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Home My WebLink About13624-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z..1.3.9.5.8. ......... Date October 24. ., 19 .8.5. THIS CERTIFIES that tile building New Dwelling Location of Property . .2.5.5. .......... .S.u..m~n..i.t..D.r.. Mattituck . House No. Street .......... I~t~r~/et County Tax Map No. 1000 Section l 0 6 .Block 01 .Lot 03 9 Subdivision ...... C..ap.t.....K.i.d.d...E.s.t... ....... Filed Map No..1.6.7.2. ...Lot No. 8 conforms substantially to the Application for Building Permit heretofore filed in this office dated .... N. 9Y.~..ra-~..~.r....29 .... 19.8.4. pursuant to which Building Permit No. 136.24Z dated ..... .D.~9.e..mfg. 9.r' ....1.3 ........ 19.8..4, 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 ......... ........... New Private One Family Dwelling ........... The certificate is issued to WINDSWAY BUILD.,ING CORP. (owner, ~ue-Ze~ow~-) ......... of the aforesaid building. Suffolk County Department of Health Approval 14- SO- 236 UNDERWRITERS CERTIFICATE NO ............. N. 7. ?.6.1.0. 2. ............................. Rev. 1/81 Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NB 13624 Z Permission is hereby gronted to: ...... ~~~.....~.......~......~Z. .... ~..~ ..... : ........................... ....... ............. ......................................... ~_= ........ ~ ...... ~..,~....,~ ............................. ~... ..................... ot premises located ot ..4~'.~,,~. ......... c~,w To. Mop No. 1000 Sec,o, .tQ~ ............ B,ock ..~..~. .......... C~ No. ~.~ .......... ~u~uont to opal,co,on ~ot~ ~..~~5~C.....Z__~......, ~.., o,~ o~prov,~ ~y t~e Building Inspector. ~. ,.~.~ .7.....~ Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ~outhold, 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. 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 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 required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land 3. Copy of certificate of occupancy $1.00 use--Pre-Existing C.O. $15.00 Vacant land, C.O. $ 5.00 Date ....... 4~./~./.~. y. ........ New Building ............ .,hOld or Pre-existing Building ............ Vacant Land . ~ ........ Location of Property ..... J ~.~....~...~...f~?/.. ,~..~.~...~. ~,..~..~, ............. House No. Street I . Ham/et Owner or Owners of Property d~..~.~ ....... .~/.~.....~..~.. ~/~'~ ' /¢' F~,~ -- · County Tax Map No. 1000 Section .... .~..~.~, ...... Block .... ~. .......... Lot...~ .~ .......... Subdivision,..~..'..'/? ./~....~, ..~.....Filed MapNo ........... LotNo .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. uonstruct~on on above described building and p~rmi~eets all applicable co,and regulations. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instruotions A. This application must be filled in typewriter OR ink, and submitted ea~ 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. B. 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 unusuat 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 $15.00 4.Vacant Land C.O. $5.00 Date ................. New Building ............. Old or Pre-existing Building ............ Vacant Land ............. ... .,_ .~. ~.?.,..~..~....~..y Location of Property ~ ~ ~ ~ ~ HOU~ NO. ~ ' r~ Street ~' Ham/et Owner or Owners of Prope~y ...... ~ .~. ~..~ County Tax Map No. 1000 Section .../.~ ~ ....... Block .... ~ ......... Lot... ~.?..., ....... ' ~~ / s,~,v,,,o,... ~. ~ ............... ,~,.~ =~,,o ........... o o....~..~ ..... ......... Permit No. / ~ ~ Date of Permit . ~/~pplicant... ~ ....... ~.. ., Health Dept. ApprovaJ. [~.~ .~.~ .~.~ ~ ...... Labor Dept. Approval ....................... Unde~riters Approval ........................ Planning Board Approval ...................... Reque~ for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $.. '~ J~~ ~,~, ~7~ ~ ' "" '/ .............. ~ ~ .................. R~. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS 1000771 BUREAU OF ELECTRICITY 8D JOHN STREET, NEW YORK, NEW YORK 10038 ~ A~l~Jus~ 25~ 19~5 315577/85 THIS CERTIFIES THAT only the electricat eq~ent ~ des~r~Oed ~e~o~ at~ int%~g~ ~ ap~i~t n~ ~ ~te q~g~pplication number in tke premises of in the followlng location; ~ Basement was examined on A~.~*~t 19, 1985 ~lst FI. ~ Snd FI. Section Block Lot and found to be in compliance with the requirements of this Board. FIXTURE FIXTURES OUTLETS SW~TCHIES FLUORE$CEN¥ 42 DRYERS RANGES OVENS DISH WASHERS EXHAUST FANS SYSTEMS E NO OF CC. COND PER ,~ OTHER APPARATUS~ R I C AW.O. OF CC. COND AWG OF HI-LEG NO OFNEUTRAtS A. WG OF NEUTRAL 143 This certHicote must not be altered in any manner; return to the office of the Board if incol'rect. Inspecto may ~O.PY,F01~ BU LD NG DEPARTMENT THIS c0p~oEc~R~[~C~i~E credentials. TOWN OF SOUTItOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION / Building Permit NO. /3 (please print) ' Plumber ,~-77~/' ~A/ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (~iumber' s signature) Sworn to before me this ~ day of 0F , Notary Public, ~ .County Notary Public NOTARY PUBCIC, State of New Yo~k No, ,~707878, Suffolk Cou41fl~, Term Expires March 30, 19 FIELD INSFECTION COMMENTS , FOUNDATION (1st). FOUNDATION 2. (2nd) ROUGH FRAME & FLUMBING INSULATION PER N. