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Home My WebLink About11276-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...Z. 1.2. ~ .~.7 ......... Date ...... g.u.g.u.s.~...6 .................. 1~.~. THIS CERTIFIES that the building . .I.n.g v. 9.u.n.d...s ?L~m.m..~.n.~ .~99.1. .¥ .i.~.h.. f'..e.n.c.e.: ...... Location of Property .1.2..5.0..H.a..:'.Z.e.n.e...L.a.n.e. ........................ .N.a.~.r. J:..~.u.c.k. ....... House No. Street Hamlet County Tax Map No. 10O0 Section . .q.~..~ ....... Block ..... .2 ......... Lot ..... .3.~ .......... Subdivision ............................... Filed Map bio ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated ·..3.u.L.y.. J .~ ........... , 19.8.1. pursuant to which Building Permit No. 11276 Z dated .. d..u.l.y.. ] .4 .................. 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 ......... for an in~round swimmin~ pool with fence enclosure. The certificate is issued to ...F..v.a.n.q~.s.. ?....~.a.l. qn..e y ................................... (owner,/~{~X of the aforesaid building. Suffolk County Department of Health Approval ....iq./. g. ................................... UNDERWRITERS CERTIFICATE NO ...... ~ .5 .3.0.1. 7..5 .................................... Building Inspector Rev. 1/81 (THIS PERMIT MUST BE KEPT ON TH,[ I~P,I~V~ISES UNTIL FULL~ COMPLETION OF THE WORK AUTHoRIZeD) N°. ;t1276 Z Oote i....i. ........ ,¢.'¢" .................. , ~9'~'~/ Building Inspector, ~ ~.,~,~.;~,, Permission ~s hereby granted to: ......... .......................................................................... ?~ .................. ~...~~:.~.....~.~ ..... .~...&..~ co~~,o~ ~o~ ~o, ~0oo s~,o~ ..... z.~.~. ...... ~ ~....~..~ .... ~o~.o....~.~ ...... ~ur~u~nt to ~pplle~tion d~d .............. ~.~.~..~..-. ........... , 1. , ~nd ~pprovod by the Rev. 6/~30/80 FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall ,~;~uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This appiicat[on must be filled in tvpewriter OR ink, and submitte~to the Building Inspec- tor with the following; for new buildings or new use: 1. Fina( survey of property with accurate location of all buildings, propertv lines, streets, and unusual natural or topographic features. 2, Final approval of Health Dept. of water supply and sewerage disposal-iS-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters, 4. Commerc{al buildings, Industrial buUdings, 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. 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 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/ land use 3. Copy of certificate of occupancy $ 1.00 --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property .......... ~/¢~ .5~.O ........ ,/~, ,/~L,~-,/¢,~,, ,/:/~,~,~, ...... ,__~l/~/,"~, ./,~,~,/~'., ~:~ .~[?~* Hou~ No. Street /Yam/et Owner or Owners of ProperW ... [~t~... ~:,.. ~4' ~ .......................... Cou.w No. moo S.ction ..... ...... ...... ...... Lot ..... ....... Subdivision ................................. Filed ~ap No ........... Lot No .............. H~alth ~ept. ~pproval ........................ kabor Oopt. Approval ........................ ~nde~riters A~roual ..... ~ ...... ~Q/.~ ....... Plannin~ Board ~pproval ...................... B,quest for Temporary Cortificato ..................... Final Cortificate ...... ~ .............. Fee Submitted $ ............................. Construction on above described building and peC~m ~meets all applicable cod~s..and regulations. Rev. 10-10.78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~'~J~L~6 ~ J,~}OJ, 85 JOHN STREET, NEW YORK, NE~ YORK ~0p38 THIS CERTIFIES THAT FIXTURE OUTLETS IEC~ETACLES SWITCHES FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS DRYERS DIMMERS S E A W G NO OF HI-LEO OF CC COND C E OTHER AFPARATU$. NEUTRAL /~ I copy m. ~u,~mNe .E.~.~mT. *.,~ cop~ 0~ ~,~ ~t .OT ~ ~.Eo ~N ~NY ~A..~..~J -~UFFO/-~< Co., An/. Y. FIELD INSPECTION 1. FOUNDATION (lst) FOUNDATION (2nd/ 2. COMMENTS ROUGH FRAME & PhUMBING INSULATION PER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ^pprove .: ........ isa ,pro ed a/c ....... ":: ,' " .......... ............................... . . . . ., ~' - (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No ............. