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Home My WebLink About11182-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y, Certificate Of Occupancy No.Z. ~. J .5.5.0. .......... Date ....... ~a..vg.h..~. 9 ................. 19 ~.3. THIS CERTIFIES that the building ................................................ Location of Property ..1.3. g.O ..... The Strand East Marion County Tax Map No. 1000 Section ...0.39 ...... Block ...0.2. .......... Lot ...0.~..9 ........... Subdivision...P.e.b..b .17 .B..e.a.c.h.. F.aF.m.s' ....... Filed Map No. 5.2.6.6....Lot No, . ] .2.1 ......... conforms substantially to the Application for Building Permit heretofore filed in tiffs office dated · ..i~laT.. l 5 .......... , 19 8.1. pursuant to which Building Permit No..1. ~. J .8.2.. Z. ............ dated ....... ~l.u.n..e..1.1 .............. 19 .8 J., 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 ......... ...... a..pr.z.v.a~. 9..on.e. r?.a.m..iCy..d..w.e.5.~.~ .n~.. ....................................... The certificate is issued to ..... .b.~O..Lp..o..., .~..~.~..~p.~.q~..~ ................... (owner, of the aforesaid building. Suffolk County Department of Health Approval . .3.3.-: S..0:-.53. t' .1.2./. 3. .0/.8.2. ~. ~.o.b..~ ....5 '.. y.t.~. 3:..a, UNDERWRITERS CERTIFICATE NO ......... .N..5. ~( ~.3.8.0. ............................... Building Inspector Rev, 1/81 FORM NO. 6 TOWN OF SOUTHOLD Buiiding Depar~men~ Town Hall SouthoM, N.¥, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A, Th~s application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor ,,v~th 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 tooograehic features 2. Final approval of Heaith Dept, of water supp y and sewerage d sposa --(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 Englneer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable, B. For existing buildings (prior to April 1957}, Non-conforming uses, or buildines and "pre-existing" land uses: ~ I. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworp statement of owner or previous owner as to use, occuoancy and condition of buildings. 3. Date of any housing code or safety inspection of buiidin§s or premises, or other pertinent informa- tion required to prepare a certificate, / 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-exlszing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 New Budding '~ ............. Old or Pre-existing Building(X) ......... =/Vacant Lend ...... Owner or Owners of Property .., ~qPTzZ,} / Ft, .~.X~//~4,/~ r?~ ......................... County Tax Map No. 1000 Section ~. ~) Block ......... ...... ' ...... · ..... Lot...; ............ ............... ¢ .~'.'; · . ,4 ...F~led Map No ........... Lot No..~.~: ~ ...... Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Unde~r~ters Approval ............. , ........... Planning Board Approval .................. Request for Temporary Certificate .................... Final Certificate ........ - Fee ~ubm,tted S.. % ~- ~ IIWO ¢3 ~/ Construction on above described buHdu]q and per~ meets all apo~cabl~odes and regulations / 10001?4 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY N 579380 THIS CERTIFIES THAT only the electrical equipment as described ~e~w and interlaced by t~ applicant named on the able application number in the premises was examlned on CJ~Ob~" 4, 1982 FIXTURE OUTLETS 53 ~ECEPTACLES 64 SWITCHES FIXTURES FLUORESCENT 44 3 DRYERS ~ 2nd FI. 3rd. ~, Section Block Lot and found to be in compliance with the requirements of this Board. RANGES OVENS DISH WASHERS EXHAUST FANS SYSTEMS E OTHER APPARATUS 1-G.F.L 1-Smoke Detector 1-4.5 gl4.1tot Water P~_ater 1-20 K.W. gl~. ~e 1-10 ~ D~sal ~a~ ~ 64'-O 16 lites E R V I C A W G NO OF HI LEG OF CC COND 4/O AWG 41o 325 W~llow Poi~g ~Thms certmflcate must not be altered in any manner; return to the office of the Board d incorrect Inspectors may be mdentffied b the r r COPY FOR BUILDING DEPARTMENT. THIS cOPY OF ~ IN ANY MANNER. , '1': ~ FOUNDATION ( ls t ) FOUNDATION 2. (2nd) ROUGH FRAME & FLUMBING INSULATION FERN. STATE ENERGY qODE FINAL ADDITIONAL // FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 76[;-1802 Examined ........... /./), 19 . .~ At~proved ~./. ............... · . .......... ? /,f, l%..~.Pcrmit No / / / ~i"': ,~ Disapproved a/c ...... ~ .................. .... (Bmldmo inspector) APPLICATION FOR BUILDING PERMIT Application No ................ INSTRUCTIONS a. This application must be completely filledqn by typewriter or in ink and submitted in triplicate to the Buildi Inspactor, 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 stre~ or areas, and giwng a detailed description of layout of property must be drawn on the diagram which is part of this apg cation. c. The work covered by this applicatmn may not be commenced before issuance of Building Permit. d. Upon approval of this apphcation, the Building Inspector will issue a Building Permit to the applicant. Such porn shall be kept on the premises avat!abl¢ 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 Occupan shall have been granted by the Building Inspector. APPLICATION IS ttEREBY MADE to the Building Department for the issnance of a Building Permit pursuant to t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of braidings, additions or alterations, o.r~or remov,a~ or~emolition, as herein describr The applicant agrees to comply with all apphdable Ia .~s, ordinances, bt. fffdi.ng.co;de/Ja6u~flg code, and regulations, and admit amhonzed inspectors on premises and m bmldmgs for necessary/ns~ct~:~i's//f/~/ ~'flF~lgtw'£~3' ~c~,.,, ~D' ' ' - ..................... 1 ................ :../.. (Mailing address of applicant) State whether applicant is owner, lessee, agent, a.rchitect, engineer, general contractor, electrician, plumber or build, Name of owner of premises .................... ~.. · . .D. ........................................ (as on the tax roll or-latest deed) If app/l~t is ~,ffJ~,~on, si~ature of duly authorized officer. / (...1 (Name and title of corporate officer) Builder's License No..~.t .~..& 0.'7....{. ?~.~./.~.4... q Plumber's License No... ~"~..~.~..0.,...~. ,. .......... Electrician's License No ........... ............ Other Trade's License No ...................... 1, Location of la.nd_.o~n~.'chich proposed work will be done ................................................ sr , c_J ................ House Num bet Street Hamlet County Tax Map No__lO00 Section .. P .3.e. ......... Block ....~ ............ ~ot... ~ .~ .......... ........... .~ ......... ~. LO[ ..... ~. ..... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................... . . . ntended use and occnpancy ........................................................ : J. i. :operty lines. Give street and block n'umber or ,terior or corner lot. Nature of work (check which applicable): New Builam~ .. dition .......... Alteration .......... Repair .......... :~. Remov, al .............. Demolition .... ~... ........ Other"Nork ......... .~. c// . · e:tr4P , ._., (Description) · / (to be paid on f'fling this application) ' /, If dwelling, number of dwelling units .............. Number of dwelling units on each floor ................ If garage', number of cars ............ ~.2~ ......................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ..................... ,~,'/' ~',t ............. Dbnensions of same strdcture with alterations or additkoas: Front .... ,~. .....,. ..... Rear . ~ .~ ''~' '"~' ' ....... Depth ...... 5.~. ........... i. Height: .... ~.~,~-J. ........... Number of Stones ........ · ' · t ,~ .'r/. (., ' ~ ..... ' ....... Dimensions of.ent re new constru.ct~on: Front ~.~.~...~... Rear ...... ~... Depth ...~. ! ......... . p Height ........... Num er of Stones ........................ Size of lot: Front ...... .ri ~... .......... Rear ......... i ........ Date of Purchase ........ ~ .... i ............... '.. Name of Former Owner .......................... Zone or use district in which preraises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: .. ............................... Will lot be regraded ............................. Will excess fill be remowed from nremises: Yes ' No Nme of Owner of premises Q~'~r I'0~-~../.V! d..~..Cqt {.. Address~.. }..~.d.e.c/.~..~.~[. ~'./J~.T.r~9.~,~one No ............ ': . Nmne of Architect..L~. l;e, tV( ~. J. ~. ( .~. ~.,? ..... Address ................... Phone No ............. Name of Contractor . ~aq.-~r...~q[-~..w e~' ....... Addrcss~..( ~'.n.%Pt .~.~.~ (~W, Phone No..rY...~. ?. (~..'.~-." . PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from description according to deed, and show street names and indicate whether TATE OF NEW 'f'~ RK.~ ' ' ' ' '~' '/~i,~': ~~~cO~---~'~'Cx'''' ' ' being duly swOrn, deposes and says that he is the applicant JS the ........................................ . ~ (Contractor, agent, corporate o.fleer, etc.) said owner or ownem, ~d is duly anthoHzed to perform or have~perfonned the s~id work aud to m~e and file ~is pplication; that ail statements contained h this application are true ..to th~ best of his ~mwledge and b~hef, ~d that the 'ork will be performed in the m~nel set forth in the application filed~therewith. worn to before me this ,~, NOTARY PUBklC~t~f N~w York ~ ~/ ~uf~ of applicant) ,, ~ Ho. 52-8t25850, Suffolk C~[~ ~ 0 0 F' Z b IL>