The URL can be used to link to this page

Home My WebLink About11303-ZFORM NO. 4 TOWN OF SOUTHOLD ~ BUILDING DEPARTMEN~ Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. g30.997. ...... Date ........ May..1.g .... ............. 198~ THIS CERTIFIES that the building ................................................ 580 Grigonis Path Location of Property . 275 ................. Jorllick. Lane ............. ~q~la.o.l~l.. House No. Street Ham/e~ County Tax Map No. ]000 Section . D.7.Q ....... Block .. D~ .......... Lot . ~)~0.?. ............ Subdivision. Ha.nves.t..Home,. .Es.tat;es ..... Filed Map No. 53,-~'~...Lot No... 1 .......... conforms substantially to the/Application for Building Permit heretofore f'fled in ,this office dated · · · J u&M · 28 .......... ,19 8.1. pursuant to which Building Permit No..1.1.303..Z ............ dated ..... JJ~ly. 28 .............. 1981., 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. ~r. iva.~.e, on.e.~am~ly. The certificate is issued to .... ltol~.er.t~. &. P. al;r~e.t,a..V.a.q .Bg.u.~.gg.n.d.~.q .ri.t; . [owner, lessee.o~ t*saanll ........ of the aforesaid building. Suffolk County Department of Health Approval 1.1.-~S0 .-6J.~ .5 [.1.z~/.O~.~../~91~.g....6~..V.~. ~.l.a.[. P. E. UNDERWRITERS CERTIFICATE NO ...... I~. 5 .6.7.7. 0 ? ................................... Building Inspector Re~. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N~ Y. BUILDING I:ERMIT CTHIS PERMIT MUST BE K:EPT ON THE PP.F. MISES UNTIL FULL COMPLETION OF THE WORK: ,~UTHORIZED) 11303 Permission is hereby granted to: ...... ....toZo...,..~l~.~...:.~:~..., .................... ~0 ...... ~..~..~:.. ...... ,..~,~....,~.~,~.,.~'~.....,..~,,z~z~.~-~.~ ...... .-~.,..'....-- .................. ,..~..~,~z..~.. ~,,~r~.~,,~ ....... /~.,~.....~o.,~,~,~ ...... opproved the Building Inspector, Rev. 6/30/80 ~=ORM 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 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.F[nat approval of Health Dept. of water supply and sewerage disposel--(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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and 'pra-existing" land uses: 1, Accurate survey of peoperty showing all property lines, streets, buildings and unusual 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- tion requ ired to p repare/a certificate. , : C. Fees: 1. 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 Date ....... New Building ..... ~,~_~ Old or Pre-existing Bu ilding(3:) Location of Property '' .~./~ .~ -,;o'j; ....... .............................. , ....... ., ... ......... Owner or Owners of Property .. ~.~ .~, .~. ~c... p,~,-,~2~, ._~.,~ V, .~., ~)~.~,,~, ~ ?, ,e~, ,v~,, ..... . County Tax Map No. 1000 Section Subdivision.; ~.~.C~.. ...... ):'.'.:~.>~:;"'",. ,.Fiied Map No. ~. .--4-?. ~ .Lot No .............. Health Dept. Approval ............. Labor Dept. Approval ...................... ,.. Unde~riters Approval Planning Board Approval ............ Request for Tempora~ Certificate Final Certificat~ Fee Submitted $ ............................. Construction on above described buildin~ and ~>t,~~o, an~t.on' ; ~ ~ ~',~ , ~ r ; .~"'', ....... .~,~-.,~~ .............. . ..... Rev, 10-10-78 ~,~..~.~ ,,~, ~-~ ~ -.~-~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK. NEW YORK 10038 o.t, p=~=~ ~n 198'1 .~p~i,c..o.:Vo.o.