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Home My WebLink About13382-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No Z13167 Date January. 16 . 19.8.~ THIS CERTIFIES that the building,.. ?.a.m..i .ly..r.. 9 p.m. ............................... Location of Property .1 9.~.5...I?Ig.p.r. ,a.~.o.q k..a..L.~ n..e ................... .~ ~ .t j..t.u 9 ¢ .... I~l~t~s~ 'NO. Street Hamlet County Tax Map No. 1000 Section . .1.1. ~ ....... Block ...... .~ ........ Lot .... 3. 2. ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..~..ug... ?..~ ........... 19 .~.4. pursuant to which Building Permit No..1.3.3..~.2.Z. ............. dated .. ?.u.g....2. 7 ................. 19 ~. §., 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 ......... ...F..a¢.i.~. F.o.q$. ~Jli. gb..w.a. ~..c.q~v.e.r.t.e..d..f.r. 9~..~ .g~F.a. ge., ...................... The certificate is issued to EUGENE MISKA (owner, t~7~eko~ ~)X X of the aforesaid building. Suffolk County Department of Health Approval ............ ~/3 ........................... UNDERWRITERS CERTIFICATE NO .................... ~p ~15.7.~ ¢ ¢ .0.. ~. 2./~.1. / ~ .6 .......... Building Inspector Rev. 1/81 TOWN OF $OGTHOLD BUILDING DEPARTMENT TO'~VN HALL $OUTHOLD, N. Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13382 Z Permission is hereby granted to~ ~ . [ ~~ ~'~' I ~ ~c~, -"v.,~~ ~.~, //~'~ ,o ....... ~t premix** I~ated ~t ............................................................................................................................. Count~ Tax Map No. 1000 Sect ......... Block ................... Lot No .......~..,~ ....... · · ~4.4~s'' .~L- 19~..~. and approved by the pursuant to apphcat~on dated ..................................................... , ...... , Building Inspector. Fee $., .~?... ................. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Bu ilding 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-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, tndustrial 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~perty showing al~ 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. 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 ................. New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Loc ion of P,operty.. . ..................... ........ House No. Hamlet Owner or Owners of Property .......................................... County Tax Map No. 1000 Section .... //~. ....... Block ..... ~. ....... Lot .... ~)~.{ ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit . .Applicant ............... ~P.~/.J~F~ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ....... .~. .............. Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above describeAdp~i:ida~.and per, pi ~.le~. nd regulations. nev.' 0-,a-?a ,2 S-u- 37 FIELD INSI ECrlON FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL COMMENTS ADDITIONAL COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by t~ applicant na~ned on t~ above application number in tl~ preo*ises of was ex~mlned on ~l~ [] 2nd FI. Section Block Lot and found to be in conzpliance with the r&quirements of this Board. FIXTURE FIXTURES RANGES OVENS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT VAFOR 2, 9 5 2 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCK! MULTI-OUTLE DIMMERS SYSTEMS NO, OF FEET SERVICE DISCONNECT S E R V t C NO'OF CC' COND A W'G* NO OF H14EG A'W'G JNO OFNEUTRAL! A-W O. PER ,~ OF CC. COND OF HI-LEG OF NEUTRAL OTHER APPARATUS: l~llalld Electric Co. P. O. Bo~ 143 Lic. 242 This certificate must not be Wtered in any manner; return to the office of the Board if i~co~rect. Inspectors may COPY FOR BUILDING DEP~e )F CERTIFICATE I ~ ANY MANNER. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1802 Examin 12~ .~'..~., 19 ~.~t Approved~ .t4~. a.~., 19 .~[ Permit No.}..~..~..~..~..~. Disapproved a/c ..................................... ............................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ,19... 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 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~ . .~/~..~:~..,.. (Signature of applicant, or name, if a corporation) .- .~.{~( ~.t~.~i~.a~./.~.~.~l..,~.-~-ilinga~ldressofa~ licant) '"'~'ff"~"'" State whether applicant is owner, lessee, agent, architect, engineer, general' contractor, electrician, plumber or builder. ............. O.¢..D. ........................................................................ Name of owner of premises ...... ~.~/.(r;~'/~. '...j~/.~?/t./Q ............................................. (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 ...... O. qd.t~.~, g,, .......... Plumber's License No ......................... Electrician's License ~1~... ~..~.~ .~. .... 1. i .... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. l. . ¢5 .................. F.o . . . k ............. l l/t rr , FuCK House Number Street Hamlet County Tax Map No. 1000 Section ..//'~-- t 0.0. ........ Block ... O.~t,c?O. ........ Lot... 0d~, ~0.0. ...... Subdivision ..................................... Filed Map No ............... Lot ............... (Nmne) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .............. } .... FkC.l ~ ............................ mzr' ,', b. Intended use and occupancy ................................. 3. Nature of work (check which at~plicable): New Building . ' ' ... Addition .......... Alteration .. ~.. ..... Repair .............. Rembval .............. Demolition .............. Other Work ............... 4. Estimated Cost ....................... Fee ............................... *'. (to be paid on filing this application) 5. If dweiling, number of dwellinglunits ............... Number of dwelling units on each floor ................ If garage, number of cars 6. If business, commercial or mixeld occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of,e,xisting stmctur%, if any: Front .... .~..~.., ...... Rear .... 7.~ ...... Depth.... ~. &. ....... lteight .... A~I ........ Number of Stories ......... ,t ........................................." -'" Dimensions of same structure With alterations or additiqrls: Front ...... ~.~r ........ Rear ..... 7.~ .......... Depth ...... ~(~ .......... !.. Height ........ /.~....~ ...... Number of Stories ..... /. ............. ..... pth 8. D~mensmns of entire new constFuct~on: Front ............... Rear ............. De ............... - Height ............... Number of Stories ..................... i i .......... 9. Size of lot: Front ...... , ........ Rear .................. 10 ])ate of Purchase ' Name of Former Owner 1 I. Zone or use district in which pr~mises are situated ..................................................... 12. Does proposed construction vioiate any zoning law, ordinance or regulation: .......... ~ti~ ................. 13. lot be regraded ........ !... 0 ............ Will ex ess fill be removed from premises: Yes ~) 14. Name of Owner of premises ..'!K0 Address ~1~1 .J00g i~l~rl'lr.0~ .... Phone No. Aqg .-'9il Name of Architect ................ ........... Address ................... Phone No ................ Name of Contractor ........ : ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly al! 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 comer lot. L O~, STATE OF NEW YORK, i S.S .......... being duly sworn, deposes and says that h~ is the applicant above named. He is the ..................... I .................................................... I (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 are true to the best of his knowledge and belief; and that the work will be performed in the mann,er set forth in the application filed therewith. Sworn to before me this NO]7~RY PUDLIq, State of New York ......................... -- Oua)Jfied. i~) Suffqlk County 52-4093,~ ~,t~ CommBsion E×pces h~arch 30, 19~ (Signature of applicant)