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Home My WebLink About11297-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N.Y. Certificate Of Occupancy No. Z.1. l,:.)5 .......... Date ...... 0c.t,o. her..1.5 ............... 19.82 THIS CERTIFIES that the building ................................................ Locatlon of Property J0o35 Nassau Point Road Cltcho ue. House No. Street Hamlet County Tax Map No. 1000 Section .. ! .1 9 ....... Block ... 0 .1 .......... Lot ... 0..1,4 ........... Subdivision...N. ~U.,s.~U..P.o.~.n..g .......... Filed Map No ......... Lot No...A ........... conforms substantially to the Applicahon for Building Permit heretofore filed in this office dated · . ~I)~.?:y..1 ? ....... , 19 :B. 1. pursuant to which Building Permit No.. 1. .1 ?.9.7...Z ............ dated ... :(u.3: v.. ¢:~ ................ 19 .~fi., 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 ......... an edditJ, on to an ex~stin~ dwetlinE. ~ The certificate is issued to GL^BYS ,q. BhYLES ................... ...................... of the aforesaid building. Suffolk County Department of Health Approval ..... .n/.r. ................................ UNDERWRITERS CERTIFICATE NO. N 57672~ *Tnxr~ Certificate reZ'aPs to the main dwelling on the property. Building Inspector Rev, 1/81 FOI~i~ NO, ~ TOW. OF SOUT,?qU BUILDING DEPARTi~N' TOWN -HALL SOUTHOLD, N~ Y BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PRE/~IS COMPLETION OF THE WORK AUTHORIZED) N°. 11297 !S UNTIL ffULL Z Dote ...... ..................................... 19 Permission is hereby granted to: ~t pr~mises oc~tea a~ ................... ~ ..................................... ....y ................................................. ~L ~ ' (~ 19 and approved by the pursuant to application dated .................................................... ~ ..... ., Building inspector. t~ Fee $ ........................ Rev. 6/30/80 Building ~lnspector FORM NO. 6 TOWN OF SOUTHOLD ~uiiding DeparTment Town Hall 8outhold, N,Y. 11.971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. Th~s epphcation must be filled in typewriter OR ink, and subr~itted in duplicate to the Building Inspec- tor w~th 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 tooograoMc 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. Commercial buildings, Industrial buddings, 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 ex~stmg buddings (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. / Co 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 ....... / tt. 4 New Build,n9 ............. Old or Pre-existing Building(X) ....... =/Vacant Land ............ Locat,on of roperty Hou~ No, Screer Ham/et Subdivision ................................ Filed Map No ..... . ..... Lot No .............. ~equest for Temoorar~ Certificate .................. Final Certificate .... Feo SuDmittod ~...~ .................... Constructioa on above described bui~din~ aad Oer~rmeet~ all ~~ a~ulations. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTR[CIT~Y 85 JOHN STREET, NEW YORK, NEW'YORK 1OO3B THIS CERTIFIES THAT only the electrical ectutpment as descr(~ed ~elow and i~troduced by the appllcartt ~med on the able applica¢ion number in the premises of in the following /ocat~o. ~ Bus.me,~ ~ ;st FL ~ 2nd FL Section Block . ~o~er I~, ~9~ and found to be in co,npl~ance with the requirements of ~his B~rd. FIXTURES RANGES OVENS DISH WASHERS FANS I 14 12 14 DRYERS SYSTEMS .C.I. Detector S E R I C NO OF HI LEG AWG OF NEUTRAL g.u~d ~lec. P.0. ~ox ~a~i~uc/% NoY, 11952 lic,242~ OENEJ~AL ,M~NAGRE cerhflcote must not be altered in any manner, return to the office of the Board J mcoryect. Inspectors may be ~denhfled by/the,r credentrals COPY FOR BUILDING DEPARTMENT. THIS COPY OF CER!I~ICATE ~M~s~NoT BE A~TERED IN A~Y MANNER. FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C,ODE FINAL FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT SOU i-HOLD, N.Y. 11971 TEL.: 765-1802 Examined.....:~-&~ 2 /..,19 :.~/~_ . ........... Dl. at,proved a/c ....... '.~_~. f~ Z'.L'_'" .......... ............. , ......... :.,... (Building Inspector) ~ APPLICATION FOR BUILDING PERMIT Application No ........ /.,., ..... INSTRUCTIONS a. Th,s application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildl Inspector, w~th 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing locatmn of lot and of buildings on premises, relatmnship to adjoining premises or public stref or areas, and giving a detaded descriptiou 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 not be commenced before issuance of Building Permit. d. Upon apprc,'al of this application, tile Boilding Inspector will issue a Building Permit to the applicant. Such peru shall be kept on tile premises avadable for inspection throughout the work. e. No bluldmg shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan shall bare been granted by the Budding Inspector. APPLICATION IS t IEP, EBY 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 braidings, additions or alterations, or for removal or demolition, as herein describe The apphcant 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 corporation) ·..