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Home My WebLink About11316-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. ¢ .~ .0.~;~ {~ .......... Date . . .~.o.c.c~r0t.*¢.~.. 't [3 ................. 19.8. l THIS CERTIFIES that the, building ................................................ Location of Property . .5.7.05 ............ ~q. tlJ, 11.w.o,~r~p../~¥~rl.cke, ........... ~ubc2~.c~g¢~... House No. Street Ham/et County Tax IVlap No I000 Section 03.7. ........ Block . 97'. ........... Lot. p.0.5.: 9.0.1 ........ Subdivision. ~}.o.c? .~.%o.qd...Op.v.e: ............. Filed Map No..t.2.6.3.2..Lot No. 15...&..~a..v.t,..qf conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. 411;,~.u.~1 t;. 5 ......... , 19. B.lpursuant to which Building Permit No...]. ! ~.1.6..g. ........... dated ...g ~ g.u a t,. ¢ ................ 19 8 .~., 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 ......... ....... 8, I~..~.cj.q :~ '9 ;[.o.~1 . ]59..~ . 9~.~.~ ~',gl~t.~.~.Y..d-.~.o. 1..1.:i..;~l.b~,..(.b e d r.o. qiI~ ) ................. The certificate is issued to ...... i~t.~.5.1d~..I}~Pp.q~,t~ ................................... (owner, iess~ot, te~emW of the aforesaid building. Suffolk County Department of Health Approval ....... ¢/.R. ............................... UNDERWRITERS CERTIFICATE NO ......... P. t5.~.5 J ~:? ................................. ./? /' Building Inspector Rev 1/81 N©. FO~ ~0. ~ ~ TOWN OF SOUTHO.~ ,~ BuILDiN~ ' D~PART~H~ TOWN HALL SOUTH'OLD, N~ Y. ' ~ (THIS PERMIT MUST BE KEPT ON THE PRE~ms~s UNTIL ~ULL COMPL~ION OF THE WORK AUTHORIZED~ 131~ Z ,~t~ ...... ~ .~:~ ....................... Permission is hereby granted to: ....... ~///~ ,.. ~ ~. .............. ...... , ......................................................................................... ,~....~ ............ Buil~llng Inspector. Fee $ ....................... ~, ~Butlding ~lnspector Rev. 6130180 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec~ tot 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. 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. 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 lin~s, 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 certificate of occupancy $1 $5.00 D ate / .~././z~./..~. Z .......... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ... ,~..~..~-~. ,~, .-~, ....... ,~./.'~./,~,,~., ,g~. ~./~-.~',, /?L.M. ,~.-, House No. Street Ham]et Owner or Owners of Property ./.~.../~..~../.~..~.. ~ .:...~..../-~..{.~..f~..~.../~..-~. ..................... County Tax Map No. ~000 Section . .~.~. 2 ......... Block ...O...~. ........ Lot..~..0...~..~-..~..~../.. Subdivision. ~2'~-~. ~ ¢. d...°~T.. ............ Filed Map No./, ,~,~, .~.., .Lot No,/~. TJX., ,~,*..~./.~ Permit No//~..xz4~..., Date of Permit?~. ~.~..~../, .Applicant, ~J.~, ,~, ./,/k..~b.,..~,'. ,~...dJ,/.~.?,¢..~/, ,-~'., Health Dept. Approval ........................ Labor Dept. Approval ........................ I ./~...~..~. ~./..¢ 7. gB dApp Underwriters Approva ............... Plannin oar reval ...................... Request for Tem%ry Certificate ..................... Final Certificate Fee Sut~m tted $ ./~..dZ, .-~. .................... Construction on above described building and permit meets all applicable codes and regulations. ,,,.,o_,o.,e O.o, z/ozp,,f-, 1000314 THE NEW YORK BOARD OF FIRE UNDERWRITERS I~J BUREAU OF I-'LBC. TRIQITY ~- 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT o.ly the electrical eq~iptnent ~ described belo~ and ~trod~ced by the applicant nan~ed o~ the above application n~mber in the pre.rises of / ~iJ.-,l,a~ ~, 15 $~llwater Ave,, 6~, N. Yo in ~he followlng location; ~ Basemen~ ~ 1st FI ~ 2nd ~Y Section Block Lot was exa,nb~ed on ~e~'V ~ ~ ~9~ and found to be in co~npliunce w~tk the requiretnents of th~s Board. FIXTURE FIXTURES RANGES :OOKING DECKS OVENS DISH WASHERS EXHAUST FANS DRYERS SYSTEMS NO OF FEET E OTHER APPARATUS E R Electric Stillwa~er Ave. 6\mct~gt~, N.Y. 11935 lic. 2670 -g Th~s cerhflcate must not be altered in any manner; return to the off,ce of the Board if incc~?ect Inspector's may be identified by t~e~t~'credenha COPY FOE BUILDING D~PARTN~ENI. THIS COPY OF CERTIFICATE ~T NOT BE ALTERED IN ANY FIELD INSPECTION COMMENTS FOUNDATION {2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.~ 765-1802 Examined ~.~,--~. ~. ........ 1 .~.. Approved ................ 1 . P~eermit No/./...~.~./'..~.~.~ D~sapproved a/c .................................... / ................. ..... ..¢5 .... ./../.. (Building Inspector) APPLICATION FOR BUILDING PERMIT Application N~. ~ ,~../'.'.~. ......... Date . .~,...z..