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Home My WebLink About11270-zFOR~ NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N,Y, Certificate Of Occupancy THIS CERTIFIES that the building Pool Location of Property ...5.3..0 ............. ~a.y.f.l.o.w..e.r..I~.d.: ............ .M.a.~.i.t.u. qk. ..... House No. Street Hamlet County Tax Map No. 1000 Section . . .1. q 7. ...... Block .... q 8. ......... Lot .. ~0.2~ 7. ........... Subdivision ............ X. .................. Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... J.u.~.7. . .7 ........ , 19 ~ .1. pursuant to which Building Permit No...1.1..2 7.0.Z. ............ dated ...... .g.u.l.y .... 1. 3. ........... 19..8.1, 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 ......... In, round swimming. Pool The certificate is issued to ................ C.Q .R.R.I.G.A..N~..E.D..W.A.R.D. ........................ (owner, l~e~-o~ of the aforesaid building. Suffolk County Department of Health Approval ......... .H./.A. ............................. UNDERWRITERS CERTIFICATE NO. N53 01 76 Building Inspector Rev. 1/81 TOWN OF $~UTHO~ BuILDiNG DE~ARTJ~EI~IT HALL TOWN SOUTHOLD, N!. Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) · 1 2 ? 0 Z Dote ............ Permission is hereby granted to: ~ ~.. ..... ~.,.~.,~...~ i~.....~ ~ ............ ~:......../..~,~:~ ...... ~.~:,~ ......... tO et premises located o' ..~,~0 /'~ +.~ .......... Lot No. County Tax Map No. 1000 Section ............ ~ ........BlocE~ · '/- ~)~:.~"- ........ purse*hr to opplic*fion d~t~d ........................ 1 ......... , 19 ~nd ~pproved by the Building Inspector. ~ / ... ~ Buil~ing: ~ector Roy. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD ["~u itding Department Town Hall Southold, N.Y, 11971 APPL!CATtON FOR CERTIFICATE OF OCCUPANCY instructions A. This apphcat~on mus~ be filled m tvPewrtte~ OR ink,, and submitted in duphcate to the ~3uitding ~nspec- tar with the foltow~ng; for new buddings or new use' 1 Final ~ey of properW w~th accurate location of gl buildings, prope~y lines, streets, and unu~dal naturgl or topographic features. 2.Final approval of Heaith Dept. of water supply and sewerage disposal-(S-9 form or equal). 3Aoproval of electrical installation from Board of F~e Unde~r[ters. 4. Commercial buddings, Industrial buddings, Multiple Residences and similar buildings and installa~ tions, a cert=hcate of Code compliance from the Amb~[ect or Engineer responsible for the building. 5.Suhm,t Pl~nmng Boa~d approval of completed site plan requirements where applicable. ~ For ex~stmg bLuldmgs (prior to Aprd 1957), Nomconformmg uses, or buildings and 'pre-exi~ing" land uses 1. Accurate su~ey of peeperW showing all property hnes, streets, buildings and unusual natural or topogroph ~c features. 2.Swam statement of owner or previous owner as to use, occupancy and condition of buildings. 3 Cate of any heosmg code or safety h~spection of build ~s or premises, or other pe~tment inf~rma- ~,on rcquued to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Cgrtff~?te of occupancy on pre ex~sting dwe ng or land use $5.00 3. Copy et cert~hcate of occ~ pancy S1 00 ~ / · '' ~ f/ .... v ~ / ~rree, . Hamlet . ........ Health DepL AOproval ....................... ~bor DeOt. Approval ........... Underwriters Approval . · ...... Planning Board Approval . .'. . qequest for Temporary Certificate . . ~A~.~/ .............Final Certificate . , .... /%) .......... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY .,/g,~.~.~l~l,~ 4 ;, 'i.~ [ 85 JOHN STREET, NEW YORK, N~j ~?-~[~'RK'~ 10038~1 in tke/ollowlng location; ~ Basement ~ 1st FI. ~ 2nd FI. [~12~(~ - I~)g Section Block Lot ~as examb~ed o~; -];J ty 3k) ~t'9[; k and yound to be in compliance wltk the requirements of ta~s Board. FIXTURE OUTLETS DRYERS tECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS FLUORESCENT SYSTEMS NO OE EEET OTHER APPARATUS. S E R i~ RCC~ A W G NO OF HI LEG A W G NO OF NEUTRALS A W g NO O E COND OF CC CONO OF HI LEG OF NEUTRAL iO>'O 10~ I~C~LO~, Ave. ~%~ uit~.~% ~:~. Y. tt95A lie. i227 GEN~AL MANAGER This certfcate must not be atered n an manner return to the off,ce ofthe Board if mco rect Inspectors maPe~lL ? //~''}/~/} ~ ~Thls ' ' y ; ' ~ . ~ y e identified by their credentials: COPY FOR BUILDING DEPARTMENT. THIS COP~ OF CE~TIFICATE~M~S~ NOT B~ ALTERED IN ANY MANNER. BUILDING DEPT COPY OFAPPLICAT{ON FORM46~EL. NEWYORKB(~ARDOFFIRE UNDERWRITERS. FILE THIS COPY WITH BUILDING DEPT WHEN REQU~IRE~ , iS N~W L~ OLD ~ REMODELED ~ - / iS ~ ~ ~ [~IT ONAL ~ , REp~VED ~ ~ ~ LI~T~E~OW ~ALL EQUIPMENT ~H ~'~ ~A ~P ~ Sde A ach't ~ ~P ~ Wat~ ' 'W : nded to cover the above-hst~ equ.~ment to be Inspect~ but if at time of In~s found ad{tton~l ~qmpment not above isted, SLUING FULL AND ACCURATE INFORMATION. A~L SPACES MI~T t~ MAY RE RETURNED, NAMEOF ~ .~ f / ~ ~ /?/?: ~ DAT~OF~ APPLICANT ~'~' ~ /~/ /~ , / /~ /r , , FIELD I~PECTION 1. FOUNDATION (1st) FOUNDATION (2nd) 2. COMMENTS ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: FOB~ I¢O, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Permit No, .,/..~.~,'.~Z..C~-~ ............ App,eation No..../../~.Z~ ............. Disapproved o/c ............................................................................................ ....... ........... 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 premmes, relationship to odjoimng premises or public streets or areas, and giving o detailed description of layout ofproperty must be drawn on the diagram which is port of this application. 