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Home My WebLink About11120-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .... ~ J.a. zt ~t~ ....... Date ........... g~Y..~ ............... 198.6. THIS CERTIFIES that the building .... ~ .c?.e. ~ ~. ~.q r. ~ la..~. !P ~.~.i~ r. 9.om. ~ ¢ .d.i~ ~. 9 P. ..... Location of Property ..... lq~5 ......... ~ J..a. rtc~. y.J..qw., l~.a. ne..' . .G.r.~ .e.n~.qr .t: ....... House No. Street ..... Hamlet County Tax Map No. 1000 Section .... .5.7.. ..... Block ....... ~: .......Lot ...... 1.2. ......... Subdivision ........... X .................. Fged Map Ho... ~ ..... Lot No ..... X. ........ conforms substantially to the Application for Building Permit heretofore Fried in this office dated .... ~1~ F;L.L. ar ........,19.8. ~ pursuant to which Building Permit No ........ J J.l. 2. 0..z ....... dated ....... /tl~?. J, ~. ~.9. ........... 19.8. ~, 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 ......... · S.~r. e ~r~ .~ 9 c.c.h. ~. ~.~t br.o.q~. ~.d.cl J~ ~ ~.o.~..~ p..e.x..~.s.~.~.n.g..d.w.e..1.1.J..n.g .. .............. The certificate is issued to ........gl)N. II~. M....&. ~.O.N$ TgN. C.$..T....I~ $.T.S.Q~ ............... (ownar,~e.q~ ~,Xt~ of the aforesaid building. Suffolk County Department of Health Approval ................ IlAR ...................... UNDERWRITERS CERTIFICATE NO ...................... I~5 ~ 9.6.~ 5 .................... Building Inspector Rev. 1/81 TOWN OF~ ~O_UTHGI~D TOWN :HALL SOUTH'OLD, N. 'It'. BUILDING PERMIT ; (THIS PERMIT MUST BE KEPT ON YHE PI~E~IS~S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) '~ N? 1112 0 Z go~e .... ~4:.,..(-.?..&.7.. ............... , Permission is hereby granted to: ~---~ ~ ......... ................. .......... ~.......z.~..4 ............. :;....~ ................. ~. ........... ~..q.~z~..~.~.~ /~'7/ at premises located at County Tax Map No. 1000 Section '"~/~'~'"'7" ..... Block ,...~'~.~. ......... Lot No..~.Z~.. .......... '" ~ : '19 ., and approved by the pursuont to application doted ............... i ......... ' Building Inspector. ,~ ~i uuilding :respecter '- Rev. 6/30/80 FORM NO. $ TOWN OF SOUTHOLD Building Depar~men~ Town Hall SouthoM, N.Y. 11971 APP,JC,~T~ON FOR CERTIFICATE OF OCCUPANCY instructions A. Th~s a~nlicat~on must be filled in typewriter OR ink, and sub~itted in duplicate to the Building Inspec- tor wt[n the following; for new buildings or new use: 1. Final suPpey o1: property with accurate location of all buildin§s, property lines, streets, and unusual n.%dral or tooopraohic features 2. Final aoproval of Heaith Dept. of water supoly and sewerage disposal--(S-9 form or equal). 3. Aporoval of electrical installation from Board of Fire Underwriters. 4. Commeroal buildings, Industrial buiidings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the buildinG 5. Suomk Planning Board approval of completed site plan requirements where applicable. B. For existln9 buildings (prior to April 1957), Non-conforming uses, or buildmes and "pre-existing" land uses' ~ 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topo§raph~c features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Da~e of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a cert~fica[e. / 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-existingBulJdmg(X)._..,~%_ --=/Vacant Land - Hou~ zVo. Srreet Ham/at OwnerorOwnersofProperty ~/IU ~' ¢ C°~a~ County Tax Moo No 1000 Section .. ......... Block ............... Lot ................ Subdf,/~s~oR ................................. Filed Map No ........... Lot No .............. Health Dept. Approval ........................ Labor Dept. Approval ......................... Under"praters Approval ........................ Planning Board Approval .................. Request for Tempor,~ry Certificate ................. Final Certificat~ ..... Constr~ctlon on a~ove described building and per~irmeets all app~cabl~o~es and ragu at one 1000771 THE NEW YORK BOARD OF FIRE UNDERWRITERS ~c~ BUREAU OF ELECTRICITY [~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 ..re ~t: 5, 1981 ~6829 - 81 ~..,,~.,,o. ~o. o.~,,~ N 530435 THIS CE~IFIES THAT only the e~t~e~ equipment ~ ~se~ ~l~ and int~ ~y t~ appl~ant ~ on t~ o~e ~pl~at~n numar in t~ p~m~es of in the following location; [] Basement w.~ex.,.i.edo. ~mC 3, 19~1 [] Ist FI, [] 2nd Fi. Section Block Lot and found to be in compliance with the requirements of this Board. FIXTURE ] FIXTURES RANGES OVENS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT VAPOR 6 fl 6 6 DRYERS MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF F~ET DIMMERS SERVICE DISCONNECT S E R OTHER APPARATUS: 1-G.F.I. .o. OF CC. COND, C NO. OF HI-LEG OF HI-LEG NO. OFNEUTRAI CF NEUTRAL ~_~!m~/glec. Go. P.O. Box 143 Magtituck, N.Y. 11952 lic. 242-E GIflE~AL MANAO# 11 Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by,their credent a s COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FieLD 1NS~C'i LUM FOUNDATION ( FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION PER N st) , , ~ ~ - .~/.