%--. .... / INST RUCTIONS a. Tins apphcation must be completely filled iu by typewriter or in ink and submitted in triplicate to the Buildi Inspector, w~th 3 sets of plans, accnrate plot plan to scale. Fee according to schedule. b. Plot Flan ~howmg location of lot and of bmldings on premises, relatmnsh[p to adjoining premises or public stre: or areas, and giving a detaded descriphon of layout of property must be drawn on the diagram which is part of this apF catmn. c. The work covered by fins applicatmn may not be commenced before issuance o£Building Permit. d. Upon apprc,'al of flus apphcatmn, the Building Inspector will issue a BuBdmg Permit to the applicant. Such pern shall be kept on tile prennses avadable for inspection throughout the work. e. No budding shall be occupmd or used .'n whole or in part for any purpose whatever until a Certificate of Occupan shall have been granted by the Budding Inspector. APPLICATION IS ItEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t Bmldmg Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulahons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and admit 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 bnild. ............................................. cg.L,J.. ~. ~R ................................... ,~an,e of of,,~o,,~sos Ad..~ ./..L....b.A.. .~.U..l~ !.~ O ~ owner ............................: ............. (as on the tax roll or latest deed) If applicant is a corporatmn, agnature of duly anthor~zed officer. (Name and htle of corporate officer) Builder's License No ................ . ~.~. 7 ..... Plu ~ ber s L~cens~ No ......................... Electrician's License No. Other Trade's License No ...................... ~ I. Location of land on which proposed work will be done ................................................ : .5. Ti . :a. T. : R. . . .... .............. 4. : ................ House Number Street Hamlet County Tax Map No. 1000 Section ..... t~.7 ........ Clock . .~.~ ............ Lot .~.q~-.O~ l ...... Subdiv,sion ..... : ..... e.'~ ~ :. (n .~4~ ..... Filed Map No. .~ .~.3 ..... Lot/:'~ .. J.~... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy . .~. -ff ~ ~ ~ a. ~..z~. aJ.l ............................................. b. Intended use and o~cupancy ............... ~: Nature of work (check whicl, applicable): New Building .......... Addition . ~ Alteration Repair .............. Removal .............. Demolition .............. Other Work ............... '.~c~. ~. 0 r_) ,~ i~.~ (Description). Esti d C : mate ost .................................. x, ee .......................... < ........... (to be paid on filing this application) If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage number ot' cars ' If business, commercial or mixed occupancy, specify hature and extent of each t~;pe of use ............ ~. ...... Dm~ensmns of ex~snng structures, if any: Front.. ~.O ......... Rear .. .0 ......... Depth .. o~--.~ ....... lleight- /.-,.5"! ' Number of Stores' ~ ."}x- Dimensions of same structure with alterations or additions: Front ............ Rear .... ~2 ....... Depth ...................... Iteight .... /,,J~../ ............. Number of Stories ...CC.. ~. ~ ............ Dimensions of entire new construction: Front Rear Depth He ght ............... Number of Stories ....................................................... Size of lot: Front . /..,,<-.O ." ............... Rear ...................... Depth ...~.,~ .......... Date of P chase . i ...... .. ............ Name ot For er Ow. er ......... bi i k ....... Zone or use district in which premises situated ' are .................................................... Does proposed construction v~olate any zoning law, ordinance or regulation: ............................... Will lot be regraded ...... ~ .0 ................. Will excess fill be ~emoved from l~remis.es: _ Yes Name of Or:ncr of prem~sea/~T./,(D&.. 1'~ .o.R.~./~ ~dressJ~. ~"~./.lJ..wb~/?/q.01.~ :.~..o~, hC6~'~o.(/~. Name of Arciurect ............................ Address ...... ' .... · ......... Phone No ................ Name of Contractor Address Phone No PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions fi'om roperty hnes. Give street and block number or description according to deed, and show street names and indicate whether tenor or corner lot. I'ATE OF NEW~ORK, - S OUN~FY OF ~ ..... (Name of indMdual sighting contract) 3ore ~]amed. said owner or owners, a~d is du[Iy authohzed to perform or have pet;formed the said work and to make and file fids ~plication; that all statements contained in this application are true to the bcs~ of his knowledge and belief; and that tho ork will be performed in the manner set forth h~ the application filed tl,erewith. wonl to before me this