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Home My WebLink About11275-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Zqq666 Date May q2 19 85 THIS CERTIFIES that the building . ~,ddi~zS. oz~ ..................................... Location of Property ~.779.0...~¢5~...?.~.~. ........... ._... 5~?}5~? ............. ....~. House No. &treet Ham/et County Tax Map No. 1000 Section ...~ ¢~ ..... Block O& .Lot Od 3 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Apphcatmn for Building Permit heretofore fled in this office dated ..... ~¢~..5 ........ 1~. pursuant to w~ch Building Pemit No. q5275Z dated .. ~7. O 3. ................ 19 .~2, was issued, and conforms to a~ of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ..... ~9~. ,~. ~. ~k~$~, .~¢..~¢¢5~. ¢?,~5 ....................... The cemficatelsissued to ~TON~ C, & GXORG~ C of the aforesmd budding. Suffolk County Department of Health Approval Building Inspector Rev. 1/81 FOR3~ NO, ~ TOWN O:: SOUT.O~.* BUILDING DEPARTJv{ENT TOWN HALL ,SOUTHOLD, N, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE5 UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 11275 Z Permission is hereby granted to: ~o ....... ~r~..~...;.~.r ./.¢: ~ .~.~.......<~.42..~./.~.~ ~......~..~..x./~/.~.~..~.~.~ ........... ..~,~../.~.?.. ....... ~../.~.~....~. ............................... :_.;....! ................ ~ ........................................ County Tax Map No. 1000 Section .... ./../..~..,'~. ........ Block .'.....~. ........ Lot No..~./.~ .......... and approved by pursuent to epplicatien dated ..... the Building Inspector. Fee $..(,, ................... Rev. 6/30/80 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, 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. Commercml 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 Aprd 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 features. 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 certihcate of occupancy $1,00 $5.00 Date ..... New Building ............. Old or Pre-existing Building(Z) ....... .~ fVacant Land ............ Location of Property . ..! ~.7-~D. ....... .~. ~!.~....~..~. ,. ............ ~')'~q-~7~-.~.*/~c..~. ............ House No. Street Hamlet Owner or Owners of Property. q . .,: . ..... . . . ....... County Tax Map No. 1000 Section ..... I/..~.~'. .....Block ~:)q Lot Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. I/..~?..~., Date of Permit ?..I.I. ~1 .~.~, .Applicant .................................. Health Oept. Approval ....................... Labor Dept. Approual ...................... ,.. Underwriters Approval ...................... Planning Board Approval .................. t,. - ~ Request for Temporary Certificate ..................... Final Certificate ....... : ......... ~ Fee Submitted $ ............................. Construction on above described building~;~.d permit'meets all app~cable~c.o.de~ and regulations. Applicant -.(~~- ~._. ~_ ,('~..., ,~m~,, ...... Rev, I0-10,78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ES JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT ~n the following location; , ~ Base,ne,,~ . ~ 1st FL ~ 2nd FI. Sectioa B~o¢~ Lot FIXTURE FIXTURES RANGES OVENS DISH WASHER EXHAUST FANS 3 0 2 3 DRYERS ~:15RNACE MOTORS FUTURE APPLIANCE FEEDERS TIME (~LOCKS MULTI-OUTLET DIMMERS SYSTEMS NO OF FEET S E R V I C NO OF CC COND A W O NO OF HI-LEG A W ~ NO OFNEUTRAL$ A W G pER ,~ OF CC COND OF H~-LEG OF N~UTRAL OTHER APPARATUS Th~s certificate must not be altered ~n any manner, return to the office of the Board d incorrect. Inspectors may be idenhf,ed COPY FOR BUILDING DJ=PAR'i'MENT. THIS COPY OF CERTIFIC MUST NO? BE ALTERED IN their credenhols. FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) 2. COMMENTS ROUGH FRAME & FLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: TOWN OF SOUTIIOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-I 802 - Applicant Dear ~ : This is to advmse you that the job~under Build~.n~ Permi. t No. iJ ~l~7~-~issued to~~ M.~O~k.,~ ~ (~ on '~/~/ ~ -~[~t~ is c~mpleted 'and a final inspection has~ has not~ been done. In order to complete this fmle, it ms necessary that a Certmficate of Occupancy be issued. Please fill out the enclosed form(s), return same to the above office with a check for $5.00 payable to the Town of Southold. Please mndmcate to whom the Certmfmcate of Occupancy is to be mailed, and arrange with thzs office for an inspection date. Thank you for your prompt attention. Very truly yours~ Victor Lessard Administrator VL:ec Enclosures FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971' TEL,: 765-1803 Exalnlnc ..... , Approve ............... ·.. ermit No ......... Disapproved a/c ....... ' ......~ ...... . .,>,.~. ...... ,.. j ( B/dild'iWg Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No // .~..~..~., Date ..~..~. ....... 