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Home My WebLink About12912-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z. 1.3.6.6.1 .......... Date ..... 8.a¥..2.0. ..................... 198..5. THIS CERTIFIES that the building .O.n.e...f.a.m.i..1 y..d.~ .e .1.1.i.n. ~ ......................... Location of Property ....~.Z.N.T..H.R.O.P...D.R.]i.V..E. House No. ' ......... Street ' ' County Tax Map No. 1000 Section 0.0. .9 ......... Block ........ 9. ......Lot 1 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... F.e..b :..1.6. ......... , 198.6. . pursuant to which Building Permit No...1.2.9.1.2. .Z ............. dated ... Rap. c h..6. ................ 19.8.zt, 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 ......... One family d..w.ell, i..ng.. ...... The certificate is issued to J4%M~.]igM. B....~. H. Rt~¥..~.L.]~C..E..H.~..A.S.E ........................ of the aforesaid building. Suffolk County Department of Health Approval ....1.6 :-.S.Q 7 .2.9 .............................. UNDERWRITERS CERTIFICATE NO. P e n d in g 5 / 1 6 / 8 5 Rev. 1/81 Building Inspector FOB.~ NO. 2 TO~N O~ $OUTHOL~ BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12912 Z Permission is hereby granted to: · ~:...~..~ ...... ~ ~_ ,,, prem,se, .................... ~ ........................... ~ .... ~ ......... County Tax Map No. 1000 Section ............. [.~ ........ Block ....... ..~. ........... Lot No...,J..~ ............... pursuant to application doted ...~..~.~...~..~...'~....~.~....'~..~. .............. , 10~...~..,-- and approved by the Building Inspector. Fee $ ........................ Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ~outhold, N,Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instruotions 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: I. 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 peopertv 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 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/ land use -- 3. Copy of certificate of occupancv $1.00 Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date .......................... New Building .... .~. ....... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ...t-,~).l./N}.""C, ~Ij.L4~.O.p. .....~j~..I.~ ~'..,..~[~ [~...~S.~ .~. ~' ~ ' Hou~ No. Street H~mlet - ~ ~ Owner or Owners of Property ..~.~...~.,...~...~...AL~...~A~ O~'~O Countv Tax Map No. 1000 Section ...0~ ....... Block ...... ~ ....... Lot ...... (. ~. ....... Subdivision ................................. Filed Map No .......... :Lot No. ............. Permit No./.~.~./~,~ .4~_Date of Permit~/~./Z~.¢A pplicant. · .~/~'.~ · · · .~..~ Health Dept. Approval. t..~.."..~...~'..--. ~ 7' ..... Labor Dept. Approval ....................... Underwriters Approval ........................ Planning Board Approval ................... Request for Temporary Certificate ..................... Final Certificate .... .J'~. · ·. .......... Fee Submitted $.....~./..~.. ~.. ................ Construction on above described building and permit meets all applicable codes and regulations. 6'~4~ Applicant . . . ~ ............... ,,.,o.,0.,, -- ' = THE NEW YORK BOARD OF FIRE UNDERWRITERS 1035057 BUREAU OF ELECTRICITY' }l~h-g 85 JOHN STREET, NEW YORK NETM YORK 10038 ~ ~o, ~s ~,,.~..~.~o.~.~.~ ~o~/~ N692472 Date THIS CERTIFIES THAT only the electrical equlpn~ent ~ described be~w and ~ntroduced by t~ applicant named on the able applicat~n number in the premises of was examined on and found to be in compliance with the requirements of this Board, ~y ~4, 1985 FIXTURE OUTLeTs 36 DRYERS SWITCHES FIXTURES ' OVENS FLUORESCENT DISH WASHERS EXHAUST FANS SYSTEMS NO. OF FEET OTHER AP~RATUS: Motors~l-F 2-G.F.C.I. PER ,E OF CC. COND 1 3/0 R V I C 2 NO, OF NEUTRALS Dl¢in ~leot~ic Co. Water~ord, UW 06385 This certificate must not be altered in any manner; return to the office of the Board,if i,~correct. COPY FOR B01LDING D£P~RTMEN?. may be I ANY MANNER. ~' F~LD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY QODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1802= ., 19 8.1[ Permit No. ]..~.cj .~.2C_.... Received .......... ,19... