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HomeMy WebLinkAbout11392-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. ~.1.t. 077 .......... Date .... .J.~tlY..1.3. .................... 19~.2,. THIS CERTIFIES that the building ................................................ Location of Property .1.1 '~ 0 ...... ~l...0. ~...-~ g~;tJ-.l~. B.o,~ql~. B.cl, .......~,t~ ~ $ .~.u.c.l{ ...... House No. Street Hamlet County Tax Map No. 1000 Section . .0.99 ....... Block . .0.3. ........... Lot . .0.1. 1. ~ 9.0.2. ....... Subdivision...[ ........................... Filed Map No. 2[. ...... Lot No. X. ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated · ~ ~ p.[.e, r0 ~07.. 18 .......1 ~.1.. pursuant to which Building Permit No... '~ .1 ~.9.2.. dated .~o. p.l;.o.I)ll)~['..2~ ............. 19 ~.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.~, Ar4d. ~..g.L.q~.~..L.o..~,r.~..e.~. ~. ~.g.5..n.,r~. 9.n.q-r ~'g3r,.~.~. y. ,~?.9 .~.3..~.n.~, ....................... The certificate is issued to .... ~..v .~.e?. e...~1.qh. ~ .t'.a.r'. ~ 13. .................................... (owne~., te~ee,or- ~e~a~ of the aforesaid building. Suffolk County Department of Health Approval .... r~/.~ ................................... UNDERWRITERS CERTIFICATE NO ....... hl. §.6.~855 .................................. Building Inspector Rev. 1/81 BUILDING ~ER~I~ (THIS PERMIT MUST BE KEPT ON THE~ P~EMIS~ES· ,. UNTIL, ·I' ULL COMPLETION OF THE WORK AUTHORIZED) ' Permissioh is hereby granted to: ~-~ .......... :.,../...c?..~/,~, at premises located at ...~.../.. Building I~spector. e ~.v ...................... Cou.~ T~× Mop No ~000 Se~on .~ ~.. ..... mo~ ~.~ ~ Cot Ua '~Zr..:.~..~ pur~uont to apphcahon doted .. ~ .......~.~........~ ....... ~ , lA . ~.., and 3pproved by the~ ·ReV. i6/30/80 [: I 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 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. 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. C. Fees: 1, Certificate of occupancy $5.00 2, Certificate of occupancy on pre~existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date .... New Building .. ~. ~(~ .... Old or Pre-existing Building .... ~ ..... Vacant Land ............. Location of Property .... ]./ .7.~ ...... j , ~ . .~ .......... ,~/', ,¢lr,~, (:'~L'(,~_4/( House No. Street Ham/et Owner or Owners of Property .................................................. County Tax Map No. 1000 Section . /.O.O(2..-% .~..~.. Block., 3 ........... Lot .... Il, .~. ...... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No../../.~..¢~..~ Date of Permit . .~.~¢~.../.Applicant., '. ,,~.o,~., .~,,~¢. z~. ~. ,/'~f~..~'?.~ ...... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for TemporaW Certificate ..................... Final Certificate ....................... Fee Submitted $ ...... ~.: .0.0' .o,~ ............. Construction on above described building and permit meets all applicable codes and regulations. Applicant,., ................................ 1ooo560 THE NEW YORK BOARD OF EIRE UNDERWRITERS BUREAU OF ELECTRICITY 8,5 JOHN STREET, NEW YORK, NEW YORK 10038 ~ J~l~ 23, 1982 ~ppl~,,.tio,,No.o.file 150597 ' 81 ..re N 566855 THiS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named orr the above application number it the premises of John Wohlfar~h, 1120 Baflle Beach Rd., Matr4Ltu~k, N.Y. i,, th~ follo~i.g location; [~ B.~,~t ~] Ist ~i. []]] ~,,d ~m S~ctio,, ~io~ rot tvas examined on ,JIJl~l~ £ 7 ~ J.~02 and found to be in compliance with the requirements of this Board. FIXTURE SWITCHES OUTLETS 3 ~ DRYERS FIXTURES RANGES OVENS DiSH WASHERS EXHAUST FANS INCAN~CEN~FLUORESCENT SYSTEMS NO. OF FEET E R V i OTHER APPARATUS: Elec. Room ~a~er/e: 2-2.~ K.W. Move exieting service to haw location. OF CC, COND. C E Fmr~ternach Elco, 1094 Say Shore Ave. Bay Shore, N.Y. i1706 lie. 677-~ This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be CQpY IFO~E BUILDING DEPARTMENT. THIS COPY OF FIE~,~D I~SPECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY G,~DE FINAL ADDITIONAL COMMENTS: I~ FORM NO. 1 fo ~ TOWN OF SOUTHOLD .ftc/If//. BUILDING DEPARTMENT l~/~'/i (~]D~ TOWN HALL 8OUTHOLD, N.Y. 11971 TEL: ~65-1802 Approved .~. ~ ..... 1~. Permit No.. ........ .... ...... , ,. (Buil(l~g I~pector) Date .................. INSTRUCTIONS a.