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Home My WebLink About11053-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ..... g 105.5 t ...... Date ......... Jun e. 3.0, ............... 19.8. 1 THIS CERTIFIES that the building ................................................ Location of Property ..... 2.00. ~.u.r~.~e..L.~.~.o., ......... .S9.u.g.h..o.l.d' ~. New York House No. Street .............. ~,~r~/e~' County Tax Map No. 1000 Section ... 07B ...... Block .... '. 09 ........ Lot ...... ~.~ ........ Subdivision B'ays~.rl'e 'Terrace ............. Filed Map No..3034. · .Lot No.. 2/* ......... conforms substantially to the Application for Building Permit hbretofore filed in this office dated ........ Mo,~¢h..1.2 · · ·, 19 .~ l pursuant to which Building Permit No....t .1.0.5.}..g. .......... dated ...... Marc2~. 13 ............. 19 .0.1,, 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 ......... ............ Ab.o.'~e. Or. ound..Eool ................................................ The certificate is issued to ....... P. auJ...R., l~.ede r~.en ................................. of the aforesaid building. Suffolk County Department of Health Approval ........ N / It ............................... UNDERWRITERS CERTIFICATE NO ...... N.~ 00.0.6. ................................... ...... . Building Inspector Rev. 1181 TOW~ O~ S~UTi~O~ TOWN HALL SOUTHOLD, N~ Y. BUILDING :PERMIT! (THIS PERMIT MUST BE KEPT ON ~H,E PRE~ SES COMPLETION OF THE WORK AUTHORIZED) ' UNT L (ULL NO, J.~1053 Z Date ..... ~.~..~ ....... ~ ............... , 19..~..~ Permission is hereby granted to: ....... .... ~.....2,.~,.~.~4_....~./.~..~ ....... ~ ....... ~.~.z.~,.~.~.~...'~../.u.~....~, .......... ,o....~.~.7..:~.~..~..z: ....... .x.~:~.~.....~.~.~.,,,~,~......~~,~...~,.~..~ ~.~C2...Z:C...',.,,r:~,,~. ..-',,?..,,~.~x"~.. .................................... ,. ................ ~...~ .............................. at premises located at ...~J.-~). ......... ~..~.~J' ~'~'~,... · · ~/'-.'}: ':' / · ! .... ~: ...... ~ ..................................................................... ~' ' ? 'i' ' ' '~:? " .... ~,~/~ z~~ ~~ .............. ~.~.....~.V... ...... County Tax Map No. 1000 Sect,on ;.....(,~..Z.~,,' ..... Block ¢...,:~,..~,. ....... iLot No ....... .~...~.,.~;... pursuant to application dated ........ ,/.,.~.~,,~:....../...L~,.~.;....., :lg.~.~;./and approved by the Building I~spector. Fee ,$....:...~ ............... FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.¥. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 featu res. 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 featu res. 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. 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 Date June 8 1981 New Building ............. Old or Pre-existing Building ............ Vacant Land ............. 300 Summer LaneI So. uthold~ New York Location of Property ................................................................ House No, Street Hamlet Owner or Owners of Property ........ ~,aul R. Pedersen County Tax Map No. 1000 Section 078 Block 09 Lot.., 0.23 Bayside Terrace 2034 24 Subdivision ................................. Filed Map No ........... Lot No .............. 3/13/8% , Paul R. Federsen Permit No. 11053Z Date of Permit .......... Applicant ......... Health Dept. Approval ........................ Labor Dept. Approval ........................ U nderwritars Approval...~.57.0.0..0 .6 ........... '...Planning Board Approval ...................... ' '" - f t F lC f t × /'~ Request tor/emporary L;erti ica e ..................... ina ertl ica e .................... Fee Submitted $ ...... 5.: .u?. .................. Applicant..~.~. ;-~..c;~.~. ?.~.¥..'./~..~/. ¢./,~, ,o~,~. ......... Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY May 13, i~S1 S~ ~OHN ST.EET, NEW ¥O~K,].~.O~K ,OOSs THIS CERTIFI~ ~ ~ outsi~ inthefollowingloc~f;1].~]~dJ~ment ~ lstFI. ~ 2nd FI. Section Block Lot was exandned on and found to be in cotnpliance with the requlretnents of this Board. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES iNCANDESCENT FLUORESCENT VAPOR DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIMECLOCKS UNIT HEATERS MULTi-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R I C NOlO E COND. OF CC. COND ---- -- OF H~-LEO OTHER APPARATUS: (S~m~ Pool) ~I?~s c~rtificate covers compliance at lthe ~a~e of irmp~ction ~ly~ Bec~e of u~usual ~nviror~ent:s it is aRvisable to have ~requent test aad/c~, repairs made by a q%~lified person. A, WG OF NEUTRAL All,der G. tf~bbox~d Box 222 A~ebogue, N. Y. 11931 [Ac: #304 This certificate must not be altered in any manner; retur~ to the office of t~e Board if incorrect, inspectors may be ,coPY ~OR RtJli. VmNO DEPARTMENT. TNIS COPY OF MuST NOt ~E[ALTERED~ mN ANY MANNER.' F ~ELD"~iNSPECT i0N COMMENTS FOUNDATION FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY CO E FINAL ADDITIONAL COMMENTS: cc / 6~Y~ Examined ./..