~,l. 150999-81 P~249032 N 547707 THIS CE~'T~'' ) o~ly the electrical equipment as described below and introduced by the applicant named on the above appllcatio~ number i~ the premises o~ Robert Van ~, 960 ~ Par. h, Sour. hold, N.Y. in the followlng location; [] Basement [~ 1st Ft. [] 2nd Fl. Section Block Lot was examined on ~ ~4 ~ 1~ and found to be in comptiance with the requlrements of this Board. FIXTURE FIXTURES RANGES OVENS EXHAUST FANS O~ITLETS SWITCHES DRYERS FURNACE MOTORS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET OTHER APPARATUS: 1-20.0k~ Fur~ace,l-4To~ A.C. Unit 1-4.5~,~ H.W.H. NO. OF CC. CO~D, PER ~r 2 OF CC. COND. 4/o NO. OF HI-LEG NO.O~tNEUTRAL~i A.W.G, OF NEUTRAL 2 ~ 52.3. ~ MARAi,R p,~ 11 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FIELD INSPECTION COMMENTS FOUNDATION 2nd ) 2. ROUGH FRAME & ?LUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL tENTS: POB~ NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTNOLD, N. Y. Examine, . .~../...~......~'....~... .......... , 19....~../.. Application No..~./.....~....~....~.~.. ............ Approved ........................... , I .. I~rmlt No...~./. ............ · D sapproved a/c . ...~.. ..~. .. (Building Inspector) AFFMCATION FOR BUILDING PERMIT ~ote ......... ~.. o'.. ............... , 1¢ ............ INSTRUCTIONS a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Building Inspector, with 3 set~ 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 or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this 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. APPLICATION IS HEREBY MADE to the Build ng Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town o.fjSouthold~ ~uffb k County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of build~hgs, addi~Ji0ns Or a terations, or for removal or demolition, os herein described· The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Address of applicant) State whether applicant is/o~vner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................. L ,~), .,~. ,/1/~ ,., ,~', ~ .......... ~ ............. ~ ............. ,..; ........... :;~ ..........: .;.: ~' ..... ~ ........ .~.., ....... ~.,...x..~.;~.~w.. t../..~.~.' ; ..~..(.5/~.Z:..~ .,;~. ........ -- m...'~.. ..................... if applicant/~.~or~e,~ig~ dulywau~. (Name end title of corporate officer) Builder's License No ..................................................... ~ / Plumbers License No...,,~,,/,'...~ ................... ~..,~-~/...'~,~. Other Trode's License No ............................................... '-'4~ 7~- Location of land on wh.icjh prapose~d ~yprk w be done Map No Lot No / Street and Number ~ ~ ~~ . ~0~01~ Municipali~ State existing use and ~cu~ncy of premises and intended use and ~cupancy of proposed construction: a. Exisiting use a~ ~cupancy .......... ~ ........ b. Intendod use and ~cu~ncy .......... ~ .......... /4~ ............................................................................... .............................................. . ............................. Nature of work'(chec[~ which applicable): New Building' dditioh Alteration ................. ,,_ (Description) Repair .................. Removal .................. Demolitior.;-; ................. Other Work ..................................................... · ~"~ .~ .. ^.~ ......... Fee · .~... '/~ ~ ........ Estimated Cost ....... .-J.-.-~"f'"~"~""' ....... (to be paid on fi ng th s app cat on) If dwe~ ng number of d~elling un ts ......... ..~..~...~...