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Home My WebLink About11247-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy- No.Z.1. .17.8.5 Date July 16 83 THIS CERTIFIES that the building ................................................ Location of ProDerty 12785 Main Road East Marion - h3~s~ 'No: ....................... 's'tle~i ....................... h3~ie~ County Tax Map No. 1000 Section ..... 0.3. .1 .... Block 05 ..... Lot 007 ....:.. Subdivision ..... X. ......................... Fi/ed Map No....X ..... Lot No..X. ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .J.u.n.e...2.2 .......... 198..1. pursuant to which Building Permit No.. 1124 7 Z dated ...... .J.u. 1. y..6 ............... 198. 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 ......... .... ~n .~ ~.i.t.i. 9v..t,o., .e.x.i.s..t.i,n.g, .d.w.e.!~. ,i.nF..* .................................... The certificate is issued to ALTHEA REYBINE ..................... ?o¥.b;. ...................... of the aforesaid building. Suffolk County Department of Health Approval n/r UNDERWRITERS CERTIFICATE NO N 530995. Rev. 1/81 ~ Ul lng Inspector T~N TOW~:~ALL i SOUTHOI~D, N,. y~ (THIS PERMIT MUST BE/KEPT ON ~H,E PkE~IS] S UNTIL F~LL COMPLETION oF THE WORK AUTHORIZED) i ~' 1!1247 Z permission is hereby granted to: at premises located at C~ty Ta~ Map No. 10(~0 ~ection Bloc~ PUrsuant t~ application dated B~il4ing Irispector. F~; . . .:... Rev. / ~.~'~"'..,, ~L°i No; ..~'~"Z ......... ..... ; '19.~.:.; and ~pproved by the ~ooo121 THE NEW YORK BOARD OF FIRE UNDERWRITERS I.~ BUREAU OF ELECTRI~C!TY ~- .~.~[5~, ~[0~, ].~;~ 86 JOHN STREET, NEW YORK, NEW YORK 1~O38 ~.~ ~,~.,o.~o.o.~,,~ 133~z - ~i N 530995 THIS CERTIFIES THAT only the electrical equipment as ~scribed below and introduced by the applical~t named on the able applicatio, number in the prelnlses of in the following location; [] Basement ~ 1st FI. [] 2nd FI. Section Block Lot · vasex~ml,wdo. .~LE~*¢ 6~ ~[.(J~ a~dfou,~dtobei~con~p!i~r~ewlththerequlre.net~tsofthisBoard, FIXTURE I FIXTURES RANGES %OOKINGDECKS OVENS DISH WASHERS EXHAUST FANS 2 3 DRYERS OTHER APPARATUS~ E R C NO, OF CC COND. A ',N G A, W, G, NO, OF NEUTRALS A, W G PER ~' OF CC, CONO OF HI-LEG OF NEUTRAL 11971 GENEI~AL MANAGER This certificate must not be altered in any manner; return to the office of the Board if Incorrect. Inspectors may be identified by their credent als COP~, OR B I[DING DEPA ~I'ME f. 1~H[$~CO ¥ * f FJ-' ; ' ' T I A Y ANNE ~ r~I .NOT~ E N N M Ro 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, properW lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposel-(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 Date.. ,~,..~.~.. ,~...~..~../ .......... New Building ............. Old or Pre-existing Building ... ~'~,. ..... Vacant Land ............. Location of Property . .,~.~....~...~-... ~. ~.~.x .... ~"'~. ~,'~'.rnl~'~ House No, ~ Owner or Owners of Property..~.,..~., ' .................... County Tax Map No. 1000 Section ...~.~../ ........ Block .... .~.-~. ....... Lot.. ,~)..¢? ..~. ....... Subdivision ................................. Filed Map No ........... Lot No .............. PermitNo./~'.c~.'~/...~... Date of Permit.~.~.~J~./ .......Applicant~..~~~.:-;~?~'' Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval./~¢f..5 3.0. '~. '~. -~' ..... Planning Board Approval ....................... Request for Temporary Certificate ..................... Final Certificate .... /J~ ................ Fee Submitted $..~..,.~.~ .................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ~. ~.~.. ,~. ,./~;. Rev. 10-10-78 FORM NO, 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in Wpewriter 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 electrica~ 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 Amhitect 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), Nomconforming 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 occupancv on pre-existing dwelling or land use ' 3. Copy of certificate of occupancy $1.00 $5.00 .......... New Building ............. Old or Pre-existing Building .. Z. ....... Vacant Land ............. Location of Propertv. .~..c:~..~..~..~.,. ~././././././././././~..:../,..~..~,, .'~: ~-~... · ............. County Tax Map No. 1000 Section . .~/. ....... Block .... ~ ...... Lot..~ ~. ....... Subdivision .Filed .......... Lot No. ................................ Map No .............. Permit No. .. Date of Permit . .Applicant · Health Dept. Approval ........................ Labor Dept. Approval ........................ k/ Underwriters Approval ,..,.-...-. ............... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate . .~. ................... Fee Submitted $ .~ ?..~. .................... Construction on above described building and,,~erm, it meets all applicable codes and regulations. Rev. 10-10-78 76S-1802 BUILDING DEPTi INSPECTION ~~ [ ]FOUNDATION 1ST [] ROUGH PLi3G. [] FOUNDATION 2ND[ ]INSULATi0~ [ ] FRAMING [ ]FINAL FIELD IN~ECT~ON 1. FOUNDATION (1st) FOUNDATION (2nd) 2. COMMENTS ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMME, NTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1805 Examined .