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Home My WebLink About11097-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z10766 No ................ November 6 81 Date ................................. 19... THIS CERTIFIES that the building ................................................ 50768 County Road ~8, Southold, New York Location of Property ............................................................... House No. Street Hamlet County Tax Map No. 1000 Section . .~..1 ........ Block .... .o .......... Lot.....9:~. .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated March 2~ l~1~- pursuant to which Building Permit No. 11097 Z April 8 81 dated ............................ 19..., was issued, and conforms to all of the requirements of the applicable provisioqs of the law. The occupancy for which this certificate is issued is ......... Private 0~e Family D~elling Henry' C. Deering The certificate is issued to ..................... [o~,n'o~ ................... of the aforesaid building. Suffolk County Department of Health Approval 11-S0-25, 10/28/81 R. A. Villa P. E. Pending UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 For~ No. ~ TOWN OF SOUTHQLD BUILDING D£PARTMENT~ TOWN' HALL SOUTHOLD, N~. Y. BUILDING P,ER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 11097 Z Permission is hereby granted to: ............................... ,~,:.t:.'.f::.......U...~:.....: ............ ,~ ..~.t/:~ ......... .~ ....... :~:~.~.~.:~.~.~. ....~.~.....:~. ~ ~ ~.:~. ~:~.....~.~.~.~.~.~.~ u~0~ T,: ,'g~'~"~ ~i" ~':~ :~: .... :. ~5. ................ ::..: ....... ~ ...... ............................................................... ~'"~U '"~_o ~ ~o~ ~ ~tl-~ll. ~ J =t premises Io¢~ted ~t ........~ ........ ' .............................................. ~ ......................................................... County Tax Map No. 1000 Section ~ / BJ=k 0 .... Lot No. ~~.' ~ pursuant to application dated ........................................................ , ........... Building Inspector. Fee $...L .~. ............... Buildino Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcation must be filled in typewriter OR ink, and sub~T~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 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 (pr~or 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 ../O'-'2'~-~/ New Building ............. Old or Pre*existing Building(X) ...... =/Vacant Land ............ Location of Property ........ Z ~ O. ~/ /~o c, d ~'~ .~.~ ? /ct'/ House No, Street Ham/et .. o County Tax MapNo. 1000Section ...~ ....... Block ...... d ........ Lot...~.:~ ........ Subdivision ................................. Filed Map No ........... Lot No .............. Health Dept, Approval ,/,/. ,'~:',~.~. ,/~/~.~.,,,~./, pproval ............. ~.. Underwriters Approval ........................ Planning Board Approval ............. Request for Temporary Certifmate ..................... Final Certificate Fee Submitted $ ............................. \ Construction on above described budding and permit meets all aBpt~c_able~oOes and regulations. A Icant .~. -~ ~ pp .... ..... .................... Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by tke applicant named on the above application number in the premises of in the following location; ~ Basement ~ Ist FI. ~ 2nd Fl. Section Block Lot was exatnlned on (p~'tobe~ ~ O~ ].9~ and found to be in compliance wltb tke requirements of tkls Board. FIXTURE FIXTURES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT DRYERS OTHER APPARATUS' E R V t C E NO OF CC COND A W G A W G 4 4 IAc: 956'g GENEI~AL MANAGER This cerhflcate must not Be altered in any manner; return to the office of the Board ff mcc~rrect inspectors mo)' be identified by their credenhals. COPY FOR BUILIDiHG DEPARTMENT. THIS COPY ~ ~ i ~, ~ ' IN MAN~II~R. , o~ caun~ CAT~ ira' s~ ~o~ ~, ~tT,~a,~o ~NY ___FIE~D Z~SPECTION COMMENTS FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY COQE 5 FINAL ADDITIONAL COMMENTS: Memorandum from BUILDING INSPECTORS OFFICE TOWN OF SOUTttOLD Town H^LL, SOUT~IOLD, N. Y. 11971 765-1802 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ............ Approved ............... .(~.f~..?., 19 .~../Permit No.~" ........... --//C~ 7 Z.. (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No. /( b q ~ INSTRUCTIONS a. Th~s 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 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. .......... ...... ture of applicant-,-oxmq-~e, if a corporat'on) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .... /f.~..~.r-. ~, . .~. :...~. (~.c'..r' !'.~.? .......................................... (as on %he tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and t~tle of corporate officer) Builder's L~cense No .......................... Plumber's License No.. d J z/ ,,0 Electrician's License No. Other Trade's L~cense No ...................... 1. Location of land on which proposed work will be done .................................................. x ................ 4.o..,,. .................. House Number Street Hamlet County Tax Map No. 1000 Section ..... 0.~.:/. ....... Block 6 Lot Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... .V~.. c. r*.~ ..... .a? ................................................ b. Intended use and occupancy ...... O. O.~. . . .f.a. .~. [./~-- /,4 o ~, e_ 3. Nature of work (check which app!icable): New Building ....~'. ..... Addition .... ' Alteration .......... ~ Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4 Estimated Cost .... ' Fee ...................................... , (to be paid on filing this,arpplication)M 5. If dwelling, number of dwelling units ..... .~.. roe ~- s.. Number o f 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 structuresI if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ..................... ,. Height .......... , ............ Number of Stories ...................... 8. Dimensions of entir%new construction: Front .... 3.3. .. ....... Rear .... 3.3. ~ ....... Depth .... ,~. (/. '. ....... H ~,ight ,~ P... b ....... Num6er of Stories ..... /'~ ............................ ~' -; '~' '] 4' ' '~' 9. Size of lot: Front ..... ./.~.0.,.~. i .... .. ..... Rear .... /..kO.'.a. ............ Depth . .,~?,/,.:...,, ......~,?,.... ,?- ~, :- 7/; ,~,,./< * ~o/;r4 .-~:~!',~,.; 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: .... ~..o. ........................ 13. Will lot be regraded ....~,.e. 4. i .............. , ....Will exces_s fill be rem. eyed_ ~r. om premises: Yes No 14. Name of Owner of premise' s H4 O r.f..C:. Q.o .e r: ?.~Address g.~. ~I,.~..X/,.c.~..Ay.~,..~fl.~.~Phone No..'~'?.~'..".q.~./.,ff'... Name of Architect . Address Phone No Name 6f Contractor ......... ; ................ Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all 'buildings, whether existing or proposed, end, 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 interiororcornerlot. ~w;dd/e /~oud - C. I'~, STATE OF NEW YORK,. COUNTY OF. ....... :s.s ... ,/t/¢.O .r.~;...~. :..~.o..~r..'.~.~ ...................... being duly sworn, deposes and says that he is the applicant (~ame of individual ~igning contract) above named. He is the ......................................................................................... (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 ......... .,2.3. ..~.. ........ dar of.../~..¢F'.74 ........... 19 .ff../ Nota~ Public ...... ~ ,.~,. ~ ............ Count~ ~ , . .~, ,~ NOTARY PUBLIC. State of New YorR .... Qual, ~n Suffolll Co 52-466194~,~ "(Signature,of applicant) Comralss~on Expires! Ma ch SO, 19~/ 6 ,?- 0 ::C z 0 0 t~ J O]'dlflO]'d ltOtt3'.Jdt~ll O