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Home My WebLink About11423-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. ~.,.1.1.2.3. ! .......... Date ....... qq ~9.b.e,~.. THIS CERTIFIES that the building .......... , ...................................... Location of Property . .3.5. 8 0 .............. t4.o.r..i; h..3 ~ i~..B.p. $¥.e ................ [~'.~, ¢ a.~... House No. Street Hamlet County Tax Map No. 1000 Section . .0.1.5 ....... Block . D.1 ............ Lot .. J),Q~ ........... Subdivision. 9.P.e.e.n.. &cxe..s ................. Filed Map No. 95.6.0....Lot No.. 1 ~ .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated · .~.0. p.~.e.m.D .e.e..2. g ...... 195J. pursuant to which Building Permit No. , .1.! .~ ?.3..Z. ........... dated . .O.q .t, 9~.o.r' . .1.6 ............... 198..~., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ..... .a.n..~.~.~.~.,.~. a..~.~.qn...~p..~.r.~y.a.~.,, p.n.~ .-.~.a.m.~..~ y..a.~.,.e.z.x.x, ng~ ..................... The certificate is issued to ..... ~. 9?.e.n.X.c..o..~...~ 9.s.e...L 9. ?.e. ............................. (owne,$ of the aforesaid building. Suffolk County Department of Health Approval .... UNDERWRITERS CERTIFICATE NO .... N !500997 · One~fomily use only. Building Inspector Rev. 1/81 BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES COMPLETION OF THE WORK AUTHORIZED) 11423 Z Permissio~ is hereby gronted to: ................................. ~ ............... ~";'"""? ......... :"7"" Coan~ lox Mop No. 1000 Section ........... (...x~ ...... / ....................... p~r~uant ~0 ~pp~ic*fion a~t,a ................................... :~.5~....~,~ 1'~ ~., ond} oppr~ed by tho Bui ding inspector. ' Build!: Imector FORM NO. 6 TOWN OF SOUTHOLD Buiiding Department Town Hall $outhoJd, 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 ~he fo]}owing; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topograohic features, 2. Final approvat 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 'or Engineer responsible for the building. 5. Subm it Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings ahd "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. / 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 -7 New Building ............. Did or Pre-existing Building(Z) ..... =/Vacant Land ............ location of Property ,-*.~,~.'~,-~ ~.Q~/~/ , ..~.4~..~,e/¢~ ' ¢~/Z~ ~ Hou¢ No, ~(re¢~ Ham/et Owner or Owners of Property ,.~..~..~ ~O~ County Tax Map No.,1000 Section ...... ~ ..... Block .. / Lot ~ ~. Subaivision (Z~'=-~ ~Z4~ .Filed Map No. .~0 .LotNo. Permit No. , Date of Permit ~ ./,Applicant ....... ~.~. ', ........... Health Dept. Approval ........................ Labor Dept. Approval ......................... Underwriters Approval ........................ Planning Board Approval .................. . ,., Request for Temporary Certificate ..................... Final Certificate ........ - ......... * Fee Submitted S ............................. Construction on above described building and permit mc, ets a~app~i,cable~co,des and regulations. A~p cant . _. .... ,.~.~ ........ "Z ....... ~, .... Q-o. / / / THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the eleetrical equipment ~ described ~e~ a~d i~trod~ced by ~Oe app~c~t na~ o~ the able application n~n~ber in the pre~nises of in thefol~owing location; ~ Base,nen~ ~ 1st FI, ~ 2rid FL Section Block Lot was examined on ~ ~7 , ~980 and yo~nd to be $n compliance with the requirements of this Board. FIXTURE OUTLETS RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS DRYERS FURNACE MOTORS APPLIANCE FEEDERS TIMECLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERV CE DISCONNECT S E R *~Le~ go~n ~mr~ra:3-1.5, 4-i.~, 1-.75, 1-o65, 3-.32J I C E NO OF HLLEG Wi irm Late (~:~mnpo~c, ~. Y. 1944 ~m~1049 Per ~ This certificate most not be altered in any manner; return to the office of the Board ff incorrect. Inspectors may be identified by FOR credential ~ ~ E'~D INSPECTION FOUNDATION (]st) COMMENTS FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: STATE OF NEW YORK COUNTY OF SUFFOLK DOMENICO LO RE and ROSE LO RE, his wife, being severally duly sworn, depose and say: 1. We are the owners of the premises known as Lot t~18 on a certain map entitled "Map of Green Acres at Orient" and filed in the Office of the Clerk of the County of Suffolk on October 13, 1962 as Map No. 3540. This property is also known on the Tax Map for the County of Suffalk as District 1000, Section 015, Block 0100 Lot 002.000. This affidavit is made to certify to the Town of Southold that we as the owners of the aforementioned premises will not rent for ocuupancy as a separate unit, the downstairs portion of the premises nor will we rent the entire house for occupancy by more than one family. 3. We make this affidavit knowing that the Town of Southold Building Department will rely upon the representation contained herein. Severally~worn to before me No tary/Fubllc ~REOERICK J- TEDESCHI I40TARY PUBLIC, State of New york No. 52-394§400 .Qualified in Suffolk Counh, _ ~.',~ ~.~mmissien Expires March 30, W .Rose LoRe FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL,: 765-1~02 Disapproved a/c . . .'.~ ...................... '. ~'~.