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Home My WebLink About13597-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building...fa...v.ag.e. ...................................... Location of Property ...... 5530 Pequash Ave. Cutchogue Hou~o No~ ....................... 's'debi ....................... h~d, iei County Tax Map No. I000 Section ... ! .1.0. ..... Block ....... 5. ....... Lot . .3..6 ............. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ... ~q,q-~,..2.0. ......... ,193.6.. pursuant to which Building Permit No ....... ! .3.5.9.7..Z ........ dated ...... ~ 9 ¥.-..~ Q .............. 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 . ~'9~' ..... ~. py.~.fi. & .~.~.~. s..~3.q s..~.uA ~..d 3.n.~...a.n.d.. ? .%n.?..v.~..~.o...~.a.~. a..&e.. ........................ The certificate is issued to ....... 1}. ~. C. .Itfi?. ~. . ?.D. E. ?.S. Ofi. ................................. of the aforesaid building. Suffolk County Department of Health Approval ........ [1 [ g ............................... UNDERWRITERS CERTIFICATE NO ................ ~! .~ 7.2.~.5. 9.0 ....................... (Garage and storage only--Non Habitable) Building Inspector Rev. 1/81 FOIR~ NO. [ TOWN O~ $OUTltOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEPJ~AIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 13597 Z P. rmissiorl is hereby granted t~.. · ..~'~~~" ........ ~ .... . .... .......... ...... ~,.~,.~..,...~....~ .......... ~~......~.~ ........... ~~..~~~ .................................... .,,,.,,,,~.,,.,...~ ...... ~~~..~ ....................................... ......................................................... .~:~ c~.~ ~.~ ~., ~. ~ooo s.,,.. ..... /z~ ........ ,,~ ..~ ......... ~,...~ ............. pursuant to applicotion dof~ ..~...~ ........................... , J~ and approv~ by t~ Building Inspector. Fee $..Z~.. ............. Rev, 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, 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-iS-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 peoperty 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 or land use 3. Copy of certificate of occupancy $1.00 New Building ............. Old or Pre-existing Building , ,~ ......... Vacant Land ............. Location of Property .5~3D, .2eq.uash. Ave ................... ,C.U~¢ ho~;ue ................. House No. Street Ham/et Owner or Owners of Property . .~.c.~a..r.~..~ ~ .d.e.~. ~ o. p ........................................ County Tax Map No. 1000 Section .... .1.~.0. ....... Block .. ~ ........... Lot...~L ........... Subdivision .... N//A ......................... Filed Map No ........... Lot No .............. Permit No. ;],~.5c)7..2;. DateofPermiti1/.30/~.Applicant ~'.q~r$~'p.qr~r~;. ~";°~; as agent for R. A,~dersoQ Health Dept. Approval . . N/.& .................. Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .... ~ .................. Fee Submitted $.. ,,~.,00 ........................ Construction on above described building and per~~~'l~'lic'~ble~~/~, / codes and regulations. { (~_ ~ agen~ ~ Richard ~Aaderso~ R~, 10-10-78 lOOlO~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~- 0.£ 85 JOHN STREET, NEW YORK, NEW YORK 1003i~ ..re ~,,~.~ :~1. 19~5 Ap,,l'catlo.~'o. on.,'.e ~6~5/~S N 728500 THIS CERTIFIES THAT only the electrical equlprner&t as described below and introduced by the applicant named on the above application number in the premises of i, the following location; [] Basement ~ 1st FI. ~ 2nd FI. C=~2~e Section Block Lot was examined on J~J~'~J~ 1~ ~ 19~ and found to be itt compliance with the r~quirements of this Board. FIXTURE FIXTURES RANGES OVENS OUTLETS SWITCHES DRYERS FURNACE MOTORS APPLIANCE FEEDERS TIME CLOCKS MULThOUTLET SYSTEMS NO. OF FEET EXHAUST FANS DIMMERS SERVICE DISCONNECT OTHER APPARATUS: S E R I NO. OF CC. COND A, W.G. NO, OF HI-LEG PER ~' OF CC. COND V C E A, W, G NO. OF NEUTRALS A. W, G, OF HI-LEG OF NEUTRAL 11935 2941 This certificate must not be altered in any manner;, return to the office of the Board if incorrect. Inspectors GENEI~AL may be identified by their credentials. ~ENT TH I ANY MANNER. ~ COMMENTS FIELDINSPECTION ~ FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. STATE ENERGY qpPE FINAL FORM NO, 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL /7 <_ 19 .~.~.7 / f PLEASE TAKE NOTICE that your application dated ~ .~ co..~ ~ ~ ~o. ~000 s~o~ ...//Q ...... ~oo~ . .ORS: ....... ~ot .~SZ ....... Subdivision ................. Filed Map No ................. Lot No .................. is returned herewith and disapproved on the following ~rounds. .. ~:~...LT...~a:..~ .... ~zLZ~..~~ Y.. ...:~...~.. ~..'~<n~ ~ .... ~z~.: .................. ........ ~..