HomeMy WebLinkAbout11042-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. ~.1.t.~ .1.8 .......... Date ...... l~Og.ey.qbe I'..3,0 .............. 19.82
THIS CERTIFIES that the building . .c.o.~.¥~?.s.~9I~ ...................................
_~ ..... ,. r~O0 Center Street Mat tit~lck
Location u, --,~vc,~y · ·. -: ...........................................................
House No. Street Hamlet
County Tax Map No. 1000 Sectio~ .1.2.3. ........ Block ...0. 2. .......... ~ot ...0..1 9 ...........
Subdivision X .. ·Filed Map No. X .Lot No. X
conforms substantially to the Application for Building Permit heretofore filed in this office dated
·...F.o.b.~ t.t~ ?.y.. ,19 ...... 19 .8.1. pursuant to which Building Permit No.. ! 1. 9.4.~...7, ............
dated .... .~.a?.e. ,h..3 ................ 19 .a.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 .........
....c.o.n.¥ .e r:~.~.9 ,n' .o.f...F,.a?.a.g,e..t.o...b?.d.r. 99.m' .&.. ~?.o.~.a. ¢.e. ?..og.m' .o..n..e.x.~..~ .e.i.n.~ .......
dwelling.
The certificate is issued to ...... 9.e.qi?. g~..~.~: . .&..~.a..r 9.1.y..n.. ?....D..up.r.e.o. .................. (owner, ~.~ mt~a~8
of the aforesaid building.
Suffolk County Department of Health Approval ...n./.~. ....................................
UNDERWRITERS CERTIFICATE NO ........... ~. 5. .~.7.~. $ ..............................
Building Inspector
Re~,. 1/81
ro~ ~'o;
TOWN O~i
TOWN HALL
SOUTHOLD, N~ Y.
BUILDING
(THIS pERMIT ~UST BE KEP~ ON TH,E P~EMIS~S
cQMPLETION OF THE WORK'AUTHORIZED)
11042 Z
UNTIL FULL
Permission is hereby granted to: .
....... · .~.~.~=..~.,.....~'~ i
........
~o.....c.~.~....~........¢~.~..~...?.~. ....... :..:~,~..~...~~ ....
............ ~.~ .......... ~..~ ....... ~Z~.~... ~. .,. .........
at premises located at.
co~ ,o~ ~p ~o. ~o00 s~,,o, ..... ~.Z.Z. ..... ~o~k .~.C...~ ....... ~o,,o. ;...~.~..~ .......
pursuant tb application dated ....... ~.~~,....g.~...:,....., 19 ., and approv~ by the
Building I~spector,
: Re~,~6/30Z80
FQRM 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 subn~ tted in duplicate to the Building Inspec-
tor with the following; for new bul]dings 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 building~ 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.
8. 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
New Building ............. Old or Pre*existing Building(X) .........., =/Vacant Land"
Location of Property .q~??~q.)~ .... ~Z?'~'~/''' '~"~/"~:' ~ :. ~//~' Z-
Hou~ No. Street Namlet
Owner or Owners of Property .......... ~.,: . ;. ;- ........................
County Tax Map No. 1000 Section ../~ ........ Block {~ Lot..
Subdivision ...................... ...........PiledMapNo ......... ..LotNo. '
Perm t No. ~/~{~ . . Date of ~ermit 4.~[~) .... A~¢licant . . e.. ~...~,~, ....
Health ~o~t. Ap0rova~ ........................ kabor De0t. A~proval ...................... ~..
Unde~riters Approval .~D,..,~ 2 2/b'~ , ,Planning Board Approval
Request for Temporary Certificate Final Certificat~
Fee Submitted $ .............................
Construction on above described building and permiCmee~s all ap~cabl~odes and regulations.
_ ,.--. . ~ : :: ,. - .,~ ,
1 3502 THE NEW YORK BOARD OF FIRE UNDERWRITERS
~ BUREAU OF ELECTRICITY
~-- 83 JOHN STREET, NEW YORK, NEW YORK 10038
Oate Rovembe~ 18, 1982 .~p~,Uc,tionNo. o,,yue '192808-82 N 583745
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number ~n the premises of
George Dupree~ 71C Center St., Ma~ituck, '~.Y.
in the following Io,'ation; [] Basement
was examined o. November 12, 1982
FIXTURE
OUTLETS
2
RECEPTACLE5
8
[] 2nd FI. Section Block Lot
and found to be in compliance with the requirements of this Board.
SWITCHES FIXTURES RANGES OVENS DISH EXHAUST FANS
FLUORESCENT
2
DRYERS FURNACE
SYSTEMS
NO. OF FEET
E
OTHER APPARATUS:
Electric R~om Heaters:l-2.0 K.W.,
1-~ka~ke Detector
E R
NO OF CC COND A W G,
PER ,~
1-1.25 K.W.
I C
NO OF HI-LEG
AW, G,
OF Hi-LEG
NO. OF NEUTRALS
Three "C" Elect. inc.
Rt. 1 Box 4~M Sound Ava.
Riverhead, N.Yo, 11901
Lic.~3327-E
Per
This certificate must not be altered in any manner;, return to the office of the Board if ~incorrect. Inspectors may be dent find by their credentials.
O Y, ~R BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MU$;~ NnT .n :n'.Tn,,~r~ ,,.
FI%~LD z~NSPECTION
FOUNDATION (ls%)
FOUNDATION (2nd)
COMMENTS
e
ROUGH FRAME&
PLUMBING
!
