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Home My WebLink About11336-zFORM NO. 4 TOWN OF SOU"hOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy NoAt 10b.8. .......... Date . .J,u.n.e..~.~ . . 82. THIS CERTIFIES that the~ building Location of Property . ] 52-.~ ................ ~.qQ¥~..B.q~(l .... ... ,l~i .t; .t $.t.u. c. .k .... HouM No. ~treet ....... Ham/et County Tax Map No. I000 Section .1.00 ........ Block . .C[3 .............Lot. p.l.q, .O.0.2. ....... Subdivision..;i~l.e.l~ ]~!~.s.t: Estat~.s Fil dM~pN 62.~.9. LotNo $ conforms substantially to the Application for Building Permit heretofore Fried in thla office date~ ~,U ~P,~ t, ~ 198. ! ilding P ! ' ' .............. , . pursuant to which Bu ermit No. 1336 Z dated .. Aqgl~$.~.. 1 {~ ............... 19.8.~., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ~pe.-. f. 0.mi ~ dwe 1. !in~* ..... ~..~r. iwa~ ............................................... . The certificate is issued to .Jq~$..~..qe. orEia Leventeris ..................... of the aforesaid building. Suffolk County Department of Health Approva! .~ 1 .-8~1~ ~..~/.~$/.8.~,.. p.b.t., ' R P. E.-- see note below UNDERWRITERS C£RTIFICATE NO...~J. 5 5.1.7.{ i) ................. ...................... sPPivat;e ~].1 .i[h high nit;vat;es: ~at;ar not; t:o be uaed £ov prepaPat;lon of baby fovmul, a ov use by infant;s un~leP six (6) moni;hs of age. Building Inspector Rev. 1/81 FOF~ NO. 2 TOWN :OF ~OUTH~L~ BUILDIN(~ TOWN 'HALL SOUTHOLD, N~ Y. BUILDING PEP.~iT! (THIS PERMIT MUST BE KEPT ON THE PREMISI S UNTIL ~ULL COMPLETION OF THE WORK AUTHORIZED) ~No. 1~3~ ,' z Dote ...... ~..~.~.z.....z....~:, ......... , Permission is hereby gronted to: ~/~ /~/.~ ~ ~ / ~/~e --- ........ z~.Z...~r~...~,~.~,.~....:: ....... ............... ~o....ck~m~.....oJ~.~: ...... ~,.~....~;~z~:~ ......... :.:....: ......... .~.r..~r~.....~ff~.~.~.~..~....~.....: ........... ~.. .r..~z.~ .......... co~ ,o~ ~,p ~o. ~00o so~o~ ..~ ......... ~. ~ +..,~.~ ........ ~[o~ ~o..~.~.~.~... .......... , ond opproved b~ the Building Inspector. Fee $..~....: ............... i B~uilding !~nspector FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY QODE FINAL ADDITIONAL COMMENTS FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATtON FOR CERTtFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and subr~itted 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 ali 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. 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, Data 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 $1.00 $5.00 Date ..... ~ .. New Building ...~. ........ Old or Pre-existing Building(X) ~. ....... ~/Vacant Land ............ Location of Property .... - .................................. :~.' ..... ~ --. ,~ ...... House No, Street Ham/et Owner or Owners of Property .~.~..~./',(. ~...~. '. ~,~: .~l -'T,.'~. ~.q~ $ ........................... County Tax Map No. 1000 Section ...I.Q.O ........ Block . ..~ ........... Lot..]..L(?.; ]~_.~ ....... Permit No ........... Date of Permit [ ~ ~ ~(~...Applicant .... 4. '~ ............... Health Dept. Approval ... I/. .'~. ?..'.~..~, :': ........ Labor Dept. Approval ......................... Underwriters Approval Planning Board Approval - Request for Temporary Certificate ..................... Final Certificate .,....~..- ......... - Fee Submitted $ ............................. Construction on above described building and pe,rm,.it'meets ali/a'~P~cabl,~co_des and regulations. Applicant ......................... '.'.. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRIC!TY 85 JOHN STREET, NEW YORK, NEW Y,~ORK 10038 THIS CERTIFIES THAT only the electrical equipment es described below and introduc~,b~ t ~l~, applicant n~:ned o, n the.above application rttt~mber~l~he premise$ of tn the/allowing location; [] Base,tent [] 1st ICl. [] 2nd Fl. Section Block Lot was examined on ~'~ ~bX~J J.b ~ ~ and found to be in complia,~ge with the requirements of tkis Board. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS 24 26 DRYERS SYSTEMS NO. OF FEET $ E OTHER APPARATUS: FuCtrre Appliance Feeders,l-2~14, 1-,-2#12, 1-2~10 i~G.¥.L, l~,S~oke Detector, 1-15.0kw Elec. Furru~e Itea. t Pu~p I C A W G NO OF HI tEG A W G NO OF NEUTRALS A W O OF CC COND OF HI LEG OF NEUTRAL 2/0 1 2/0 ,~moforcl, N,Y~ 11900 Lic:Z677g Th,s cert,f,cate must not be altered ,n any manner; return to the office of the Board f !nco~rect. Inspectors may be COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERT!FICAT~ h~S~ NOT BE A~'TERED IN ANY MANNER. COUNTY O~ SUFFOLK DEPARTMENT OF HEALTH SERVICES The attac?md s~provsl was issued subject to the ~otatioa contained be]oW our approval s't~,~. Yfou!d you please the follo~ing condit'tm~ of' ap?,ova], on the ~ma! C of 0 as tkis will ensure that any ~'bure o'~er will be made a~,~at'e of the nitrat~~ problem. