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Home My WebLink About11468-zFORM NO. 4 TOWN OF SOUTFIOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Sou(hold, N.Y. Certificate Of Occupancy No. $.15.0A 9 ....... Date'. ....... ,Iune..t~ ...: .............. 1982 THIS CERTIFIES that the building .... - ............................................ Location of PropertyHouse' .1.0 lNo.O ...............Doa~. D ~.' i y.~aStreet ................ 'C'u t;c h'°'gU e '/eiHam County Tax Map No. 1000 Section . .1.16 ....... Block .. 135. .......... Lot .. 13.1.1. ........... Subdivision. 13.e.txc hw.o.o.d. C r>.lOa~r ........... Filed Map No. 72.7. .... Lot No..5 ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ~.o.¥~l~.b.e.['. 5 ......... , 195.~. pursuant to which Building Permit No...1.1.%618..g ........... dated ...hlgy~.n1~¢I'..1.~ ............ 198 .t., 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. ...... .d.~. c..k..~d, d..:[~.~qn...a.n.~. ~?.t,..J..a~..¢ .n.c.l.qa. U.v.e' .o..f..e.x:i, ~s .'b.inE,' pp.r. qt.~, .:~?gr..l'!a..b.i.'r-.a.b..lo The certificate is issued to ....~a~'?~r..P.,..~.a, Tl p?. ..................................... (owner, ~ee.o~ of the aforesaid building. Suffolk County Department of Health Approval .... .~1/. a .................................. UNDERWRITERS CERTIFICATE NO ..... ~. .5. 5. .6.9.6.8. ................................... Rev. 1/81 Building Inspector BUILDING TOWN ~HA~L SOUTHOLD, N. Y~ i BUILDING pER~ITi ~ (THIS PERMIT MUST BE KEPT ON THE P'RE~ISiiS UNTIL JLL COMPLETION OF THE WORK AUTHORIZED) Permissiofi is hereby granted to: , , Cou:,~ T~¢ ~ap No 1000 5oct on .................. ~ ~l~ .................... : ~l~t ~ ......................... pUrs¢ont ~o opplicotlon dated ..... ........ ... ~.... 19..,..r.., ond opprov~ by the B~ildlng Ifi~pector, Fee $ ........ .. ............. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and sLibmitted 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 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 installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of compleied 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 cocJe 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 Date ..... .'~./d?/..~'. ,~. .... New Building ............. aid or vre-existing Building ............ Vacant Land ............. ,_ocat,on of' roper,,, ..... ........ ....... ~o,,ty ~ M~ ,o. ~oo0 s,~,~o~ .... (X~ ...... B~ook .... ~ ...... Lo~ ....... ~( ...... Health De0~. Approval ........................ Labor De0t. Approval ........................ Underwriters A~proval ...... ~lanninfl Board A~proval ...................... ~equest for Temoorar~ Certificate ..................... Final Certificate .. ~. .................. ............. Fee S~bmitted Constructio~ on above described building and per~it meets alii[cable codes and regulations. ~oo~wj Rev. 10-10-78 1( ? o/ 1000221 THE NEW YORK BOARD OF FIRE UNDERWRITERS ELECTRICITY. OFY.o., ' AF~il 13, 1982 85 JOHN STREET, NEW THIS CERTIFIES THAT only the e~e trical equipment ~ described below and introduced ~the ap~t ~m[d on t~ ~b~ ap~licatlon nu.~ber in t~e premises of ~ P. Taylor, s/s B~h ~d ~., ozz ~ ~., ~ Ave. & ~t in the following location; ~ Basement ~ Ist FL ~ 2nd Fl. Section Block was examined on ~ 8 ~ ~ ~2 and ~o.nd to be in compliance witk the r~q.lrements of tkis Board. FIXTURE OUTLETS DRYERS FIXTURES RANGES COOKING DECKS , OVENS EXHAUST FANS 2 3 FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIMECLOCKS UNIT HEATERS MULTI-OUTLE1 DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: 1-O.F.C,I. t -S~Dke Detector S E R V I NO' O~ERCC~COND' OF A' W' O'CC COND., INO'OF HI.LEa~ OF HI-LEG NO OF NEUTRALS AWG. OF NEUTRAL P.O. ~ox 482 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectorz may be identified by their/credentials. THIS COPY OF NEW YORK STATE DEP;~RT~NT OF E~VIRON~NTAL CONSERVATION Regulatory Affair9 Building 40~ SUNY ~ . Stony Brook, NY 11794 (514) 751-7900 Robert F. Flacke Commissioner A COPY OF THIS AUTHORIZATION MUST BE AVAILABLE ON PROJECT SITE TIDAL WET!~NDS NOTIFICATION LETTER APPROVAL Dear This is to inform you that we have reviewed the notification letter (or permit application) filed on (cl~r~ /~ 19 ~ and have determined that it will not he necessary to file a permit application (or secure a tidal wetlands permit) to with your project adhering to the special conditions (if any) found on this letter. cc: U.S. Army Corps of Engineers NYSDEC Law Enforcement - Region I Regional Permit Administrator t (qg? Date Issued E. xpiration Date FORM NO, 1 TOWN OF SOtJTHOLD BUILDING DEPARTMEN I- TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved (Building Inspector) APPIdCATION FOR BUILDING PERMIT INST RUCrlOi'.iS Application No, (' / Cf (O ~ 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, accurate plot plan to scale. Fee according to schedule. b. Plm lq:m showing location of lot and of buildings on premises, relationship