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Home My WebLink About11119-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMEN'[ Office of t_he Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the bmlding . . ~[.~.e.~..a~.5.q~. ................................. Location of Property . 9.9.5 .... Ylidd3,e~;or~ .~(~, ..... S~eet ' ' .G.~.e.e. .np.q~.~.~. N. ¥. House No. 1[0 25 Hamlet County Tax Map No. 1000 Section ..... ~-. .....]Block ............... Lot ................. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated April 46 84 ...................... 19... pursuant to which Building Permit No.. fi.q? J.9.g. ............ dated . April. 29 ................. 198'J.., 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 ......... .... A. &orme~..add£tSorz..&...d.e.e..k .............................................. The certificate is issued to .. James. ~.. &..Shirley. G....~cl~arl~ ....................... fowner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO ~28~ Building Inspector Rev, 1/81 ~,olt~t NO. ~ TowN,o:~ ~u~.O~ TOWN HALk SOUTH'OLD, Permission is hereby granted to: BUILDING PERMIT (THIS PERMIT MUST BF- KEPT ON TH,E PRE~IS~S UNTIL F, ULL COMPLETIC~N OF THE WORK AUTHORIZED) N9 11119 Z Date. [..~.. ....... ~..~: .................... , 19.~t~./ ..... ~..~:...~. r,e.e..~e':'J..a.,~... ~,~ .......... .~. - '-- - × -- "' ~o'._ ./.w.....~'~...'~.,'.,.,~::. ~o ......~..~..~.r..~.w..c,.T.. ...... .~. ........ .C?... ......... .,Z. ...... O......,.~ *'~:~"7'"-' .... ~.~ /::/.?.,tOt,.~. 6 ~ ~.~././.,.~.~.~ .. .................. ~5 ................ ~ ......................................... f .................... at premises ocated at ............................................................................... Goun~ T*x ~op ~o. 1000 S~ction ..~... Bilk ,..~ ~ kot ~~ .... pursuant to ~pplicofion: d~tod .~ ~ } :......, 19 ond opproved by the Buil~lno Inspoctor. 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 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 ~ines, streets, buildings and unusuat 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- tton 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 ...~. ....... Vacant Land ............. Location of Property ~ ~). ~ '~ ~ /-3 4:~, ~.,~, ~P,~ -:, ~ House No, Street Ham/er Owner or Owners of Property .':~3.~'~fY:~.¢: :~:~;.. ~ ..... ~ .~.~. ~. '' ~] e~ ~''//' / County Tax Map No. 1000 Section ............... Block ... ~ Lot ~ ~ Subdivision ................................. Filed Map No. ~ .Lot No. ;~ P,,mit No. Ii. [ :i ~... Date o~ Pe,~t ~ ? .t ~..A,p,ica.t .~:~'~-; ;~ .... ~. :'.~ ~.V. ~... Health Dept. Approval ..................... ~abor Dept. Approval ........................ Request for Temporary Certificate ..................... Final Certificate .. ~ ................... ,e, S,~t,eq $..~? ~ > ........ (~ L-':~:'. ) .... Construjtion on above described buildi~n~ permit me~s all ~lic~le ~es~nd regulations. ............. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTR!CJTY~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~n the following locatio,t; ~ Basement ~ 1st Fl. ~ 2nd FI. Section Block Lot FIXTURE FIXTURES RANGES OVENS DISH WASHERS FANS DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIMEC[OCKS UNITHEATERS MULTI-OUTLET DIMMERS SYSTEMS NO OF FEET SERVICE DISCONNECT S E R V I C OTHER APPARATUS. OF CC COND NO OFNEUTRAL$ AWG OF NEUTRAL I,ic. #1049-g GENEI~A/ MANAGER Th~s cerhflcate must not be altered ~n any manner; return to the office of the Board if incorrect Inspe~ctors may be ~dentified by their credent COPY FOR BUILDING THiS COPY OF~ IN ANY MANNER. THE NEW YORK BOARD OF FIRE UNDERWRITERS '~1~ BUREAU OF ELECTRICITY. ~-- 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electrlca~ equipme~ t as described below and introduced by t~ applicant ~med o~ ~he able application number ir~ the premises of in the following Ioc,,t,on; ~ Basement ~ 1st FI. ~ 2nd Fl Section Block Lot was examined on ~a~)~tl~y ~3~ .[~JS~ attd found to be in compliance with the requirements of tkts Board. FIXTURE FIXTURES RANGES OVENS EXHAUST FANS DRYERS SYSTEMS NO OF FEET E OTHER APPARATUS: E R 'V I C OF CC COND PER ,~ 1 AWG OF HI LEG l~c. 1049-F, GENEI~AL MANAGER 11 Per_ t1~ Th~s cerhflcate must not be altered in any manner; return to the office of the Board ff incorrect. Inspector's may be ~denhfled by their credentials. ~ . , ~0~ ~OR B~!LDING DEPAi~TME~NT, THIS, COP~, O~,F~ ~C~.~T!~!~C~,~ ~J!~T~. bfl,,~ ~J~,~_EIR~Ep IN ANY MANNER, F i C LD ~.£N S.~ C'i'iON FOUNDATION FOUNDATION 2. ROUGH FRAME & PLUME 3. INSULATION PER STATE ENERGY ~ODE 4. FINAL FEE: FOLL( i.' Fo FO 2~ R6 3. IN~ BE ALL THE STATI NOTED BY ~ BUILDING AT 9 AM TO 4 PM FOR THE ylNG ~INSPECTIONS:. qDATION - TWO REQUIRED POURFD CONCRETE ~1--I - FRAMING & PLUMBING ILATION ~L - CON'S~RUCTION MUST iOMPLETE FOR C. O. ;INST~UCTION SHALL MEET QUIREMENTS OF THE N.Y. CONSTRUCTION & ENERGY ~ NOT RESPONSIBLE FOR FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1B02 ~pproved~.