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Home My WebLink About13564-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. ,Z.q.~ 75.0. ......... Date ...... A..u¢.u.s.t...1.3 ................. 19.8.5. THIS CERTIFIES that the building .. ?. d..d .i.t.i.o..n..a.n.d...a.l.t.e.r..a.t.i. q .n .................. Location of Property ... ] 5.3. O. F.l.e.e. .t.w.o. qd...R.o.a.d. ........ .C.u.t.c..n.o.~u..e .................. House No. Street Hamlet County Tax Map No. 1000 Section .... .1.3.~ .... Block .... .5 .......... Lot . .1.2.: .1 ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. ~c~¥ .. 2.1 .......... 19 .~t~ pursuant to which Building Permit No....q .3.5.6.6. .Z ............ dated ..... ~ o. ¥ ,..~ ! ............... 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 ......... .... Acj~li.t. iou. ~.nd. a,l,f,~r &t.5,9~..t.q. ~y.i.s.t..i.n~ .o..n.e, .f.a..m.i.l.y., .d.w.e.l, 1, .i,n~,., ......... The certificate is issued to ..... .D.q~ .a.l.d..&...G.e.r.a..1.d.i.q e...F.i, qn..e ?.t.y. ..................... (owner,XIq;~ of the aforesaid building. Suffolk County Department of Health Approval ......... N. [.A .............................. N703639 UNDERWRITERS CERTWICATE NO .................................................. Building Inspector Rev. 1/81 FO~w NO. ~ TOWN OF $OIU?HOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NM 13564 Z Permission is hereby gronted to: ............. ............. ................. '1 ............... '-F' .................... ~r .......... ~ ................................... Ot premises Iocoted ot ............................................................................................................................ ~unty Tax Map No. lO00 Section ..... 1,...~...,'~. ....... Block "'~" Lot No ..... .1 .......... .~ ...... pursuont ,o opplication doted .... ~..~~......~... ............... , 19..~....~, ond opproved by ,Be Building Inspector. Fe~, ~: Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY ~ot~r~ OF SOUTHOLD __j 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 featu res. 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 pr~operty 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. C. 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 Date ........................ New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property /. ............. ; ............... ~) ............... House No. Street Hamlet Owner or Owners of Propert .... ,~.?., .~.. ,.~ .-..~.~.~.L~./. ................ :~}~, ..... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Perm,t NJ3 ~'~ Z~ Date of Permit .............. pp ...................... ~.__. ·. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .~... .................. Fee Submitted $ ............................. Construction on above described bulldog an~~~blec~od~l~3d regulations. Applican//~. ~y.~. :~. ~'~'-'-'-'-'-'-'-'-'~.. · ~ · ..................... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK THIS CERTIFIES THAT only the electrical ~quipment ~ described below and int~duced by the applicant named o~ the able application nu,~ber in the premises of in thefollowinglocation; ~ Basement ~ Ist n. ~ 2nd kl. Sectlo,, Block Lot was examined on ~ ~' ~' ~ a~d found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES OVENS DISH WASHERS FANS OUTLETS SWITCHES FLUORESCENT 4 16 5 4 DRYERS FURNACE MOTORS APPLIANCE FEEDERS TIMECLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R OTHER APPARATUS: panelff~ard, s: ~l~t.r. 125~ps 1-~S.F.C.L 1.~oke b~tec~r I C NO.O~CRC,~COt'I[~I AW.G. NOOFHI4EG A. WG NO, OFNEUTRALs AW.G. -- OF CC. ¢OND. OF HI.LEG OF NEUTRAL ~ Fmrbor Lane Sou'~hold, N.¥o 11971 ~tc. 282-E - This certificate must not ~e altered in any manner;, return to the office of the Board if inco,rrect, Inspectors may be identified by their crede~tk~Js. ~ cgp¥ FQR qUlLOING DEPARTMENT THIS COPy O~F CE~I~!q~T ~0T,,B.~ ~r~TEREI)~N ANY MANNER F1ELD INSPECTION 1. FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ~ODE FINAL COMMENTS ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined..'9. 