~..~. ...... , 1 .~.~. ~;Pr°~.''~' .... ~_~..1 ~..( >. Pe Fruit No./.tt6~..~;./7..?. , · app :o~ed a/c ..... ~...~ Application No. ~/t/~.~.. ~. ..... : · INSTRUCTIONS a. Thi ~ plicatio must be 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 detailed description of layout of property must be drawn on the diagram which is part of this aPr~ cation. c. The work covered by this application may uot 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 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 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 inspections. . ........ (Signature of applicant, or name, if a corporgtion) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, Ntune of owner of premises. ~.~('. f.../(~ .7/'-.r~.~.,...~.~..)4 ~.~.'~'' .................................. (as on the tax roll or latest deed) If applicant is a~corporation, sjgni~ture of duly authorized officer. (Name and title of corporate officer) Builder's License NO ........ ~../..~...~ .~.,. ....... Plumber's License No ....... .~ .~...~. .......... Electriciau's License No .... 'Z .~.~ ..~. ......... Otimr Trade's License No ...................... 1. Location of land on which proposed work will be done ................................................ .... ....... . & .......... :./:.. .z.( ./., .......... House Number Street Hamlet County Tax Map No. 1000 Section ..... ~..~../ ......... Block .. ~¢>...~. .......... Lot0~. 2'. ............ 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 ............... ~.q~ ................................................. b Intended use and occ,pancy .d..re. L Nature of work (check which applicabl~): New Building .......... Addition .......... Alteration .......... Repair Remo'val Demolition Other Work ~ Estimated Cost Fee ~ (to be paid on filing this application) ;. If'dwelling, nu~nber of dwelling units ............... Nmnber of dwelling units on each floor ................ If' garage, number of cars i. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... I. Dimensions of e_xi,sting structures if any: Front ..... ~. J/w:. ......Rear ...~...Z~.- ....... Depth .. ~t..d). ........ Dimensions of same structure with alterations or addmons: Front . ..ff..~..~4..."YS,. ..... Rear.. .............. Depth .................. .. : Height ...... ':': .............. Number of Stories .... .~. ? ?..'!--r .......... h Dimensions of entire new construction: Front .. ,7.'.~. ~..t4,.~ ... Rear ............... Depth .............. Height ............... N~u~mbe~regf Stories .......................... ~ ........... ~ ~ >; · 1.,~. .......... ). Date 6fPurchase ........... .................. iSame, of Former OwJmr ~¥.~./~'~.~.~.~.. ~.e,),~. ~'.~..~.. 1. Zone or use district in which premises are situated..../~..~.? .t ~/.¢n ,/7. (~.~./. .... , .................. '. ......... _>. Does proposed constructio, n/,viol~te any zoning law, ordinance or regulation: . 3. Will lot be regraded ... ??~.o,... ................... Will excess fill b.e removed from premises: Yes (No~) PLOT DIAGRAM Locate clearly and distinctly alli buildings, whether existing or proposed, and. indicate all set-back dimensions from roperty lines. Give street and block number or description according to deed, and show street names and indicate whether :terior or corner lot. TATE OF NEWA~RK, .,~ .~ ~ '' .... (Name of individ""-" ~ ' -' '}'"' ~l:l's~'~n;;'~;;i ..... >ore named. .... being duly sworn, deposes and says that he is the applicant is the..; .................. ~ ........................................ ~ ............. //' ~ (Contractor,~ent, corporate officer, etc.) said owner or owners, and iii duly auttrmSzed-to-l~'~form or have performed the said work and to mttke and file this )plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the 'ork will be performed in the m~m r set forth h~ the application filed therewith. ~om to before me this . , .............. day of ............. ,19.. ot~pub[ic, ..... ~. ~ .... ' ~nty , , ; ......... March ~fl 19 ~ MR,S. A. £. WARO '% r , / Y~RlffI'E..D pBIOR TO II'i.~?ALATIO~o - ~ ~ ' ; c ~FLAC~ 5y ~W Y~: GYP. DP -TA~, ~ - ~PPROVED AS NOTED ................... 755-1802 9 AM TO 4 PM POR THk ~LA~¢ ~ [ ~Om-gK~ ~c~lr~ ~A STATE CONSTRUCTION & FNFRGy ~~~ ! ' ' ' DESIGN OR CONSTRUCTION E~RORS, AL T : X ,., , ~al · - - ~, ~ ~ ~ .... ~ ._ _~, ? :[ PARTIAL TOUHDATI0 LAB, NchitectandEoDneer'sSea, a.d thisDooumentexce~ OPO~ ALTerATIOn5 TO;' _. ZA,&5- ALTH~' , 'IH~ Signature on,y good for initial use of "Alteration6 . ALBERT A. SACCO A.o GORDON K. AHLERS ' --', --, ...... ' :.,: '; ',.' by an Archite :~t or Licensed Profe~ II i . drawing. Change, alterations or re ~ ~ ~: L L.. : ~. ~ Section 72~ Su~ivision 2. /~ '~ . ' vows°Ut ArchiteCt~aland°rSi~atureEn~n"r'Son Approval. me,N.Y. SUt. E ucation Uw,/Z.~ ~ ~ , 5~55 MAIN RO~'AD, SOUTHOLD, N.Y. 11971 - 7; - .:~..,F ~, ;