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Home My WebLink About11331-zFORM NO, 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Buildin§ Inspector Town Hall 5outhold, N.Y. Certificate Of Occupancy No. ,gq ~I 6.%3 ........ Date ......... ............. 19.83 THIS CERTIFIES that the building ..... ~.qlcl,5-.~.~.9~3 .................................. Location of Property . .655...~O~"4a .HO~e.~.q~'.. ~ar~e ............... ~Q¢~J~qld ........... House No. Street Hamlet County Tax Map No. I000 Section . . .O~3 ...... Block . . .Q/+ .......... Lot .... 00f3 .......... Subdivision .............................. Filed Map No ......... Lot No .............. conforms substantially to the Applicatmn for Building Permit heretofore filed in this office dated .... .A.~g~.~..'[ 2 ...... , 19 f3.'], pursuant to which Building Permit'No ...... .l.~[ 33.q~ ........ dated ..... A~g~.~..q2 ........... 19 ~3.']. , 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 ......... .............. ~wo..S~ory .Add~tio~ ............................................ The certificate is issued to ...Cecil.ia. &..gohn..~es.~.e~' .............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval lq/A UNDERWRITERS CERTIFICATE NO. · lq5955~0 ~uilding inspector Rev. 1/81 FOi~M~ ~O~ 2 TOWN !HALL SOUTH'OLD, N. Y. BUILDING PER~iT (THIS PERMIT hAUST BE KEPT ON T,HE UNTIL ULL CQMPLETION OF THE WORK AUTHORIZED) ~ N9 11331 Z D~te ,..;.. ................ , 19....... Permission is hereby granted to: [ ~o ..~... ~.s ~ ~r~.~z ...... r~ ~......~, ~.... ~ .~ ~z~ ~ ~..... ~ ~..: ................ ..:(~:~.~:~.~...~..~ ...... ~:~..~....~...~ ............ ~ ........................................ p .............. ' '"' "T" ' ............................................................................................... ~....~ .......... ~r~....~.,7.- cot __.................... purs~ont to app'hc~hon' d~ted . .~..~.~ ................. ~ ~...~ ...... 19 ond ~pprovod by the Butl~lnO Inspoctor. 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 typewfiter 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 buddings, property lines, streets, and unusual natural or topographic featu res, 2. Final approval of Health Dept. of water supply and sewerage disposat-(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 buikJing. 5. Submit Planning Board approval of completed site plan requirements where applicable, B. 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 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1,00 $5.00 Date .. B u rid in g~¢~...~...' .~' .... Old or Pre~ Build,ng(X) ...... ,/Vacant Land ............ New Location of Property ~.,.5".~,'~.....~.~22~ ~<~,~'~....~R~.¢./~. ........ House No. Street Hamlet Owner or Owners of Property ~/ ~ ~ 0 ~, ~,. ~'. Co.. yT No. 000s o o. Lot. Subdivision ................................. Filed Map No. .......... Lot No. .. ........... Health Dept. Approval ........................ Labor Dept. Approval ......................... Unde~Hters Approval ........................ Planning Board Approval ...~ ............ Request for Temporary Certificate ..................... Final Certificate ................. Fee Submitted $ ......................... Construction on above described building and perm~ets all app~i,cable~Codes and regulations. Ap p ho an .~---~ _.~._..~. ....... / ........................ THE NEW YORK BOARD OF FIRE UNDERWRITERS .~L BUREAU OF ELECTRICITY ~ ~'1~ ~L~2J,.~C,[~- ]-.(Jr ~'~'~ 8,5 JOHN STREET, NEW YORK, NEW YORK 10038 ~01~0/~3 ~ ~,, · NI5 CERTIFIES THAT only the electrical equipment ~ described below and ~ntroduced by the applicant ~tned on t~ able application number in the premises of was examined on ~C~ ~ ~ ].~ and found to be in cotnpliance wtth the requirements of this Board. FIXTURE FIXTURES RANGES 20~KINGDECKS OVENS DISHWASHERS EXHAUST FAN~ DR~ERS FURNACE MOTORS ~ FUTURE APPLIANCE FEEDERS ;PEC~ALREC'PT T~M~LOCKS BELL UN,THEATERS MULTI-OUTLET DIMMER~ This cerfif~caf~ must not be altered in ~n~ m~nner~ return to the office of the Board ~f ~nc~rect. inspectors ~oy be identified by ~he~r credentials COPY FOR ~UILDING DEPARTMENT. TH S COPY OF CERTIF C~TE MUB~ N~T BE/~,LTER~ED iN ~NY MANNI FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME FLUMBING INSULATION PER N. Y. STATE ENERGY G,ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined~./~t~ . .F. ~ ..... , I .