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Home My WebLink About11444-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southold, N.Y. Certificate Of Occupancy No..g~ D,EI9/~ .... Date ...... ~..ebl'~7.2.6. ............. 19.8.2 THIS CERTIFIES that the building .add.£~;ion. ..................................... Location of Property . ~5.9.tf30 ............ ~.~ .t;.e. ,gq.a.d..2.5. ........... O. r.e.e.n. [~.o?.~ ...... House No. Street Hamlet County Tax Map No. t000 Section . 0,4.5 ....... Block ....0.5 ......... Lot ...0.0.1. ........... Subdivision... X .......................... Filed Map No...X ...... Lot No....X .......... conforms substantially to the Application for Building Permit heretofore filed in this~, office dated ·..Ocl;o. bet~. .1.9 ...... ,19 8,1, pursuant to wkich Building Permit No...t. 1. .4.~p..g. ........... dated ...N ovmnbev..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. 1.au~dr~.. v.o.o.~0, o.a.d.x..~.Xp.n...~.o..a.n...~.x.X.~..~.X.n.g...~.,.o.X.X..X.n.~.,. ................... The certificate is issued to ...... .P.a.~n. ~9.k' .~ .o.a.l.~y.,..I.n.c.: ............................. (owne~ l~e,e~, of the aforesaid building, Suffolk County Department of Health Approval ....... nJ.~. ............................... UNDERWRITERS CERTIFICATE NO ......... ~..5.~ .1.2~5.6. ............................... Building Inspector Rev. 1/81 TOWN SOUTH'OLD, NvY. BUILDING:' PERMIT' (THIS PERMIT MUST BE KEBT ON THE P~EMISI~S UNTIL ULL ' COMPLETION OF THE WORK AUTHORIZED) ~1444 Z Date;~ Permtssior is hereby granted to: * R,v. 73o~8o~ FORM NO. 6 TOWN OF SOUTHOLD BuildiRg 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 wlth 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 a~d 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 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. Co 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 ~. ~,~--2_.7:~_, New Building ............. Old or Pre-existing Building(X} ',,/.'~-~. ...... ~ ZVacant Land 'i ........... House NO, ' ...................... 'S'tr'eet ,~ Hanflet County Tax M ap N o. 1000 Section .. ~ ~c/.,~. ...... B lock ... ~ .~..'~,. ..... Lot .... .~. ?./. ....... Subdivision .... .~ ............................ Fired Map No....~ ....... Lot No.../~. .......... Health Dept, Approval ........................ Labor Dept, Approval ...................... ,.. --~ Underwriters Approval . · Request for Temporary Certificate ..................... Final Certificate .............. Fee ~ubmitted $ .... ~,;~.~.~. .............. Construction on above described building and perm~e.~all ap~ca~l~od~nd regulations. lOOlO71 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electr~ ~[pme~t ~ described be~ow a~d introduced by the apptlca~t named on the above application n~mber in the premises of ~s~'s, ~ ~ad, s/~ ~ss ~ ~s~'s, F~sC St~ W.~ite in ~he followlng location; ~ Basement ~ 1st Fl, ~ 2nd FI. wasexaminedon F~ 11, 1982 FIXTURE OUTLETS 2 Section Block Lot and/oand to be in compliance with the requirements of this Board. SWITCHES FIXTURES RANGES =OOKING DECKS OVENS EXHAUST FLUORESCENT DRYERS 1 SYSTEMS OTHER APPARATUS: Ki. ec.Ro~ Heater/s, 1-1.0 K.W. E v I C PER ff R AW, G OF CC COND. NO. OF HI-LEG AW, G OF HI-LEG NO, OF NEUTRALS O & S Electric Bo~215 $~thold, N.Y. 11971 1~.578-E BUll THIS , OF ANY MANNER.~, # s. 4'(-o4'~o:"~. - 3oo.0 ICHOLAS u) 0 u) MAP OF LAND SUI~VEYED ~, PAT21CtA' D20S505 AT "A I~AM 0 tVIAQ U £" I'OV~N OF ~JOL)THOLD, FIELD INSPECTION FOUNDATION (1st) COMMENTS FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C DE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOV~'N OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1802 Approved..,~O..~.... 2~.., 19~.. Permit No ......... Disapproved a/c ....... '....'~-.~-.....~... f/~..~.. / ................... :.Z-.CE. 77~.-..~-~-7.. . . / ' (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No~ ...... 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, accnrate 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 stree or areas, and giving a detailed description of layout of property must be drown on the diagram which is part of this apg cation. c. The work covered by this application may uot be commenced before issuance of Building Pe~it. 