~_~ .... ~ ~ ,,~_ ~nd) ~~ " ADDITIONAL COMMENTS: STATE ENERGY qODE FINAL 765-1802 BUILDING DEPT. ~~ INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS:~ ~ FINAL FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 xarmned , , ...... Z...Ig ...... )isapproved a/c ...... . .~.':T~'-:: ..................... - (Builch. ngCl.nspector) ---- . APPLICATION FOR BUILDING PERMIT 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 giving 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 ,hall 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 ,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 3ui!ding 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. Fhe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to ,dmit authorized inspectors on premises and in buildings for necessary inspections. ... ............................. (Signature of applicant, or name, if a corporation) .... ~,~ . //.ZL . . &. .~. ~ ,,¢M . .//.~. 7/. ........... (Mailing address of applicant) gtate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....5..~ .A..~?.47~.~.'. ........................................................................ · 4amc of owner of premises...~.~..cp..~.. ~.... ~-a.-~.t.~r,_ ....................... ~..~.0-.*q, .~....~....~..~o~c~.')... (as on the tax roi1 or latest dee'd) ~' tf applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No. z.'~,,4/.,7/&v/-u )O..~...,.,.~,~ ... Electrician's License No.. L~9.~.-/.'~. ~...~.A.,ffv-.,~ ..... Other Trade's License No ...................... 1 Lo atio ofl d wl ichpop d k ,ill bed c n an on 1 r ose wot v, one ........... .. j.¢..~.~: ................ !~ !~.~ .V<~...L.-~ ........... ~.~,,¢, ~ ............................. House Number Street ~ Hamlet County Tax Map No. 1000 Section .................. Block .................. Lot ................... Subdivision .................................... Filed Map No ............... Lot ............... (Nmne) State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy .. Ope.. 4r'.vr-. ]':~{ ........ .,c~.e~ ........................................... a. b Intended use and occupancy 3 N of k( hicb 'pli bl ) Ne B ildi Additi Alt tic . ature' wot checkw ap ca e: w u ng .......... on .......... era n .......... Repair .............. Remqval .............. Demolition .............. Other Work ............... (Description) (to be paid on filing this application) If dwelling number of dwelling ~ni~t? ~-- Number of dwelling units on -- i. , ............... each floor ................ If garage, number of cars ......................................................................... i. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structurds, if any: Front .... ~,( ......... Rear...~/. ......... Depth · .~/~ ........... Height' .../.6 .......... Number of Stories ................................................. ! '"'" Dimensions of same structure with alterations or additions: Front ...~../. ............ Rear .~./ ............. Depth ...... z/~. ........... .. Height ...................... Number of Stories .... /. ............... L Dimensions of entire new construction: Front ....... .3.3 ...... Rear . ~.~ ........... Depth . t.~. .......... Height . .'-7 ............ Number of Stories... / ................................................... }. Size oflot: Front ..... t3.'Z.-.I ........... Rear ..... I~] .............. Depth .Z..2..O. ~. ). Date of Purchase ........... ' .................. Name of Former Owner ....... C sm.; ........... i. Zone or use district in which pr{raises are situated .................................................... ~. Does proposed construction violate any zoning law, ordinance or regulation: (I/~, ............................. L Will lo{ be regraded., ~/o ..... i ................... Will excess fill be removed from premises: Yes ~? L Name of Owner of premises .~.,;~.. ~It~.~ ....... Address/~.g,?.].s/~w~.~,~ ]~.. ?.r,. Phone No ............. Name of Architect ........... Address ................... Phone No ................ PLOT DIAGRAM' Locate clearly and distinctly alll buildings, whether existing or proposed, and. indicate ~1 set-back dimensions from · operty linked. Give street and block inumber or description according to deed, and show street names and indicate whether w-terior or c'orner lot. rATE OF NEW YORK, .~ o OUNTY OF. ~.. ,~..z~-. ~.% .~./.C.~'~ .... /~q.~.~..../~o~r-r.. ..... i .................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) cove named. eisthe ' (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this' pphcation that all statements contained in this application are true to the best of his knowledge and belief; and that the ~ork will be performed ~n the manner set forth in the application filed therewith. worn to before me this ............ ayo .~.~ ....... , lotary Public, . .q~. · r~-../~-. &"..o.. ,a;/.~. ~ .......... County ] { QualiftedN°' 46~ifi Suffolk Courtty~.~ ~ Term Ex,,ires Mar;h 30, 19 ~:, ,~ T LA'F$ON · C[RT I:ICA,TE: ,. . ~]~pROVED AS 'NOTED ~? NOTIFY BUILDING DEPARTMENT AT 765-1g(~2 9 AAA TO 4 Pm FOR TH~ FOLLOWING ~N~PECTIONS: ~1. FOUNDATION - TWO REQUIRED FOR P,qUR~Fn CONCRETE 2. ROUGH - F~AM~NG & PLUMBING .t