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Home My WebLink About11446-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPART~IENT Office of the Building Inspector Town Halt Southold, N.Y. Certificate Of Occupancy No... Z 11.t81 ........ Date ....... P.e.c ¢rab.e.r...1 fi ............. 198. 2.. THIS CERTIFIES that the building ................................................ Location of Property .... 5505. ,¢/ickkam. A.v.e.~, .Mat. tituck House No. 'S't/e~i .................. Ham/et County Tax Map No. 1000 Section . . 1.0.7. ...... Block .Q.~ ............ Lot . ...0.0.2.: .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 · ..October. 2.0 ...... , 1981. pursuant to which Building Permit No... ~i. 1. 4. .4.6.Z. ........... dated ...November..4 .............. 1981., 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 ......... .. s.ons.tr.ucg..lA stall stable The certificate is issued to Dr, G. Semer of the aforesaid building. Suffolk County Department of Health Approval ...... N/A ............................. UNDERWRITERS CERTIFICATE NO ..... 576181 Rev. 1/81 Building Inspector FOEM I~0.~ 2 Town OI I~uILDIH~ (THIS PERMIT MUST BE KEPT ON THE pRE/~ dSES ONTiL iULL COMPLETION OF THE WORK AUTHORIZED) NS 144o z oo,, ........ Per~issiofi is here~ granted to: - .. ... ~ .,.,. ...~ to .......... ~ ........ ~ ........ ~...~ ............... .~__..~~,,.?~~ .......... ~ .......................... ...... : ......... :.~ .............. ~ ........... .~.~.~ :..~._.;..~ ,..,~ ............. ~ .......................... ............................................................ ; ........... ....~ ...;~ .~;.. ~ .... ~ ' '~ " . .................... COUn~ To~ ~ap ~o 1000 Soction ~2. ; .... Boe~..:~ ........ : ...... ~Cot ~o.~.~... ' put,ant to opp!icotion doted . .... ........ · ......... i....;;...., ., and gpprov~ by the Bull~lng I~spector. · FOUNDATION (lst) COMME~S ~r~ ~ ~ FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined .~.0../~.../ .... ,19.~./. Approved .o. .. .< .... Disapproved a/c ......... ~ .................... 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 Buitdi 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 apr. cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such peru shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan shall have been granted by the Bui/ding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit 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 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, and admit authorized inspectors on premises and in buildings for necessary inspections. ol$o (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, enginee grt(~eneral cont~racto~ electrician, plumber or bnild~ Nmne of owner of premises .... '~...~. .... ~ .... .~.. ,~t~. ~ ............................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. t.3 (Name and title of corporate officer) Builder's License NO .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... ' House Nfimber '. Street Hamlet ~ Subdivision ..................................... Filed Map No ............... Lot .............. (Na~ne) 24 State existing use and occupancy of premises and intended use and occupancy of proposed construction: ~ a. Existing use and occupancy ~'~ · a.4 t~t/ 6 : b. Intended use and occupancy ........ Nature of work (check which apblicabl . ddition .......... Alteration .......... Repair .............. RemoVal .......... Demolition .............. Other Work ............... Estimated Cost.. o O C> ~ ~ (Description) /.4-?. ....... Fee ..... 7 .............. -r ........... " (to be paid on filing this application) Number of dwelling units on each floor If dwelling, nmnber of dwelling Units ........... If garage, number of cars ..... ............... If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............ '... Nmnber of Stories..' ........ i ............................................ Dimenslons of same structure with alterations or additions: Front ................. Rear ................. Depth ...................... Height .......... .. ~ .......... Number (If Stories ............. t ....... Dimensions of entire new construction: Front ..... ~..