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Home My WebLink About13287-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z..1.4.~3..4 ......... Date ......... .J'~..n. ua r y. Tills CERTIFIES that the building-.-. B~.. d~.3,11ng. ............................... Location of Property ...965 ................... ,S, alta. iro..way .......... M. at.tituck.. House No. Street Hamlet County Ta× Map No. 1000 Section , . .lO0 ...... Block ., .Qi .......... Lot ...022 ........... Subdivision ..... S, altaire..~.sta.~,es ....... Filed Map No...46~2..Lot No..5.4 .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .JBlY.. 12 .......... 1919.4. pursuant to which Building Permit No...13213.7..Z. ........... dated ......... 4ullz..16 ........... 1984., 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. ~.z $¥a.te. on.e -. family, d~e 1 ling,...a~, al~pl ie.d. fo~ ...................... The certificate is issued to ........ .C..145~L.E.S.. ~. B.E.g!.NA..IFS, .Z.Z.A.~.S~ ................... (owner, ~es~e~'o ; of the aforesaid building. Suffolk County Department of Health Approval . 13~-.80,-123,. 1.l/2 9/85, Stephen. .A...C.osta, P. UNDERWRITERS CERTIFICATE NO ......... II7.08 926 ................................. Plumber' s Certification 11/5/84 Rev. 1/81 Building Inspector ~0~ NO. ~ TO~N O~ $OUT~OL~ 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? 13287 Z Permission is hereby granted to: A -- .... ....... ..~.~..,...~.~ ...... .u.~..~.~ ........ at premises located at ...... ..~..(~...~.. ......... ~~...~.....~ ......... .~.~ .......... County Tax Map No. lO00 Section ..... .J...~ ........ Block ......... !. ........... Lot No ........~'-...~..;. ........ pursuant Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD 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 i~ll~ 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}. v~ 3. Approval of electtica~ 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. Fnr existinrj buildings (prior to April 1957), Non-conformia9 u~es, or buildings and "pre-existing" land uses: 1. Accurate survey of p~"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 bu ildings. 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 occupancv on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 Date ............ Old or Pre-existing Building .... .~'/./~ .... Vacant Land ...~.//Z~ ....... Location of Property ~'~-~ ~ ~ ~,~c~ ~d~ Hou~ No. Street Ham/et Owner or Owners of Property ............................................................ County Tax Map No. 1000 Section .............. BI6ck' .. / Lot ~ Ioo -1. ~ .......................... Subdivision . . .~. q~ 3.~4~l~..~ ...... Filed Map No ......... ~ .Lot No ......... Permit No./ ~ ~{~: ~. Date of Permit Z~/.~ ~ .Applicant .qfi4~&{{7.~g.+~-. ........ Health Dept. Approval .. ~ ...... Labor Dept. Approval ..................... Unde~riters Approval ~ ~[/~:~...Planning Board Approval. ~ ................. Request for Temporary Certificate ......... ~/ff ......... Final Certificate .. ~ .................. Fee Submitted $~'~ ........................ Construction on above described building and per/~it meets a)l applicable codes and regulations. PP ............. ................. ~' I "~ : THE NEW YORK BOARD OF FIRE uNDERWRITERS '.:: 1000009 ~ BUREAU Or ELECTRICITy ~ ':: ~-kl': '/-, ~ , 85 JOHN .... STREET: NEW-YORK, NEW YORK 10038 ' ' :THIS CERTIFIES ~HAT.. t, ;,; -~ . - , ,- o~y th~ el~cal equipment ~ described ~elow and introduced by t~ app!ic~n~ed o~ the ~bove application ~mber in ~he premises of " ~.:-~ , C',. Ma~arese, 965 Salta'~re Way~a~ti~ck, NeW:York ~..~,~ ~. ~%tie;uQutside~ 24 ..... ' Scotia.: Block Lot OVENS F~ ~Fu~nace:'M0gors - t-2F H';P. 1-4F H.P;~ ---)Future- 'Appliance Feeders- l~hoo~-t4w2, 1-C;P.-10-3, l&oven-10-3, 1-D.W.-12- ' :Special' Rec'pt.- 1-20amp., 1-30amp;, ~otors: 1-1 ::..12- Track. 2 Fixture~, 1- Smoke Detector, 4- G.F.I. ' 'i- ' !..""Al B..M.' EleCtric ' ; : ~ : l0 Lou Ct. i~:: :. . '' .', Huntington Station, N.Y., 117~6 ~hi~ cerfificO~e'mu~t not be offered in ony manner; re~urn *o the Offic~ TO'~N OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 CERTIFICATION TEL. 765-1802 Date ///~"'I~ ~/ Building Permit No. / 3~ Owner L~i-/W4~~6_ (please print) (please print) I certify that the solder used contains less than 2/10 of 1% lead. in the water supply system (plumber ' s ~nature) Sworn to before me this J~ day of ~~-~ , Notary Public,//~J-~ County Not~y Public PHYLLIS ATKJNSON ~90TA~ pUBEC, Slale of New ¥o~ N~. ,52- 4665676 Qu~llfied in Suffolk County Cemmi~sion Expires March 30, TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date //l~/~ ~ Building Permit No. / 3~ 7- ~ Owner L~i~ (please print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this 19 ~q Notary Public, ~ County N~ub~ic PHYLLIS ATKINSON J~OTARY PUBLIC, Slate of New York No..52-4665676 Qualified in SuffoJk County ¢omml,sion Expires March 30, 19~ FIELD INSPECTION FOUNDATION FOUNDATION ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY q?DE 2nd) FINAL ADDITIONAL COMMENTS: 7GS-180Z BUILDING DEPT. INSPECTION [ UNDATION 1ST [ '1 ROUGH PLBG~i FOUNDATION ZND [ ] INSULATION FRAMING [ ] FINAL. REMARKS: iNSpECTOR 7GS,1802 BUILDING DEPT, PECTION IHS ~ [ FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [~T'FBAMING [ ] FINAL DATE, INSPECTOR .... 