!
,!
INSULATION PER N.Y.
STATE ENERGY
co E
FINAL
ADDITIONAL COMMENTS:
FORM NO. 1
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N,Y. 11971
TEL.: 765-1803
Examined ./~./~.'.. ~) .... ,197./.~
Approvea ~.xl-'~'./..'~........~, ..
Disapproved a/c ..... . _ ..~. ..........
(Building rfispector)
APPLICATION FOR BUILDING PERMIT
Application No ~/(~ ~d~x'//
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 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.
(Mailing address of applicant) /y,~,j ',.0---
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
........ ....................................... ; ...................................... .
....... ,q,'. I
Name of owner of premises
las 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 ...... ~. ~.~../~. ...........
Plumber's License No .........................
Electrician's License No .... .~..~(~ .~. ~ ..........
Other Trade s License No ......................
1. Location of land on which proposed work will be done ..................................................
..... . ............. . ..... . . .x¢.)i ...........................
House Number Street Hamlet
County Tax Map No. 1000 Section .... /.. '.2:...~. ......... Block ..... .Q ~ ........ Lot....~../. ~ ..........
Subdivision ~ ~' Filed Map'~'°~~-~ ....... Lot..'~ .......
(Name)
2. State existing use and occupancy of premises and intended use arid c;dcupancy of proposed construction:
a. Existing use and occupancy ..... ~..~ ~c4~.~ ~.. :.~. .........:: i... ~ ...................................
b Intended use and occupancy
3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ........
Repair .............. Removal .............. Demolition .............. Other Work ...............
/.~..~-. ~. (Description)
4. Estimated Cost ....... ~.~.'-'f4~. .~. .................. Fee ...............................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ............... Number o f dwelling units on each floor ................
If garage, number of cars .... ~ ...................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .....................
7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth..., ...........
Height ............... Number of Stories ........................................................
Dimensions of same structure with alterations or additions: Front ................. Rear ..................
Depth ...................... Height ...................... Number of Stories ......................
8. Dimensions of entire new construction: Front ............... Rear ............... Depth ...............
tteight ............... Number of Stories ........................................................
Size of lot: Front ...................... Rear ...................... Depth ......................
Date of Purchase .... q~.r. ~,~. ................ Name of Former Owner .............................
Zone or use district in which premises are situated .........................
Does proposed construction violate any zoning law, ordinance or regulation: .... i ~D.' i i i i i i i i i i i i i i i i i i i i i i i
Will lot be regraded ............................ Will excess fill be removed from premises: Yes No
Name of Owner of premises .................... Address .................... Phone No ................
Name ~of Architect ......... i ................. Address ................... Phone No ................
Name of Contractor .......................... Address ................... Phone No ................
10.
11.
12.
13.
14.
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 number or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NEV~ir'~K~, . S S
COUNTY OF .... ' .
above named.
being duly sworn, deposes and says that he is the applicant
He is the .......................... .g~...~-s.,,.~.~.z..~. .................................................
(Contractor, 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 all 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 ~ed therewith.
Sworn to before me this
.... , ..... ..zT .....
Nota_ry~.ubli.c, ......... ~ ......
Term Exp r
GRUHILL'S TEAM OF
THE
or Ours
E~PI~RTS PROUDLY PRESENT
GEORGIAN
ALL OF THE SPECIFICATIO(NS LISTED
BELO~ ARE INCLUDED IN THE PRICE:
Poured Concrete Foundation
Frami~5, aS2,~ 16 i~ches o.c.
Dual entry Ce,~amic tile bath
Vinj~ a~best~s tile in kitchen
Co~dre~ f~xtures in Bath
Com~etc interior~painting 2 coats
Cedari~ ~kes all aroused
~'~×ter~or t~im 2 coats oil base pain't
Br~'~ ~ 'chimney
Hot r~'ater Baseboard Heating
A!~E ('~pper Wiring
Wo ~ ~' ~ heathing
S~ou~!~ust Driveway - 500 square feet
Wel:_ and jet pump to 100 feet deep
You-~ r_hoice of gas or e£ectric stove
Wood cabin,ts your choice of color
Al~ c~ectric fixtures including
C o i ? er wiri~ g
100 ~mp. 110-220 Volt electrical servic~
Dou~ie hung wood windows
A~i electric circuits grounded
Furl' y insulated
Gym seal finish on all floors
Washrng mac~inc hookup and dryer outlet
Ga;~ag e included
cesspools included
Bak~ white enamel storm windows
and doors included
~ oui~ide electrical outlet included
2 out~,"..de wa~er faucets included
Stained interior woodwork
Cedar shakes all around
INCLUDED: Energy saving requir~ments as
~, per Public Service Commission
OVER ~15 YEARS IN THE SAME LOCATION
335f~ P,O,UTE ~ql2, N, EDFOF~5~ ~(.¥. PHO))E: ($16) 732-1070
D~T~ECTIOrN'S: L.~.E~:~ez, swa~ ~a,s~ t~ R,cc. 7i2 (exit ~64~
t<~.,.~/~ ~ m,<.~c to mo6els. <'~,;~J~ic~ East ~<, Rte. 'I12, go
Sour~h ? m,~ ~o models. 0~; ~Sunriso ~ighway East to, R~e.
~112 ~o north for 5 mil~6 ~n'~mod~ts. OR; Po~tio~ road Ea~
to Rle. ~i2 go north for i mile to models.