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Home My WebLink About11071-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Zq397q Date October 29 1985 THIS CERTIFIES that the building ....~ p.D.I. ? .5.0.N. ................................... Location of Property ..... ~ .5..13.5. .L .L.~.?.D.. ~.0JI. Q ....... CU TCH OGU E House No. Street Ham/et County Tax Map No. 1000 Section ..... ~, .0 .4 .... Block 1 ,Lot 4 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ~.a?.q h.. J .6 ........ ,19 .~ J. pursuant to which Building Permit No... q q 0 7 q Z dated . J~ r ¢ h..~ 5 ................. 19 ~. J., 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 ......... .... ~aDx ~.r.aN. ~o..Ex ~s.~.:~¢..q~. F.~.~ .z F.~..?..~b.~.~.~.9.. ........................... The certificate is issued to ERNEST POULSON (owner, ~s~e~ ~a~x XX of the aforesaid building. Suffolk County Department of Health Approval .......... ~ ,/~ ............................. N..519825 UNDERWRITERS CERTIFICATE NO ................................................ Building Inspector Rev 1/81 FORM NO. 2 TOWN OF $0UTHQLD BUILDING DEPARTM, EN'I~ TOWN HALL SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES ,UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 11071 Z ~ate .....~./ff.C .~ ...... ~..6~ ......... ] 9..~../ Permission is hereby gramted to: ........... ......... ........ /.~..~....././../.].. .................... ................. .......... ..~... ~..~..~.~.~.:..-...~..~:....-./.. ......... tO ..... · ........... J~'""~ ...... . ~.c...~.,/~: ~~.. ~.~ ................................... ~t premises loc,ted ,t ....Z5 ........ ~..~'~..~..--.-;"~.~~ ...... CounW Tax Mop No, 1000 Section ,.../.Q:..~ ....... Bilk ,..,~ .......... Lot No....~.~.~ ...... and oppFoved by Building Inspector. Fee $...~.2~......~': ..... 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 typewriter OR ink, and submitted mm 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 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 Ap_ril 1957), Non-confo, rming uses, or buildings and "pre-existing" land uses: 1, Accurate survey of p~'~operty showing all property lines, streets, buildings and unusual natura~ or topographic featu res. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings, 3. Date of any housing code or safeW inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate, C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy $1.00 4 .Vacant Land C.O. $5.00 Date .......................... ~ew Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property .... Zf .... .~.L[/?. ~/. ~:') ~.T~H° ~ ~.~. ~"~ House No. Street Hamlet Owner or Owners of Property County Tax Map No. 1000 Section ...... /.~C).~./. .... Block ... (' Lot. Subdivision ................................. Filed Map No ........... Lot No .............. PermitNo..[I..0.~J.t.~: Date of Permit q;~[ .Applicant .................................. Health Dept Approval Labor Dept Approval Underwriters Approval ........................ Planning Board Approval ................... Request for Temporary Certificate ..................... Final Certificate . .' ..................... Fee Submitted $ .... ~ OO Construction on above described building and permit meets a~l applic~[C'~,es a'nd reJulations, .... ........ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK ~C~038 Applicatio~ No. on file ~1 F~ ~ ~ ~ ~ ~ THIS CERTIFIES THAT only the electrical equlpmertt ~ described below and int~duced by t~ applicant named on the above application nu tuber in the premises of in the followlng location; ~ Basement ~ Ist FI. ~ 2nd FI. Section Block Lot was examined on ~v~)~ ~ ~ ~[ ~ ~ and found to be in compliance w~th tke requireme.ts of tk is Board. EIXTURE OUTLETS }~ECEPTACLES SWITCHES FIXTURES RANGES OVENS EXHAUST FANS INCANDESCENT FLUORESCENT DRYERS FURNACE MOTORS APPLIANCE FEEDERS TIME CLOCKS MULTI-OUTLET DIMMERS SYSTEMS NO OF FEET SERVICE DISCONNECT S E R V I C E NO OF CC COND PER ~' OTHER APPARATUS. AWG OF CC COND NO OF HI LEG A W O NO OF NEUTRA[$ A W O OF HI-LEG OF NEUTRAL liu.~ 242~ Thts cemflcate must not be altered in any manner, return to the office of the Board ~f Incorrect Inspectors may be COPY FOR BUILDJi THIS NOT IN ANY MANNER. FIELD ~i~SI'~.~T ION COMMENTS FOUNDATION (Ist) FOUNDATION 2. ROUGH FRAME& PLUMBING INSULATION PER N.Y. STATE ENERGY C0~E FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 7654803 .~. '?...," -- 19 ?.'! Application No.././.(?. ~. / ......... Examined .,. , .- ,..~'/"~xt/~ .... Approved .~.X.~: . . .~..5~..., 19 .~./.. Permit No.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date...?!!.~. ........... 19~. ! . 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 avadable for inspection 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 code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature or,applicant, or name, if a corporation) .-..tt ................ (Mailing ad'dress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................ ............................... Name of owner of premises~.~'~. ~} I.l~'~ .'f (~e~J ~ ~ ~,~ ~J (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. ~ t '~ elumber'sLicenseNo...~..&/~?.-~..~~.~ Electrician's License No../.(.C.A..~.F~/V.~.. ......... Other Trade's License No ...................... Location of land on which propos~Twork will be done ...... _. ........................................... House Number Street Hamlet County Tax Map No. 1000 Section .... ! .O..~. ......... Block .... ! ............. Lot...,~. ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premise~nd intended use and occupancy of proposed construction: a. Existing use and occupancy I ~ ~, b. Intended use and occupancy .. /~ f..~ O r (/r~ ~ / ,A~?.~&,: ~ ~Tt~~ · 3. Nature of work (check which applicable): New Building .......... Addition..........~ Alteration Repair .............. Removal .............. Demolition .............. Other Work ...... ' ......... (Description) 4. Estimated Cost ...................................... Fee ...................................... (to be paid on filing this application) $ 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 natur~ and extent of each type of use ....~ .......... ~, ...... 7. r)imensions of exis~ng structures, if any: Front...(,.~...'~..*'. ..... Rear ...~..~. ?...~:... Depth...~.q: 9..' ...... Height ...[ ~ .'?...-. ..... Number of Stories ....... [ ............... ;,. ...................... ~. ......... Dimensions of same ~tructure with alterations or additions: Front . .~.'l..'~...:. ......... Rear ...h.~..-~.. r ......... Depth .... ~.~..'9..~. ........ '.. Height .... ) .(~ .-9. ~ ........... Number of Stories .... [ ................. 8. Dimensions of ontire new construction: Front ............. Rear ....~.: .+. ....... Depth ...'~.t?.l ......... Height .... ~.~1..'.~. ~ .... Number of Stories ' ' ~' q' ~ ................................ ' ......... 9. Sizeoflot: Front ... I.~~ Rear Ig~O ''~ Depth 10. Date of Purchase ............................. Name of Former Owner ............................. 1 i. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... .~..O: ...................... 13. Name°f owner °f P es[~ Will lotberegraded remi; .~. 9.[i~.~.~.~ .,~ ........... Will excess fill be rera~ved from premises:_ Yes Name of A~chitect ......I.~l~: ~ ............ Address ........ , .......... Phone No .............. '. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NE~YORK, ~OUNTY OFs~.~. q~ S.S ' ............... ......................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is ~he ........................ ..~..~...1~?~...~.~. ~ .................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform 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 manner set forth in the application filed therewith. Sworn to before me this / Q ~z~ .day of ~ UNDA K, OAW~O# · ' ' ............................ ti , ~,. ,,~ (Signature of applican Term F. xplres March 30, 19 , $'hh