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Home My WebLink About11026-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southold, N,Y, Certificate Of Occupancy No. g.l.0.fl 19 ....... Date .......... THIS CERTIFIES that the building ................................................ Location of Property .1.08.15 .......... G~'.ea¢. ~P. econ~..c .Be5'..t~[y.d... ....... l~Ii~.b.~.~..t;.u.c?.. House No. Street Hamlet County Tax Map No. 1000 Section . .I~ ~ ....... Block ·, .Q3 .......... Lot ...q t I~ ........... Subdivision ...... X ........................ Filed Map No...~( ..... Lot No.. ~ ........... conforms snbstantially to the Application for Building Permit heretofore filed in this office dated .~an~a~. y. 2.9. ........ ,19 ~.1. pursuant to which Building Permit No... 1 .192.6. ~ ........... · dated ... F.e.~r~.r~..~. ............. 19 8.1., 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.n ..... a{lc[J..t-ton..and. ~lt~r~t,:Lon..t;o. ~B, .~;i..a. ti~.[zg..~[¥ .e~.l..~,n. g.. ....................... The certificate is issued to ..... I~z~lug. t( ~. &..~[u~L J..a, .F~pg.t4[~.c ........................ (owner, ~see er-tenant4 of the aforesaid building. Suffolk County Department of Health Approval .... n/~'. .................................. UNDERWRITERS CERTIFICATE NO ....... ~. .5 2. 5 9.6.3. ................................. Rev, 1/81 Building Inspector FORM NO. '~ Tow. O~SO¥~.~L, ii BUILDING DEP~RTJv(~ ~T'~ TOWN HALL $OUTHOLD, N~ ¥. 7 'BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PRE/~',IS~ LJNTiL F~LL COMPLETION OF THE WORK AUTHORIZED) ~ : Rev.. 6/30/80 Fee $ ........ ~. .......... ..... Building I~spector. Bud ng ns~ c to .....~.,~.~..z.~.¢~..~....~.z~.....~....~',~.~c~4.~.~r~o.~....~.~ .......... ...... .~....,.~:.~.~.....~.~.~.....~ro ~.cs.~.....~~-'.~ z~z~....~ ....................................... at~;emses ocated~t ([~....~....~.~...~....~Z~': ...................... ................................................................................. ,....; ......... ~,...:, ........... purs0ont ~o application datod ...... . ~ . , 19 ~ ., and approv~ by tho 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 naturat or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposa)-(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 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 topograph ic featu res. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any I~ousing code or safety inspection of buildi,pgs or prem~ iaea, or other pertinent informa- tion required to prepare a certificate. 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 New Building ...... ,Z~ ..... Old or Pre-existing Building ............ Vacant Land ............. Location of Property...//.~..z~. House No. Ham/et Owner or Owners of Property , ~,4f~-¢~. ~. ,¢~, ."~~ , . . ,~..~--~, .......... County Tax Map No. 1000 Section .... /'..,/~. ,¢2/ ..... Block , .~., .~ ........ Lot., .¢~../. ~' ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.//.&?.,~.g;..;~ Date of Permit .~/.~./~./.Applicant .................................. Health Dept. Approval ...... '..'~.. .............. Labor Dept. Approval ........................ Underwriters Approval .~j~¢~7~.~..~. ..... Planning Board Approval¢~. ~. Request for Temporary Certificate ..................... Final Certificate ... ~ Fee Submitted $..~..~..~ ............ Construction on above described building and pe~eetsgll applicab~codes aod regulations. ......... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITy ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 ,.,e .~'~ ~5, ~.~. *,plicat,o. No. o..~,le :L~0~3Z-~i N~0~ ~ ~ ~ ~ ~.:3 THI~ CERTIFIES THAT only the electrical ~uipu~ent q~ ~scri~ed below and i~troduc~d by the ~plicant named o~ the above a~olication nu tuber in the premises of k~a ~ec, ~ec~d.c ~ Bl~L ,W/o ~ Ave., ~tti~, N. Y. was examined on 3~ 18,1.981 and yound to be in compliance with the requirements of this Board. FIXTURE OUTLETE 45 RECEPTACLES SWITCHES 32 32 45 FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS YIMECLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R V I - C NO OF CC COND A W G PER ~' OF CC, COND AWG NO, OF HI.LEG OF HI-LEG R NO OF NEUTRALS A, W G OF NEUTRAL MO Jotm St~am~ke Jr. Per~y' a Rd. Riverl~ad, N. Y. 11901 Lic: #2074 This certificate must not be altered in any manner; return to the office of the 8oard if :incd~-rect. FOR BI/ILDING ,THIS COPY OF may FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING DATE COMMENTS INSULATION PER N.Y. STATE ENERGY COpE FINAL Memorandum f~'om .'