~........Number of dwe.'~i,ing ur~ts on e~ch ti[oar .......................... If business, commercmt or m~xed oc~upanO~, sp ~ ~' Rear- ...............................Depth .................... Dime.~sions of existing structures, [{ any: Fror~t ............................ Height ........................Number of Stories ............................................................. ; .................................................. · . ructure w th alterations or addmons. Front ......... Rear Dtmens~ons of same st t, u-nber of Storms .................. ~ ........... '~-'} I · Height ............ '"~;~- / ~ .dl?~.. Depth .~e...< ....... Depth ........................ ~ .... Kear ..... ~., ................. DimenSions of entire new construchon: Front ....... f/..~' ................. -~ I ~/~ ................................................................................... ~ Number of Stories ...... ...................... -I~"~-~ _ Depth ..2-3.¢~'-~''~'''~'" ...... Height ............ ./ ~_.~ Rear ..... /... J..~'~ ................. Size of lot: Front ......... ~. ........ : .................... ~ of purcl~ose /'"~' '~''~ Name of Former Owner ..... ~.....:7. ................................ · ~iomte o y ' : ....................................................... Zone or use n zoning Iow, ord nonce or regulation ~:, '[~ ,,4/ Does proposed construct,on ......... ,4 from ~remises: ( ) ,Ye~.s./ ~ ~l/r~o ,/~ ~ Will lot be regraded ..-F/~-'~;'~;~/~'g~;i ~.~.t-~-/..~.e''~c~e'~O?~''~''~'''~''''~''~'''''''¢~' ~°°~'NO~'''~'''~''~''O'''O'''%' Name of O~n~ mc premises .~'/R ..... .~.~/:'.~., ............... !. Address ................................ Phone No ............ ................................ ~ :~ .... ....... p~d~-D~/~A ~'""'"'"',~to,~ ~f c~ Nam~ ~'~ '"'~~ ~~ . Address ...~[~ Phone ~o ....................... · osed o~ indicate oil set~k ..,. ,, = '~;~s hether existing or prgp '~ ~ ~ . ¢~eet ~ a~ ~cote ~OUNTY OIF .. ' duly sworn, deposes and soys that he is the opplicom ................. above nom~dL j~',. . ~ /' - ................................................................................................. ,, ._ .be ...... ~~"'"'~'~-~"~ent corporate officer, etc.) _ '~ -.,~rk and to make and fil~ ~e ~ ........... ~ ' -- ~- have performed the sa,p,y%.__.aed,e and belief; oho ,, ~ ~,.~ ¢~¢ ~- p~or~ u~ -~- true to the best at ms ~nu,, ~ f ¢nid o~r ¢ ~' ~ t~ '%z¢-~d ~ ~i~ ~p,CoUO~ u,~. ¢qed therewith ' ¢ ~ -- .~ ~ ~ ~ ~" ~_ ~ ~ ~ the oppucanon -, / th PP ~ ';1~ ~ m~,,~'~ tm ~e' ¢ tha~ the ~,~ ..... ~ ...~.E....d..:. ~ =: .... ~,' ......... -' ~..C ............ ~' · ......... : .................. :"';t ....... NotaW~i~~~ ~/ (S,gnoture of aPphCO ) ~ ~, ~ ~ New Y~ ,:~omm~~ 30, ~ V'v' ! L.I-. I ~lVf 5 1,,1.~,9°04'E. - ID.4.49 ri -. ANN 0 I THE WATER SYSTEMS FOR CONFORM~ SUFFOLK is)/// SUFFOLK COl SERVICES -- CONSTRUCTIOt DATE: H. S. REF. NO.:_ APPROVED: SUFFOLK CC DIST. S I000 ¢ OWNERS ADDR DEED: TEST HOLE SUFFOLK CO. HEALTH OEP'r, APPRO.V~AL FI. So T~ WATER S~LY AND SEWAGE DI~AL ~ SY~S F~ THIS R~O~CE. WILL ~~ CONFORM TO THE ~ANDA~ ~ T~ ~ ~~, ~.~ ~F~K CO. OE~. OF HEALTN~RVICE5. A~LICANT SU~OLK COUNTY DE~. ~ HEALm ~~ 5ERVIC[5 -- FOR APPEOVAL OF ~~ D~__' CONSTRUCTION O.y ~ ~ff~ DATE: . e~ MAY ~ ~, ~ ~. ~. ~~ inspected bY t~S department ~d found ~ ~FOLK CO. TAX ~et of general ~gi~erl~ .... ,, :, ,/ ,' DEED: L~/~ ) P. / ' ' / SECTION 7~09 OF THE ~W YO~ STATE ~* ~ ~c. ~, I~I. R~ RI K VANT YL, .Ew