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Home My WebLink About11236-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ..... Z1070.6 ...... Date ..... g.e. p .~.e.m.b. 9 ?..2.9. .............. 198.1.. THIS CERTIFIES that the, building ................................................ Location of Property ...... 9.2.5...P.~:i:.y.a.~.e.. R..o,a.d, . (~ .1.. Orien t ~ New York House No. Street Hamlet County Tax Map No. 1000 Section . .0. ! .7 ....... Block .... ,...0.1 ....... :Lot ..... 9.0.2.: 1. ...... Subdivision ........................ i .......Filed Map No ...... :..Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated June 21 8.~ 11236 Z ..................... , 19.. ursuant to which Building Permit No ...................... dated ....... q¢.l~.. 1. .............. 19..~. 1, was issued, and conforms to all of the requirements of thc applicable provisions of the law. The occupancy for which this certificate is issued is ......... ...... Bedroom Addition to Dwelling The certificate is issued to . . .H, 9?.a. qe...T.o.~, y ..... roh;.'o ..................... of the aforesaid building. Suffolk County Department of Health Approval ..... N/.R ................................. UNDERWRITERS CERTIFICATE NO. N529621 Building Inspector Rev, 1/81 SOU1 (TH,S PER~,T MUST B~ KEpT COMPLETION OF THE WORI~ AU'rI~I~RIZED~ Permission is hereby granted to: af :premises ,..~...' ......... ~ ....................... ~' ........... ~ ............... ?"";":'~' m'"'"':":~'l?" ' CO ty To Mop No. 1000 Section PU?SOont (o application dat~d and ~pprowd by the FORM NO. 6 TOWN OF SOUTHOLD 13uilding 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 approvat 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, B. 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, C. 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 ............. Old or Pre-existing Building ............ Vacant Land ............. Locat iD n o f Property . .~..'~.z~. ~ ~..~. ~ ~ .... %~.~'~...~..~./..~ ,E.,~'. ,_~..o~., ?....~.~..-. .......... House No, Street Hamlet Owner or Owners of Property · .~..~. ,/~/~. ,~,c~. ~, ,'~. ~,- ,~'.~ · · ~. ~' ?~/,/: ~ County Tax Map No. 1000 Section ....... /.~ ...... Block ...... /. ....... Lot Subdivision ................................. Filed Map No ........... Lot No .............. 2~ ' Permit No././ ........ Date of Permit .... , ......Applicant ................................ Health Dept' Appr°val '/?~/" '~" '2"~' '~'~' '/' ' '~'~"~'~ '/°¢'/' ' Lab°r Dept' App r°val ............. ov I Plann.n Board A roval UnderwritersAppr a ........................ ' g PP ....... '/' ...... ~'~' Request for Temporary Certificate ..................... Final Certificate ...... ,L/, .......~)~J' ,,~,. Fee Submitted $ . . ..~ ......................... Applicant. ~.?../J/'~'.~.(.~/. ~,~C... '{, .~,~... , .~z~,~<,. ~:~-,~//Z~, ................. 1OOO708 THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ BUREAU OF ELECTRICITY F- so, THIS CERTIFIES THAT only the electrical equipment as ~scr~bed be~w and introduced by the applicant ~m~d on ghe above applicatlon number in the preodses of w.sexami.edonin the following Ioeatg{k~ ~Bas, ~ ~ 1st FL ~ 2nd Fl. Section Block Lot and found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES OVENS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT MERCURY VAPOR 3 8 6 3 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT S E R V I C A w.G. NO. OF HI-LEG OF CC. COND. OTHER APPARATUS: .o AW.G, OF Hi-LEG NO, OF NEUTRALS A, WG OF NEUTRAL Sal Prato, Electr~ian Wlggin's GYe~.~o~, N,Y, 11944 ~e. 1049~ ~ ~===~:.~=;:red in ony menner, return ,o the office of the Board [pco~rec,: Inspectors may be COB~ OR B ILDING DEPARTMENT. THIS COP F T FIELD INSPECTION ~ COMMENTS FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. Y. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL,: 765-180~ Examined .~X-q~../, ...... ,19 . ...~ Applic'ti°n N°.//'~'' ?'' ......... Disapproved a/c ............ ~. .......... ~ ........... / . ~.. ........ ~. ~.~:~FF .............. