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Home My WebLink About11451-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. gl .1.1.!.7 .......... Date ..... g.ugu$.t..5 .................. 19 8.2 THIS CERTIFIES that the building ................................................ Location of Property ,. [27 § ............... ~ Ot~ ri.d, .I) I';[.v.e ..............Gs'.e enp.t~e t; .... /~ouse No. Street Hamlet County Tax Map No. 1000 Section . Q.3.~ ...... ~Block .. 9.2. .......... Lot . 02.3. ............ Subdivision.Eia~.t~el'n...qhot'~,a,.S.e. ct;.2 .... Filed Map No, 4.62~6...LotNo..7.8 .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .O.c t~ o b.e.~.. 20 .......... 198.1. pursuant to which Building Permit No..1.1.45 ~..Z ............ dated ...lq q¥.e/~b.e. ~?..1.0. ............ 19~ 1., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .... a. ~.r. iva.t.e, on.e.-.fam.:Lly, d.~elling ......................................... The certificate is issued to ...... 9 ~.b.e,~. ~. ........................... (owner, ~e~ee.c~ of the aforesaid building. Suffolk County Department of Health Approval l 1 .-g.O-. 109.~.. 7./.1.9./.8~.~..l~Ob.t.o..&,..~.~, ~.~.~,~ UNDERWRITERS CERTIFICATE NO ........ ~. 515.t~.8 ] 0 ................................. Rev. ~/81 sOUTHOLD, N~ Y. : BUILD~NG P,E~iT (THIS PE~IT MUST BE KEPT ON THE PRE~IS~S UNTIL I:ULL COMPL~ION OF THE WORK AUTHORIZED) ! 4 51 Z Dote to: verm,$ston nere~y grome~ ...... ~.~(~...-:.~r.:~.. ,:...~.~z..~ . . ~o. ~ ~.~ ~.~.~z ...... .~ ~ ~~ ~..:...~~ ............... .' ........ ~.: ........ ~.~ ..... :..~.~.:~.~ ~~..~ ........ ~ p¢~o~ ~o~t~d ~t:: ..... ~..~.~ ............ ~. ~ ~ ~ ~. · · .~/..~ ... · ~TZ~ C6"~, T? Mop No, lO00 Section ..... ~.,~.~ .... Bilk ~..J~.~..,~:..J, Lot No, ..~ Buil~ ng I~pector. F01~3~ NO. 6 TOWN OF SOUTHOLD ~ Building Deportme,t Town Clerks Office 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 Inspector with the following; for new buildings or new use: ]. 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 installations, 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 property 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 formation 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 BLlilding ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ........... ,'-~./.~,~ .......... ..'.~.....~...~..~. ......... J~.~.,/.~,./...~..~ ...................................................... S Owner Or Owners Of Property ........................ ~ ..... I ............................................................... Subdivision ..~...~..~'.~.~._~.....,.O~..~.~../..~. ................. Lot No, .2,~-,, Block No ............. House No...~.....~:..~...6 Permit No./.Z.~..~../. ...... Date Of Permit/.././~.~.z..~./...,Applicant .~..6~z~-J: .A j2~...~....~.~.~ ~ Health Dept. Approval ..,~.~.......~.~...~../.o..,.)z.. ........ Labor Dept. Approval Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FJnoJ Certificate .......... .~.... ......................... Fee Submitted $ .................................... Construction on above described building ~nd permLt ,m~ets ~11 applicable codes and regulations. Applicant Notary Public ...,,,,~.,,.~. County /J '40T'AR¥ PUBLIC, State ~f New York ~ Ne. 52.8125550, T~ ~[res M~ 30. 19~ (stamp or seal) C.o. J. uooooo THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTR C TY 85 JOHN STREET, NEW YORK, NEW YORK 10038 O,,te J'u~e Y, 1~82 153635/82 ~,ppii,~,,,io,, ~,o. on slle N 5648[0 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above appl~catlon number in the premises of Su~-Ark Con. S/S Sound Or~v~q[~,O West~ood Lane, Greenport~ N.Y. £05 in the followlng location; ~ Basement ~ 1st FI. [] 2nd FI. Section Block Lot was examined on Jklrl~. 3, ~k98~ and found to be itt complia~t~e with the requirements of this Board. OUTLETSFIXTURE SWITCHES FIXTURES RANGES OVENS EXHAUST FANS FLUORESCENT 20 22 DRYERS OT ER APP~ARATUS: ~-~Am~Ae de~ector E R V I 4 C A w G, NO OF NEUTRALS OF HI-LEO 1 4 Fred ~arsch 354 Glen Drive GENERAL MANATEE//,,r ' ~~ $~drley, N.Y. 11967 Lic~2555-E 11~ , , , ,, This certificate must not be altered in any ma~er~ return to t~e office of the Board if ~co~rect. l~spectoF~ may be identified by their ¢ ials. FoR THIS COPY OF I~ ANY MANNER. FIELD INSPECTION ~ FOUNDATION (1st) FOUNDATION (2nd) COMMENTS ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: Memorandum from.... BUILDING INSPEC'rORS OFFICE TOWN OF SOUTHOLD TOWN HALL, SOUTHOLD, N. Y. 11971 765-1802 /! FORUM ~/0. 1, TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. Examined ..................... ~... ............... , ~proved ...~....4~. ......... , 19.~. Permit No ................. Application No. ,./.~ .......................... Di d / sapprove a c ............................................................................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building 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 streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. 