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Home My WebLink About13524-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of' the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..g. 1 .~2.9.~ ......... Date ..... O.a.v.q t.~..2.3 ................... 19 ~.6. THIS CERTIFIES that the building ....... g. cl..d.t.~.J: .o .n ................................ Location of Property ..... 2..9.5.0..g..a.n.s.~. o..n..~o.a..d ............... C ul;c h0.gue House No, Street ................. County Tax Map No. 1000 Section ..... 1. 1 .1 .... Block ..... 5. ......... Lot ....7.: ~. .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... 0 c .g.... 10 ......... ,19 B 4. pursuant to which Building Permit No .... 3. 3. .5 .2.4. Z. ........... dated ..... hi o.v.... $ ................ 19. ~ .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 ......... .... gd.d.~,~ ~ pr..~9..e.x g ~ .~.±.~ ~..o.n.e...t.a.m.t. 1. y..d.~e, }3.&n.g.. ........................... The certificate is issued to . ~.g....&.. ~.S. ~ . .d.g.~. E..S..b{.~. ~ .~.~.~ .............................. (owner, t~ex~ of the aforesaid building. Suffolk County Department of Health Approval ......... ~./.g ............................. UNDERWRITERS CERTIFICATE NO ................. ~!.7.3 ~J ,7.(~ ........................ Rev. 1/81 Building Inspector IL~R,~ NO, e~ TOWN OF $ou'rltOLD BUILDING DEPARTMENT TOWH HALL. SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) .t 13524 Z Dote ..... Permission is hereby granted to: e .............................................. ~ .......................... g.....~ ................ County Tax Map No. lO00 Section ........ ~..!..J ......... Block ....... ~ ........... Lot No....L:..L ............. pursuant to application doted ...(~.~.....J ...................... ~ 19..~..~., and approved by the Building Inspector. Fee $...~....~..:.~ ...... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hail Southotd, 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, B. For existing buildings (prior to Aprit 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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. C. 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 Date New Building .......... ~. Old or Pre-existing Building ...~ ..... Vacant Land ............. Location of Propertyc~'~ 0 ~. ~ ..~.. ~/& ~'~ ~.~..~. '~ ..... .~..~.. Houso No. Steer '~ ' ' ' ' Owner or Owners of Property .. County Tax Map No. 1000 Section ............... Block ..... ~ ...... Lot... ~/. ........ Subdivision ............... r... ................ Filed Map No ........... Lot No .............. Permit No./~..~..~.~. ',~ Date of Permit L/~.~./.°~. ~..Applicant...~/rh: .~ .~'.~..~...~. .......... Health Dept. Approval ........................ Labor Dept. Approval ...................... Underwriters Approval ........................ Planning Board Approval .................... Request for Temporary Certificate ..................... Final Certificate ..................... Fee Submitted $ ............................. Construction on above described building and permit meets a. II applicaJ~le cod. es and regulations. Applicant .................................... THE NEW YORK BOARD OF FIRE UNDERWRITERS l[~J00~o BUREAU OF ELECTRICITY ~-F~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electrical equipment as described belotv and introduced by the applicant r~a~ed on Ehe above application number in the premises of J~ra ?~.~T~y~ Velm~an l~xd, Ju~vl; A~!tca- ~le~t Covt~ P~d, C~tct~g-ae, N.L in the following location; [] Basement [] 1st FI. [] 2nd FI. Section Block Lot wa~ exa.,ined on Jenl~r~ t6 ~ 19~ FIXTURE OUTLETS 14 tECEPTACLES SWITCHES 15 14 and found to be in compliance with the requirements of this Board. FIXTURES RANGES OVENS DISH WASHERS FLUORE$CE~'~ VAPOR FUTURE APPLIANCE FEEDERS DRYERS FURNACE MOTORS JNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FRET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: I .3 ~bn A/C S E R V .I C E AW.G. AW, G, PER ~' aP CC. COND, OF HI-LEG 3/0 NO. OFNEUTRAI OF NEUTRAL 8/0 Li~ 2670E This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors ILDING DEP,~ GENEI~AL MANAGER Per ][]* may be ,identified by he r credenhals. FIELD ~NS F~%2 T ION FOUNDATION {1st) COMMENTS FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY FINAL ADDITIONAL 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ,~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined . .~...or-P-.q~....~...~.., Approved . ./~.~..'~.., 19~.~1. Permit No.J..~.~.~.~..'.4~.. Received ........... ,19... Disapproved a/c ...................... ~: .............. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. ' Tins 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 tins 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 the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances pr 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, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspectio~ , .~...~ ...... . "-' (Si~~_na ~/~ , P..~..... ......... ...... ..... ;;s; State~' wn(~[~.er,~p~p7wh ther applica~agent, architect, engineer, general contractor, electrician, plumber or builder. Nameofownerofpremises "~" '~'""'~t'~) ......................... If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... y.~.. ................ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... c~5'0 ~ 1. Location of land on which proposed work will be done... V~. ~. C~..O.._.~,. ~,..~. ~ ................... d ........... ..........................................Hamlet / County Tax Map No. 1000 Section ........ ¥¥ ~ ....... B1 ........... .... Lot.../. ........... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisfinguse and occupancy..~.~S.~[~ .... ~].~: ................................. b. Intended use and occupancy ..... ~r '"'- '"~ ................... : ..................... 3. Nature of work (check which afiplicable): New Building ..... ' ..... Addition ...... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4 Estimated Cost I.~..~. Fee ~ *-' (to be paid on filing this application) 5. If dwelling, number of dwelling hnits .............. 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 tyl0e of use .................... 7. Dimensions of existing structurqs, ffany: Front .... ~/~...~t~ .... Rear . .-~.~... 9' .... De th..~. /~..t.t'.. Height. /~.f. .......... Numberof Stories ..... t.! .............................. P. ............... "" Dimensions of same structure wlth alterations or additions: Front ... ~"th~J'~ .'~ .... Rear . .,,('~.~:1..~ ...... Depth...St/...Lw.[4 .lC ...... !.. Height.....//.._~(j,; ?: ........ Number of Stories ............. /. ........ 8, Dimensions of entire new construction: Front. ,;~,/,. . Rear ....,~..a-. ..... Depth . ./.~ ....... Height ............... Number of Stories ........................................................ 9 Size of lot: Front Rear Depth 10. [)ate of Purchase ............................. Name of Former Owner ............................. 11. Zone or use district in which pr~mises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ....... ,.. ................... Will exces_s fill b~ removed from premises: Yes No Name of Architect ....... .'~..:.. "...: ........... Address .... ~ ........ Phone No. PLOT DIAGRAM Locate clearly and distinctly alli buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, !S.S COUNTY OF ................. ............................. :. ................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. tie is I'he " ' ' (Contractor, agent, corporate officer, etc.) of said owner or owners;, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application a~e true to the best of hi'.s knowledge and belief; and that the work will be performed in the mann{r set forth in th6 application filed therewith. Sworn to before me this ........... ,]/..~. ...... day oP... ~...C~.. ............. 19 .~.'~ Notary Public, .... i · [-I[Li'tl K: t)[ Vt~E . . i, ............................ rq o°~ "~ASE 01c ,/