The URL can be used to link to this page

Home My WebLink About12947-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No... ~..~ .2.8.3:. 6. ........ Date ......... S.e.p~.. ..... .2.7. ........... 19 .8 .~. THIS CERTIFIES that the building ..... .O.b.e.. ¥.a.m.~ .ly..D.w..e.l.l.~. g .................... Location of Property ....... ~p,4.5, ............. ,~p.r.t~b' ~B.a&z, .V.i.e.w...R,d... ..... S.o.g.t.h.q 1..d,. House/Vo. Street Hamlet County Tax Map No. 1000 Section . O 79 ........ Block ... 9.4 .......... Lot ....P/.Q..0.6.6. ..... Subdivision..l~ar~or. L.igI31:~ .............. Filed Map No ......... Lot No...6. 4. ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... iq.. ,a.~g,h, ..... 1.2. ....,19.8..4pursuant to which Building Permit No.. 12947Z dated ..... M..a.rp.h.....1.2. ........... 19.8..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 ......... ....... ?.rJ va.e.e.. p e. ........................................ The certificate is issued to ...... ~?gp.e.z~, W.~.i.J, .i.a.m. ,~...C9.r.~..n.n.e' ...................... (owner, levee or tenant) ' ' of the aforesaid building. Suffolk County Department of Health Approval ....... [ ~ r~.q': 4. ~ .......................... N657991 UNDERWRITERS CERTIFICATE NO .................................................. Rev. 1/81 Building Inspector lrO~ NO. ~ TOWN OF $OUT~OLO BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12947 Z Permission is hereby granted to: ....... ~Z/.4~.~.;,~,., .......... ;. ........ :~. ....... ....... ~..z.. ...... .Z../ .............................................. ....... ...~....c.,.~z~..e..~r ...,~..~..... ~ (~o ~.-~7.~_, ~ ~-7 ~-~.~ ~ ~.~ ~...~~: ~ ........ '"~'~"~-"~ .......... ,:~' .............................................. IL ~. "~' ...... -,~/~~"7 ................ ...... ........... at premises I~ated at ....~~'J ....... c~,~ ~,~ M,~ N~. ~ooo s,:~, ...~..~ ....... ~ ....~.~ ....... ~.~ N. ............ ~ ........... ~'- Building Inspector. Fee $...../....~... 2~....~ BuildlRg Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLO Building Department Town Hall ,~uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted-J~=d~-'pHcct~to the Building Inspec- tor wlth 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- - lions, 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 features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. ~ 3. Date of any ho?sing code or safety insp,ect on 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 --Pre-E×±st±ng C.O. $15. O0 3. Copy of cert ficate of'occupancy $1 00 / · ' Vacant land C.O. $ 5.00 Date ......................... . New ~bilding ' .~.. Old or Pre ......... -existing Building ...... · .... Vacant Land.. .......... . Mouse Irc. Street Ham/et Owner or Owners of Property . ~_,~. ,;//2~ · . ' County Tax Map No. 1000 Section ...O.~ ~ ...... Block ..... ~ ........ Lot.. ~. ..... Subdw~sion.. ~ ............. Filed Map No ........... Lot No .... ~ ...... Permit No.X~.~ Date of Permit ~ ~. ~Ap~ ,~c, . . ~ ..... Health Dept Approval ...'...Labor De'p~ Approval Unde~riters Approval Planning Board' Approval Request for Temporaw Certificate ..................... Final Certificate ...................... . Fee Submitted $~ ........................ .onstruction on above described building and permit meets all applicable codes and regulations. C,O-~_ ~ 2,~1~ Applicant. ~ ~,~'qq .. . ............... Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY giltl~ C~per~ NoPt~ ~0~'i~¢~ Drlve~ Bz'ig~xtine ~'. k P~ise ~oz'e Rd. ~ ;Southold~ FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FIXTURE SYSTEMS NO. OF FEET E DIMMERS E R V I ' C NO. OF HI-LEG -L/O OTHEE APPARATUS: Denai~ D, Claire Jr,,~ Per 11 This certificate taus, .o, be al,ered in any manner; return to the offke o( the ~oord if i,¢or,ec,. Inspectors, may be i~enfified by their COPY FOR B01LDING DEPARTMENT. THIS COPY OF CERT{FICATE,~U8~ NOT BEA~TERED INANY MANNER FIELD I. NSPE,CTION__ .......... DATE COMMENTS 1. FOUNDATION ( l st } FOUNDATION (2nd } 2. PLUMBING / ~oN ~ ~. ~. 7 -/ - ' STATE ENERGY .