~This appl'ication must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi Inspector, xvitb 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Hot plan showing location of lot and of buildings on premises, relationsh~p to adjoining premises or public stre¢ or areas, and gMng a detailed description of layout of property must be drawn ou the diagram which ispart of this apg cation. c. The work covered by riffs application may not be commenced before issuance of Building Pe~it. d. Upon apprc','aI of this appJication, the Building Inspector will issue a Building Pem~it to the applicant. Such porn shall be kept on the premises available for inspection throngbout the work. e. No building shall be occupied or nsed in whole or in pa~ for any purpose whatever until a Certificate of Occupan sh~l have been granted by the Building Inspector. ~PLICATION 1S tIEREBY MADE to the Building Department for the issuance ofa Bu/ldingPennit pursuant to t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for dte construction of buildings, additions or alterations, or for removal or demolition, as herein describe The appIJcant agrees to comply with all applicable laws, ordinances, building code, honsing code, and regulations, admit authorized inspectors on premises and in buildings for necessa~ inspections. ................... (Mailing address of applicant) _ con r ct ~, electfici ~ .... State whether applicant is owner, lessee, agent, architect, engineer, general t a o' a.,, i¢mmoer or mill& Nmne of owner of premises ......................................................................... (as on the tax roll or latest deed) If applkant ~s a corporation, signature of duly authorized officer. (Nalne and title of corporate officer) Builder's License No.. . .'.'.'.'.'.'.'.'.'.~., .~. ............. Plumber's License No ...................... Electrician's License No..'~..~--~ .'7/, .~.~..t:l~"7. ......... Other Trade's License No ...................... ...... I. Location of land on which proposed work will be done, ~ ..................................... House Number Street Hamlet County Tax Map No. 1000 Section ] ~0,~.7~.~ ...... Block .... ~ ........ Lot .... /.. ............ 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 .... [ ...................................... ; ..... · ,. .................... b. Intended use and occupancy ........................... Nature of work (check which applicable): New Building .......... Addition .......... Alteration ... ~ Repair .............. Removal .............. Demolition ........... Other Work ............... Estimated Cost ................ Fee ......................... .~ ........... (to be paid on filir~g this application) If dwelling, nmnber of dwelling units ............... Number of dwelling units on each floor ................ If garagd; mamber of cars ........................................................................ If business, com. mercial or mixed occupancy, specify ~ature and extent of each type of use ..................... Dimensions .of~exi,sting structures, if any: Front..: ..~.~. ....... Rear ....~-~. ........ Depth~.~ ............ Height ... I..'~..,.~.. ..... Nnm bet of Stories .O/ti .~i~.--. ................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ... ~'t~ ................ Number of Stories ..... Dimensions ofentire new construction: Front ~.O ........ .... Rear .~, .~. ........ '~e'p't~' i~':~ i i i i i i .... Height ...[ .~ ....... ~_. Number of Stories ..... 1~./~.~.--~. ........................................... Size o/lot! Front ...I..O.~l~ ........ Rear ...... ~.~.q~. .... · ....... Depth I.~."/ .................. Date 6f Purchase .......................... ;.. Name of Former Owner ............................. Zone or use district in which premises are situated.., i .............................. ~:. ................. Does proposed construction v,iolate any zoning law, ordinance or regulation: ..K~..~.... ~ ....................... Will lot be regraded ..... ~,/,,~,~ ................. ... Will excess fill b.e remoYe.d from premises:~ .Yea , No Name of Ov.,ner of premises I~., ~[J~'F.~. ~'~. · · · Addressl~ .~.'~..~1~...~.. Phone No.]~./~.: .(,-~'.... Name of Architect . ~%t...,~...~.. ~.X ?,.0..~...... Address .O%...a~. f..O~f,~t...~. ..... Phone No.~'. 4J :R I.~ ....... Name of Contractor ...,~1~"~,~'~. ................ Address ................... Phone No ................ PLOT DIAG RAM Locaie clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from roperty lines. Give street and block number or description according to deed, and show street names and indicate whether ,terior or corner lot. rATE OF NEW YORK, OUNTY OF....N.a.~.~ .a.u ....... S.S J~- Wohlfarth ................................................ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) >ove named. e is the Contractor (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 >plicatioa; that all statements contained in this application are true to the best of his knowledge and belief; and that the · ork will be performed in the manner set forth in the application filed ti~erewith. a, orn to before me this . 3rd . -"~ . September 81 .... County N&ssa%I × .................. k_,/ ~. ,h (Signature of applicant) Mory I~nn Tome:k/ 06 ~ IBoille Beach Home O~ners A~soclaflb~,/nc. ~ "/ . DATE : MAR 20, 1980 SURVEY FOR ARLr_~ ~: W~HLr©RTH AT MATTITUCK TOWN OF sOUTHOLD SUFFOLK COUNTY, NEW YORK ~UNAUTNOR~ZED ALTERATION OR ADDITION TO THIS GUARANTEED TO. SURVEY IS A VIOLATION OF SECTION 7ZO9 OF THE USLIFE TITLE INSURANCE COM~NYOF NEW YORK ~0~ ,ER AVENUE YOUNG ~YOUNG .,v ..Ew~o.~ ¸1, ,I OF OCCU~A~,CY / ~ C~6~T