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: Examined'-~.~.. l~ 19' .~. Approved ~...[..~ ..... , 19~ermit 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N,Y. 11971 TEL.: 765-1802 Received ........... ,19... Disapproved a/c ...... :~. '~ (Building Inspector) APPLICATION FOR BUILDING PERMIT a. This application must be co 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 tiffs a~plication may not be commenced before issuance of Building Permit. d. Upon approval of this appligation, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept off 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 BuiMing Inspector. APPLICATION IS HEREBY MiADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the T6wn of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, 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, buildinfi code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspe, at~n~. / /0 /¢ .... . .m¢ ......... (Signature of app/l'.yfant, or name,~i~a l~rp.oration) (Mailing address of applicant) Date .......... ~//.~..., 19 .~.¢ INSTRUCTIONS npletely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 State whether applicant is owner,i lessee/agent, architect, engineer, general contractor, electrician, plumber or builder. [ /. (as/on the fax roll or latest deed) Builder's License No ....... ; ............... ,... Plumber's LicenSe No.. [.(((~.,/.(~. ~ Electrician's License No ..... ~ ~ OtherTradesLlcenseNo...,, ................... I. Location of land on which pro¢osed work will be done ......................... House Number ,i Street o. 10~0 Section ..... ~. ............ Block .... /.. County Tax .Map N !' ' ~ Subdivision ....... .~/. i ...... Filed Map No. '- t i(Name) 2. State existing use and occupano: a. Existing use and occupancy b' Intinded use and occupancy Hamlet ............ ........ Lot ' of premises and intended use and occupancy of proposed construction: 3. Nature of work (check which applicable): New Building . ~...~'. ·... Addition .......... Alteration .......... Repair ............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost ......... ~,.--~.~4..,--'Y.'W~ ...... Fee ........ ~.. ....................... (to be paid on filing this application) 5. If dwelling, nuxnber of dwelling units ..... ~ .... 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 ..................... 7. Dimensions of existing structures, if any: Front .....,.,......., Rear : Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... tleight ...................... Number of Stories ...................... 8, Dimensions of entire new constmctiom Front .... ,~. 1~ [ ...... Rear ... {~ .~.)~ ........ Depth . .~..O ~! ........ Height .... ~'. ....... Number of Stories .... ~'~: ~ '~' ';~',LJ ........................ ~' ............ 9. Sizeoflot: Front .... ~.1,0.~.6',~. .......... Rear ....... ~' .......... Depth ..3./~.~.:.~..~. .......... 10 Date of Purchase ..... Name of Former Owner 11. Zone or use district in which premises are situated...~:77-,: ~ ............................................... 12. Does proposed construction,~iolate any zoning law, ordinance or regulation: ... 13, Will lot be regraded ..... t.].c77. ,~ ...... I ......... ~.,. Will excess fill be removed from premises: Yes ( No 14. Name of Owner of p ~e ........... } .... .a~..VXAddress .[ ............ ,~ .... PhoneNo ................ Name of Architect .... .'7'Y.~. ................... Address ........ ~.:q..~.'.~...~?.. Phone No ................ .¢l~.f... ~J~....~l..l!... Address ... ~ ....... '..L, .....Phone No, . L~... !' ........ Name of Contractor PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back din~ensions from property lines. Give street and block number or descr/ption according to deed, and show street names and indicate whether interior or comer lot. STATE OF N. JY-. q'RJt , lA ,d o s COUNTY O ~ ' 3 ......... FT. '~... ! ......... ~ ..... ' ...... '.:.. . ~., being duly sworn, deposes and says that he is the applicant (Name o[ individual signing contract) above named. He is the ................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfomed the said work and to make and file this application; that all state~nents contained ~ this application are true to the best of his ~owledge 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. ......... 190./ ~raRv pySu~, ~ a ~m ~ ' (S~gnature of apphcant~ No. 52~I~850, 8~f~ ~ Iorm ~xp~ros March 30, 19~ ; ~ Z m <. 0 < <_ .r · 1- m