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Home My WebLink About11157-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N.Y. Certificate Of Occupancy No..Z'~0856 ......... Date ...J. gr~gg.r.y..t.~ ................... 198..2. THIS CERTIFIES that the, building ................................................ Location of Property 4@38,5 .............. Bound..V.£ow. &v. emue .......... Bout, ho3..d.. House No. S~reet Hamlet County Tax Map No. 1000 Section . .05 .1 ....... Bloc]( . .0 !. ........... Lot Q.1.1 ............. SubdJwsion .... X .......................... Hied Map No...× ..... Lot No, ,, ~C ......... conforms substantmlly to the Application for Building Permit heretofore f'ded in this office dated ·., A,I~n:L ~..3.0 ......... 19 E,I. pursuant to which Building Permit No. 1.'t ~ 5.7..g ............. dated .... Hay..1B ................. 19.2,'!, was issued, and conforms to all of the requirements of the applicable provisions of tl~e law. The occupancy for which this certihcate is issued is ......... ....... an..acces.so~y..st~'u~tu~'e..in · l:t~e, re~r., ya~.d, ar~a .................... The certificate is issued to ..... R.i.char.d..Itenga te~.b, ul:g .............................. (owner,~t;~ of the aforesaid building. Suffolk County Department of Health Approval ...... N./.I~ ................................ UNDERWRITERS CERTIFICATE NO .............. bl./.E ................................ Rev. 1/81 TOWN BUILDING *OWN "ALL SOUTHOLD, BUILDING pERMIT (THIS PERMtT MUST BE KEPT ON ~H.E Pi~,E/~IS~S UNTIL K~ULL COMPLETION OF THE WORK AUTHQRIZED) P~Jssion is hereby granted to: af premises ~ocatea at ....~ ........................................................ ',.,~ ................ ~ ........................................ ~ .~. ~ / pursuant to apphcatlon ~dated ........................................ ,..:,,,,..~- ..... 19.....~.. and approved by the Build no ~ ~Pector Building Inspector. .... R?v. 6/30/80 : [ ' , FORM NO. $ TOWN OF $OUTHOLD , Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcotion must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: l. Final survey of property with accurate location of all buildings, property lines, streets, one unusual natural or topographic features. 2 Final approval of Health Dept. of water supply and sewerage disposol--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similer buildings and installations, a certificate of Code comphonce from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te plan requirements where applicable. B. For existing buildings (prior to April ]957), Non-conforming uses, or buildings end "pre-ex'st'ng ' land uses: 1. Accurate survey of property showing oll property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent formation required to prepare a certificate. C. Fees: ]. 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 ................. New Building ....... .~ ...... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Owner Or Owners Of Property ..~.~....../~ Subdivision .................... .,.~C ..................................u I'"~ '~.,...Lot No. _L! ....... Block No ....... ./,.... House No./~.,J~',.S Permit ,o /..L/:S:...~....~ate of Permit~l...~.f./..~.?A/pplicant .~..~......~....'.....~. ................... Health Dept. Approval ..... ~..~....~..: ............................ Labor Dept. Approval ....~/.'...~..~. ................................. Underwriters Approval ....... ~./.~...~..'. ............................. Planning Board Approval ..~.!(..: .............................. Request For Temporary Certificate ........................................ FinoJ Certificate ....... ~ ................................ Fee Submitted $ ..,~.-.,.~..~) ..................... Construction on above described building and.oermit meets c~l applicable codes and regulations. Applicant ........................................................... Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) -z , TOW~ OF $OUTHOLD BUILDING DEPARTMENT TOWN C~ERWS O~FICE ~UTHOLD, ~. Y~ ............................... ................................. ..................................... 9isopproved o/c .......................................................................................... Application No ................................. //I (Building Inspector) APPLiCATiON FOR BUILDING PERMIT ~, , Date ........................ , .. INSTRUCTIONS a. This application mu~t be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plat 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 ..~reas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of th~s 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. APPk[CATION IS HEREBY MADE to the Bui, ldi'r~g 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 Regular ohs, 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, bui ding code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary !nspections. .............................. (S~gnat~l~e of opp, licont, or name, if o corporation) ............... ........................