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Home My WebLink About11193-zFORM TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z10635 Date ......... ?.u.g..u.s.t..1..9 ............. 191}.1.. THIS CERTIFIES that the building ................................................ Location of Property 150 Third Street, Laurel, New York House No. Street Ham/et County Tax Map No. 1000 Section .. 1. .2.6 ....... Block ...? ........... Lot . .1.2. ............. Subdivision..O..o.o.r.g.e...I.,..T..u..~.h.i.l:l. ......... Filed Map No..8.6. .I .... Lot No... 7.1 ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated May 27 19 81 pursuant to which Building Permit No. 11193 Z June 14 .8.1. dated ............................ 19 , was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy ~r which t~s certificate is issued is ......... Addition to Dwelling The certificate is issued to . . .Ill..a.n.c.Y...M.a.~.t:.n. 9 .......................................... (ownerXl~,.",m~llrl~X of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO. NS300? 1 Building Inspector Rev. 1/81 TOWN ~0~ BUILDING TOWNHAU. SOUTHOLD, N~. Y. ! ~ULL BUILDING P,ER~IT! (THIS PERMIT MUST BE KEPT ON ~HE PRE/'~IS~S UNTIL COMPLETION OF THE WORK AUTHORIZED) N0. 1119~ Z Dete .., ....... ~t.. .... .~J........(..~...., Perm ssion is hereby gra~ted to:. ~ , ~ ~ ~...~.~.~ .......... ~~:~..~4 ........... ~ ........ ~.~ ............ ~~.~, . .............. ~,~....~ ........ ~ ...... ~...?~, ~ ,o~ ~,."=..... .... ......... · -.... .......................... : .............................. ..... : /~o ~d~~ . at premises located aT .., ..................................... p4* ......... "" t"~'~ ..................... * ....................... ~ ~ .... , , ~ .. ...... ~unty T~x Mop No. I000 Sect on ~. .~ .... ~B oe~ .... ,,.,.~. Lot No ......................... pu;rsu~nt to ~pphcahon d~tod ......................................... ( ........ ~,..., 19. an8 opproved by the Building Inspector. ,~ Bu[ldJn~rl~eGtor R~v..6/30/80~ : ~ ~ ~ , FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buddings 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 Planmng 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 lines, streets, buildings and unusual natural or topographic featu res. 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 New Building ............. Old or Pre-ex~sting Budding ~/ Vacant Land ::/,>.,./.. ................ Location of Property .... /.~,'~ .................. House No, Street Hamlet Owner or Owners of Property ......... ~'? ................................... County Tax Map No. 1000 Section ..... ,/-~ ~> .... Block ..... ,~.~. ....... Lot ..... ./?-.; ....... Subdivision . :~,,.. ,~z'Z,,~ ././~, ............. Filed Map No. ~.-~.'./. .... Lot No .... ,~../. ...... Permit No. /../,Z~.",-~.. Date of Permit .~ .... Health Dept. Approval ........................ Labor Dept, Approval ..................... .~. Underwriters Approval ........................ Planning Board Approval ................ Request for Temporary Certificate ..................... Final Certificate .... /;../~....~.~ ?'. Construction on above described building and permit meets all applicable codes and regulations.~/~ ~/, . . Rev. 10-10-78 THE l)ate THIS CERTIFIES THAT NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~B6 JOHN STREET, NEW YORK, N[EW YORK 10038 ~ppIicatio,, No. ,,,, Sile N 5 only the electrical equipment as described below and introduced by the applicant named on ~he above application nu tuber in the premises of in the ~llowing location; L~I Basement ~.s ,~a,,..ed o. JU t5~ 30 ~ i961 [] 1st FI. [] 2nd FL Section Block Lot and flound to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT DRYERS SYSTEMS NO OF FEET OTHER APPARATUS: E R AWG OF CC COND 4 C NO OF HI LEG AWG OF HI LEG NO OF NEUTRALS Tbs certificate must not be altered in any manner; return to the off,ce of the Board if incorrect. Inspectors may be :~ FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & FLUMBING INSULATION PER N. Y. STATE ENERGY C~DE FINAL ~/~ / ~ /' --~ ~..~?. ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ^ppro ed ............... l ..Pe mit Disapproved a[c ....... --~'...~....~.~ ........ ................. (Building Insvector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No.~ .