~. Disapproved a/c ....... ~PPLICATION 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 Buildi Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of bu]khngs on premises, relationship to adjoining premises or public stre~ or areas, and gwmg a detaded description of layout of property must be drawn olt the diagram which is part of this apl; cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon apprc;'al of this apphcation, the Building Inspector will issue a Buil&ng Permit to the applicant. Such pern shall be kept on the premises available for inspection throughout the work. e. No bnildmg shalI be occupied or used m whole or in part for any purpose whatever until a Certificate of Occupan shall have been granted by the Building Inspector. APPLICATION IS tlEREBY MADE to tile 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 bnildings, additions or alterations, or for removal or demohtion, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and ad,nit authorized inspectors on premiscs and in buildings for necessa/iy !nspections. (Signature of applicant, or name, ii'-4 corporation) Coo. .,t. [4¢lailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, ... ......................... , .......... ............. . ........ , .............. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly anthorized officer. (Name ana title of corporate officer) Builder's License No... [ J. ~ ................. Plumber's License No -" Electrician's License No. ~' Other Trade's License No ...................... 1. Location of land oil which proposed work will be done ...... .~.v~.rl..~.hp~o.~.~ E4 .................. ?,,4 House Nmnber Street Hamlet County Tax Map No. 1000 Section ... ~.6'. ?. .......... Block ....o-..~. ........... Lot °O°~ Subdiv~sion ..................................... Filed Map No .............. Lot ............ (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy b. Intended use and occupancy . . . ~...~.~.~ .; . 4..'~ , . .% .'~ .......................................... Nature of work (check which applicable): Repair .............. Remeval ............ Estimated Cos~ .~..~ ./~ .¢~.! .~. ~ It' dwelling, number of dwelling hnits ..... ~-~ .... If'garage number of cars ~ New Bui/ding .......... Addition ........ Alteration .......... Demolition .............. Other Work ............... ~, ,~/~"-'" (Description) ..... vee ./..~.d ...................... ¢ ......... (to be paid on filing this application) ,. Nnmber of dwelling units on each floor...} ............ i. If' business, commercial or mixeq occupancy, specify nature and extent of each, type of use . ~ ............. 7. Dimensions of existing structure~, if any: Front..[~,~; ......... Rear . .I..~ ......... Depth .~ .(..'1 ....... Height 2..,~1,~ ......... Num'ber of Stories . ...'2_2 ............................................... Dimensions of same structure with alterations or additions'. Front ...,,~ ~, ...... .. ... Rear ....] .~. .......... Depth .................... ~.. Height ..... ~. O ............. Numbq]; of Stories .... 7,.,... L Dimensions of entire new constr,uction: Front ...~, ..~. ........ Rear . .~..t"t' ........ Depth .. Y ......... Height .~, .C> .......... Number of Stories ......... ~ ......................................... ). Size of lot: Front ........... i ........... Rear ...................... Depth .................... ). Date df Purchase ........... ~ .................. Name of Former Owner ........................... 1. Zone or use district in which premises are situated ................................................... !. Does proposed construction viol:ate any zoning law, ordinance or regulation: ........ 2 ..................... t. WilJ lot be regraded ............................ Will excess fill be removed from premises: Yes No [. Name of Owner of premises .... ................. Address ................... Phone No ................ Name of Arclntect ........................... Address ................... Phone No ................ Name of Contractor ......... , ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly ,qll buildings, whether existing or proposed, and, indicate all set-back dimensions from roperty hues. Give street and block humber or description according to deed, and show street names and indicate whether terior or corner lot. TATE OF NEW,,,Y~ //- 'SS ......... (~ ~ ~. ~ ~ .... ~ ~' ~ .............. being duly sworn, deposes and says that he is the applicant (Name of ~di~ idual signing dontract) >ove named. e is the .................... ~ (Contr~ent, corporate officer, etc.)~ ...... "7. ....................... . ......................... f said owner or owne~, and is dn~y a~orm or have performed the said work amt to m~e and file this )plication; that all statements cont¢ined ~ this application are true to the best of his knowledge and belief; and that the ork will be performed in the m~ndr set forth in the application filed therewith. worn to before me this q0~50, s~f01~ Coup_ ~ ,, ~ tb~gnature o~appJican~) , F 9 I0 11 12 13 14 15 16 19 23 ~4 25 26 27 29 30 31 32 33 34 / , ~ 7,55-187 ~, AM TO 4 PA,l FOR THE ~ FO~ POLI~D CONCRETF {,