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved ....~..~ .i.~P.., 19~.Xf. Permit No?l...~...~-.~. ~ ~ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUI LDING PERM IT 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. ¢. 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 i~ ~ ............................. ;itid .... (Signature of a~Plicant~,(~ name, if a corpo ' ) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. '" Name of owner of premises .~..]{.4.~.~.E.~.. .~..,~.D...~.~.~../..~d .'~..~..2. ~.~. ~.~.G.~. .............................. · (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 .......................... Plumbers License, No ...... :'~''[,~ ....... Electrician s License No ................ .L-.D E~. Othernfrade's License No ...................... ~ 1. Location of land on which proposed work will be done..~.+..~..~..~..~.~.~'/.~'.].ff.ff..~.~.:, 'h'?. '~'~i '~'~'~"e')' '4~:~ ...... House Number Street Hamlet County Tax Map No. 1000 Section . ~e.O. ............. Block . ]. :.-....2..2_ ....... Lot...~...~..~ ......... Subdivision .~.~..Z?..,~! .~.~..fi.g?..~.~.~. ............ ' ...... Filed Map No..~.~. ~.~x ...... Lot...~. / ......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ..b//.~. .... .~g-. '/~C*~/.tb~... ~ l.O..~..~ ................................ (_/) -y ,~', Z h. Intended use and occupancy ~.~?.~-.~. ~c'¢ pg,?//~J3 .,: ..... · . .~ .......... . ................. /' 3. Nature of work (check which a )plicable): New Building .. ~..'. ·... Addition ........ Alteration .......... Repair .............. Rem )val .............. Demolition ............ Other Work ............... (Description) 4. Estimated Cost .~...~..~. ~ .0.o.o. ......................... Fee .................................... '" (to be paid on filing this application) 5. If dwelling, number of dwellin l units .... ./ .......... Number of dwelling units on each floor .... /. ........... If garage, number of cars ...~0. ............................................................... 6. If business, commercial or mixe, d occupancy, sgacify nature,and extent of each type of use .... /5/JH ........... 7. Dimensions of existing structurps, if a~ ...... ~.}./~- .....Rear A.j}flf:......//,~... Depth .............. Height ............... Number~a'ffStories .................... jr. t...,~ .......................... Dimensions of same structure/~ ~a!t_e..r_a~t, ions or additions: Front ..... ' .~_..[ ;::_..:_Rear ................. Depth ...... ~ .... Height ......... ., ............ Nuffiber of Stories ......... ; ...... _. ~' " ..... ' ' ~ ' · o' o/ t &// ~'-q 6 8. Dimensions of entire new eonst,ructlon. Front ...6 ........... Rear . ~ ............. Depth ~ ...... '(' ...... Height . .l.~( .......... Nuinber of Stories .... ~.a/,~ ............................................... 9. Size of lot: Front . ....... .l.o.o. .... : ............ Rear ...................... Depth ....... . .~'.. z~.~,.,tt~°t ;~* · 10. Date of Purchase ~a. qu,,~-/-i, loo . i[~3 . Name of Former Owner ,t~.c.t:/&~/- Zone or use &strict ~n which p,em~ses are s~tuated ..................................................... 12. Does proposed .construction ~,,k lat-,e,any--~onmg'l~,~ ,' ,'' o~dman~,,~ ' '"~ or r~g" ula,ton.*' . . ~O .......................... . 13. Will lot be tegraded .... ~.~.-~ ' ' ' .................... Will excess fill be removed from premises;, Y, es 14. Name of Owner ofpremises¢'q~.~.F~.4/~qL~J ... Address }l.~.~.P$~.q.~.~./../~..~. Phone No.~ .~'.tg,]. ?).z?.ay.~.~'... Name of Architect .. ?.1.~.. '.i m~i;i,~-je, h'F__ ' .,, c~,a,~-~;e~;4;# ;O,","h~ .... .................. Acluress ............ /... t ,... ~1,~.,, N,, ................ ../~...'~. ......... Address . ~/'~.~ .//f..~./$ ..... Phone No0. J.. ,~ ......... Name,of Contractor . i.~../~..~- 0~- ' o,/~ ,~ 7 Locate clearly and distinctly al property lines. Give street and blocl~ interior or corner lot. iS PLOT DIAGRAM buildings, whether existing or proposed, and, indicate all set-back dimensions from number or description according to deed, and show street names and indicat~ whether C. ~ , "~ "~/~ -[-- ¢, · 2.' ' ~o 2::~L'rAt~::..- WAY. ~ . STATE OF NEW YORK, . :! ",, ~'"'~"~~--'"'*~'q,./J~.~. ~,~..4-: 2'.~. l.q'.2-2-///'~q&~., being duly sworn, deposes and says that he is the applicant ~ * (Name of individual signing contract) above named. I He is the... (Contractor agent corporate officer otc ) of said owner or ownm:;, and ~s 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 manfler set forth in the application filed therewith. Sworn to before m,%~>i~ ........ , .... ~'~., .t(. .... day~.. ,/fl~...~'..d..~.. .......... , 19 .~'.ff Notary Pub~,, ;.. ;F, ,~, .',~), .... ............... [7,00 \ · i' ~ ¢o ......................... 8'- I I