... BUILDING INSPECTORS OFFICE TOWN OF SOUTHOLD Town HnLt~. So,moLt>. N. Y. 11971 765-1802 FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 E ami ed.. 5. ...... Approved . .~":~47.~...~ ...... 1 .~.~. Pe=it No...~ f.~. ~ ... ~~ (Building Inspector) APPLICATION FOR BUILDING PER~IT Z ..... Application No.. [./...0: .~':~. "5 ....... INSTRUCTIONS a. This application must be completely filled in by typewriter or 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 of property must be drawn on the diagram which is part of this appli- 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 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 1S 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 all 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, i~' a ~6rporation) · ..... ............ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder s License No ...... -.~.'. :~T .......... !5~. Plumber's License No...~. ~../°./.~..t' .~.6/?..?57. ~ · .~) ~? Electrician's License No..~...cr.~.' ~..Z?.Z~ ~ ....... Other Trade's License No. ~.,~..~..O..-~.-~....~.~.~.a." .~. ( .'?5 1. Location of land on which proposed work will be done .................................................. ....... ............. .... ........................................ House Number Streett Hamlet County Tax Map No. 1000 Section .../..~..~. .......... Block ...O..~· ............ Lot...(~.4..~. .......... 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 occnpancy.. 'J~.oo¢.{} t '.~4~...dg~'.~.,..~~~ ..................... ', 7 ...... . ........ ~,. _. ..~; ,.,.'~ ; ..... b. Intended use and occupancy ...~..~.e~.[j t .w.~... ~.~. ~~~c..d..~..~<F~-.~/.%~e .... 3. Nature of work (check which applicable): New Building .......... Addition .... .~ .... Alteration ... ~ ..... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost ....... . OO O Fee ...................................... . (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... / ........ Number of dwelling units on each floor ................ If garage, number of cars ....... ; ......'~-~ ......................................................... 6. If business, commercial or mixed o'ccupancy, specify nature and extent of each type of usc ............. ~ ....... 7. Dimensio~ns of existing structures, if any: Front ..... ~'~.t ...... Rear . . ~ ~. ! ...... Depth .... Z.~. ....... Height .... }~,~/. ....... Number of Stories ........ ] ............................................... Dimensions of same structure with: alterations or additions: Front ..... ~0.t ......... Rear ....... ~O~ ........ Depth ...... ~'~. ~. .i Height . J~,~ '. Number of Stories .[ 8. Dimensions of entire new construq'tion: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................... 10. Date of Purchase ........... .] ~O/.'~/. gO ..........Name of Former Owner ..... ~,.~,~x~ ............. 1 1. Zone or use district in which premises are situated ...... .~ ............................................. 1 2. Does proposed construction v~olat~..any_~oning law ordinance or regulation: .... ~.o. .......... 13. W~ll lot be regraded ...z~.-;-.~,_.....~.. ..... Wall excess fill be removed from premises:t z Y~-Z 5° 14. Name of Owner of premed ~¥~1~.~..~'al~.t¢.q,)... Address /qlg(,..~.~..my P.Kv*.)'. [~X[I~. Phone No?...-.f?:... Name of Architect . A &~ .... Address pq~o~ JfflT,. ~51~.~1,1. Phone No, Name of Contractor .... ~.6~'. ~ ~.¢ .[* ~..~s~...~..~Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block m [tuber or description according to deed, and show street names and indicate whether interior or corner lot. STATlt OF NEW Y,~RI~ ,,,, ~ S COUNTY OV.~... ~' ......... · ~~~. .......... being duly sworn, deposes and says that he is the applicant . (Name of individual sign!ng contract) above named. Heis the .............. (,/ (,~>fitractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application~ that ail statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ...... c~.~j~.. ......... day of. ~J~'~.~f~. ..... , $otat~P. ubli~ .................. {~ .~2~./.~. County