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Home My WebLink About11337-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z.1.09.43 .......... Date ....... .gp~'.:kl. ].4 ................. 19 .~3~ THIS CERTIFIES that the, budding ................................................ Location of Property .. 135.5 .................. ile o.v.a .B om.el .............. [qa.t~t,~. Pm.c.k. House No Street Ham/et County Tax M[ap No. 1000 Section .. 100 ....... Block .... 03 ......... Lot ...010.,.1 ......... Subdivision..Inle.t, .~as.t, .1~ ta.t, es ....... Filed Map No. 6.2q 9 .... Lot No .... 1 .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .. A.t~&us.t,..(~ ......... , 19 .a l pursuant to whmh Building Permit No.. 1 ~ 3.3.7.. ~ ............ dated .. ~.u.tSuu L..I.~3 ............... 19 ,¢.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 ......... ...... a. ~.u. iv a.t,.a, on~.~fam&l$, d ~.e, 11 iz~ ....................................... The certificate is issued to ....... ~4icha.el. &..Chpis. til2a..Levcr~pi~ ................. (owner, I~,,~.~e or_t~rwnt) of the aforesaid building. Suffolk County Department of Health Approval .1.1.-,~ 0~-.7. 1 ~ · .4.Z l 2/i3.2 ~. g.o.h'c.. A... V £.Lla ~. UNDERWRITERS CERTIFICATE NO ...... Ig..5.5 ] 7 7.0. .................................. Rev. 1/81 N°. TOWN OF, $OUTHOLb BUILDING DiPARTMI~N~ TOWN HALL : $OUTHOLD, N~ Y. ~ BUILDING~ FE~iT~ (THIS PERMIT MUST BE KEPT ON ~HiE PRE~IS~S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: tO at premises located at ......... ~^ ~ ...... /~rJ . Bock i~, ~ ,~d., ....... ~Lot N~.~,-,I~,,' .,/,. ~oun'w /OX ~op INO. ~uvv o~lu,,~ ~ ~ ~"~"'~'~ ........ . ~..~. · · ~/'~ · ................. BuilSing~ Inspector, Fee $.Z.. ................... ~ ~ - R~v. 6/30/80 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 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 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 ceruficate 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 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 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 . .i ?~.~,~... , ~' .. .. . /t.d ....................... House No. Street Ham/et Owner or Owners of Property .]Y~(i~.J~../~.~L-~'~ ........................... County Tax Map No. 1000 Section .. ,~.0.~). ....... Block .. ,'.~ .......... Lot../..~.;. ~/ ........ Subdivision ~,~Jq ./~_~...~ ./(q-./'. ~.~ ......... Filed Map No. ~..~-.~.q...Lot No..i ............ Permit No. ~(?bf~.~. ·.. Date of Permit .~.~.-. ~.1..Applicant. ~.~..~. ..... .~..~..~!~.~.% .-~? ....... .2. I Health Dept. Approval ... ~ ! ..... ;'~ ......... Labor Dept. Approval ...................... ~.. Underwriters Approval ........................ Planmng Board Approval .................. ~ .., ~equest for Temporary Certificate ..................... Final Certificate ................ - Fee Submitted $ ............................. Construction on above described building and permit~rgeets all apl;~cable~codes and regulations. ..... ............... plicant .... ,..,,, . · THE NEW YORK BOARD OF FIRE UNDERWRITERS 1000321 BUREAU OF ELECTRICITY ~ E5 JOHN STREET, NEW YORK, NEW '~ORK 10038 0,,~ Februa~Tf 22, 1982 ~p. li..aon ~.. oW,'. 146073-81 N 5 5 1 7 7 0 THIS CERTIFIES THAT only the electrical equipment as described below a~d introduced by~ the applicartt ~at~ed o~ Elto above appl[ce~t~o~ rtumber i~ the pre,n~se~ of MBke Leve~er~% W/S Reeve Ave., 644 S. of Harborview Ave., M~Ctlt~gk, N.. in the following location; ~ Basement ~inedo~Feb~a~zT 18, 1982 ~ 1st FI. [] 2nd Fl. Sectton Block Lot ~d found to be in cotnpllat~ce with the require~nents of thts Board. FIXTURES RANGES OVENS FIXTURE 20 Z4 DRYERS MULTI-OUTLET SYSTEMS NO OF FEET EXHAUST FANS ~,~cu.re Applim~ce Feeder~: 1-2~14, 1-G.F.L, 1-b~oke De~ec~or 1-15.0kw Elec. Furnace Heat Pump R V I C 2/0 AWG OF HI E INa OF NEUTEALS AWG OF NEUTRAL 2/o G.O. Electric, ~ 6 Poplar Ave., Megford, N.Y. 11950 Lic:2677E ?e~ 11 Th*s certif%cote must not be altered ,n any manner; return to the office of the Board if !ncoirech Inspectors may be ~dentified FOUNDATION (~st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: Ex am in e d ~/,~.t~f~ 19 ~ Approved ~.~i /' °~> ' Disapproved a/c FOR~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Application No. //fl/ Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or ~n 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 th~s apphcation 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 ~nspection 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 Bmlding 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, h.p~sing code, and regulations, and to admit authorized ~nspectors on premises and in buildings for necessary insllecti~ns. ....... ........... (Signature of ~pplicant,or nam~}~ corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, e~,~'~e'eneral"~0n~ctrician, plumber or builder. Name of owner of premises . .