19o°/ a. Tins application must be completely filled iii 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 ~howing location of lot and of bmld,ngs on premises, relationship to adjoining premises or public sire* or areas, and giving a detaded description of layout of property must be drawn on the diagram which is part of this apt: cation. c. The work covered by this apphcation may not be commenced before issuance of Building Permit. d Upon appm.'al of this apphcation, the Building Inspector will issue a Building Permit to the applicant. Such pern shall be kept on the premises available for ,nspection throughout the work. e. No buddiug shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan stroll have been granted by the Bui/ding Inspector. APPLICATION IS I IEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t Budding Zone Ordinance of thc Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the constructmn bf buddings, additions or alterations, or for removal or demolition, as herein describe Thc applicant agrees to comply with all applicable laws, ordinances, building code, honsing code, and regulations, and adm,t authorized inspectors on p~em,ses and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) ] State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, Name of owner of plellliS~S~-~. ,~.~ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No...,=,~.Lr~.. ............... Plumber's License No .............. .(-77- ........ Elect,' cian s License N ~ ~/~-'-,~?~ Other Trade's Liccnse No ...................... Location of land on which proposed work will be done ".. ....... .............. ............ House Number Street Hamlet County Tax Map No. 1000 Section . . .{tiS- Block .O.qg' Lot Sub&vision .................................... Filed Map No ............... Lot .............. (Name) State existing use and occupancy of prem,ses and intended use and occupancy of proposed construction: xishng use an '.~ .~-,.<,< .' .~ .~..x-~9...~~ a. E d occupancy . . ; .... b. Intended use and occupancy . .~.,..-~ .................................................. 3, Nature of work (check which applicable): New Building .......... Addition .......... Alteration ......... Repair .............. Rem6val ............. Demolition .............. Other Work ............... 3.....~.. 0 C~IoO ,~J. ~T .-~. (Description) E C stimated est ...... : .................. Fee .................. ¢ ........... .; (to be paid on filing this application) ;. If dwelling, number of dwelling ;mits .............. Number of dwelling units on each floor ................ If garage number of cars" ;. If business, commercial or mixe.cl occupancy, specify ~at_u~re and extent of each type of use .................... I. Dimensions of existing structures, if any: Front.../ff. ~ ....... Rear ...~.~. ........ Depth .. ~--.IP ........ Height.....~. ....... '... Nnniber of Stories ....... ]. ............................... ¢ .............. Dimensions of same structure with alterations or additions: Front . .~. ~ .e~. ..... Rear ~.~(o. t.~../5" . ~ t Number of Stories Depth Height .............. Dimensions of entire new construction: Front ............... Rear ............... Depth ............. Height ............... Number of Stories ................................................... 1. Size eliot: Front ./.q.Q.. ' · .I ........... Rear ... ~ .q .o. .............. l~epth . 2= O.O,...~,*, .......... ). Date 6fPurchase 111 .el ~..! .................. Name of Former OwnerCk~.~...~,,-~ · Zone or use district in which prcnuses are situated ................................................ ~. Does proposed construction violate any zoning law, ordinance or regulation: .. ~-~' . ' . .................. .1. Will lot be regraded .... '.~.j ................... Will excess fill be removed from premises: ~ .N.o L Name of Owner of premises ~9't~T4 t~?.c..4.~.qv~ ~/~. ~.,~t~'d~ ./40.}fl:.T.~7 IT~-.a-. {~.. Phone No.S~.8:: ~.et .~. (~ .... Name of Architect . -- .... ' ...... Address ...... '...: ......... Phone No ...... ..... ----' .... qN.. . Address o . 4 e~.~.. .(B.~.'T'JTl'[-t,-4~f~-.PhoneNo. q~'~.~7 ..... Name of Contractor .,. ~ ."~.~..~ ... PLOT DIAGRAM Locate clearly and distinctly ,-all; buildings, whether ex/sting 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. JoO TATE OF NEW ~'6'~, -- . OUNTY OF~ .... S.~ ~,/~.~..~ ....... i'~.~. ·. i~'~· ....... being duly sworn, deposes and says that he is the applicant ~ame of indMdual siguing contract) ~ove,named. e~sthe ............. ~ ....... 1...~ ......................... ~ .... :~.'fS,~, e.,; .......... . i (Contractor, agent, corporate officer, etc.) smd owner or owne~, m~d ~s duly authorized to perform or have per, formed th'e sa~d wor~ 'anti. to make an~ file flus ~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 rammer set forth ~ the application filed therewith. worn to before me this ............ ........... ,, , ' ..................... ~ X ~ ~arc~ ~u, ~.~ ~ (Signature of applicant) -I