- ~o~ ADDITIONAL COMMENTS: BUILDING DEPT. · INSPECTION FOUNDATION ZST E] ROUGH pLBG. [ ] FOUNDATION ZND [ ] INSULATION FRAMING [~FINAL DATE · iNspECTOR ~C~. r ~ FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ^pproved ....... , l mermit D~sa~pmve~ a/c ...... : .~..~. ............. ~ ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 issue a Building Permit to the applicant. 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 taws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessaw inspections· · .,ZSo. x...7. (Mailing address of alSplicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· ............ ,~ ~ ~.~_,¢"c,../~.. ~ c,.[o 2'(~.~.c .T/~..~?'. ....................................................... Name of owner of premises . .dt.2,'//~'~ ~-~..C', .~...C'~.~: h.~ E...Zr~. .... ~.oo/a¢,C'. .......................... (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 ...... .,~. O. oc'~. ............ Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. House Number Street Hamlet Tax Map No. 1000 Section .... ~.7.~9 ......... Block ....... '.~. ......... Loi....~../,(. d].~ ........ Subdivision ...... ./~.q~. 0r~y-: .(iq. ff~).~./~.,J_..__ ............ Filed Map No ............... Lot ...d-,~.. ......... State existing use and occupancy of premises and intended use and occupancy of proposed construction: use and occupancy ........ ~.a.c.' .o ~ .................................................... ~'xgled property lines. Give street and block interior or Corner lot. 3. Nature of work (check which applicable): New Building .. ~....... Addition .......... Alteration .......... ' ~ Repair ...... ' ....... Rem. val .............. Demolition .............. Other Work ............... ~ , lf~ r~.'i -.~ -~' -- ~. (Description) .... ..................... 4. Estimated Cost ..... ~.-:? tT~O, .00 .................. Fee.., . . (to be paid on filing this application) 5. If dwelling, number of dwelling .units .... /. ......... Number of dwelling units on each floor.../ ............ If garage, number of cars ..... i;2, ................................................................. 6. If business, commercial or mixefl occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Nurflber 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 .... ,:5-.~f ....... Rear . ..37. ~..~ ........ Depth . .3.~./. ........ ~ Numb f Stori ' .:;k . ._... Haight .... 2. ~l ....... er o es .......................................... 9. Size of lot: Front ...... M3~" ........... Rear' ' ' Z$~" ......... Depth . Z'. (..w~ ............ 10 Date of Purchase i Name of Former Owner 11. Zone 3r use district in which pr~mises are situated .... ~.e,~cfen.~ ~/. ................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ./o.o ............................ 13. Will lot be regraded ...... .y.¢ < ................. Will excess fill be re.moved f~rom premises: Yes 14. Name of Owner of premises ~i ]/i,.~.~. ~ooffa ~ .... Address ...~.o.~.~./,.o./~.../.~.,)'~,.. Phone No.. ~ ¢6'. 7/~.o... Name of Architect ......... 4 ' ' Address ................... Phone No ................ Name of Contractor .~"~0~/~. ~'.'.'.'~o~,~; ~i i i i Address .~.a ~ ~ ,'.c 2' '~?~ )~' ' ' ' Phone No..70~.~.*Md 7... PLOT DIAGRAM Locate :¢le~riy and distinctl~ ali buildings, whether existing or proposed, and, indicate all set-back rlimension~ from number or description according to deed, and show street names and indicate whether STATE OF NEW YORK, COUNTY OF ................. (Name of individual sigoing contract) above named. .... being duly sworn, deposes and says that he is the applicant He is the ..................... 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 am true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this t~o, 4707878, Suff?~ Cou~]ty .~ I? ~<o () .............. --'~r SF? II Al4 9 13 C ~>z <o 121 ..~ .q 'al mz~m o AP,T2OTZD AS NO'I~D 7~D-~0~ 9 AM TO 4 PM FO~ THE FOLLOWING tNSPE~IONS: ~. FOUNDATION - ~O REQUIRED FOR POURED CONCR~E ~. ROUGH - FRAMING ~ PLUMBING ~. INSU~TDN ~. FINAL - CO~TRU~ION BE COM~L~E ~LL CON~RUCTiON SHALL ~E REQUIREME~S O~ THE N.Y. ~A~ CON~ION & ENERGY COD~. N~ RESPONSIBLE D~I~ OR CON~RU~ION ERRORS. k ~ copper tubing is used for water distributing sys!em; piping shall be of types K or L on!.,/ .> f ~ ,3 L f ' 2 - b ~ IZ