-d// ~'7,~ 0~ ~'~"~'~////''' :. (Building' ' Inspector) i ,~ .,/z1 ~ APPLICATION FOR BUILDING PERMIT Application No ....... -..~ ...... Date .. 7 ........ 19~/ INSTRUCTIONS a. Tins application must be completely filled in 'by typewriter or in ink and submitted in triplicate to the Buildi luspector, with 3 sets of plans, accurate plot plaa to scale. Fee according tc schedule. b. Pint plan showing location of lot and of buildings on premises, r~lationshlp to adjoining premises or public stre¢ or areas, and giving a detailed description of layout of property must be drawn on the diagram which ispart of this cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of fids application, the Building Inspector will issne a Building Permit to the applicant. Such pern shall be kept on the premises available for inspection througlmut the work. e. No buihth~g shall be occupied or used in whole or in pa~ for any purpose whatever until a Certificate of Occupan shall have been granted by the Building Inspector. ~PLICATION IS I IEREBY MADE to the Building Department for the issuance of a Building Pe~it 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 bnildings, 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, ~d adm'it authorized inspectors on premises and in buildings for necessa~ insu~tions. , '' f ~ignature of applicant, o; ;mine, i~a State whether applicant is~ Iosse¢, agent, architect, engineer, general contractor, electrician, plumber or build, (as on the tax roll or latest deed) If applicant is a corporation, signature of duil, authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's Licensz No ......................... Electrician's License No ....................... Other Tra&a's License No ...................... I. Locatibn of land on wider proposed work will be done ................................................ House Number Street Hamlet Co,,,tyNo. 000 S otio .......... moo* ¢..: ...... Lot.. (Name) .... ~ / ¢ -- -- 2. State existing use and occupancy of premises and inteuded use and occupancy of proposed construction: a. Existing use and occupancy Z f~/~/¢~ ~*c&/~ ~ b. Intended use and occupancy ............................... ~.., ................... Nature of work (check whicl, applicable Repair .............. Removal .. ;. lfdwdling, number ofdwcllingunits New Building .......... Addition .......... Alteration .......... .......... Demolition .............. Other Work ............... (to be paid on filing this application) (~. ........ Number of dwelling units on each floor ................ lfl;arag¢, number of ears .... : ...... j ........... , .................................................. i. If business, commercial or mix¢[ occu[bncy, specify natnre and extent of each type of use .......... ~. .......... z. Dimensions of ex/sUng structnr:s, if an t: Front .... .'/7 .~. .......Rear .... ,tT~.. ...... Depth ...~.ff. .......... Ilcl-,bt .... .'~(P ........ Number el ~tones ........................................... ~:.../: .... F'Din~ensions of same sm~cture with alterations or additions: Front ....~77 .......... Rear . ~... /vtO \Depth. ....... W .......... '... Iteil j~t .'.'F? ................... Number of Stories ...*--x. .......... ~...2'... ,a o~k,*J Dbnensious of entire new conslruction: Front ..... .,/7¥'. ..... Rear ..~'..~,. . Depth ~.ff... ~,~...~ Height 9-0 Numberof ~tories 'u" .... :. 1. Size o,flot: Front ..... /.I.o. ....... ~_/?.. , .... Rear ...... (/.o. ..... · ....... .Del.)th .... '.,~.470.. ). Date df Purchase .......... :..__',' ............ Name of Former Owner ............... I. Zone or use district in which premi'ses*re situated ................................. 2. Does proposed c~o~nstruction viol~ any zoning laxv, ordinance or regulation: ........ ~ ...................... L Wilt lot be reg:'ad~d ........ ,4r.~ ................. Will excess fill be removed,from premises: Yes 1. Name or own:r of premises . .'4)..o..,r,'~.4-ff/.C.Q..Z.o..ff.~.. Address .~./..~..~..,~..~.~.,~..//'..~..,.,.~ . . Phone No...4~. )..7 Name of Architect ..... '~.. ~9..L~4-f. ff~ ....... : . . Address . ~.~.. ~.~.4'-].q .~'...~.~... Phone No ................ Name:of Contractor .... ,~...~..~.'~.~, Address .................. Phone No ............. PLOT DIAGRAM I,ocate clearly and distinctly ali bnildir s, whether existing or proposed, and, indicate all set-back dimensions fi'om ;operty lines. Give street and block nun:be~ or deserip'tion according to deed, and show street names and indicate whether terior or corner lot. I'ATE OFNEW YORK, OUNTY OF ................. S.S ~::)/'7'~,&,//~ O ~o .~.~ being duly s~,vori*l, deposes and says that he is the applicp, nt (Name of indMdual sigping conl fact) Contractor, agent, corporate ofi'icer, etc.) ..... & .......or c,'am~, and is dnily authr izod to perform or have performed the said work and to make and file this >plicationl that all statements eoniained in this application are true to the best of his knowledge and belief; and that the 'ork will bb performed in the mannbr set for :h in the application filed therewith. worn to before me this ....... g.), ............. day o, tary Public. ........... NOTARY P~U B L~l~?,?~i~'~,' Ye rk No. 3~-9 ~54200 ~ommlssion EXpires Morch ~ ...... County (Signature of applicant*,