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 buikling 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 Bnflding Inspector. APPLICATION IS HEREBY MADE to the Bnilding Department for the issuance of a Building Pe~it pursuant to t Building Zone Ordinance of the Town ~f Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, Ibr the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with ~11 applicable laws, ordinances~ admit authorized inspectors on premises and in buildings for necess~ ~ectio~ding code, hoti~///code, ~d regul~ions,} ~d X .~ ~~p~~ifa~poration) (Mailin~f .pl~nO / Sta~e whether applicaut is owner, leSSgg, agont, architect, engineer, ggneral oontraotor, el~otNoian, plumber or bull& (as on the tax roll or latest deed) ]f applicant is a corporation, signature of duly anthorized officer. (Name and title of corporate officer) Builder's License No. 5"-~ Plmnber's Licens~ No. ~"~t~.~. .~/57. ~..~./,~ ..... Electrician s License No.'/-,oW.O- Other Trade's License No ...................... 1. 'Location of land on which proposed work wilt be done ................................................ House Number Street County Tax Map No. 1000 Section ~'~-- Block (~}.:.D-. Lot (DC'D/' Subdivision ..................................... Filed Map No ............... Lot .............. (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... .~'-. [q~.l./rt. ~.-. ..... ,f~.(~. ................................... ; ..... b. Intended use and occupancy ... ~'~. --- -~- ~-c'"""r{9 . .~./..sr... 3. Nature of work (check which applicablg): New Building .......... Addition . .~ ..... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 3tt'Z.,/~j-'(_.~O f ,,,--~ /~'"'~ ~ (Descripti0n). ' Estimated Cost ............ ~ ....... 'x/..~r ....... , ...... Fee ..... r' .z~. ........~,~--...¢. .......... (to be paid on filing this application) ;. If dwelling, number of dwellingiunits '-"----' .... Nmnber of dwelling units on each floor ................ If garage, number of cars .... i .......... - ........... ............................................ i. If business, commercial or mixe:d occupancy, specify nature and extent of each type of use ....'mw.. ............... ~. Dimensions of existing structures, if any: Front ..... ~..t/. ...... Rear .. ~.¥ ......... Depth..~.'~ .......... Height ..... [,~.. ........ Number of Stories .... [ ....~. .............................................. Dimen'sions of same structure with alterations or additions: Front ...~..~ ........... Rear ..../4..(" ............ Depth .'¥.~. [ Height ./~. ..... Number of Stories I .. L Dimen'sions of entire new construction: Front .... ~.~ ........ Rear ...9.q¢ ......... Depth . iz:.~. .......... { ~. Number of Stories Height ................................................................... ~ oo , Rear kSc, o Depth ..~..~.r_3. ). Size of lot: Front .......... ~.... ................................................ ). Date 6fPurchase .......... ~ .................. Name of Former Owner ............................. 1. Zone or use district in which premises are situated ............................... > Does proposed construction violate any zoning law ordinance or regulation: I. Will lot be regraded ........ i .' .................. 'Will excess fill be removed from premises: Yes No L Name of Owner of premises ' . Address ................... Phone No ................ Name i>f Architect ........ r':x .............. ... Address...; Phone No Name :of Contractor 3 ~./Y~. ~.~.?:-~:.d~.. ......... PLOT DIAGRAM Locate ~clearly ~d 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 :tefior or 6orner lot. ........ ~ I*~.3~...~~~~ being duly sworn, deposes and says th~he is the applicant (Nanie of indivi~al si~ng contract) >ove named. ' (C ) ontractor, agent, corporate officer, etc. f said owner or owne~, m~d is duly authorized to perform or have performed the said work and to m~e and file )plication} ~l~at all statements contained in this application are true to the best of his knowledge and belief; and that the · ork wflI be performed in the manner set forth in the application filed therewith. worn to before me this .... ~glzss50. Su~f~2~~ ( ~ Si natur a licant