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Home My WebLink About13581-zFORM NO, 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate O[ Occupancy No. Zq 3686 Date July 30 19.8~.. THIS CERTIFIES that the building a~$~ion. 5980 Great t>eco~ic Bay Blvd. ]laurel Location of Property ............................................................... House No. Street Hamlet q 28 02 008 County Tax Map No. 1000 Section ............ Block ............... Lot ................. Subdivision ........... ..... .... x ...........FiledMapNo ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated November d8 84 ..................... , 19... pursuant to which Building Permit No...~35.8.q.Z. ............ dated November 26 1 84 ............................ 9..., 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 ......... Unheated greenhouse enclosure to umheated porch. The certificate is issued to ............ JOI~BI. &..GLORI~k.~O/_d~St~l... (owner, ~ .................. of the aforesaid building. Suffolk County Department of Health Approval N/A NT0d 26d UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 l~OlI.M NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWH HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 13581, Z Permission is Hereby granted to.~ ...... ~~.~. ...... £~~ ...... ....... ~,...z.~.~_~..~:..~.....~.~.cz~ ,o....~ ~ ~.~ ~...~ at premises I~ote~at ....~~..~~~.C....~...~,.t .................. ..................................................................................................................... ~~.~..~':..~ County Tox Map No. 1000 Section .... ./.~...~... ...... Block ..~..~.. .......... Lot No. ~.~.... .......... p,~uont to opp,,cot,o, dot~ ...~.~......../.~ ........................ . ,~...~ ond oppro~ by t~e Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall 8outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY _ town oF ,,o otD j Instructions This application must be filled in typewriter OR ink, and submitted ~ II~li~l 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 pZ*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.. ~.,r.~. · .c~.... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ' Owner or Owners of Property .. ~.~..~... .~..r.g.~.q/~¢ ............... Countg Tax Map ~o. 1000 Section ... [.~.~ ....... Block ............. lot ......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ~.. ~??/... Date of Permit ././/2<.~Y/Applicant... ~ . .,~'..~. ~: .~z,¢...,~J.. .............. 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 all applicable codes and regulations. ,. ~'.0.~¢-~ 1'3~/o Applicant . ../k"T., .f,~/¢~-~4 ~ ........................... loooe63 THE NEW YORK BOARD OF FIRE UNDERWRITERS [~ BUREAU OF ELECTRICITY ]~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 ..re ,~uly ~.3,:tg~s ~...c~.o.~o.o~.~~oeo~/~s N 701261 THIS CERTIFIES THAT only the electrical equipment as described be~w and introduced by t~ applicant ~at~ed on t~ able application number in the premises of Gloria & John Rozansky, Peconio Bay Blvd., Mat~ituck, N.Y. in the following location; ~ Basement ~ ~t F~. ~ ~.d Ft. garage Section Block Lot wasexaminedonJ~y ~5 t ~985 and found to be in compliance with the requiretuents of this Board. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS FANS OUTLETS SWITCHES DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS MULTi-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: Panetboards~ 1-23 (cir.) S E I C E NO. OF CC COND PER ~ 1 R V OF CC, COND, 2/0 ~0 OF HI-LEG A W,O NO, OFN~UTRA/5 A W.G OF HI.LEG OF NEUTRAL 2/O 150amps., 1-4 (cir.) 100amps. Glenn R. Bradley Box 382 Laurel~ N.Y., 11948 This certificate must not be altered in any manner; return to the office of the Board if ' COPY FOR BUILDING DIEPARTMEN1 118 )PY ; It GENERAL MAN~G~ be ideotlfied b~' their cred~'~js. FIELD INSPECTION FOUNDATION (1st) COMMENT~ ~. FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY QODE \ ADDITIONAL COMMENTS: FINAL } 'FORM NO. 1 ~ TOWN OF SOUTHOLD ~ BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N,Y, 11971 TEL.: 765-1802 Approved ~/.{~..... · .~. · .... 1~. Permit No. ~.~.~.( -~ Disapproved a/c~ ~~, APPLICATION FOR BUILDING PERMIT Received ........... ,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 Buildhng 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 th~ 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 code, and regulations, and to admit authorized inspectors on premises and in building for necessary i~l~ections. __ / ~ / (Sigr~ture of applicantS', or n~[~he, if a corporation! 7. (Mailing address of applicar¢) State whether applicant is owner, lessee, agent, architect, engineer, general, contractor, electrician, plumber or builder. Name of owner of premises .... ~ d~../,~: .~4<~.. '.F-~-.....~/.~..~.--.~.~5~./~..~ .......................... y Y (as on the tax roll or latest d~ed) If applicant is a corporation, signature of duly authorized officer. (Name and title of c~orate officer) Builder's License No ..... ~..0. ................ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be done ...................... ,~ ............................ .. :. ............................................ Hamlet House Number/ Street -- County Tax Map No. 1000 Section .x/,7- ~ 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..~.'..X~...~'..x~....~..'.~...-~.~'.% .~,,. ,~:..}...~.C...(~..~.. ~v.~.'.C)...~..~.--~ ......... b. Intended use and occupancy..C,~¼ .x,,~...~ 7.~ .', .... C.~.~;. v. ~x~._.. ,~... O./5.t ,q ~,~'T~.~. .... 3. Nature of work (chec_l~Kht .~pl~hcable): New Budding .......... Addition .......... Alteration .......... Repair .. val ............ Demolition ............. Other Work .............. ~mm,~. "~1~ ~ ,i i (Description) 4. Estimated Cost .... v..'.'~ ...................... Fee ...2~. ............................... :';' .i:I ~' (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 mIxe¢ occupancy, specify nature and extent of each type of use .................... 7. Dimensions of existing structures, if any: Front ...... , ........ Rear .............. Depth ..... . ......... ' ' ' 17 . 27 Height ............... Nuraber of Stones ....... 6. g. ..................... Dimen io of struct re with alt rati ns or add't' Front Rear s ns same u e o 1 lens .................................. Depth .................... i.. Height ...................... Number of Stories ....... ,. . .(. ........ Dimenstons ire new constructton: Front ....! .......... Rear ............... Depth ~ ....... Height ............... I~umber of Stories .................................................. 9. Stze of lot: Front ....... i ........... Rear ...................... Depth ............... 10. Date of Purchase .......... ~ .................. Name of Former Owner ............................ itin hichpr~ ' 'tuat d 11. Zone or use distr c w mlses are st e .................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .............................. 13. Will lot be regraded .. ~..~'. ................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ~'i ~*~k~.~ ¥ ...... Address ~5~. ~'~o...~.cq~.~. ~.. Phone No...~.q..~.~.~ Name of Architect ' Address Phone No Name of Contractor ....... i ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly ali 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, COUNTY OF . ............................ ~ ..................... being duly sworn, deposes and says that he is the applicant (Name of individual sigping contract) above named. He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~ly authorized to perform or have performed 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 Notaw Public, . ...... ~. ' ......... County : ,I~RY PUBLIC, ~tate of New York ' // *~' ' ~/ ~' (S~ure of applicant) ~R*, 4707878, ~ufrolk County ~erm Expires Marct 30, 19~