19 Approved .k). ~ .~04'. · · .~.}.., 197~. Permit No. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT BLDg. DEPT TOWN OF SOUTHOLD Received ........... ,19... Date ................... 19 ... INSTRUCTIONS a. This 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 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 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, building code, housing~ode, and regulations, and to admit auth°rized inspect°rs °n premises and in building f°r necessar~2t.~,~Pe.~ctiT.~,,~2~ ~/d,,~ ~ ' /9 ,~ /~'' '~'~~~'cant, or name'(~ ~ 'c;rporation) · /6"3 o /r:-~/~"e 7 ~'o 'o ~"~; iI~'ailing address of applicant) State whether a licant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nameofownerofpren~sgg.~.~.49.~.ff.4.?. ~ ~ -~,e',4'42r_~ ~: ~.....~-./.~.~. ~ ...... (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 ~..6/~ ~ ?.d~. % ................................. House Number Street Hamlet County Tax Map No. 1000 Section .... /.~. 7 .......... Block ....~.. ............ Lot... [~.*../ ......... Subdivision ............................. Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and oc.cu, pan~y: of proposed construction: a. Existing use and occupancy ..../~...~ " ~ b. Intended use and occupancy ...................................... 3. Nature o.fwork (che~k%V'hicli'{p~licable): New Building ' .... Addition ....~A~..... Alteration ...... ~....~ Roper ! ~ Demolition Other Work /i (Description) 4 E timated Cost L " i ' (to be paid on filing this application) 5. If dwelling, number of dwelling! units ..... f ......... Number of dwelling units on each floor .... ~' ........... 6. If business, commercial or mixed occupancy, specify natur, e agd extent of each type of ,use ..................... 7. Dimensions of existing structurgs, if any: Front..-~.~f~..g .,-~.... Rear ...-~. p.fS..~...~... Depth..~f. 5~. ......... ........ Number of Stones ... / .......................................... Dimensions of same structure s [th alterations or additions: Front .... .~'..~.; ~. ...... Rear . ..~.4,.~.. .... ~.. :5 ..... ,ght ...................... Number of Stones ... d.//'~- .......... ~ 8. Dimensions of entire new consl ruction: Front ../.~ .......... Rear ./~. ........... Depth 2~ >. ........... Height ............... Nm abet of Stories ........................................................ 9. Size otlot: Front .... /.~O. ............... Rear .... /..~P.. .............. Depth . .~ ~...Y. .............. 10. Date 6fPurchase ............................ Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction vioilate any zoning law, ordinance or regulation: .,~f..~. ........................... 13. Will lot be regraded ' Will excess fill be removed from premises: (~ No 14. Name of Owner of premises .. ~ .................. Address ................... Phone No ................ Name of Contractor ............................... PLOT DIAGRAM Locate .clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. G~ve street and block number or descnpt, on according to deed, and show street names and indicate whether ¢ STATE OF NEW YORK, i ~ ~ COUNTY OF ................. !~''~' ...........................' . . ':t,.* ................ .... being duly sworn, deposes and says that he is the applicant (Name of ind~wdual mgnmg contract) above named. : He is the ' ~ ~' (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 l that all statements contained in this application am true to the best of his knowledge and belief; and that the work will be performed in the manta r set forth in the application filed therewith. Sworn to before me this .... .~/.'./~.xc~.. ............ day of ..........~..~ ~/ .~..-~. ~ .~...-x--r.., 19 .'~..~/ Notary Public, ...... ,~;~.,, · . County ' ~ ' ~ ~ HELEN K DE VOE - 'i "/' .~/" ' (Sig--ture NOTARY PUBLIC, State ol Npw York ........ of applicant) NO. 4707878, Suffolk Go~ntY_.~....~. ] Tem~ [XplrOS ~ e 30. !9~ - NO'rE I Phone 477 0400 ~, ~ain Road GRF£NPORT. N Y. 11944 , ~