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Home My WebLink About11222-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate O[ Occupancy Date September 3 ~.1. THIS CERTIFIES that the building ................................................ 3120 Kennys Road, Sou~hold, ~ew York Location of Property/,/~d,s'e 'N'd ....................... 'S't/e$i ....................... h~A/ei' County Tax Map No. 1000 Section . .0.59 ....... Block ...0.2. .......... Lot ...0.0.3. ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated June 16 ~J ..................... , 1 . . pursuant to which Building Permit No .... 1..1.2.~.2...Z .......... dated . ...J.u.n.o...3.0 ................. 1 ~ .1.., was issued, and conforms to all of the requirements of the applicable provisions of the taw. The occupancy for which ttfis certificate is issued is ......... Inground Swimming Pool and Fence The certificate is issued to Had'vixen /tllan (owne~,"~l~iO~ of the aforesaid building. Suffolk County Depart~nent of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO ..... ~.~ .5.2.9.0.8. 9 ..................................... Building Inspector Rev. 1/81 TOWN: BUILI~iNG (THIS PERMIT MUST BE KEpT cOMPLETIOh, I OF THE WoRK Perrhission is hereby granted to: ,0NT!L ~ULL and ~pproved by the FORM NO. 6 TOWN OF SOUTHOLD J3uilding Department Town Hail Soutbold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled irt typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Final ~rve¥ 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, Industria~ buildings, Multiple Residences and similar buildings and installa. tions, a certificate of Code cornpiiance from the Architect or Engineer responsible for the building. 5.Submit Planning Board approval of completed site plan requirements where applicable. B.For existing buildings (prior to April 195/), Non~conforming uses, or buildings and "pre-existing" land uses: 1. Accurate mJrvey of peoperty showing all property lines, streets, buildings and unusual natural or topograph c features. 2_.Sworn statement of ownm or previous owner as to use, occupancy end condition of buildings, 3.Date of any housing code or safety inspection of buildings or premises, or other pertinent info-rrna- lion 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 ~uilding .~..~'.. ;,., ..... Old or Pre-e~J, sting Building ............ Vacant"i~and ............. Location of Property~..~ ................................. ouse No. ~ ] ,, , ~'~ ~l I Str~,~ ~ . ~ -- H~mlet Owner or Owners of Property .,~.~' .'~., .~ County Tax Map No. 1000 Section.. ~,~.~., .C~ ..... B~lock 6C;~ Lot 0 0 · .~... Subdivision ............... ~.'. ................ Filed Map No · ~ .Lot No ~ermit No. J~. ~.'~/.~r.'.~Date of Permit ~/~3.t~;pl~'cant ...... ~>.'~i ~''. i .~. '.~. ',~.. i '.. rea th Dept. Approval ' -'~ Labor' ~ ,/l~'l~////'~f~/~ J" ...... /, ........ Dept, Approval ..... ~ ..... · ...... Underwriters Approval ~.~,.,,~ .-. ,.~..~..-?. ......... Planning Board Approval . i qequest f°r Temp°rary Cor t'f'cate L;;.:'" ................. Final Certificate .... .................. ~. :ce Submitted $ .......... ~ ......./~ /)/~ ~ tx ' ~,~0c,~,:, THE NEW YOR BOARD OF FIRE UNDERWRITERS B~JREAU OF ELECTRICITY / ~'L~.~ ~'~ i~3~ 85 JOHN STREET,~ NEW YORK, NE~:[~K_ 1OO38~ Date APplication~o. o.s,. N 5 2 ~ D 8 4 THIS CERTIFIES THAT only the e~ctrlcal equipme~tt ~ described 6clew and ~ntrbdHced by the ap~lleant named on the able application number in the ~remlses of in the/otlowlng location; [] Base,neht ~.~ ex.,,,i~don July 23, 19~1 FIXTURE } OUTLETS EECEPTACLES SWITCHES DRYERS [] 1st El. [] 2nd Fl. [)UtSif'~J~ '-- ~(~YJ~., Section Block Lot and found to be in compliance with the requiremettts of this Board. FIXTURES, RANGES OVENS FLUORESCENf~ FURNACE MOTORS FUTURE APPI~JAN(~E FEEDERS EXHAUST FANS TIME CLOCKS MULTI-OUT[ET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: S E R V I C E- NO, OF CC. COND A, W O NO, OF HI-LEG A, W O A, W G PER ~ OF CC. COND OF HI4EG OF NEUTRAL NO O~ NEUTRALS This certificate must not be altered in any manner; return,to GENEI~AL MANAGER Per_ .:f.J~ the office of the Board if incorrect, inspectors may be identified by their credentials. COPY FO]~ BUILDING DEPARYMENT, THiS ~OPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. BUILDING DEPT, COPY OF APPLICATION FORM 46-EL NBW ~ORK B~ARiD OF FIRE ~ . {, FILETH~COpYWITHBUILDINGDE~T.W~E~E~I~ED., , L ~' ~ -~ ~ LIST BELOW ALL EQU!.MENT W~ICH ~U{~N~ ~A~CEO ~, , ~o~ ~e au{~H~ed to ma~e th~ inspection and adjust tha fee t~ cover the additional ~q~i~{~ ~ P~Y t ~'~llcant'?" ' ' FIELD INSPECTION FOUNDATION (~st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C~ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 ' D TEL.: 765-1802 Examined ~g?~.4-...{/ ~0 .... , 192/. Disappro~t(d a/c ..... ~.. i .................... (Building Inspector) APPLICATION FOR BUILDING PERNliT Application No./ff .