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Home My WebLink About13227-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..g. ! ,4 .3.7.1 .......... Date .. fi.p?. }.1..2. ? j .................... 19 .8.6. THIS CERTIFIES that the building ....Fg.o.~. ........................................ Location of Property 1000 STILLWATER AVE. CUTCHOGUE County Tax Map No. 1000 Section .... 1.0.3. ..... Block ...... 7. ........ Lot ..... 7. ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... d u n.e.. l 3 ......... ,19~. pursuant to which Building Permit No .... 1.3. 2. .2.7.Z. ........... dated .... 3. uO 3.. 1. 5 ................ 198. 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 ......... .... A bo.~.e, gr.cmnd..laOO2[..and. £.er~c e ............................................. The certificate is issued to .... ?ATRICIA & RONALD SUdESK~[ ................. ?o¥.'o;, ..................... of the aforesaid building. Suffolk County Department of Health Approval ....... .~./.~ ................................ UNDERWRITERS CERTIFICATE NO .............. 517 1 2 4 2 9 Rev. 1/81 Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N? 13227 Z Permission is hereby granted to: ~~..,~....~..:~ ........ ~.L.~.~: ..... ,~ I'a ~ ~ ........................ ~ p~,~ ~ed ~ ..2.~>....~ .................................. Coun~ Tax ~ J .~ pursuant to application dated ................ ~ ...................... , 19..,..,~LJ.., and approved by the Building Inspector. Fee $.L.~...~. ............ Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted -, ~mmmma 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 Amhitect 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 property 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 anv housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $§.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 $15.00 Date ..... .~. ':-/)./~. ~..~ ......... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property .... House No. Street Ham/et Owner or Owners of Property ... ~ ,~.~.~....~.~,'~ .~.,... ,.~.0 .,~.~./~. ,~ .... .~'..r~:?~ .~.~ ./. ........ County Tax Map No. 1000 Section /~!~. ........ Block ...~. .......... Lot .... ~.,. ......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ate of Permit ~P.~.. pplicant .................................. 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. Applicant ...... C-'~ ~ .......... Rev. 10-10-78 -:' zoousos THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY V ~)~L 85 JOHN STREET, NEW YORK, NEW YORK 1003~ /' N 712 THIS CERTIFIES THAT only the e~c trlcal equipment ~ described below and intmduced by t~ appllca~t named on the abo~e application number in t~ premises of Su]e~4~ 1000 Stol... W~:~r Ave~ r CW~, N Y wasexamlnedon O~Y 7~ ~9~5 andfoundtobeincompliancewithther~quirementsofthisBoard, FIXTURE OUTLETS ~ECEPTACLES SWITCHES DRYERS FURNACE MOTORS FIXTURES RANGES OVENS FLUORESCENT FUTURE APPLIANCE FEEDER! TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: S E R ,V I NO, OF CC, COND/ A W G, NO, OF HI-LEG PER ~ OF CC, COND, C OF HI-LEG NO OF NEUTRALS OF NEUTRAL t[arbor La.~ ~X~X. of the ,oord if moo,root. 'nspecto,s moT¢:e identified by their ~. ~ ~O UILDINGBEP TMENT. THISC PYOF,C R~IFIC ~E US~NOTB ALTE~ IN ANY MANNER. FIELD '[;~S PECTION FOUIlD A 7 10ll ( 2nd ) ~U~'H FHAME & PLUMBING C,O D E 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL,: 765-1802 Examined.~. ........ [..~7..., 19~.~. Approved . . .~t./.~'7 .... 19~.tJ. Permit No../.~.~...~.~..~.. Disapproved a/c ..................................... Received ........... ,19.. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date . ..23 ..... , 19..~/. 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. ~ . (Signature of applicant, or name,e- if aFdor~if a~orporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nalne of owner of premises ..... ~. ~ .................................... ............ (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. . . ./.'~. .O.O. T,~~ . ~~/~. ' House Number Street Hamlet County Tax Map No. 1000 Section /~..~..T.~..~.~, .... Block .................. Lot ................... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use an*d occupancy of proposed construction: a. Existing use and occupancy ...... :..~:~...... ~ .......... ~::::ii:::. b. Intended use and occupancy .... ~i.. .iiiii 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteration .......... Repair .............. Removal ............ Demolition .............. Other ~ ,i. ~ / ~' "'~"! ~ (Description, 4. Estimated Cost .... ":..~.q. ' ~.. ................... F .... ~. .................... : ....... / °-' (to be paid on filing this. application) 5. If dwelling, number of dwelling ~nits ............... 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 type of use ..................... Dimensions of existing stmctureg if any: Front Rear Depth Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .. ................... i. · Height ...................... Number of Stories ...................... 8 Dimensions of entire new constrUction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...........~ ........... Rear ...................... Depth ...................... 10. Date of Purchase ........... [ .................. Name of For/ncr Owner ............................. 11. Zone or use district in which pr~mises are situated .... ~. ~ .~---~; ................................. ; · 12. Does proposed construction viol'ate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ......... ................... Will excess fill be removed from premises: Yes No Name of Owner of premises ' Address Phone No Name of Architect .......... ! ................. Address ................... Phone No ................ Name of Contractor ......... I ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly ail.i buildings, whether existing or proposed, and, indicate ail 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. ~:.~ 7'" *,':' .... r '*^ '!'~ 4 PM FOR TH~' [:" ' '~' ~'"."EC' 'IONS: :.t', .... " lWO REQUIRE~ ., '~ ......U""m CO~CRETE v ~ "m~ F",[, . ~qAMI~ & PLUMBING 2 U,'"l" ,~ ~ ~k.I 4. '~5TM '- C'%h~'STR~CTION MUST ~ ".;'*¢k7TE FO~ C.O. AL' C~k'qT2~ICT[ON SHALL MEET ~Hr RFO ~ ~=MENTS OF' THE STATE OF W K¢, ./ CONSTaUCT ON COD~S. NOT D~tGN OR CQ~I~U~T[ON COUNTY~ .... ....--~ ~~~i~~ '. ......... being duly sworn, deposes ~d says thane is the applicant above named. e is the . ~ ...... ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is d~ly authorized to perform or have perfomed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work w~l be perfo~ed in the m~n~r set forth ~ the application filed therewith. Sworn to before me this ___-- ............... ~~ ~ / (Signature of applic~t)