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Home My WebLink About13088-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No... Z..1.2.9.6.9. ........ Date ............ .N 9.v.e.m..b .e,K' 8, ......... l 9 8..4, THIS CERTIFIES that the building ...P..r.iy.a.~ .e.p.n.e...P.a.m.i..ly..D.w..e.l.l.J:.n. g ............. Location of Property 860 Pvt...R.d.... i} 7 ........... 9.r.~.e..rig ....... ill'ici I~t~ts'~ 'N'O: .................. Street County Tax Map No. 1000 Section ....0.1.8. ..... Block ....0 .3 .......... Lot .... 9.2.9. ......... Subdivision . .X ......................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·...~pr. ~.J_ .....2A ..... 19 .~ 4 pursuant to which Building Permit No ...... 1.30 8.8.2~ ......... dated ....... l~ay. .......... 3 ...... 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 ......... Private One Family Dwelling The certificate is issued to ........... .W.A.L..T.E.R..a...iyl~...R.J..O.R.Y..S..Ig.I.T.H. ..................... (owner, ler~e~ of the aforesaid building. Suffolk County Department of Health Approval ........... J..4.-xSQ:-~.3. ..................... UNDERWRITERS CERTIFICATE NO ................... N.6.~420.0 ....................... Building Inspector Rev. 1/81 FO~ NO. ~ TOWN OF $OUTHOLD 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? 13088 Z Permission is hereby granted to: -~ .... .... ~L ....... ~.~ .......... ~.~ ............... ....... .~-~.?~. ~...~...~.~ ........... ~o .......... .~.~.~...~..~.~.~..c~ ........ .~.../~.~-~......~/.~.~....~ .......... ~ .............. ......... .z...'~.~_.z.;m: .......... [..V'~z~(-~...~.Z~,~___________________~.~....~.~..<~......(. ................ at premises located at ....~' .~.(~ ............ ,: ....... '.~.......Z ......... .~..~/~..~'./~/~) County Tax Map No. 1000 Section ....~..../..~... ........ Block ....~...~ ......... Lot No...(~...~:...~.. ........ pursuant to application dated .... ~[.~....~ff.~.. ............. ,19..?.~.., Building Inspector. and approved by the Building Insl:~:tor Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ,~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted-J~=~'pHc"~teto 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 featu res. 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. For existing buildings (prior to April 1957), Nomconforming uses, or buildings and "pre-existing" land uses: I. 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. 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land use 3. Copy of certificate of occupancy $1.00 --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 New Building ....~... ..... Old or Pre-existing Building ............ Vacant Land ............. Location of Property . ,~l~,... ~,/~'.~,. ~,~).:~, .?. ..... ~./~./.4~,, ,~'/ ..... ..~,: ~ ............ House No. Street Ham/et Owner or Owners of Property ~, ,[~,~-, ,T, ~-~ ~, +. ~ J~,~.~ ~ .~....~.~..'~.-~J~ ...................... County Tax Map No. 1000 Section ....~.~ ......... Block .. ~. ........... Lot. ~.~.~ .-. ~.~ ..... Subdivision ................................. F~led Map No ........... Lot No .............. Permit No./-~.~.~'. ~-~. Date of Permit .-~..~./~.~.' .Applicant .~)~ Health Dept. Approval ~e.~. ~,. !.R. ~'.~ .......... Labor Dept. Approval .-~-~ ..................... Underwriters Approval .o.~.'T. ~.R~ ~.~ .... Planning Board Approval .-~ ............ Request for Temporary Certificate ..................... Final Certificate . .~ ................. Fee Submitted $.. ¢~.~' ~. ~. ................... ~-J H~ n~d~ ~--it meets all applicable codes and regulations. Construction on above described building a pe~ ~) :~_ ,~_~(o~ Applicant..~--.~.~..' .................. Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY i~;C~(51~ ~,j~ ~ 8~ JOHN STREET, NEW YORK, NEW YORK 10038 .-,~ ~.~.,~.,, ~o. ~.~.~ ~/~ N 664200 THIS CEETIFIES THAT only the electrical equipment as described below and introduced by t~ applicant ~med on tl~ above application number i~ the premises of Wal'~r & ~l~j~y ~, ~va~ i~ 87 off ~n in ~he follo~ing lock,ion; ~ Basement ~ ls~ FI. ~ 2nd FI. S~tlon Block Lo~ FIXTURE FIXTURES OUTLETS SWITCHES 1t 13 and found to be in compliance with the requirements of this Board. RANGES COOKING DECKS OVENS EXHAUST FANS DRYERS CT R APPARATU : 1-G .F.I. 1- ~k~)ke dete~t~¥ E R V I C E NO, OF CC~ COND A W G. NO. OF Hi-LEG PER .~ OF CC COND. 1 A. W.G. NO OFNEU/RAL: OF HI4EG ~[~ee C Electric~ im~'. lt~. 1, Box 45/~ ~ut:td Avenue l{ivo~ead~ N.Y. 11901 L1~3327 PeF This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspecto(s may be identified b~ COPY FOR B~UILDING DEPARTMENT. THIS COPY OF CERT FI ~CATE MU T NOT BE ~LTEfl£D IN ANY MANNER FIELD INSPECTION 1. FOUNDATION (1st} COMMENTS FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULAT%ON PER N. STATE ENERGY ~ODE o FINAL ~r d/~! ~.~ ADDITIONAL COMMENTS: 765.1802 BUILDING DEPT. IHSPECTIOH ~ [ ] FOUNDATION ZST ~ROUGH pLBG. [ ] FOUNDATION ZND [ ] INSULATION /~RAMING [ ] FINAL REMARKS; ~ ?.,~F.- ~~, ~ DATE INSPECTOR FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ~.~..~..~. ..... , 19 .~. Approved . .~..fl..~.. ~ ...... 19~..~. Permit No../..-ff~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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. 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 codq, housing code, a.nd, regulations, and to admit authorized inspectors on premises and in building for necessary ins~~ectio . ~.~'/x/~ ~0~t~ /-/~,~,f (Signature of applicant, or name, if a corporation) .~.~.. B?. x'...q(.~.~.-...d. ?.~.~ ~r.~.~.,, .~.,¥ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............... ~ .G. ~ .~. ~.~t,...c..~..~T..~..~.~e..~.-.3 ............................................... Name of owner of premises ~ ?..k,.~..~-...~ .~..k.'~. k~...~.°. .~..~..~..~. ~.~. ?.~. ................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ..... ?,.o..(e. ~...e,..o. a,.~. ,0,..-...-fe, v-,.~., ..... (Name and title of corporate officer) Builder s License No .......................... Plmnber's License No....~. ~..~7. :..? ........... Electrician's License No...~. ~.~.T.~ ......... Other Trade's License No ...................... Location of la~.~n ~ich proposed work will be done. ~.~..'T.'..~..°.'.~.~ Plm, lO. 0, O- o~t~..~.-~.. House Number Street Hamlet County Tax Map No. 1000 Section . ...~.~.. ............ Block .~ ............... Lot...........Pc: L-~ ~,~ t ....... 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 ~4 ~ .I~..~,. ?.. ~..k.~. ~ ~, ~ ct_ ~ ~, 3. Nature of work (check which applicable): New Building ...N~...... Addition .......... Alteration .......... Repair .............. Ren~oval .............. Demolition .............. Other Work ..... } ......... i ~ ~ ~ (Description) : (to be paid on filing this application) 5. If dwelling, number of dwelling units .... .,~.. ...... Number of dwelling units on each floor ./. ,~.~'.q,~"~ ..... If garage, number of cars ... ~.q/~ 15 ............................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structuies, if any: Front ............... Rear .............. Depth ............... Height ............... Number. of Stories ................................................. . .. .. Dimensions of same structure '~,ith alterations or additions: Front Rear ............. Depth ................... I. · · Height .......... ,, ........... Number,of Stories ...................... 8. Dimensions qf~ptire new conslruction Front t.~/ Rear /~./. De~th ~ / ,r Height ./.~. .. Number of Stories */ ~ ............ t ..... · ~t '~' .................. 10 Date of Purchase ,--. . Name of Former Owner 11 Zone use district in wh'ch p~emises are ituated 12. D6es proposed construction vi61ate any zoning law ordinance or regulation: . ~..g) ................. 13. Will lot be regraded ... ~.. ............ ,_._z_ ...... Will excess fill be rern~oved from premises:.,, Yes 14. Name of Owner of premises '.~..~?-.~'~ .1l.,....~..~.,.T.. 14..' Address ~OX 2~.-.~. ~ t ~,~..T~hone No. ~. ,g~...-~. ,~....~'~.. Name of Contractor " ·; ~" ~ '- Pho ........ , ................. Address ~ ~ .................... ne No. ~..t ............. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and bloc; number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ................. ............................ ~ .................... being duly sworn, deposes and says that he is the applicant (Name of individual sig~ing contract) above named. (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 are true to the best of his knowledge and belief· and that the work will b~ performed' in the mann{r set forth in the application filed therewith. Sworn to before me this .......... ............. Notary Public ...... ~..~.~i ~),/,~.~.~.0:~,,... County NOTARY PUBLIC, State oJ New Yor~ . . . NO 470'/878, SaJJotk C/ouiltv ~ (Signature of applicant) Term Expires Ma~ch 30i 19~$ I ? b ! ? 94 06-- -x I Ill o ~ 4¢¢:74 Z ~m<~ · ,r.~ ~}-{ANIAN ~_ ~ ,~ , ~ , / , V-~