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 o 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 port for any purpose whatever until o Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o Building Permit pursuant to the Bud ng Zone Ord nonce of the Town of Southold, Suffolk County, New York,~pnd other applicable Lows, Ordinances or Regulations, for the construct on of buildings, additions or alterations or fo.r/~ovol or demolition, os herein described The applicant agrees to comply with oil applicable laws, ordinances, bulldog c,~de, housing ~e, anted regulations, and to admit authorized inspectors on premises and ir~ buildings for necessary/~nspx~tions. // /, .............. ........ (Signature at app leant, a e, ipa corpo ' ....... ....... .............. (Address of applicant) State whether applicant is owner, ]essee~chitect, engineer, general controclor, electrician, plumber or builder. ~. ?._~.~~ .............................................................................. if appli or ~du~y authorized off'c . ............. ......... .......... :..../..: ............... · (Nome and title of corporate'"'officer) Builder's License No ..................................................... Plumber's License No ........ ~, .................................... Electricians License No ........ ~ .......... ~. ..................... Other Trade's License No ........... .~,~...~.. .......................... Location of land on which proposed~work will be.~done. ~Map~,No.' ............................ ~,... Lot No ......................... Street and Number .... /.?.~X(~...~...~.../~,~.....6~-~;:)~.~*....~'~-,~-.~.~-(,~?. ...... ./~...-°:.'"~'~."~-..:"~. ................................. .~g/~.~ Municipality State, existing use and occupancy of p~'emises an~d intended use and occupancy of proposed construction: b. .................................................................. ~ Nature of work (check which bppllcoble). New Building.. ................ Addition .............. Alterati~o~ .~.....~ Repa,r ................. ~,.,emoval .................. Demolitior. .................. Other Work ~ .~... .............. ...~,.~... .¢(/ ~,~ , .~ (Description) 4 FstJma/ed Cost ........../. ........... . ..................................... Fee ...rf~.'...../... .................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............./. .............. Number of dwelling units on each floor .......................... If garage, number of cars ................. ~'~ .............................................................................................................. 6 If bt~siness, commercial or nmxed 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 JwJth allerotions or additions'. Front .................................... Rear ........................ Depth ................................ H~ight ............................ Number of Stories ....................... r ........ 8 Dimensions of entire new construction: Front .....................' ............... Rear ............................ Depth ....................... Height .................... Number of Stories ................................................................................................................. 9. Size of lot' Front ~/ ~ ~ ..... Rear ,/ d? (? De~th 10. Date of Purchase .......... ..~.....I...~....C~.Z...~...~z~-. ......... NAme of Former Owner ..~.~' 1 1. Zone or use district in which premises are situated ....../~"~*..r-4=......~. ........ i .................................................................... 12 Does proposed construction viqlate any zoning law, ordinance or regulation: ........................................................ 13 Will lot be regraded ......~....C~ ............... Will excess fill be removed from premises: ,(~ Yes ( ) No 14. Name of Owner of nremises ~:~:~ (qEDJ~Ad,'lr,,--J/JC~z~-u~ .~_.~.. I~h,~,~ ~,~,, d:=O-~ Name of Architect ..~t ............................................... ,- ~ Address .............................. Phone No. Nanle of Contractor ................ Address ..... Phone No~.i......~ ............. PLOT DIAGRAM Locate.clearly and distinctly alll buddings, whether existing or proposed, and indicate all set-back dimensions from propc'rty lines G~ve street and 51o¢k number or description according to deed, and show street names and indicate whether interior or corner lot .CTATL-- OF NEW '~DRi~I_ ~//4 ¢ ~ n .................................. , ......... ~.~..~..~,?,~..~..,..., .~...~.~.. .......... $....bemg duly sworn, de~osos ond sgys that he is the (Name of inoividual signing contract) _ ~ ] above named.,~ ~ ~ x ~ , ~ (Contractor(age,corporate off~ otc ) ~ oF sa~d owner or owners, and is dul~ authorized t~form or have perfo~d the said work and to make a~ file this application, that all statements[ contained in lhis application are tr~to.~e best of hi~kno~edge and beheF; lk, aT the work w~lt be performed in the manner set forth in the applicati~ file~ therewith. // Sworn t~efore me this ~ Z : ~ / ~ ~ / ............ ....... ..... ............ / Notary PuN,c,. ................... ~...3:~ ...... Coun~ ............ ~.~~ ..................... ~OTARY P~BUO, ~ate of New Y~k HO, 52-8125850, ,Suffolk CouAty Term Expires U~rch 30, 19 ~ Z S, "¢4~ '4- ~ '40" W. IMAP OF' L.A~-4D : GUaca~fee~' tO * ' Sou,hold ~av~n~s a ~ surw~cd J~.~';.Z~.,,~,?~,t