~. [C~.~7~, ./¢.~...~-....(~.' .~.e:l..~. I.~.~.~.l.~. .... ~.~~.~ ............... (as on the tax roll or latest deed) If applicant is a corporal, signature of duly au~orized officer. ...... .... .... d (Nan~e and t~tle of corporate officer) Builder's License No .......................... Plumber's License No.~.~. ~I~.J~.~U. IJ~/t}~. ~' ' Electrician's License No..~'.~....O.... ~.~.~.~-~f. ~.t.(._. Other Trade's License No ...................... 1. Location ofland on which proposed work will be done. . .[~J/~ .... (~..~F,.x~.~..{).<[~r..~.~....~.t '~. ~:'T.,.~....~.../:~/?.~. ~.P.. ~. I)~, ~t,,:... ~,~:. ......... ./.4..~7/~..~. C_ .,:,._. .................. House Number_~ 1~ ~--- Street Hamlet County Tax Map No. 1000 Section.. .(..C~.~. .... ... .... Block ~. .............. Lot..[~.t./. ..... .... .. Subdivision ,-~f~:/~'/.~. ~/~-~;:~...~ '/~.4~ :~/.~. .... Filed Map No.. ~.~...~.~. ...... Lot .... l .......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .. ~'.' ~/Jc.c-~'~.'..7"~. b. Intended use and occupancy ....... ..... /... ~ ' .~.~..~C../. ................... New Building' ~' 3. Nature of work (check which applicable): .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition ~ ........... Other Work ............... .~.~.~,~..~. , ~r~. 5t,,ot~,,' .. . (Description) 4. Estimated Cost . .'..'~.,. ........................ Fee . Z... :': ........................... , (to be paid on filing this application) 5. If dwelling, number of dwelling Units ............. Number of dwelling units on each floor ................ If garage, number of cars . .~. ! ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure~, if any: Front ............... Rear .............. Depth ............... H eight Number of Stories Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... ~.. Height ........... ~ ........... Number of Stories ............ ! ......... 8. Dimensiop. ste~f entire new construction Front....~.L[. ...... Rear. ~.~! .... Depth ~ .~. . Height .}..~ ............ I~umber of Stories ...... I ....... , ........................... , ............. Size of lot: Front ...~.~ .... I ........... Rear .... I..~..~ .............. Depth . .~.. 3. ~ .............. Date of Purchase ' Name of Former Owner Zone or use district in which premises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: .. Will lot be regraded . .~. ~:~...~ ................. , '~/ill exce~s fill be removed from premises: Yes Name of Owner of premises .~I~..*.f~i~.g.~f~'~c/~[~r~s~ .~f;~...~. .............. Phone No ................ Name of Architect .~ ...... ;. ................... Address .................. ,,P.~ne No ............... Name of Contractor~O~2~O. ~2~ .~ ...... Address~. 30/~.~f~ ~t~_..~fi6ne No.~/(~.L.'(~I..~. .... 10. 11. 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly all lbuildings, whether existing or proposed, and. indicate all set-back dimensions from propet~ty lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW Y~. K.//~, ~ ~ 'S S COUNTY OF ~ ~ ~:~-~ ' ' ........... ~. ~.~.~.~.~Y... ~...~.~)~ fi.~..~..~..., ........ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. Heis the ...................... i .....~ ~, ................................................... . ~,(Contractor)'agent, corporate officer, etc.) of said owner or owners, and is duly antho]'~ed_ltM~form 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 manntr set forth in the application ~ed therewith. Sworn to before me this ............. · ///~- ...... day of ..... ~., 19 ..~ ~ JUDITH T. TERRY' ~__~ Notary Public, State of New YorR Commission Expires March 3,0, ~/ ". stv~ld be noted t~ ~ ~is ~ ixoperty is ~at~ in e~ ~r~dturat wa~ supply ~ ~ ~e S~l _ analysis ~¢~ i1( ~r~. LOT ,t ~T EXCAVATION INSPECT]ON REQUIRED 2 The sewage disposal and water inspected [,y this dop~ri~:nt to be sat isfact ory~---A ~ · of General ,-'-OWN ,O~- .~CA3TF40[_£~, ,',,,'.': ~ Z ? facii!:,l~2 fort.~:'". .... ~ ' 'i: : ~er of General Se~l.o~ tO00 lOC) ~ 10. I 7. ~E$tDEr,,IC.E',o COY~IPLy' ~'~T, kl.Y.S. ENE'RG't' COt)E 7'2 1'2_ B.P. * ~ ,NOTIFY BUlLiNG ~PART~ 765-1802 9 AM TO ~ PM FO~ FOLLOWING INSP~CTIONS: L]. FOUNDATION - ~O FOR POURED CONCR~E 2. ROUGH - F~MING & PLUM~ING 8. INSULATION 4. FINAL - CONSTRUCTION BE COMPLETE FOR C.O. ALL CONSTRUCTION SH~LL THE REQUIReMeNTS OF ~ATE CONSTRUCTION & CODES. NOT RESPONSIBL~ FOR DESIGN OR CONSTRU~ION "_ L. ~F_ %/ tc~ T I '0 hq :,J?E. NO: 4-'-'( N o O r -i RE. NO,