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, Dlurnber or builder. , -0 , c; c>, .-(? !f applicant is a corporate, signature of duly authorized officer, (Name and Htle of co~orate officer) ......... .......................... Plumber's License No ................................................. Electrician's License No ............................................. Other Tra Je's License No ............................................... Locat on of land on wh ch proposed.work wJJJ be done. Map No ' . ................................... Lot No ......................... Street and Number ..~,.~,6;~,..L)...~.~'.,...,~,~,'x~,-~/,,: ................... ~'"~'~fl--'~'"' '"'t ...... '/}' ";'?'"L7 ......... ~MU~ICIpOII~ State existing use and occupancy of premises and in~ended use and occupancy of proposed construction: o Exisiting use and ~cupancy ............ ~.~.~,~ ................................ ~..~, .......... ~ ...................................... b. Intended use aod eccupancv ..,~., ................... - .............................. ~-.,.,.~ ........................................ Locate clearly and distinctly a property lines. Gwe street and bi whether in(erior or corner lot 3. Nature of work (check which ~applicable): New Building ................. Addition...........)/x . Alteration ............. Repair .................. Removal ..................Demolitior, .................... Other Work .................................................. ~ ' ~' (Description) ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... .-?.: ................. Number of dwelling units on each floor ......... ~ ............... ..... 6.If business, commercial or rmxed occupancy, specify nature and extent of each type of use ........... ~ ........... 7. Dimens,ons of existing structures, ,f any: Front ........~./...~ ........... Rear .......... .c./'....~. .............. Depth ~....~.. .......... Dimensions of same structure: with alteratmns or additions: Front ......... ~':..~ .................... Rear ...~....~.. ............... Depth ......... ~...'~.. .............. Height ........ '~...: ............. Number of Stories ............ --. ................... 8. Dimensions of entire new coqstruction: Front ................... ~ ................ Rear .......... ~ ............. Depth ...'r: ................. -- Numberi of Stories Height .................................................................................................................................... 10, Date of Purchase ............... ~ ...................................... Name of Former Owner ...... -: ...................... ,.................. .... ,. 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... )~$~,c?....'.: ...... ; ........................... 13. Will lot be regraded ...kt.~.=~_,~ ........... Will excess fill be removed from premises: ( ) Yes (~L) No t4. Name of Owner of premises ~)~.~'~,/.!.J.[&~> ::' ::~. Address Name of Architect ...... ~ .............. ; ..................................... Address ............. '-; .................. Phone No ..................... PLOT DIAGRAM I buildings, whether existing or proposed, and indicate all set-back dimensions fror )ck number or description according to deed, anc. L, show street names and indicot .S.S STATE OF NEW _YORK COUNTY OF ...~!4Z~(.4.>,( ......... ......... .~]'~.r;;~./.'.C/..: ...... (..~.'./,.:/...>;~)i.': ...................................... bmng duly sworn, deposes and says that he is the applican (Name of individual si~jnJng 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 fil this application; that all slatements contained in this application a~e true to the best of his knowledge and belief; an that the work will be performed in fha manner set forth in the application filed therewith. Sworn to be~re me this ; , ~ /q ,,~" /'~ (Signature of applicant) ffOT M' I' ~.OWAI ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY r 85 JOHN STREET, NEW YORK, E,XTU.E 1T DRYERS FURNACE MOTORS ~ 1st FI, [~ 2nd 1FI. Section Block Lot attd /ound to be in compliance wtth the requirements of this Board. FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FLUORESCENT MERCURY VAPOR FUTURE APPLIANCE PEEDERS TiME CLOCKS UNIT HEATERS MULTI-OUTLE DIMMERS SYSTEMS NO OF FEET SERVICE DISCONNECT OTHER APPARATUS. $ E R V I C E NO OF CC COND PER ~' NO OF HI LEG OFA W G NO HI LEO J. AWG OF NEUTRAL COPY FOR BUILDI THk tY OF <l IN ANY MANNER. FEE:_ .I b BY: ~ NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MU" BE COMPLETE FOR C O, ALL CONSTRUCTION SHALL Mr"'" THE REQUIREMENTS OF THE N" STATE CONSTRUCTION & ENERcY CODES NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS.