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Home My WebLink About11074-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z10628 Date August 11 ................................. 1981 THIS CERTIFIES that the building ................................................ Location of Property .. . 2.0. Q0...N.a.s. sau PoSnt, Rg.ad, Cutcho~ue, New York hous'~ ~/o. ' .......... 'S't',:e~( ...................... h$r~[~i County Tax Map No. 1000 Section 104 . .Block 010 .Lot 010 & 011 Subdivision..N.a.s..s,a.u..P..o.~.n.~...C.l.u.b..P.r.o.p.....FiledMapNo........156 .LotNo.17.9...&..P./.0.!.8.0. conforms snbstantially to the Application for Building Permit heretofore filed in this office dated March 17 1981 11074 Z ...................... . . . pursuant to which Building Permit No ...................... dated Hatch 25 19 81 , was issued, and conforms to all of the requirements of the apphcable provisions of the law. The occupancy for which this certificate is issued is ......... One Family Dwelling (Addition) The certificate is issued to Richard Wall III .................... ..................... of the aforesaid building. Suffolk County Department of Health Approval N/R UND ERWR ITERS CERTIFICATE NO. N 5 2 8 0 9 5 Building Inspector Rev. 1/81 FOll~ NO, ~ TOWN OF $OUTHOLD BUILDING D£PART~ENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~EMIS~S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 11074 Z Date .... , .... i .......... Permission is hereby granted to: : .......... .,(.~...~.~......~:.~,.~..z,.~..~ :~...~ .......... ~...,...Z......~,.,.72,/.~....~_z;__.~. ........ ........ ~~.Z~ ......~.~.~ ......... ;//7~- , ,: ....... ~ .......... f~L...::~...~... ~ ......................... ~ ...... 'V premises .......... ~'~: ................... 7 ......................... ~"'~ ................ ~'~'~, ........ 'L' ~- ~ ~.~.[~[~ ...... d2.z~ ..z:2~/ ......... ~.~.,~.: ......... ~.~,:...~z.~...~.Z~...{~... Coun~ Tax Mop No. 1000 Section .... ~.d..~. .......Bilk .,~{g~ ......... Lot No. ~.~..~.~.// Building Inspector. fee ,..Z~L-.. ........ Rev, .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 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 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 lines, streets, buildings and unusual natural 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 safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 t/ ~/'¢//Z/ Date .......................... New Building ............. Old or Pre-existing Buildm§ .. ~ ........ Vacant Land .......... Xr~.,' .... ~. ~ .'.c~ .......... C!M./. ~ . Location of Property House No. Street ' ~? ' ~rnie't Owner or Owners of Property .~'~./;~.:/~.~.' .~. .............................................. County Tax Map No. 1000 Section ........... Block .............. Lot ~'~/d~ Subdiwsion ................................. Filed Map No ........... Lot No .............. '/~" ' ~ ,,~/4.¥.~¢./. Applicant "~--~ ' Permit No..x/x.,.'.~.~,~. Date of Permit ....... Construction on above described building and permit meets all applicable codes and regulations. Rev le.lo-78 FIELD ~NSPECTION COMMENTS FOUNDATION FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY cope FINAL ADDITIONAL COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT otdy the electrical equipmen~ as described below and introduced by the applicant named on the above application number in the premises of ia tbefollowing locatlon; ~ Ba*ement ~ l~t FI ~ 2nd FI. Sectton Block Lot ~* ~-,J ~ ],9~ and found to be tn comphance w~th the requirements of this Board. FIXTURE FIXTURES RANGES OVENS DISH WASHER OUTLETS 4 3 2 DI~yERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS DIMMERS SYSTEMS NO OF FEET SERVICE DISCONNECT S E R V I C OTHER APPARATUS. NO OF NEUTRA£S A W G OF NEUTRAL l 4 Drive 1&¢. ~'"76/~- , GENERAL MANA,~E Th~s certificate must not be altered ~n any manner; return to the office of the Board if incorrect. Inspectors may be idenhfled by their credentials. COPY ~OR ~ILDING DEPARTMENT. THIS COPY OF CERTIFICATE ~ 'S~ NOT B~ ALTERED IN ANY MANNER, FOB, M NO, ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. .................................... 19...~./... 19 ........ Permit No .............. /...6. ............... Approved ........................................ , ~ / / C2 Disapproved a/c ............................................................................................ ................................................... ............................. 7T::......_.._.....~,,;~...::~:....; (Buddmg Inspector) Application No../././.~.~?.. .............. APPLICATION FOR BUILDING PERMIT Date ...... ~..~..~. ~,./../. ........ ../..7.. ....... , 10.'~..~. ...... INSTRUCTIONS o. 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 ofproperty must be drawn on the diagram which is port of this application. 