(~?..~..% .~...t.~..., 197/. FORM NO, 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved . .1~.~.../~.~. ,~... ~,.~.., 19~. f. Permit No../[.(..f..~..~..~ .~ Disapproved a/c ................ ~.......--~. ...... ~. ...... __ /~ APPLICATION FOR BUILDING PERMIT Application No.././. ~...~.-.5, .. Date /4~c~-{ ./..2:-. 19 g:> I INSTRUCTIONS a. This application must be co~npletely 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. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stre~ or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apt cation. c. The work covered by this application may not be commenced before issuance Of Building Permit. d. Upon approval of this application, fire Building Inspector will issue a Building Permit to the applicant. Such pen~ 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 Occnpan 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 t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describc The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, architect, engineer, general contractor, electrician', plumber or build, Name of owner of premises ~ ./? .F~..~../~..:..~..~-. ).D .~7. !~,. ?' ............... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. Plumber's License No .............. License No' ' '~" Electrician's Other Trade's License No ...................... Location of land on which proposed work will be done ............................................... ...... .................... -oow¢ House Number Street Hamlet County Tax Map No. 1000 Section .... ,c3. '7(~ ....... Block . O .~.. Lot. ,~'.~, Subdivision /C4/q~0'~ ~./4/,5-!bt~ T~-~ACE Filed Map No. ~.,O,,.~.,~, Lot (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................. b. Intended use and occupancy ~'Cx),/q/M ,A)~' ~OOC- . .~..' Repair .......... __._ RemoVal... :..:..:. Demolition .............. Other Work ..~..~r.~.~/.,~.~ ~O'~dP O0 -- ~ ~ (Description).. Fee ........ Estimated Cost ............. ~ ..... (to be paid on filing this application) If dwel~ng, number of dwelling units .............. Number of dwelling units on each floor ................ If gamge, nmber of c~s ..... } .................................................................. If bus~ness, commercml or m~xed, occupancy, specify natuLe and. extent of each type of use .......... ~ t .... D~ensions of exis[ing structures, if any: Front ........ ~ .... Rear .... ~.~ ...... Depth . .Z ~. 7. ...... Height ~. Number of Stories ......... ~ ................................. t ....... Dimensions of same structure with alterations or additions: Front ..... ~ .~ ........ Rear ...~ ~ ........... ~ t ~' ~ . ~ . Depth ....... ~.. Z ......... Height ..... l~ ........ ~ ....... Number 9f Stones..~ ........ ., .... D~mansmns of entire new construction: Front ....... ~ ..... Rear .. ~/ .......... Depth .. Z~ ....... He~t .. ~.7. ....... Number of Stones ..... ~ .................................. z ........... S~ze of lot. Front ../..~...~ ........... Roar .... ~.~ ............ D~plk ........... ~ ~ ......... Dai~ o~ Puro~aso ...... ~ff~..~ Z7 ~ ....... ~amo of Former Owner ... ~.G...&~t ~.~.'. ........ coperty lines. Give street and block humber or description according to deed, and show street names and indicate whether tefior or corner lot. Zone or use district in which premises are situated ....................................................... Does proposed construction violate any zoni?g law, ordinance or regulation: .... Will lot be regraded ........ ,~ .......,4": ......... Will exce~ fill be removed from premises: 2_~'~z No Name of Owner of premises . ~...~./~.-../f.~?..~..~.. Address ,7{: .'~ ~.. ~.~.L~.'.~..c~..0~. Phone No..Z./....-.... /. Y.7 ?.. Nmne of Architect .......... i ................. Address ................... Phone No ................ Name of Contractor ......... ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all i buildings, whether existing or proposed, and. indicate all set-back dimensions from TATE OF NEW YORK, OUNTY OF ~/~..~.-d~.d .... '. I a.~ . (~:'. ...... .~. AO~.¢ff.,.. ~d~..~q.~..~. d. ......... being duly sworn, deposes and says that he is the applicant (Name of individual sigfiing contract) bove name ~ ~c~ e is 'the ............................................................................ '. ' (Co~iractor,~ cor~;;at; of fib;r, etc.) f said owner or owners, and is du!y authorized to perform or have performed the said work and to make and file this pplication; that all statements contained in this application am true to the best of his knowledge and belief; and that the ,ork will be performed in the mannbr set forth in the application filed therewith. worn to before me this ; ....................... day o,f ......... , LINDA F. KOWALSKI NOTARY RIJDLIC, State of New Nb. 52,4524771 ,, ~ualified iii ,8uHol~ County j Co~missionjExpires March 30, 19~~ (Signature of applicant)