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Home My WebLink About13039-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z329~+6 October 29 No .................. Date ................................... THIS CERTIFIES that the building .... S.t:u. ,d~.q, .a.d.d.~ ~. $,o.n ...................... Location of Property R.O W (pole 818) off road to East End-F~s..h.er..I..s~.a.n.d. i~s'e 'Al'o: .............. '~'t/e~i ............... County Tax Map No. 1000 Section 08 ...Block 01 ,Lot 6.3 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore flied in this office dated A Iv r i 1 1 0 19Bfi.. pursuant to which Building Permit No. ~ ~.0.3 9. z dated ...... ~. D ?.~.l.. ~..6 ............. 19 .Off., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is .A ....... non-h, abitable sgudlo additlon to an accessorx.g.a?,a, ge., The certificate is issued to Allerton &Rlga Cushman ... ..................... i ................ of the aforesaid building. Suffolk County Department of Health Approval ........... ~/A ........................... UNDERWRITERS CERTIFICATE NO .................. 4) ~ 6 ~ 6 ~ ~ 8 Building Inspector Rev. 1/81 I~OB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13039 Permission is hereby granted to: ...~..~...~........$~....s.:u.,...~.~.:~..~...~ to. c.~ K) ~ ~ ~'"'~ ...... ~'~~'"'~, ~_~,~'~ ................. ~'"'~~ ,~ ~ i~ ~ ............................... o, premises located at ...~..I.~..:.?...:,.~.~.....~.~.~.....~a.~...,....~..,.~ ............ ~..~.~....Y~.~..~ ........... ..%.....~.~...~?..!.~.~, ............................................................................................... County Tax Mop No. 1000 Section ....... ~..~ .......... Block J Lot No. .. ~ ' ~-~. , pursuant to application dated .......... .~...~.....~...~..!....~. ..................... , 19.~..~.., and approved by the Building Inspector. Fee $~:/.....: ............... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instruotions BLDG. DEPT. TOWN OF SOUTH,0LD 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, 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 $5.00 3. Copy of certificate of occupancy $1.00 ., , ~'' D ate . .-:'./.~. ':~. ~.:. ,;~. ~. .......... New Building ..... ~ Id or Pre-exi~ing Building ............ Vacant Land ............. LocationofPro crt ~Z,~,~-/ ~ ~'~ ~,~ ~ o ~-~ ~,~- ~-~ . . House No. Street Hamlet Owner or Owners of Property ~%~- ' . County Tax Map No. 1000 Section ~ Block .~... Lot... ~ '~ Subdivision ................................. Filed Map No ........... Lot No .............. Permit NoY', ,~'.Q.~. ~. Date of Permit ~.~',-,/.~.'~. pplicant . ?, ./; ¢, Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .'7. .................... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and j~egu at ons Applicant ~../.~t~...~.~'. ??. ,~. ?Sk~..6&.~?. ~..~.. ........... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YDRK 1003E~ o.t~ Jva~¢: O1, ~1,~ ~71'~87184 THIS CERTIFIES THAT only the electrical equipment as ~scribed bel~ and introduc~ by the applicant ~med on the able application number in the premises of Alle~on C~n, P~k ~ Fi~rs Is~d~ in the/ollowing location; ~ Basement ~ Ist FI. ~ 2nd Fl. ~Si~ Section Block Lot was examined on ~y ~ ~ ~4 and found to be in compliance with the re~tuirements of this Board. FIXTURE OUTLETE 1 I 2 RECEPTACLES SWITCHES FIXTURES RANGES OVENS EUTURE APPLIANCE FEEDERS DRYERS FURNACE MOTORS EXHAUST FANS TIMECLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: 1-G.t%G. l $ E NO OFpE~C~COND. 199 Nieaxgic J.~tve&- Road Lic~3160 This certificate must not be altered in any manner;, return to the office of the Board if iocor,r~ct COPY FOI THI! ICATE MI ' BE ALTER J GENERAL MANAGER Per may be by their credentials. MANNER. F I F~LD I~NS~ECTION FOUNDATION FOUNDATIOU 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY COMMENTS FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL..: 7654803 Examined ~.~. -~ - .~,~ ....1~..., ... Approved ~.~.. J.q .... 19~.~). Permit No...~:q... Disapproved a/c ..................................... Received ............ ,19~q.?(/ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be c6~npletely filled in by typewriter or in ink and submitted to tile Building Inspector, with 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 street 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 permi 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 Occupanc: 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 th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o 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 tt admit authorized inspectors on premises and in building for necessary inspections. · (Signature o~ffj{pplicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... ........................................................................... Name of owner of premises ~..~. · ~..~..~... ~>F,~q-?~: ~r~. ..................................... (as on the tax roll or latest deed) If applicant is a corporatign, signature of duly authorized officer. (Nar~i(and title of corporate officer) Builder's License No... ~..~.. ?. ................. Plumber's License No....~../..//.J..~.'7./5.~. .......... Electrician's Licedse No..~..d~..~. .;¢z:~ .......... Other Trade's License No ...................... 1. Location of land on which proposed work wilI be done ....................... , ......................... ......... ......... ............... Street House Number ' u Hamlet County 'Fax 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: b. Intended use and occupancy .......................... 3. Nature ofwork(checkwhichapplicable): New Building .......... Addition. ......... Alteration ......... Repair .............. Removal .............. Demolition ............... Other Work ............... (Description) 4. Estimated Cost. Fee (to be!paid on filing this application) 5. If dwelling, number of dwelling units... ] ........... Number of dwelling units on each floor....'77.., r ........ If garage, number of cars ' 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front... ~ P. ........ Rear ....~. ~ ....... Depth. ~. ~ ......... Height ~' Cz/. Number of Stories'. .... /. Dimensions of same structure with alterations or additions' Front .~..o. ~ Rear .07. o. Depth ...o~. ~. ............... Hei t ................... Number of Stones . ? ............ 8. Dimensions of entire new construction. Front ..... .~. ........ Rear... ~ ~ ....... ~.' ....... Height /.~. 'Number of Stories ./ i' Size of lot: Front _~?/¢~...~'i~e~ .~gg0~_.~.Rear ......... ' ............. >epth ...................... Date of Purchase ~. ~. ~.~7~. ............... .,,Name of Former Owner~*-x-. ,X~ ............ Zone or use district in which premises are situated. ~. ~g~.....,~ ............. ; ............................ Does proposed constroction violate any zoning taw, ordinance or regulation: . ~ ........................... Will lot be regraded , .~-~ ................ ' ' ' ..... Wall ex?~cs.s ,fill be r~emgved from premises: Yes Name of Owner of premises ~,,-~, ........ Address ~z-J,. ~ .~.~.. Phone No ............... Name of Architect ....... ~ ........ # ~ -~' 'r~ ' ' ' Address ....~ .............. Phone No ................ Name of Contractor~..~,~-..~('~t.a/.~,,. d~o. Address ..~'~ ~ .~... Phone No~57~..~.~:ff.-~.. f~ 10. 11. 12. 13. 14. 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 sho'w street names and indicate whethe~ interior or comer lot. / STATE OF NEW~OI~,I~, ~ ,,, COUNTY OF .~ .... ~'~ and (Na~ of individual signing contract) above named. He is the ...................................................................... ~ ........... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfo~ed the ~aid work and to m~e and file ~is application; that all statements contained N this application are true to the best of hi's knowledge and belief; and that the work will be performed iu the m~ner set forth in the application filed therewith. Sworn to before me tliis ............ z ,g, ..... ...... ......... Nots, Public~.~~... ~. ~ ~ ~ ~ ~.. County ~,~,,,,, ~.~,,. ~,t,, *~, 1~ i (Signature of applicant)