......... (Name) 2. State existing use and occupanc7 of premises and intended use and occupancy of propgsed~onstruction: Repair . . Removal ..... n{plition .............. Other Work .~..~ .~...,~ (Description) Estimated Cost ... ~ ~- d..) Fe · ; ,- ........... (to be paid on filing this application) ;. If dwelling, number of dwelling units .... ~ ........... Number of dwelling units on each floor ................ If garage, hum ?er of cars i. If business, commercial or mixed occupancy, specffy~nl~t~r~ and extent of each type of use ..................... t D ensonsofexstngstmctures, if any: Front . . ~ Rear ~! Depth '~Z! . lle~ht .......... N mbcrotStones .............................................. Dimensions of same structure with alterations or additions: Front ................. Rear ................ ~. Depth ...................... Height ...................... Number of Stories ...................... I. Dimensions of entire new construction: Front ............... Rear ............... Depth .. ! ............ Height ............... Numar of Stories .... /. Slzeoflot Front ..... .t.. ¥~ Rear ~z6,1 . D~2~,h ~ ).Dateo'fPurchase .... /Jt/~ ................. :../~ame_q£1~onnerOwner .,~/~.~.~..~.' ....... 1. Zone or use district in which premises are s tuated. ,,~.t~ ................... j:.. .... ~. ............ 2. Does proposed constructionfliolate any zoning law, ordinance or regula:ion: . ./."t~. ~. j .................. 1. W/Il lot be regraded ..... .~ .c~,~.... t/ ............ .. Will exce~ fill be re~ov_E~ from premises: Yes t. Name of Owuer of premises .~. ~ ...... Address . ~./.f-:tiq'.t..~. Phone No.7~.q. :~Xq.~{~. .~.'.~. Name of,A.,rchitect .../~,.. l~; '1~.'.' ............ Address/t~..,-[:......~.~ ........Phone No ............... Name of Contractor ?. :../.Wr~X,~ ........... Address ~ ....... Phone No?..~./. 7.~.!..Z..fi.. PLOT DIAG R/uM Locate clearly and distinctly all buildings, whether ex/sting or proposed, and. indicate all set-back dimensions from roperty lines. Give strezt and block number or description according to deed, and show street names and indicate whether tcr/or or corner lot. OUNTYO~'... S.S X (' ame of i;di,'id;,41' i .......... b ing duly swo , s the .................... (Contractor, agent, corporate officer, etc.) f said owner or owne~, and is duly authorized to perform or have performed the said work and to make and file this )plication; that all state~nents contained ~ this application are true to the best of~owledge and belief; and that the 'ork will be performed in the manner set forth h~ the application filed fi~erewith. worn to before me this ........... / ......... , I OF OCCU?A~eC¥