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 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 olteratlons, or for removal or demolition, as herein described. The applicant agrees to comply with oil applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ....... ' ................................... (Signature of applicant, or name, if a corporation) ...... ...... ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........ .,~..!..C.~.~.~. ........ ~.?...~/~....~ ..................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ............ 2 .................................... Plumber's License No ................................................. Electrician's License No..Z~,/4w'../~...~'.A.....=~...~..~..~...~..~.¢? Other Trade's License No ............................................... l. Location of land on which proposed work will be, done. Map No.: ......... ./.~..~.. .................... Lo~t No ......................... Street and Number .......... ...~..~..~.~.~/:f ....... ./~.P.,~.~..~....,....~......~...~....~....~.. ................................... .~.~.~..~'.~..~. ............ Munfcipallty State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ................ .~../.~....~.~..,'~......'~....(..~..~ ......... ~ ............................. b. Intended 3. Nature of work (check which applicable). New Building'. ................. Ad&fion .................. Alteration I ................ Repa,r .................. Removal .................. Demolit,or. ................... Other Work ........ ./~..~.C.~.....' ............... (Description) 4. Estimated Cost ............. ¢~./.~....: .............................. :...Fee 7..(. .................................................................. : ................ (to be paid on filing this application). 5. If dwelling, number of dwelling umts ............................ Number of dwelling umts on each floor ............................ If garage, number of cars .......................................................................................................................................... commercial or mixed occupancy, specify,nature and extent of each type of use ..... .,4~'/..~..% 6. If business, 7. Dimensions of ex~sting structures, if any: Front ........ ~...o. .............. Rear ................................ Depth .................... Height ........................ Number of Stones ........ ¢~. .................................................................................................... D~mensions of same structure with alterations or additions: Front ....................................Rear ........................ Depth ................................ Height ......................... Number of Stories ................................ 8 D~mens~ons of entire new construction: Front ..., .............. , ................ Rear ............................ Depth ........................ Height .................... Number of Stories ................................................................................................................. 9. S~ze of lot. Front ........................................................ Rear .......................................... Depth ................................ 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 Iow, ordinance or regulation: ........................................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes { } No 14 Name of Owner of premises .................................................... Address ................................ Phone No ....................... Name of Arch,tect ...................................................... Address ................................ .Phone No ....................... Nome of Contractor .................................................. Address ...... . .......................... Phone No PLOT DIAGRAM .. ' Locate clearly and distinctly oil buildings, whether existing br prop6sed, 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 Io~ STATEOF NEW'~K,,¢/ .~,~ l~ COUNTY,--- ,- ~ .r~ O_~F ..~...f""'J-, ................ ..~...~....../~ ........ ~ ....... be,ng duly sworn, deposes and sos that he ,s the opplicam (Name of individual signing contract) above named. He is the ...................................... ~ ........ ~ ............................................................................................................... ( k,~.Contracto~, agent, corporate officer, etc ) of said owner or owners, and is c'i~ly autl'roci-z'effto perform or have performed the said work and to mCke end file this application; that ali statgments 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 apphcation filed therewith. Sworn to before me this ~-. ~, ~ ....... o, ......... ............................. Notary P//?lic, . ........................ x.o,¥ff'ic/t-~4k¢,~.. County : I ~/' ~BBLI~H, ~a~eNoE~INLLeEw York I ['lO. 52-8125850, Suffolk I 'Term Expires March 30, 19~',~'- CC