The URL can be used to link to this page

Home My WebLink About11032-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall 5outhold, N,Y, Certificate Of Occupancy Z10712 Date October 2 19 81 THIS CERTIFIES that the. building .......................... .. ..................... 20075 Main Road Orient~ New York Location-of Property ............................................................... House No, Street Hamlet 017 03 005 County Tax Map No. lO00 Section ............ Block ............... Lot ................. Subdivision ......................... ....... Filed Map No ...... ;..Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated February 18 198.1. . pursuant to which Building Permit No. 11032Z dated February 24 81 ............................ 19..., 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 ......... Addition and Alterations to Dwelling (Bathroom) Isaac T. Edwards The certificate is issued to ..................... ~o~n.e.r,./~s, te~p~t~[~ ..................... of the aforesaid building. N/R Suffolk Connty Department of Health Approval .......................................... N511086 UNDERWRITERS CERTIFICATE NO .................................................. Buildin,, InsiJector Rev, 1/81 TOW. Or sOU~T,0L~ TOWN HALL ~O~THO~B, ~ ~. C~MPL~IO~ OF ~HE WORK ADTHORI~[D) N? 11032 Z Permission is hereby granted to: at p~emises located at !;..'~i'~''''~'~'~g~''''':''' ................................................................................................. Coufity Tm< Map No. 1000 Sect on¢...0./...7.. ........ Black .~*~: ~.: ...... ..., Lot No. ~J.r=.Zo.C : . . ~~ Z~, , 19~ and o proved by fha BuilOIng I~spector. ' ? Fee Rev. :6/30/80 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 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 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 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 Date ...~.." ~'~ .~.J ............... New Building ............. Old or Pre-existing Building ~ Vacant Land Location of Property ~0o.r~ ~'... ~FI.I ~/.. ~O/~J) ....................... (~.R ~,~F ~J [ ................. House No. Street Hamlet Owner or Owners of Property .I5.R/~C. T,..~ '~-,,p.C.F~C.O.g ............................ County Tax Map No. 1000 Section ....~..~. ~', ...... Block ... ¢~..,~ ........ Lot.. z~. ~ ~ ...... Subdivision...". ....... '.,~ .................. Filed Map No ........... Lot No .............. / / Permlt~/o. //.~..~.~Z. Dat; of Permit . .~..~/~./.AppJicant ............................ ~.~ ./~). b rDe t J~ ,~" Health Dept. Al~proval ........................ La o p . Approval ................ q.\ .... Underwriters Approval . /.~.. ~'~. ./ ./ .¢¢. ¢.~. ............ Planning Board Approval .......... .)L~.~4..I I~[. . ~::;~s~:t~r~p.~.y,.~c::I ............... Final Certificate ~ .,~b, ~j~( !',~)' ' Construction on above described building and permit meets ali applicable codes and regulations. Applicant .~. r,. ~ .............................. Rev. 'Jo-10.?e THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEV~ YORK 10038 ..,e ~'~,ua~' 27, i~Si ~..l,ca.o. ~o.o.~.~ iio2~ - in the foHow~n~ location; ~ ~ase,nent ~ ;st FL ~ ~.d FL Section Block Lot w.~ ~x~,,,~ao,~ o. Fev~ 23, 1981 a.d ~ound to be i. compllanc~ ~ita ta~ rdqulre,nents of ta~ Board. FIXTURE OUTLETS SWITCHES FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS MERCURY INCANDESCENT FLUORESCENT VA~O~ 2. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TJMECLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO, OF FEET SERVICE DISCONNECT S E R V I NO, OF CC COND A W G, NO OF HI-LEG i ~_'~/o · OTHER APPARA?UE= ?mzelboa_rd/o: 1-17 eir. 100 maps., 1-19 cir., 100 amps. z Sa]. Pta[o, Electrician, Gr~ort;,. N.Y. 1194/4 1ic.1069-E GENEI~AL MANAGER This certificate must not be altered in any manner; return to the office of the Board ~f ,nco.~rect. Inspecto[s may be identified by their credentials. COpY I~Ol BU?DING DEPARTMENT. THIS COPY OF cERTiEICAI~E]M0$T NOT B,E~ALTERED IN ANY MANNER. T APPROVED AS NOT,El) · FEE: / ~'%"' _.BY: NOTIFY ~B',..IILF~NG DE~'-,"~'~'/~ENT 755-]80;~ 9 ~.