to adjoining promises or public sire{ or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apF :adon. c. The work covered by this application inay not be commenced before issuance of Building Pem~it. d. Upon appr~'.'al of this application, the Building Inspector will isst~¢ a Buildii~g Permit to the applicant. Such pern }mil bo kept on the premises ava~able for inspection throughout the work. e. No buildi~lg shall be occupied or used tn whole or in ¢a~% for any purpose whatever until a Certificate of Occupan ::HI have been granted by the Building Inspector. APPLICATION 1S HEREBY MADE to the Building Department for the issuance cfa BuildingPei~fit pursuant to t 'qu!ding Zone Ordinance of the Town ~f Soutbold, Suftblk Connty, New York, and other applicable Laws, Ordinances :{egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe :iu, apphcant agrees to comply with all applicable laws, ordinances, ~uilding code, housing code, and regulations, and ..::nit uuthorized inspectors on premises and i~l buildings for necess~lspectio~ ~ ~ (Signature of applicant, or name, if a corporation) (Mailing address o¢ applicant) .<dtr~te wbed~er applicant is owner, lessee, a_ggllt, architect, engineer, general ¢o!m--,~ctor, electrician, plumber or build (as on thc tax roil or latest deed If applicant is a corporation, signature of doly authorized officer. (Name and title of corporate officer) Builder's License No. ~_~'(~7 U e,,se ...... I.,ocation of land on which proposed work will be done ................................................ l ...... . . . .......... <'. q. .6. ........... House Number Street Hamlet // County Tax lvlap No. iO00 Section ..... ./¢..~.~ ........ Block ..... ~. ......... Lot ................. St bdivisio~ ~ ....... Lot ........ Strtte existing use and occupancy of premises and intended use amt occupancy of proposed construction: a. Existing use antl occupancy.. ~ff~..~/~ ............................ b. intended use and occupancy ~ ~ ......~ Repair Removal Dc, molition Other Work E ti d Cost ~0.,~,o O.O ,- ~ 5~ ~ (Description) If dwelling, number of dwelling units .... ./.. If garage, number of ears ................ (to! be paid on filing this application) ..... Number of dwelling units on each floor ................ i. If business, commercial or mixed occupancy, specify ~atm'e and extent of eacli type of use .......... ~ ......... t. Dimens ohs of ex st ng strtctures, if any: Front .... ~;1~. ....... Rear . .. g..7-7. ...... Depth ...... ~ ....... lleight ~ O. Number of Stories / Dimensions of same s~_mcture with alterations or additions: FronI ................. Rear .:.55 .......... Depth .~. ~.../~4'¢ ./~'~ef,.~..: .... tteight ...... ~ ~ ....... Number of Stories ................... L Dimensions of entire new construction: Front ............... Rear . .... , .......... Deptt~ ............... Height ............... Number of Stories ......................... ! ......' ......................... }. Size eliot: Front ........ ~ ~'.' ......... Rear ..... ~ ~ .......... . . Depth ... ,-~..'.'.'.'.'.'.'.'.'O~.2~. ............ ). Date 6fPurchase ............................. Name of Fenner Owner .......... ~ .................. 1. Zone or use district in which premises are situated ...................... ............. ' .................. !. Does proposed construction violate any zoning law, ordinance or regulation: . ................... ........... 1. Will lot be regraded ........ .,~.'4~. ................ Will excess fill be removed from premises: Yes No L Name of Owner of premises rz'.~..A}efi(..~.~.,ff.g'.w .~... Address.~v4'~ ,~..,e7. '¢'~,~,0.~? Phone No.?,-~'d.. -. O-..o, 5-/. ..... ..................... ~'~'~'4 ': ....... Phone No ................ Name of Architect . .. ~' o .'.. Address ......... . ..~.'..~.... Phone No.,.Z .~.'-..~././.~7 ..... Name of Contractor ...~.: C~",,~...,~(ed~.o~ ....... Addres .. . 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 number or description according to deed, and .show street names and indicate whether terior or corner lot. rATE OF NEW Y~O,RK] [ . ~ k S S OUNTY OF. ~ .~.~ ' ....... · ~ ...................... being duly sworn, (deposes and says that he is the applicaat (Nanie of individual signing contract) ~OVO nalned. e is the ......................................................................................... (Contractor, agent, corporate officer, etc.) "said owner or owne~, and is duly authorized to perform or have performed the said work and to make and file tiffs ,plication; fl~at all statements contained in this application are true to the best 6fbis knowledge and belief; and that the ork will be performed in the manner set forth in the application filed therewith. ,yom to before me this ......... , ............. day of .............. 19 . NOTARY PUBLI~ SIoto ~ Ne*; Ynr~ , No. ~-~6~077 ' ' ~ " '~ ~ Commis~ion Exoir~ ~arch ~O, I~ ~ ~ '~- 1. (Signature of applicant~ G 0 ~:~OTtJ, $TEI>5 TO ~ T::¢~..-'¢ ¢N t C. T~.AN oct,