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Home My WebLink About13621-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy 3648 July 19 85 Date ................................. 19... THIS CERTIFIES that the building .... a.d..d.i.~.5:, o..~..~.~.d.. ?.e.~o..v.8.~.5:.o..~.. ................ Location of Property .. ~3Q.5. .................. K.$.n~..~.~. ?.e.e.~. ............ .O.~.~.e.~..~ ...... House No. Street Ham/et County Tax Map No. ] 000 Section ..... .~.~. .... Block ........ ~. ...... Lot .... /! !1 ........... Subdivision ................ .x .............. Filed Map No .... .x ....Lot No ...... x. ....... conforms substantially to the Application for Building Permit heretofore fried in this office dated December 3 84 ~ 362~Z ..................... ,19... pursuant to which Building Permit No ...................... December q2 84 dated ............................ 19 .... 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 ......... Non-cor~forming accessory use as sleeping quarters with bathroom · h'dd; ' ~ '~b'~'~ t ib~ J ......................................................... ROBERT SCHN00R The certificate is issued to ..................... ..................... of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO. N69f1578 Building Inspector Rev. 1/81 FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, No Y. BUILDING PERMIT (THIS PEPJ~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ i362i Z Permission is hereby granted to: ............ .......... ~....~...~ ........ ~.....~.~ ............................................... County Tax Map No. 1000 Section ...... ..O....~....~ ...... Block ..... ..(~....~::... ...... Lot No.....~...~.. .............. pursuant to application dated ....... ~ .................. , 19..~..~.., and approved by the Building Inspector. Fee $. ~..~-. :~...'~.- ...... Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in wpewriter 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. 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 Planning 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 p~operty 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 required to prepare a certificate. Fees: 1, Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 Date ...................... / New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property House No. Street Ham/et Owner or Owners of Property ,./?~ ~ ....... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No../.~..~.~./.Z.. Date of Permit ./.;L/~?.~.....Applicant... ~pcP,-4~.../0..~. ~....~. ........... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... ' Fee Submitted $. k~J..~O~.. .................. Construction on above described building and permit meets all applicable codes and regulations. ~' Applicant ................................. Rev. 10-10-78 TOV/N OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 BLDG. TOWN OF SOUTHOtD CERTIFICATION Date ~TLY 9 19~ Building Permit No. Owner R0t~Rm SCIT~'00F, (please print) Plumber CARL H. EIFd ~- S0F I~'C. (please print) I certif~ that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber' s signature) Sworn to before me this Notary Public ,\ ~-~L~L County Notary Public F~ELD 'INSPECTION FOUNDATION (1st) COMMENTS FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS' 1000091 BUREAU OF ELECTRICITY ~ ~1~ [1'~ ].9~,,~ 85 JOHN STREET, NEW YORK, NEW_~ORK 10038 ~1141/85 ~,~ ~.,,~.on ~. ~,,~ N 691578 THIS CERTIFIES THAT only the electrical equipment us ~scrlbed below and int~duced by t~ applicant ~t~d o~ t~ above application number in the premises of Robt Sclm~r> K~g 22~t, ~ient, N.Yo in ~be follow~n~ Iocat~; ~ was examined on and found to be in compliance with the requirements of this Board. FIXTURE OUTLETS 15 DRYERS RECEPTACLES ].7 SWITCHES FIXTURES RANGES OVENS DISH WASHERS EXHAUST 15 FLUORESCENT SYSTEMS E E R V · I C NO. OF CC. COND, A, W.G. NO. OF HI-LEG A W G, PER ~' OF CC. COND OF HI-LEO OTHER APPARATUS: l~tric Room }le~t~rs: 3.~2.0kw, lpl.25kw. i~.F.C. I, 1-~mke Detcmtor. NO. OF NEUTRAL~ OF NEUTRAL Peter Bogovic No. ~yv:lew Read So~thold. N~Y, 11, 71 Lic. 137 GENERAL MANAGER .. Per ~~:~.e~.~n.~y~,m~anner; return to the off,ce of the Board ,, ,ncorrec,. Inspectors may be identified COPY;FOR B~ILDING DEPARTMENT TH S COPY OF CERT FICATE MU~T NOT ~ 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined..¢~.~. ! .~.., 19~.~. Approved .~.~.t.~,~x-~..~.~.., 19~.~.. Permit No..J.~.Jq..~.~..:~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19.. · Date ................... 19... INSTRUCTIONS a. Tkis application must be completely filled in by typewriter or in ink and submitted to the Building 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 streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- 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 issued 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 Building Department for tt~efissuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, Ne.3~¥qrk,/}nd other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations//~/~o) rfn/loval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, ]Su~n~ 9to~le, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary )4~ft)/o,,r/s/ _ ~ -- (~'~/'~n'~ ;r nam e, if a corporation) .. 6 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . '~ 0 B..~.~ .-C.....~.c.' .~ .N.O. 0../~ ................................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. ~' Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ..... 4.3. ?.s.7 .................... ..... .77. .................... ................ House Number Street Hamlet County Tax Map No. 1000 Section ... ~ ~ .~ .......... Block .... ~ ............. Lot .... .~.'7. ........... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . b. Intended use and occupancy . .$/0./~l/~.. Lu .T// . . B~r~p,00.S...f/p~).(r/ag .......................... 3. Nature of work (check which applicable): New Building ..... · ..... Addition .......... Alteration .... Repair Removal Demolition Other Work I ~ (Description) 4. Est]mated Cost ...... Fee ................................ ~ '~ (t g thi ppli ) ~ o be paid on illin s a cation 5. If dwelling, number of dwelling ~nits ...0. ~.~. ........ Number of dwelling units on each floor ................ If garage number of cars ' 6. If business, commercial or mixed occupancy specify nature and extent of each type of use .................... ...... '~. P. ' Rear ~0 ' Depth ~.O. 7. Dunens]ons of ex]stmg structures ff any: Front .................................. Height & ! / Number' of Stones' Dimensions of same structure w~th alterations or additions: Front ~.' .o. .............. Rear . .qT.o. ............ 90 ight of St Depth .................... ;. He d / t Number eries ...... .... 8.Dimensions of entire new constrUction: Front ............... Rear ............... Depth .............. Height ............... Number of Stories ....................................................... 9. Size of lot: Front ........... ........... Rear ...................... Depth ..................... 10. Date of Purchase ............................. Name of Fenner Owner ............................ 11. Zone or use district in which premises are situated ....... .~....~..oN..~: .................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ...~.0. ....................... 13. Will lot be regraded ...... a..i ................... Will excess fillbe ram. over from premises:.o6 Yes No 14. Name of Owner of premises .~ ~ *A ..... q tg...~... Address t~,~.l:~sr~N..~. -~ ~[. Phone No... ~4~.~ .... 60... ....~ ............ Address .............. !t.?.~. Phone No ................ Name 0f Architect' 'Ch~'~ ~0 Nme of Contractor ....... .... ~. ~0 ~ ...... Address ...... ~N ~*.~f?~' .. Phone No ...... ~ ¢?.~. .... PLOT DIAGRAM Locate clearly ~d distinctly ~llbufldmgs, whether exist~g or proposed, and. indicate ~1 set-back d~ensions from prope~y ~nes. Give street ~d block ] mmber or description according to deed, ~d show street nines and indicate whether ~te~or or corner lot. STAT OF NEW YOaK, COU~Y oF ................. S.S ............................. ~ .................... being duly sworn, deposes ~d says that he is the applicant (Name of individual signi,ng contract) above named. He is the ...................... ' ................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfonned the said work and to make and file this application; 'that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ....... ./:~ ...~. ........... day of.. ~.~w.. ............. , 19 .~. ... County / (Signature of applicant)