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Home My WebLink About11447-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southold, N.Y. Certificate Of Occupancy No..g. 1..].3.8.2. ......... Date ...... D..e.c?.m..b.e.r..~6. .............. 19 .g..2 THIS CERTIFIES that the building ................................................ Location of Property .. 55.Q5. ~/.5,.c.I¢~.r0, .g~¥.~.,..~,.t..L.J,¢gg.k' ............................ House No. Street Ham/et County Tax Map No. 1000 Section .]-0.7 ........ Block .0. zJ ............ Lot . .Q0.2.o.0.0..~ ....... Subdivision ........................ ~ ...... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..Qct;Ob. ez:. 20 ....... , 19' .8J-pursuant to which Building Permit No...J.~..4A7. Z. ............. dated .. bl.Q~terahe, z:. ~ .............. 19.8.]`, 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 ......... ·..cOn~.r. uc~..~encing, f~.~. cor.~]- ............................................. The certificate is issued to .... Dz... G,...Sem~,r... io~n'e'r,)~s's~e'~r't~n't~ ..................... of the aforesaid building. Suffolk County Department of Health Approval . .~/A ..................................... UNDERWRITERS CERTIFICATE NO ..... BI/A ......................................... Rev. 1/81 Building Inspector TOWN OF BUiLDiN~ SOUTH'OLD, N~Y. ~ (THIS PERMIT MUST BE KEPT ON ~H,~ PREMISES UNTIL ~ULL COMPLETION OF THE WORK AUTHORIZED) P~rmissiofi is hereby granted to: , at premise~ located at Bu!l~lln~ I~pector. Fee i$ ........ ~", ............. FIELD INSFECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL COMMENTS ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 /x~ TEL,: 765-1803 Examined ......... ¢ 19 0~/' Approved /~/O"2/ ..~. 19~./.'.Permit No /'/~"~.~. :~ Disapproved a/c ...... ~ 777: . .-~. .......... ~ ...... ./ (Building Inspector) Application No../.(.~..~...~ ...... APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. This application must be completely filled iu by typewriter or in ink and submitted in triplicate to the Buildi Inspector, with 3 sets of plans, 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 aPF cation. c. The work covered by this application may not be commenced before issuance of Building Pem~it. d. Upon approvM of this application, the B~ilding Inspector will issue a Building Pe~it to the applicant. Such peru shMl be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in pa~ for any purpose whatever until a Ce~ificate of Occupan shM1 haw been granted by the Budding Inspector. ~PLICATION IS HEREBY 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 buildings, additions or ~lterations, 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 admit authorized inspectors on premises and in buildings for necessa~ inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) owner, lessee, agent, architect, engineer~eral cont~lectdcian,~ plumber or build, State whether applicant is Name of owner of premises .. ~.F~,...~ .... .~...8~...~. .............................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. aine 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...~,5,x..'~ ?.( ~.~.~.q..~..a~.. ~. ~ ........ ¢.4 ~.~ s- . ..... House Number Street Hamlet County Tax Map No. 1000 Section .................. Block ............. Lot. :. . . Subdivision ..................................... Filed Map No ............... Lot .............. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............ ~.~.l.~.~ ............................... b. Intonded use and occupancy .......... ~e ~:~.. ~, q.~ ............... Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. RemOval ............ Demolition .............. Other Wot . .. Estimated Cost ........ . .......................................... ~. ........... ~ (to be paid on filing this application) If dwelling number of dwelling units Number of dwelling units on each floor If' garage, number of cars If' business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structure~, if any: Front ............... Rear .............. Depth ............... Height ' Number of Stories ' ' ' Rear Dimensions of same structure with alterations or additions: Front ................................... Depth .................... i. · Height ...................... Number of Stories ...................... Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height Number of Stories .:. Size of lot: Front ~ ~....~.1~ . ...... Rear ~ pth Date 6fPurchase Name of Former Owner Zone or use district in which premises are situated .............. . ....................................... Does proposed construction violate any zoning law, ordinance or regulation: ...~..o .......................... Will lot be regraded ......... ~. l~ ............... Will excess fill be removed from premises: Yes No Name of Owner of premises ~ Address Phone No Name of Architect ~ Address Phone No N~une. of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all! buildings, whether existing or proposed, and, indicate all set-back dimensions from roperty lines. Give street and block .terior or corner lot. number or description according to deed, and show street names and indicate whether rATE OF'NEW YORK, ' OUNTY OF....gtA .~..~...k~..,. : ........ 0..0. .................. TName of individual sighing contract) )ove named. being duly sworn, deposes and says that he is the applicant e is the .................... (Contractor, agent, corporate officer, etc.) f said owner or owners, m~d is duly authorized to perform or have performed the said work and to make and file this )plication~ that all statements contained in this application are true to the best of his knowledg* and belief; and that the 'ork will b~ performed in the manner set forth hi the application filed therewith. ~vom to before me this ............... day of .................. ,19 . .otary Public, ~q~ .~...~; .-f~f~.~---t ...... New Q~ahhe~ in Suffoll( Co*~nl~ ~ Comm~ssmn [xpires March 30, 1~ (Signature of applicant) ~LO00?~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~' ~/[~D~i~f/~' ~4~ ~ JOHN STREET, NEW YORK, NEW ~ORK 1OO38 Oate 2pplic~tion No. on file ~17 -- ~ N 57~8[ THIS CERTIFIES THAT only the electrical equipment es described below and introduced by the applicant named on the able application number in the premises of ~in ~r, ~t~ll ~., ~s ~., N. ~. ~ ~tit~, N.Y. in the followlng locatlon; ~ Basement ~ 1st FI. ~ 2nd Fl, ~ection Bh, ck Lot and found to be in compliance with the requirements o% this Board. FIXTURE FIXTURES OUTLETS FLUORESCENT DRYERS RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST SYSTEMS E OTHER APPARATUS: 2~Phof, o Cell~s. OF CC COND, NO OF NEUTRALS [A W. G OF NEUTRAL 1 410 Hichard Relyea Young's Poin~ Mattt~uck P.O. ~ 372 Laurel, N.Y. 11948 lio. R14~E COPY FOR BUll THIS OF 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 natura{ 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 dr 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 ail 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 New Building . .~.~'.~ ....... Old or Pre-existing Building(X) ......... ~/Vacant Land - Location of Property .... ~'---~ 0 ~ ~ I ~,.._ iL~,~ i~ ./:~--~ ~.~ Hou~ No. Street Hamlet Owner or Owners of Property ..... ~ ~ ~ ................................... County Tax Map No. ~000 Section ... ~. '7' ...... B{ock ....~. ~ ...... Lot..~.~..~.~ .l Subdivision ................................. Filed Map No ........... Lot No .............. PermtNo /Z~9.~.~DateofPermt ttj~/¢l Ap. licant ~ Health Dept. Approval ...... ~: ....~ ....'. '.' ':~ .... Labor Dept. Approval ...................... ,.. u n~,it.,, A,~,ow~ .~....5'7....~ ~ ~t~ ~ ......... .,~.,,i,g Bolla A~,,o~ . ....... .......... Request for Temporary Certificate Final Certificat~ Fee Submitted $.... ........................... Construction on above described building and permit'meets al.J.a,gP~cable_.codes and regulations. ~.~..LD .::~ 1(3~ J Applicant .... ~ ~.. ? I i