~..c~..~. ...... INSTRUCTIONS a. This application must he 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. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stre~ or areas, and giving a dettliled description of layout 'of property must be drawn on the diagram which is part of this apl: 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 peru shall be kept on the premises available for iuspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan 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 yzO'l}k, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, o/fo] removal or demolition, as herein describe Tile appli, ant agrees to comply with all applicable laws, ordinances, butdi~.' code, h~si~ code, and regulations, and ad'nit authorized inspectors on premises and in buildings for necessary · '~' '" i~ig~[t~r'e';i ~plicant, or name, if (Mailing address of applicant) State whether applicant is owner, less , ag~rchitect, engineer, general contractor, electrician, plumber or build, . ..... ........ :(as on the tax roll or latest deed) If applicanJfis a~:orporatio]}, si~ature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... .... - Electncmn s License No... t~.' ........ ~ ......... ............ I. Locationoflandonwhichproposedworkwillbedone.OtherTrade'sLicenseN° ...... .~... ..... '/'~'''...~..)....~j?.)...._.~. ......... ........................................................................ House Number Street Hamlet ~ ~" ? Block...,~ ....... /... Lot .......... ), ...... County Tax Map No. 1000 Section, .................. Subdivision . ~/~//~" - Filed Map No ..... · .~.~. ...... Lot .... r .~..~ ..... (Name) 2. State existing use and occupancy of psctl~ises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... w~..."~-,<. ................. ...................................... b. Intended use and occupancy ............................... · .......... ). 1. l. L $. Nature of work (check which applicable): New Building .......... Repair ............. Removal ............ Demolition . A d ... ........ Alteration .., ........ ....... Other Work ' (Description) (io be paid on f'fling this application) If dwelling, number of dwelling units .............. Nmnber of dwelling uni{s on each floor ................ If garage, nmnber of cars ...... ~.. ~ .............................. i ............................ ' ' ' specff~ nature and extent of each type of use If bus~ness, commerclal or mixed occupancy, ..................... Dimensions of existing stmctures, ifany Front J.O ........ Rear . ~..~. ....... Depth ..c(.5~. ......... Height .............. '. Number of Stories ........ [ ................... ............................ Dimensions of same structure with alterations or additions: Front ............ ..... Rear ............ ' ...... Depth ...................... Height ...................... Nmnber ofl Stories ............. . ......... Dimensions of. entire new construction: Front ............... Rear ........ ....... Depth ...... ~..: ..... Height ........... .7..'~umber.el Stories_ .......... /. ................. ! ........ .......... Size of lot: Front ZI~ ............... Rear ..... ~...'7. .......... Depthi 17~--Li~. i i i'- ........ Date of Purchase ~ame of Fenner Owner : Zone or use district in which premises are situated.., f.~..~. ............... i ........................... Does proposed constructio~,n [io~te any zoning law, ordinance or regulation: ... ~ .t~. .......... ~ ...... Will lot be regraded .....~w ....... ' ............... Will excess fill be remove~ from premises: k_ xes~ No Name of Owner of premises ~.~c~../~.l~t~... Address/~ 3'/..d~..?." .... Phone No. ~. ~.. CJ~'ff~z...q~k~'.. Name of Architect ................... ~_~[; z~'." Address ......... ., ..... .... Phone No ................ · .~."'-- .... Address . ~F/.'.27~.< .... Phone No..-2-~..~f. ..c?z Nmne of Contractor . ~-.,~,..) .......... - t PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from :operty lines. Give street and block nmnber or description according to deed, and show street names and indicate whether iterior or corner lot. i.,X' ~_.~ 'rATE OF NEW Y~)J?.g-~ ]/d e e :..~.~ % w~... {~,' ¢ ~.~ .7. being ~uly sworn, depmes and says that he is the applicant ''' (Nam; ;~'i'n~ivid~al'si~i;~'~;~im~i) 'v " hove named. e is the ' (Contractor, agent, corporate officer, etc0. f said owner or owners, ~d is duly authorized to perform or have performed the 'said work and to m~e and file ~is pplication; that all statements contained ~ this application are true tg~ ~est of his hmwledge and belief; ~d that the ,ork will be performed in the manet set forth in the application filed t~r~ith, i worn to before me this ~ . / I : ...... .............. ....... , . ~~ ...... ~~ ~m? ... ....~ilV.v~ ~ . ~M A ........ ~.~ ......... ~ NO. 52.8125850, Suffolk Co~ ' v ~'= ......... ~r "~ ~ Term Fxpires March 30, 19~ ~ '~ ; .q