~... ~. za.o.: :a .... d... .............................. .................................. RV 1/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:2 Disapproved a/c . ..' ............ . .%T-.'.'.'.'.'.~... ~ . .~ ....... .~ ] (Building Inspector) TOWN'OF ~OUT~OLD eceived .......... , 19... APPLICATION FOR BUILDING PERMIT Date ..... :7/.?... 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 code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. · ~v./r.~n.m~.~. ~;~...?.~c.: .......... (Signature of applicant, or name, if a corporation) ...... ..~..7..:..~,.,~...~..~.L.~.:. ~.~.~:.~ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................... ~,e.:.. ~.>?..~.&:. ..................................... Nme of owner of premises ... ~C.h.a.:.d.... ~.,q.d.¢r.:qn ........................................... ~ ~ / / (as on the tax roll or latest deed) a or zed o cer. ....... Builder's License No, .~.~.C'[. :.2.[.4....~.'.27..~..~.'/7~ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ............................ ~.~ .................. · .2. g.o... ¢..~.~ee~.. ~e~ .~ .... ¥ .............. .c7..4. ~/i~ ?ue. ...................... House Num'be~,,~~ Street - Hah'llet County Tax Map No. 1000 Section ...... ././.~. ........ Block ..... ~ ............ Lot ......~..~. ........... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy 4~.~..5./'.~.~. )~..~..~.....'7.../., ..... .,~~;~"~'~?~?~';::' , ::, '>~. ........... ~'z~.~ ...... ................ ,,. b. Intended use and occupancy c,~.~:. ;.,,~,,, ,,,, , 3. Nature of work (check which a ,plicable)~N~w Building .......... Addition .......... Alteration ........ Repair ..... ~ ...... Rem )vel .g..A?/.o.c..~..t~... Demolition .............. Other Work ............ ~ 0 ~ ~ '~'"~or~ '~'~7.~ (Description) 4. Estimated Cost ........ ~..S-fi~...O., 77. ................... Fee 2~../'~...~-a~. ......................... ~ (to be paid on filing this application) 5. If dwelling, number of dwelling' ugits ................ Number of dwelling units on each floor ................ ~ If garage, number of cars ...~'~,, ./O~. ~ ./-qo...~./~.~. ~ .~..f~o/?~/T)~.. ,,~ .~(&.~'Q.~..~'... ?...~.~..,('..~.':~. (?. ~. 6. If business, commercial or mixed occupancy, spec'fly natur[ and exten(of each type of use . /. :.. 7. Dimensions of existing structures, if anv: Front ~ ~..t .... Rear ~-~.~ . 'I~,~t~ ' ' ~'~ ~ .... Hmght .... /,-,~ ......... Number of Stones .... .,( ............. ..................................... : Dimensions of same structure with alterations or additions: Front ..... ,-,~.. Rear .................. Depth ............... ~ ' .... .... Height ....... 7.~ ~,~,~,',,) ....... Number of Stories ...................... 8. Dimensions of entire new constm, ction: Front .,~g,~,~,"~'?r,~ . .. Rear ............... Depth ............... Height ............... Number of Stories ......................................................... 9. Size of lot: Front ...... ,,d.t~',','~ ........... Rear ..... ./..d~.. ............ Depth ... ~.~. ............. 10. Date of Purchase .......... .: .................. Name ofF, ormer Owner .............................. 11. Zone or use district in which premises are situated ..... ~.~..~__:q~..Z~....~.. ........................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ~ ...................... Will lot be regraded ...... ~,. ........... Will excess f,311 b ,e r,e, move_~d from premises: Yes No 13. 14. Name of Owner of premises ~*i ~,~'~k~.' .~.~.~.' ~ .... Address .../..4~..~ .... Phone No. ';7..B..%r.. Name of Architect ......... ~ . . Address ................... Phone No. Name of Contractor . '.~.t./K~.~. ~...~..,~.~ .'(. ~,~'''.. Address .B.o.?4-..-t.~..,~(4.~../k/.~..~hone No. ' .~z~-"-fi/d ~,e~" /~c- c,v~ t& ............ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block! number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEWc..Ypt~K~ ..,,,~, 'S S ' COUNTY OF ,%~-D'T7~.(('[.. ,., !"Z..~ . . .: bein duly sworn, deposes .......... (/I~a'dl; 'o'fin~li-vic~t~l sii~ihg contrac~ '"'( above named. and says that he is the applicant He is the .......................................................................... i ~..~r, agent, corporat; o'f;i~;;,'e'tc.) of saki 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 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 ............. .~...~,).~.~...dayo f, ./~d~ I/W..,~_~q. .... 19 .~./~/ // , , ......... : .... NEW YORK '/ ,I ¸,2 WEc~' J. H. GEIDEMAN ~SQV ,CIA E,/Y')/g~/Z)A/ NEW YORk N. Y;' State Lic. Land Surveyor, · -~'/~ -477- Z~/. Z / Date ~ 7,' /',. _- 4 NOTED NOTIFY BUILDING 765-1802 9 AM TO 4 PM FOR FOLLOWING INSPECTIONS: l. FOUNDATION - TWO REQU!RED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3, INSULATION 4, F~N^L - CoNSTRUCTiON MUST B~'COMP'ETE FOR C.O. AL' CONSTrUCTiON S,-~AL~ M~ COD~. NOT RESPONSI~Lg Fl F ?::". MF£.e' .:?,,t~- '/'J ffL EVATION (X~N~)