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Home My WebLink About13101-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building Accessory Location of Property ........ 1. q. 7 .5..H. J:..a y.a.~.h..a .' .s..P..a .~.h .............. S. 9 .~.~.h.o. ~ .d ......... House No. Street Hamlet County Tax Map No. 1000 Sectiou . .0.7.8. ....... Block ..... 3. ......... Lot 54 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore flied in this office dated ..... .H.a. ¥...7. ......... 19 .8.6. pursuant to which Building Permit No. 1 3 1 0 1 Z dated ........ ~ .a y..7. .............. 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 ......... .... g.q¢ e &s.qr. y. ~.h~ql. j_.r~. ~'.e.a?..y.a?.d.: .......................................... The certificate is issued to ....... .L.o.u..i.s..G.a.¥.nor & Katherine Gaynor (owner, ~.~YOX I~,gtOZlX X X of the aforesaid building. Suffolk County Department of Health Approval .... ~ ./.A .................................. UNDERWRITERS CERTIFICATE NO ............. ~ ./.~ .................................. Rev. 1/81 Building Inspector FORIK NO. ~ TOWN OF SOUTHOLD BUILDIHG DEPAI~TMBNT TOWN HALL SOUTHOLD, N. Y. BUILDING PEI~AIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13101 Z Date ................................... , · .. County Tax Map No. 1000 Section ..... (~..~..~ ....... Block ....... ~.~ ........... Lot No ........ ~..~. · ......... YY\.o,.~,~ ~1 .... Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southotr}, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ia ~ 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 p~operty 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 $ :[5.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 Date ................... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property l/, 7 ~,, . .~.. ./, ,~. ,c~. ~,7~,~. ~, , ....... ,,~, ,~, .~, ............... ,?~, .~-_-_~.o,~, /,~. . House No. Street Ham/et Owner or Owners of Property ,~6~[~' ~..~...t~.~...7~..¢./...fi/.~.. .~.~..~.~.~..t.t~. County Tax Map No. 100OSection. L~.O~. Block ~ Lot. .O~,..~,, 13/o/. z Subdivision ............................. Filed Map No ........... Lot No .............. r App,,eant Permit No ........... Date of Permit ......................................... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and pern~meets all applicable c.~Jes and regulations. App cant ~ ~ Rev. 10-10-78 · ~. ~ ,, - COMMENTS FIELD I~o~ECflON ~ fOUNDATION (l~t) FOUNDATIOI1 (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C.ODE F£NAL ADDITIONAL COMMENTS: zoo1 67 THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ BUREAU OF ELECTRICITY /)ate Al:.[.c~st (~t,'[~8S .JOHN STREET, NEW YORK, NEW YORK 10038 ~m, li~atlon ;~o. on yile 343734/85 N703473 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premlses of LouJ.~z & ~atherine Gaynor~ 1!75 Hiawathaz Path, Southolc~ New York inthefollowlagloeatlon~ ~ Basement ~ lstFI. [] gna rt. Section 07~looh 3 and found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES COOKING DECKS OVENS EXHAUST FANS OUTLETS SWITCHES INCANDESCENT FLUORESCENT MERCURY 4 2 4 DRYERS ~ot 54 SYSTEMS NO. OF FEET E OTHER APPARATUS: E R V I C A. WG PER ,~ OF CC, COND NO OF NEUTRALS OF NEUTRAL 53-20 196th Street Flu~hingr N.Y. lic.~127E INs cerfificme mvs~ not be altered in an), manner; return to the offic~ of the Board if into,fred. Inspectors ropy be idenfif ed by their credentials. ) IN ANY MANNER. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ,qOUTHOLD, N.Y. 11971 TEL.: 765-1g03 Examined .... ¢.q4~ .-] ..... 1927 k~ Approved .... ..~..c9~..~.., 19i'~' eennit No. )..~/9./.'.~. Disapproved a/c ..................................... Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... 19... 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 I§spector 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 inspectom on premises and in building for necessa~5 .~~.,..~ ~ '' (Signature of'~'' '~'~'"~"~~' i~'a'c~;a'tio'~) .... · ..... (Mailing address 9f applicant)__ SooT-PI-dr..b, Ig Y, I State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............................. .0..~. ~ .e..P,,S. ........................................................ Name of owner of premises .. ~.O.~.1. g~....~....~.. K~a.7'..~.,?. ?.'...~. ~..~..~.~. ~ ........................... (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 ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. 7. c.. H,. ................. o. House Number Street )t~amlet County Tax Map No. 1000 Section .... .'~ .~ .......... Block .... .~. ........... Lot .... ,5'.Z.~ .......... 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 ~ ~$~ d~ ~.~ ~ b. Intended u se and occupancy ........ ~. (~[o. lg~ ~. ~ .... % .~x lg.c~ ....................................... 3. Natureofwork(checkwhichapplicable): New Building .......... 'Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... .~. ~ .~.5 (Description) 4. Estimated Cost ..... ; ......................... Fee ...................................... (to be paid on filing this application) 5.If dwelling, number of dwelling nits ............... Number of dwelling units on each floor ................ If garage number of cars ~ ~ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..... ."77-. :'... 2~...: ..... 7. Dimensions of existing strncture~, if any: Front ............... Rear .............. Depth ............... Height ............... Num!ber of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... i.. Height ...................... Number of Stories ............... ~ ...... ("(~'. xOimensions of entire new constrhction: Front .... ./..~. ' [ffHeight .... ~..t ........ Num~.~ber of Stories ...... 9. Size of lot: Front ..... / ./.~ ?.. ! ........... Rear ..... /. (.c~. ............. Depth .... ~..9./ .~ ............. 10. Date of Purchase .... d ,~. ~.~ .i .................. Na,,llae of F~9~_.~er O.wn~er .~. {~-~ ~I~. ................. 11. Zone or use district in which pr{mises are situated ..... ~J~.*.C/.~"~.I. ................................. 12. Does Proposed construction violate any zoning law, ordinance or regulation: ....... ~.O. ..................... 13. Will lot be regraded ......... ~.@. .............. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ..................... Address ................... Phone No ................ Name of Architect .......................... Address ................... Phone No ................ Name of Contractor ......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all ibuildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block humber or description according to deed, and show street names and indicate,whether interior or corner lot. STATE OF NEW YORK, ] .__ L.__ [.__ V'I}- COUNTY (Name of individual signlng contract) . being duly sworn, deposes and says that he is the applicant above named. 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 are true to the best of his knowledge and belief; and that the work will be performed in the manne~ set forth in the application filed therewith. Sworn to before me this .......... '~ . .~. ......... day ofi:' '~t 19~.. 7. Notary Public, ....~.'~.....~.'.~ffJ?~--~............... ........... NOTARY PUBLIC, State 0I New Ymk (Signature of applicant) -~', No 4707878. Suffolk C0uaty '[erin [xl),es March 30, 19~.~