~-/~- .... 7'.., 1~/Pe~it No.. [ ..... ~.. )isappr°ved a/c · ' ' ' '~:::'~' '~ ' ' '-~' ..........~7' ....... / (Buil~n~ns~ctor) APPLICATION FO~ BH[LDING PERMIT Application No...F~/~././~ ......... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building .nspector, 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 ~r areas, and g~ving a detailed descriptmn of layout of property must be drawn on the diagram which is part of this appli- 'ation. 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 &all be kept on the promises 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 ,hall 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 3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or t~egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. Fhe applicant agrees to comply with all applicable laws, ordina~r~s, building code, housing code, and regulations, and to ~dmit authorized inspectors on premises and in buildings for neCe~ary inspections. _ / / (Signature of applicant, or nam~e, if a corporation) · (Mailing address of applica~/~) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... ............................................................................ (as on the tax roll or latest deed) [f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .... .~.~.-~.~i ............ Plumber's License No ......................... . Electrician's License No../..~7~ .... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .... ~..~..~. 7 ............... County Tax Map No. 1000 Section ............ Block ........ Lo ...... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existlng use and occupancy of premises and intended use and occupancy of proposed construction: a, E.xistcg use and occupancy .... ~/f~..~....(2~...~.~/~.~, r .................................... b. Intended use a'~l~d'~'cUpanc~,,,;,z.:3 ....... ~.~ . .'~.~.. . .~~ ........... PLOT DIAGRJ Locate clearly and distinctly all~ buildings, whether existing o · operty lines. Give street and block number or description accordi~ terior or corner lot. Nature of work (check which ap!plicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal ............ Demolition .............. Other Work ............... ' (Description) Estimated Cost ..................................... Fee ................... < ........... I (to be paid on f'fling this application) If dwelling, number o f dwelling units ...... .,~ ........ Number of dwelling units on each floor ................ If garage, number of cars ..... ~ .................................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... Dimensions of existing structurqs, if any: Front ............... Rear .............. Depth .............. H~ght' . .............. Nmfiber of Stories ....................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................. D.epth ....................... Height ...................... Nun~e] o1~ ~tories ................ t .... D~mensions of entire new construction: Front .... ,~....~'...~.. Rear . .~....~. ....... Depth .,~f..*~. ..... Height ............... Number of Stories .... . ................................................... Size of lot: Front ....... ~. (./~.~( .......... Rear ...................... Depths/...//.f ............... Date of Purchase .... ~'. ,,{Y..~.'l .................. Name0 f ro~e~ Own~ .... ~4 ................ Zone or use district in which pr~mises are situated .......... 1 ................. ~ ........................ Does proposed construction violate any zoning law, ordinance ~r regulation: .... .~/, .~ ...................... Will lot be regraded ........ ~.~. ................. Will e~cess fill be removed from premises: Yes No~ Name of Owner of premises'-J~.?..d',~.,..~/¢ ~0~r.,~... Address .~).~/~..~.*~_/)./F..(~.'~.~..:. Ph'one No. ~.~. ~'.~./.~ f.,fff. .... Name of Architect .......... ! ..~.~ f. ........... Address I ·' '~'~'~'~' "~'~"* ........ P~tone No ................ Name of Contractor ........ ; ................. Address .................. Phone No ................ M proposed, and, indicate 'all set-back dimensions from to deed, and show street names and indicate whether rATE OF NE~R~, . ~' i .. ,.' oumy-.. ..... -. f_,/. (Name of individual signing contract) / oove named, i ag duly sworn, deposes and says that he is the applicant e is the ........................................ ~ .......................................... (Contractor, agent, colporate officer, etc.) f said owner or owners, and is duly authorized to perform or h~ve performed the said work and to make and file this pplication; that all statements coniained in this application are tree to the best of his knowledge and belief; and that the ~ork will be performed in the manner set forth in the application fi,led therewith. worn to before me this totary,~l~}c, .... ._:..~v/r-~...,.~. County( ~" I~O~ARY PUgLIO, ~tate of New Y~ / ~o. 52-8i2~50, Sutfo]~ Co~ [ Term [xpl~s March 30, 19~ ~ (Signature of applicant)