~. ....... Rear .... ~..g ......... Depth . .~'.~. ........ Height ~ ~ .~ Number of Stories ?~.. ' ~ ~'..~.~ Rear I Depth Size of lot: Front ........................................................ Date 6f Purchase ........... . ................. Name of Former Owner ............................ Zone or use district in which premises are situated .............. Does proposed construction violate any zoning law, ordinance or regulation:..~M .~ .......................... Wilt lot be regraded ....... '~q" i ?' ................. Will excess fill be removed from premises: Yes No Nine of Owner of premises ...i ............ ..... Address ................... Phone No ................ Name of Architect .......... . ................. Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all l bmldmgs, whether existing or proposed, and, indicate all set-back dimensions from roperty lines. Give street and block ,terior or corner lot. ~umber or description according to deed, and show street names and indicate whether rATE OF NEW YORK, OUNTY OF ..~.q '~.~'P./'r !(-. ...... S.S · e- i ............... '' c/('bi~fi~ of individual sig~ing contract) ~ove named. .... being duly sworn, deposes and says that he is the applicant I e is the ......................................................................................... (Contractor, agent, corporate officer, etc.) '~ f said owner or owners, mad is duly authorized to perform or have performed tile said work and to make and file this )plication; that all statements contained h~ this application are true to the best of his knowledge and b01ief; and that the *ork will be performed in the manner set forth in the application filed therewith. wom_, to~__ before~ n]e this ~,~ ....~, ~ .... q::~.. 9 ............ day of ..... fi(~...C..~-. ........., 19 .ct'fl. ~ LI~DA F, KOWALSKI NOTfiR¥ PUI)LIC, State 0f Now Y0~ No. 52-4524771 Oofllfled in Suffolk C0[Inly Commission Expires garctl 30, 198~ (Signature of applicant) looo?~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~, lZ~' 1~.~ JOHN STREET, NEW YORK, NEW yORK ~0038 N 576181 THIS CERTIFIES THAT in the following location; ~ Basement ~ 1st FI. ~ 2nd FI. &ectlon Block Lot was examined on ~t~ 9, FIXTURE OUTLETSi~ RECEPTACLES DRYERS and found to be in compliance with the requirements of this Board. FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FLUORESCENT 6 SYSTEMS NO. OF FEET E S E NO O~E~,~COND C AW.G. AWG OF CC. COND OF HI-LEG NO, OF NEUTRALS A W. G, OF NEUTRAL l'ticha~ Relyea ¥oung~ PoJ. nl; Matti'~uc~ P.O. ~ 372 Lau~l, N.Y. 119~8 COPY THIS COPY 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* tot 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, Industriar 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 P~anning 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 al~ property lines, streets, buildings and unusual natural or topograph lc 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 or land use $5.00 3. Copy of certificate of occupancy $1,00 New Building ........ Old or Pre-existing Building(:~) ......... =/Vacant Land ......... Location of Property ... ~-~"'O~-- Lz-~i~L_l[(~?/-~-~~ /~1~.~ Hou~ No. ~tree t Nam/et Owner or Owners of Property ............................................ County Tax Map No. 1000 Section /~ ,~ ..... Block . .~ ~, Lot ~ ~ O ........................ ./ Subdivision ................................. Filed Map No ........... Lot No .............. . of Permit il ~ ~ .Applicant ~) v/ I~ ~77 ' ~" ' " .............................. Health Dept. Approval ................... Labor Dept. Approval ...................... ,.. Unde~riters Approval .~ ;?"..~ ~ ~ ~'-~ .......... Planning Board Approval .......... ........ , . ., Request for Temporary Certificate ..................... Final Certificate ........ - ......... Fee Submitted $... Construction on above described building and permit'meets ajJ,~P~cable~codes and regulations. Rev. 10.10-78 ~0~~ · ~ '"~ ' ~ J, ~ , ~ %0° ,S U £~ VEYEI.) L:) / TO Vv'tv SCg,'~-~"C)Z,.K COUNT-y A,/~w Yom,~ 95' 7 TI 3 L /i · Il E I I E ......................... 'r_l t h