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buitdi 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 descriptxon of layout of property must be drawn on the diagram which is part of this apF cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon appmcal of this application, the Building Inspector will issue a Building Permit to the applicant. Such pern shall be kept on the premises available for inspectmn 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 Sot, thold, 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 Thc applicant agrees to comply with all appqcable laws, ordioances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessaw inspections. .... ,,g. :. : . . . . : :/. c... . . (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electric:an, plumber or build~ Name of owner of premises . . .~:.~..~.,~,./.C../.f... ~.,.., .O. ................................ (as on the tax roql or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .... ,'(.~. .................. Plumber's License No ......................... Electrician's License No .... /~..'~.~. O..x., ?/ ....... Other Trade's License No ...................... I. Location of land,on which proposed work will be done ..... .~./.~ ..... Z~,~../f..2'~ ?f.? .... .~../f. f../"..~. ..... ?. / :u c/< , : .................... -- House Number -- Street Hamlet County Tax Map No. 1000 Section .... /.~. ~. ......... Block ..."~64..-? ........... Lot .~ ................ Subdivision ..................................... Filed Map No ............... Lot .............. (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occu anc l~__-~rZ:P~J,~Li2, C7 /L,~_. tXr,,'O,'(~ ~'C,. N f ( k' h' ppF bl )N ildi Additi Alt ati 3. ature o work chec w ici, a ica e ; ew Bu ng .......... on .......... er on .......... Repair .............. Re:noval .............. Demolition .............. o p q .0 Fee ' Estimated Cost ...... r ............................... · · "'"'"'"' · · ! (to be paid on filing this application) L If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage number of cars ' ~. If business, commercial or mixed occupancy, specify fiature and extent of each typo of use ..................... if tiny: Front ' Rear Depth /. Dimensions of existing structures, ............................................ Height ............... Number of Stories ....................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth ...................... Height ...................... Number of Stories ..................... L Dimensions of entire new construction: Front ............... Rear ............... Depth ............. Number of Stories ' Height ., .. ...................... ; ....................................... ) Size of lot: Front , . ...... ' .... Rear Depth ) Date df Purchase I . Name of Former Owner l. Zone or use district in which premises are situated ................................................... > Does proposed construction wolate any zoning law, ordinance or regulation: .............................. 1. Will lot be regraded ............. ' ................ Will excess fill be removed from premises: Yes No J~.Name of Owner of premises ..................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of COntractor ............ i .............. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all 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. / rATE OF NEW YfllR~,,/~, OUNTY OF .~.~-.... · ' ( gcontract) "' ~ove named. being drily sworn, deposes and says that he is the applicant e is the ........................ , ................................................................ (Contractor, agent, corporate officer, etc.) f said owner or owners, and ~is duly authorized to perform or have performed the said work and to make and file this >plication; that all statements;contaMed in this application are true to the best of his knowledge and belief; and that the 'ork will be performed in the manner set forth in the application tiled therewith. worn to before me thi~, ' ......... ./. d.~.''7.: .... day of '5;' '~ ..... ,19. O~./ ua-e3~.~v0¢o auf.:olk ¢oun~r'~ . applicant) Commlssfo,I Expires Marc? 30 19~ e:~, ~N -7-'0 Wvg O~c- SouTHOLD ~UFFOLt~ Co., ~. ~