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 permit 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 Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with oil applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................. ..................................................................................................... Name of owner of premises .................................................................................................................................................. .-. If applicant is a corporate, signature of duly authorized officer. ((~me 'and title of corporate officer) Builder's License No ..................................................... Plumber's License No ........ ~-~...~'....~... .................... Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done Mop No ' ..~....~...~...~.~ ~'£c.,~ Lot No Street and Number¢/..~...~..l ............ .O~./~....~.~..~u.~ ....... J~.~../.~ .......................................... Municii~'ality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ............................. .~/.~...C-.,~..~X.~........~....4...~..~) ............................................................. b. Irffended use and occupancy .......................... 4~.¢~...~......~..,~/Z~'J./..~..~........~.!.Z..~../;/.)..~.~ ......................................... i 3. Naturb of work (check which applicable): New Building, J Addition Alteration Repair .................. Removal .' ................. Demolitior, .................... Other Work ................................................ . .., <Des riptian) -<- 7 ~ ' ....'~..~. ......................................................................... 4. Estimated Cost ................ .~. ...... ;/ ............................. ,,...Fee (to be paid on filing this application) 5. If dwglling, number of dweliing units ............................ Number of dwelling units on each floor ............................ If garage, number of cars , ~..~.~A~. , ~/..~. ....................................................... 6'. If business, commercial or mixed 'occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, Jf any: Front ............................ Rear ................................ Depth .................... Height ........................ Number af Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ H~ight ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... ,,~..~,. ............... Rear ...... ~...~. ............. Depth ,.,,~,,.f~ ............. Height .....~...~...../.... Number ]of Stories ............... ~...~...~.~. ......................................................................................... 9. Size of lot: Front ........... .~..~i~. .................................. Rear ............... .~...~.., ................. Depth ,,..?-?-~,,o..~ ............... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction viqlate any zoning law, ordinance or regulation: ...... .~... ............................................. 13. Will lot be regroded .~.~2. .............. excess · .~. , Will fill be removed from premises: ( ) Yes ~s) No .... ,~.... ~..~.,/,~. ............ Phone N o,~.~ .~ ~,~,. ;.,7,, ,~,.?,,~ 14. Name of Owner of premises ...... .~..~.~.~T.'~...... ,~..~.~/~/Zq~ ......... Address Name of Architect ................ , .............................................. Address ................................ Phon~ No ....................... Name of Contractor .......... .~,..~./.~...?.~/~.......~..~....~.~.J--~.. ....... Address ...... ~.fl.~..~..~,~'~'~.... Phone No. PLOT DIAGRAM Locate clearly and distinctly all' buildings, whether existing or proposed, and indicate all set-back dimensions from proper~y lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot, COUNTY, O ~,~..~ .~.,~, · S.S ................. ~ .......................................//// ! ........................................ being duly sworn, deposes and says that he is the applicam (Name of individual signing contracf) above named, He is the ............................. , ....................................................................................................... i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~ly authorized to perform or have performed the said work and to make and file this application; that o11 stotemen}s contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in ~he manner set forth in ¢rhe application filed therewith. ....... ~..~.....,' day of ...~.. .,.~,~/,., 19.,~../. ~? '~ .... Notary Pu ~C,~ ..', nty ................. : (// (Sigpature of applicant) JUDITH T. TERRY Notary Publlc~ Slate of New Yorl~ J No. 52-0344963 Suffolk C~)unt,~ i Commission Expires March 80, 3.a'.l ~ ' ~u,,~. co. mu~r~-, v.~, ^s,,,"ov^t. I '~- $' ~o. .9 'a~VATION I~ECTION. REQIJ~[i '~ CI~RTIF~ /,. ~ SI. IFF, ¢O. Ilt;pT.OF i. IIALTH I, .~1~111, ~; ,, ,~ '' ,I'I~'ATi:MI:fs~I' O!e INIliNT -- o. /~ ~lO~ ~E WAT~ BUPP~Y AN~ [ C~/Y O' EOB APPROVAL OF' CoN~rRU~r~ON Obtl. Y . [,F LL-~_L_.. L ................................... ':i 'i