~. (. ?.. & .... a. This application nmst be completely filled-in by typewriter or in ink and submitted in triplicate to the Buildi 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 stre~ or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apl: 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 porn 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 Occupan shall have been granted by the Bui/ding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance 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 buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, ,, d admit authorized inspectors on promises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) -- ,,' (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build( ........... ./... ................................................... Name of owner of premises ................................................... (as on the tax roll or latest deed) If applicant is a coiporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ....... ~..~..~.~ ............ Plumber's License No...~..~.~.>.>r.~t~; ./~.......... ~ Electrician's License No ......... ~..~.~.-¢T..~-. ....... Other Trade's License No ...................... 1. Location of land on which proposed work will be done..~/. · .~(.~.~...'.~...~...~..~.~...,~..~.~.~..~.~./.~'.'~' .~.~.//.~..~.~-~. / House Number Street ' Hamlet County Tax Map No. 1000 Section ..... ~. · .~..~. ...... Block ...... ~.. ......... Lot .... ~. · ~/.~. .... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ ~.../:.~¢,'.-.d ~'./{/.. . .......................................... .. / 4.'./. b Intended use and occupancy ~. ......................... 3. Nature of work (check which applicable): New Building .......... Addition .. ~ ·. Alteration .......... Repair .............. Remqval .............. Demolition .............. Other Work ............... Fee ' t. Estimated Cost ............................................ * ........... (to be paid on filing this application) ' / hn / L If' dwelling, number of dwelling units ............. Nmnber of dwelling units on eac oor ............... If garage number of car~ ' . ................................. 5. If buslness, commercial or mixed occupancy, specify natu.re and extent of each type. of use ........... ?. Dimensions of existing structure~, if any: Front... &¢..'~. :. 22. .... Rear ...~.: ...... Depth ...._~.2.....~..~..,q.. Height .... ,/:~...; ..... Numlber of Stones ....... ,Z'.. ~ .......... ,~ ...................... ~. ....... Dimensions of sa~pe structure with alterations or addi!~o~n~s: Front .~r. ............ Rear . .'~? .~. .......... Doeth . .'~.-~: ......... '.. Height ...... ./..~.~ ........ Number of Stories .... /. ~...... ...... L Dimensions of. enhre new construction: Front ..... ~..4{ ...... Rear .... ~.,~. ...... Depth .... ,~..~. ....... Height ..... ~.~. ...... Number of Stones .......... ./..>,.-, ......................................... ~. Size of lot: Front ....... .o~. ............ Rear ...... . ."'J~.... :,~fff~. f... Depth ......,¢':~ .............. ). DateofPurchase ...~.~-¢~...,'f,~..../.,~.d~.,,f ........ Name of Former Owner .Ak"~.~...,~..a.a~Pf.~.~ .......... 1. Zone or use district in which prqm~ses are si!uated .......................... 2eZ ........................ L Does proposed construction violat,,ejlny zoning law, ordina.n, ce or regulation: .... .~K..~'. ...... . .................. L Will lot be regraded ......... ¢q¢5..~.. ...............Will excess fill be re,m, go,,L~.d from premises:." Yes_ No ;. Name of Owner of premises ,eld. ia?,//. ,/~.,i¢~,/,~.q.. Address ..-.-.-.-.-.-.-.-.-~... :.'~../g. e~.../.~.. ~.~". ~ Phone Neck.z. .'.~' .~.~.'7.e~...~ar~ Name of Architect .... ~;....':'~: ............... Address ...sf~...~..~g. ,o. ~ ....Phone No ................ Nmne of Contractor ~f.~..~'~,~'~4~/~. .... Addr~ss~-¢~/',~¢~..,,~. ~.... Phone No. ~ .~.. PLOT DIAGRAM Locate clearly and distinctly all! buildings, whether existing or proposed, and. indicate all set-back dimensions from :operty lines. Give street and block humber or description according to deed, and show street names and indioate whether iterior or corner lot. TATE OF NEW YJORI<~/OUNTY O~. ' y S.S (Name of individual signing contract) oove named. being duly sworn, deposes and says that he is the applicant -I (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 pplication; that all statements contained in this application are true to the best of his kd~owledge and belief; and that the ,ork will be performed in the manngr set forth in the application filed therewith. worn to before me this i ............. . .'..'~.../f...-~...day of ...... , .~..~..., 19 ,otary Pnbl~.%~. _., .~..~.. County (-/" JUDITH T. :TERRZ~~ Ynrkf ........ - ............... -:~rs.c ss ~: .~-t... ~Sffiffil~lon Expires Maroh 80~ ~ (Signature of applicant) )