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tkis 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 buitding 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~[he Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Si3~l~hold, 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'appli~gant, or name, if a corporation) .... (Mailing address of applicant) O~ ~, ~o State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . .~/~.~.F~.,t~.. ~. :...~...,~J~... ~.~..~.~..~' .... ~.~.~.,$'~.. ................. (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...,~ ./.g.,~.."7....~. ......... Electrician's License No..,~...~..~...--.. ~ ........ Other Trade's License No ....... --"7. .............. Location of land on which proposed work will be done .................................................. ..... .A~r~.r..,ff..~..a,a. .... ~..~...t/.~'.. ~....~./.a'..x(..e--..~.t ..... ,z2'~.e-~.,v. ~.. ~....&/:fi'......a.~ $~..~ ...... ttouse Number Street Hamlet County Tax Map No. 1000 Section .... ~.~.~} .......... Block ...... ~. .......... Lot .... ./.~. ........... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy ..... ~.,~. ¢O~. .... ~.~../,~..~-..~t..~. ~. ................................... 10. 11. 12. 13. 14. property lines. Give street and block interior or corner lot. Nature of work (check which applicable): New Building ... ~. ..... Addition .......... Alteration .......... Repair .............. Rem?al .............. Demolition .............. Other Work ............... Estimated Cost ...... , ...................... ,. (to be paid on filing this application) If dwelling, number of dwelling iunits ....... ~. ..... Number of dwelling units on each floor ..... '.";' .'; ....... If garage, number of cars .... i ~AIt~". ............................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use .... .'T ............... Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure w, th alterations or additions: Front ................. Rear .................. I)epth~ ................... ~.. Height ...................... Number of Stories ...................... Dimensions of entire new construction: Front ..... ~.g.~. ..... Rear ..... ~.g. ~. ..... Depth ... ~.~../ ....... Height ..... ~ ......... Number o/f Stories ...... ~,d.~'. ............................ '~ ....... Size of lot: Front ..... //..~.'. i~ ........ Rear ......... ~./.~.: i~.'~' ~"" Depth .... ~...O./..,.~..O. ........ Date of Purchase .. ~ ~... ~. t' t'~. ~.. ........ Name of Former Owner .~.a. 4~.~..~...~.. Zone 0r use district in which pr~mises are si*uated... ~..~.~ ~ ~ ~r'~/.F'.t~, ~ ................................ Does proposed construction violate any zoning law, ordinance or regulation: .. ~.~. .................... Will lot be regraded ' · ~/~'~ . Will excess'fill be o ' ' ' · --.-- '- .... -" i '- ....................... ' removeu ~rom premises: Yes Name of Owr~Yrr~l~l~f~[se[4. '. ~,,~,,~ .'~.~....'~..r.C.~Address ,. g~.q g.. ~.~. ...... Phone No.(,~'.~. ~'~..~.-...~.~.F Name of Architect ......... ~ ................. Address ...... ~ ............ Phone No ................ Name of Contractor &q4r~¢t'~..,~,. ~q(l'~.. ?.. Address .~'YSAf~..,'~.. ,.~.t~/~t, OPhone No. ~'~'./.~.,~F~..~'. r Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from :ription according to deed, and show street names and indicate whether STATE OF NEW YORK, COUNTY OF... [3p..f.f.Q~. ...... S.S William R. Haase ................................................ being duly sworn, deposes and says that he is the applicant (Name of individual sig~ing contract) above named. He is the.. ....... ~.o.~grg.c.t. Qr ! ................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duiy authorized to perform or have performed the said work and to make and file this application; that all statements conthined 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 fil~d therewith. Sworn to before me this ........ .1' .4 .t.h. ........... day of Notary Public ....... ,,, .,'~ · .I..SCf. f. 9.1.k County NO. 52-8267950 - SUFFOL~ CoVNT'~ COMMISSION EXPIRES MARCH 30 .... · Fg.B,r.u..a.r Z ........19 84 (Signature of applicant)