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date . INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplieate 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 apl: cation. c. The work covered by ttfis 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 pern 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 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 Southotd, 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 describe 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 ................................... (Si'g'n ir'e'; plicant, or name, if a corpgrat' ) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bull& Name of owncr of pren,ises ..... ~/p..~.~. ,,~...~.~..--fi.. ~ ../~../¢w.~..... CY~.°ZY~'.~..' .<~,, .~.(~) .............. (as on the tax roll or .atest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate of~22coO Builder's License No .......... ~. ............... :' Plumber's License No .... /~.! ............. Electrician's License No. S ~..~....d?t~..~.~.~.. Other Trade's License No ...................... 1. Location of land on which proposed work will be done ................................................ Street Hamlet House Number z~ County Tax Map No. 1000 Section ...~. [..'7. ......... Block .... ~.~. .......... Lot...O.0. a~: / ....... 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 occupancy ..... ./ ...................................... b. Intended use and occupancy ...... <~,,r',~vl~_~ ~t.// ~'-~2~ 0~.~.. /O~'~./,~,~. ~ Nature of work (check which applicable): New Building Addition Alteration .{ ...... Repair Removal ' ~ Demolition i' Other Work : (Description) Estimated Cost ..... .~...~...'..'~, · . If dwelling, number of dwelling units . If garage, number of cars .......... ). 1, 1. i. Fee ' ', ~ (to be i>aid on filing this application) /. Number of dwell'ing uni!s on each floor ~-- If business, commercial or mixed occupancy, specify nature and extent of each type of use ...... -7 ...... ....... Dimensions of existing structures, if any: Front ..... ~.O. ....... Rear ... ~.q .i ....... Depth .... ~.? ....... Height .... /Y. ........ Number of Stories ........................ *' ' 'i ................. 'r ......... Dimensions of same structure with alterations or additions.: Front ..... ~..O ..... , ..... Rear .... .~.q .......... Depth .. ...... ~. 72. ........... Height ....... ~.tTt.., .......... Number of Stones .......... ~.._. _V ....... Dimensions of entire }sew construction: Front ..... ~.~. .... .,.. Rear ...... .~.o. ...... Depth ..... ./ ........ Height ....... ./.~. .....Numbpr of Stories ............ f..., ........... i ............... t ........... Size of lot: Front ....... 0./.O. ........... Rear ...... .~..~. ........... iDepth ...~ .i~. .............. Date of Purchase -- Nam~f Fo~erxO_~Jaer Zone or use district in which premises are situated.., i....%~.t?.~..~.Z/.~.t~. ................................ D~es proposed construction vi.o~te any. gzojDing law, ordinance or regulation: .... ~... ~..e). .................... Will lot be regraded ....... :7. .~"~....~.~__.~ .s~.~,. Will excess~fill b~'re~aoved from premises: Name of Owner of premises ~.e~Ac.e.../..-e...~:~. .... Address... ~ F.t.~..~2Y. .... : ....Phone No ............ Nmne of Architect . ..a .... ~ ' 'FD' '~l ......... Address ............... : ....Phone No ................ Name of Contractor (,Z..~i~ .... ~,.[cflT/..~.~. ....... Address .............. i ....Phone No. Y.~.? 7(~.~.-;57 ..... PLOT DIAGRAM ' Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all: :operty lines. Give street and block number or description according 'to deed, and from TATE OF NEW ~RK., .~ ..,~6 . ~ ~ove named. ........ being duly sworn, deposes and says that he is the applicant els the .............. ~Q~' ' 'i~on t~a~ ent, c; rp; rate office ;, et !.) ............ f said owner or owners, and is duly au~m~i~e~ ~ perform or have performed the, said work and to make and file this pplication; that all statements contained in this application are true to the best of is knowledge and belief; and that the ,ork will be perfo~ed in the m~ner set forth in the application filed therewith. worn to before me this ~ **~ E~olres ga~ch 30, 1 ~ / 2 v'~ 07 < / X