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ~7~.~. ., 1~.,.. Permit No ........... Approved> ../4 Application No./.F. ?..~..0. ....... Disapproved a/c ............. :-::~ ...... ~. /. ......... ,// (Build~ng~ispector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building 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 streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation· c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for mspechon throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy 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 the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing cg~e, and regulations, and to admit auth°rized inspect°rs °n premises and in buildings f°r necessaly inspecti°ns' I 1.~'~ ~/~.)~ ............... ,z> ........ (Signatur.,e of applicant, or name, if a c(~oration) Oxy... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer,~:cto~,~electrician, plumber or builder. Name of owner of premises . .~.Q.45[~....~...~a .~9 .............~.~ ,., ........ · ...................... (as on the tax roll or latest deed) If app, licant is a c{Tnl0oratiqn, signature of duly authorized officer. .... .... (Name and title of corporate officer) Builder's License No .......................... Plumber's License No. ~.-,..~[.~..~.~ I Electrician's License No. Other Trade's License No ...................... l~//~ /.~ ~---~',d~ ' Location of land on which proposed work will be done ........ /~4~. ~.~... ~ .... .~.(~.t~...(.. ..... ............ ............ House Nnmber I ~ Z ~- Street Hamlet County Tax Map No. 1000 Section ...~.~.~. .......... Block ,~ .............. Lot. 1..~. ~ .~-. ......... Subdivision...~.~.~,~( .~..~-4..~.~ .'~...~..~<~ Filed Map No.. ~2.~¢.q. ..... Lot.. ~ ......... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....~..~Cd~..qx~..~. .... ~ ~.~ .......................................... b. Intended use and occupancy ..... [' ~>'~' ' (¢'7 ..... E..~.%..I~..~;_. ................................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair ..... ,, ....... RemoVal .............. Demolition .............. Other Work ............... '~ ~ 2 (Descnptton) 4. Estimated Cost~..~ .O.1 ~..0.~.../.. ..................... Fee~.~: ~.:.5 .................... '..' ..... (to be paid on filing this application) 5. If dwelling, number of dwelling uhits ............... Number of dwelling units on each floor ................ If garage, number of cars .. ~.' ................................................................. ' 6. If business, commerciai or mixed ioccupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, ifany: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ..................... .. Height ........ · ...~ ........... Number 9[ Stories ......... ._~.. ~., ........ 8. Dimensions of enIire new construction: Front .,. ,rT,t-~ ........ Rear ...iT..t~ ......... Depth ...'~.. ~ ....... Height ... ].~ ......... .Number of Stories ... ~ ....... I ........................... ~ ............. 9. Sizeoflot: Front .... I.~-~.~.., ~ .......... Rear... ].~..~. .............. Depth ~'~3~..r/. .............. 10. Date of Purchase ........... ; ................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..~..: ............. ' ........... 13. Will lot be regraded . .~-~....~ ,~,,! .............. /~V_~j.~.Yil~,t,~,~cess_fill be removed from premises: Yes Name of Owner of premises ,J.o.tl'~...~.~-./~...?~..~t..:5.: ............. Phone No ................ 14. Name of Architect . ' .. Address ................. .-~h_one No .................. Name of Contractor ~6~.' .'~.' .~i )~-~.' i~.~ iii.. Address ~ .~ .q~ne No./lu~. ~.~.~t .~.,... PLOT DIAGRAM Locate clearly and distinctly all 'buildings, whether existing or proposed, and, indicate all sebback dimensions from properW lines. Give street and block fiumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW ............ .~] .k .'~.. ~. ~...~ ~.~ ........ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above ,named. He is the ..................... i .....~ ................ : .................................. , (, (Contracto,,O~agent, corporate officer, etc.) of said owner or owners, and is duly auth ' di~g.9..~>~erform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the mannor set forth in the application filed therewith. Sworn to before me..t~is , Notagy Public, State of NeW York ~.~..I ~/[ A No. 52-0344963 Suffolk Count~ .......... '~ '~' ~ ........... Commission Expires March 30, 19~r.~ (Signature of applicant) o 0 ~veH L-O '~ 8 Water not to be used for preparation of baby fon~ula or ' "use by infants under 6 mos. of age. DATE~ __LX 'x/ /-x'T 0