~3 TO 4 PM FOR THE FO[J O'&qHV ~NSPECTIONS: ]. FOUNPA] ~gN - TWO REQUIRED F~R 2~'U2:]D CONCRETE 2. RCU~SH - FRAMING & PLUMBING 4. FIN&L - F']N?:':L',JCTION MUST ALL CONT~Rt'CT~P)N SUALL MEET THE REQUIREMENTS OF THE N. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. t '~o X~o Examined.. ~.~.,...~./...., 19 .~.?. Approved . ~...~.. , . FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1B01-~ Application No./../.(j. ~'~.~.'. ........ Disapproved a/c ........... ~7~..-7 .................... / (Building Inspector) APPLICATION FOR BUILDING PERMIT Date Z-/~7 19 .~../ 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 IS HEREBY MADE to the Building Department for the issuance of a Building Pemtit 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, ~ng. code, and regulations, and to admit authorized inspectors on premises and in buildings for neces~sgp.~,-tWg~ections. [.~/~.~.~- /' , . . ................... (.. ' (SignatuiP'~fapplicant, or nanhe,~ .if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber o~) (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (N..ame 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 laird wa'which proposed work will be dono ................. .~*-~. · ~ ...... ~ .................. House Number Street Hamlet County Tax Map No. 1000 Section .... O. [. ~ ....... Block ..... ~ .~ ....... Lot.. O.~ ~ ~00. ('.. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy.../~i '~.~ ..... ~ ~ ............................. b. Intended use and occupancy... ~..~,:-,-,,t,_ 7 .... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair Rem!oval . Demolition Other Work ........... ~. (Descript~'m) - 4. Estimated Cost O co -- 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 mber of cars "~'i If business commercial or mixed occupancy specify nature and extent of each tyl2e of use ..................... 7. Dimensions of existing structures, if any: Front .... c~..~ ...... Rear ....~i .~ ...... Depth....~..~. ....... Height . ....~.~.. ...... Number of Stories .... ~ ................................................. Dimensions of same__structure with alterations or addi2[io~,.s: ~r~nt .... ~;~. ~ ....... Rear....Ct(..~. .......... Depth ....... ~. '.~ ........ i... Height ....... -l~. ~w.. ......... Number of Stories ........... ~' '7 ...... 8. Dimensions of enti, r,e new construction: Front ..... ~ .~ .... Rear ..... ~...~ ..... Depth ............... -~ Height ..... ~...-~. ...... Number of Stories ...... ~.. ............................................... 9. Size of lot: Front ..'~,~P~Z~,.,.'~-fO. ..... Rear ...................... Depth ........ 10. Date of Purchase ....... -,' ~'~'/'t'~/'~'O ............ Name of Former Owner . .~.~. :"/... 11. Zone or use district in whichLp~e~is~s are situated. ,,~&..~-~k~<..{..~. ................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ...t~9..O:T. ....................... 13 Will lot be regraded ........ ~ ................... Will excess fill be.re, mo_Yed from premises: Yes No 14. Name of Owner of premises ../~...~¢~. ),.oAddress . .~'3, '.~.' .~...d~/~'~.. Phone No..~..~.B. ~'~,~.~. Name of Architect .............. . ............. Address ................... Phone No ................ Name of Contractor ........ i ............... Address ................... Phone No ................ AGRAMI C.~;~.....~.c~' c,..,'L i o-,.f._.(L' Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S ~ COUNTY OF ...~t./:~:'O/..,/~ ....... i (Name of individual sig~ing contract) above named. : says that he is the applicant He is the ..................... ' .................................................................... (Contractor, agent, corporate officer,?te,) 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 all statements contained in this application am true to the best of his knowledge and belief; and that the work will be performed in the manfier set forth in the application filed therewith. Sworn to before me this ..... : I .~..'~.. ......... day ;f...~..~,.~...i 19 .' .~. · Quahficd ,n Suffolk Color, IF / (Signatureh~-flpplicant) C0mm:ss~oa [xp~res Uarcll 80~ [~&~/._