~..~..~....~. '~..~-~..~,...~..<~,:&¢....~.,~..~., .~ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, ....~-.~.~,~..,~. ~. Z'....C~,.~r~-;.~.~:.4...~..~..o.~. ........................................... Name of owner of pre,roses...~ ..... .~./~.%~.-..~..~;..).. ~ .~..~..0. ¥..~....'....~.'.'. ...... , (as on the tax roll or la,st deed) If applicant is a corporation, signature 9f d~uly author,,ed officer. . (Name and title of corporate 6fficet~" Builder's License No. ~.,~."7~ .................. Phnnber's Licenso No .................. ~..~. / Electrician's License No..~..~..'~...'.'~. ...... Other Trade's License No ...................... 1. Location of land on xvhicb proposed work will be done ................................................ I ~ B ~_~ /.A.'~ ~ ,4- k' - . ........ ......... ~ ........... ~~F-.~.. .~_~&c~.~..~/~.., ........... House Nmnber Street Hamlet su~i~n ~.~,:.~~ ................ ri~eu ~a~ ~o .............. Lot ............ (Name) 2. State existing use and occupancy of premises and in~ended use and occupancy of proposed ee~truction: a. x~stmg use and occupancy .... ~ .................................... ~. ~t~d~d u~ ~ o~p =~v . .~.~.n.m. ~:~. ~ ................................. 3. Natureofwor~(checkwhicb, applicable): New Bt, i/ding .~ ......... Addition.../~.,. .... Alteration ..~.,. ..... Repair . .~'. .......... Rcxnoval .............. Dcmolitiqn ._:~_ ........... Other Work ............ i. 1~ i ~ . ~ (Description! Estnnated Cos .~/~/...~..~..~. ~..~'~.. ................... Fee.../.~. ................... (to be paid on filing this application) ;. If dwelling, number of dwelling,units .... ?..x../.~... Nmnber of dwelling units on each floor ................ If garage, nam bet of cars ....................................................................... ~. If business, commercial or mixed occupancy, specify ~atnre and extent of each type of use .................... t Dimensions ofexistmgstmctnres, if any: Front ............ Rear .............. Depth ....... ,. Height · Number o£ Stories .~>...r~. t.~ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................. ,.. Height ...................... Number of Stories .............. ~ Dimensions ot'.:ntire new construction: Front Rear Depth Height ............... Number of Stones ........................................................ 1. Size of lot: Front ...................... Rear ...................... .~..~.th..~.~.A.0,:~.~.~.~.~.~ ..... ... ). Date of Parchase ............................. Name of Former Owner ....... .. I. Zone or use district in which premises are situated ...................... ,~ ~ .......... ' ................. !. Does proposed construction vmlat~' any zoning law, ordinance or regulation: /M..O ....................... ~. Wi/l lot be regraded .. t'~.~. ...................... Will exQe~ fill be removed from premises: .t//"t~.es_ a No t. Name of Owner of premises,,~. ~!~'.~..~,~/~. ~..~.Fff~.~,kddressZ'~,t~,~',,dr ~ .~O. Phone No/~.,~..-.~.'? .~... a Name of Arclmect ............................ Address ...... ' .... ' ......... Phone No ................ Name of Contractor .2~'../. ~. ~.~'~...-'~./~.,~i"~ress .------------------~'~..~r..~,"~.~..~.~.~'~ Phone PLOT DIAGRAM Locate clearly and distinctly all buiklings, whether existing or proposed, and, indicate all set-back dimensions ~'rom roperty lines. Give street and bloc}; number or description accordin and show street names and indicate wh~ther tenor or corner lot. TATE OF NEW Y/(~K, -.~ OUN~FY OF ..... (Nan~e o-Tindwidual signing contract) ,, being duly sworn, deposes and says that he is the applican~ rove named. s the .~ , ~.. said owner or owners, and is duly~ed ~orm or have performed the said wink and to make and fife thi~ ~plication; that all statements cofitained in this application aie true to ~bc best of his knowledge and belief; and thJat th~ 'ork will be performed in the m~ner set forth in the application filed tl, erewith. worn to before me this ............. ......... .... , ~W P~blic,.... ~:~ · · .~.~..~ ~ , T~rm Expl~s March 30, lg~ i i' J APPRO%':D AS NOTED FEE: ~.~f,~ BY: /,~'~,~ NOTIFY BUILDING DEPARTMENT Al" 765-1802 9 AM TO 4 PM FOR TH~ FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUlREI~ FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTI,ON MUST' BE COMPLETE FOR C. O, ALL CONSTRUCTION SHALL THE REQUIREMENTS OF THE N, STATE CONSTRUCTION & ENERGY' CODES, NOT RESPONSIBLE FOIl: DE!~IGN OR CONSTRUCTION ERRIDR~