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Home My WebLink About13129-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Zfi. 2..6.6.8 .......... Date August 6 19 84 THIS CERTIFIES that the bullding Renovation to existing building Location of Property 6215 Route 25 Laurel h~/~s~ hiol ....................... 'S't/e~i ....................... County Tax Map No. 1000 Section 125 .Block q . .Lot. q 9 · 002 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated May 1 6 ..................... 19 .~.q pursuant to which Building Permit No ..... 13129 Z dated ....M.a.y...~ .6 .................. 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 ......... Renovation of existing building. The certificate is issued to Eastern Long Island Hospital ..................... .................... of the aforesaid building. Suffolk County Department of Health Approval .... lq / A UNDERWRITERS CERTIFICATE NO. P e n d i n g Rev. 1/81 Building Inspector FORM NO. ~ TOWN ~F SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEPu~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13129 Z Permission is hereby granted to:n , .... .g.~ ........................ ~..~~ ................ .......... at premises located at ....~...~../...%../ ~ ~...~.. ~~ County Tox Map No. 1000 Section ...... )..'i.~...,~',, ....... Block ......... ) ............ Lot No...),..~..:..,o.,.o.,.,,.:~.,. pursuant to application dated ....... ..~.~...)....~. · .................... , 19..~..~.., and approved by the Building Inspector. Fee $ ...... ,,,,~,,,, .......... Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ~uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions This application must be filled in typewriter OR ink, and submitte~cp!~cct= 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. 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. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling / 3. Copy of certificate of Occupancy $1.00 landuse--Pre~Existing C.O. $15.00 Vacant land C.O. $ 5.00 New.Building .~.'F~,..u~-.~. ·~ .... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .................. : ...................................... Owner or Owners of p rH:;~rtNyO..~..~,,~.,. ~ .... ~..~_~,..~ .......... County Tax Map No. 1000 Section .... /.~..~Z.. !..' Bl¢ck... l ........... Lot.../?!..~.~...~. .... Subdivision .................................Filed Map No ........... Lot No .............. PermitNo. [~[,~,~ Date of Permit .~..-~?.Y..Applicant c'~.. ...,. ~ ......... Labor Dept, Approval ........................ Health Dept. Approval~ ...... ~ ~!-~[°¢~/ Underwriters Approval ...... . ,~..'?'?, ~ ..........Planning B(~ard Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building_an~trni~'~eets all applicable codes and regulations. Applicant ........................... · loo~381 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY , 85 JOHN STREET, NEW YORK NEW YORK 10038 ,ate AuguSt 15, ).984 .~p, llc~,~o.o,,.m.~ 284537'~84 N 655415 THIS CERTIFIES THAT ottly the electriea! equipment as described below and introduced by tl~ applicant named on the above application number itt the premises of ~mste_n L~I. Hospital~ M~in Rd. Laurel~ NoY. "DOctor's Office" in the yollowlng location; [] Baseotent [] 1st FI, [~ 2nd FI. Section l?lock Lot wasexamlnedon A~1~. ~ ~.9~ a.dfo.ndtobein~'omplia.cewiththerequire.~entsofthisBoard. FIXTURE i FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT DIMMERS SYSTEMS OTHER APPARATUS: E R V I ¢ HO. O COND OF '~C, CONO. NO. OF NEUTRALS A. WG OF NEUTRAL Jod¥ Pumil lo ' Pat ~ttztuck,N.Y. 11952 must not be aJtered in any manner; return to the office of the Board C~P~f~B BglLOING DEPARTMENT. THIS COPY OF CE~IFICATE FIELD ~OU,'DA~'IOII (15t,) FOUII~)A',~ [Otl ( 2nd ) ttOUGH FHAME & ?LUMBING 3. I[ISULATION PER N. STATE ENERGY C,ODE ADD1T'[ONAL COMMENTS: 'FORM NO. 1 TOWN Oi:: SOUTHOLD BUILDING DEPARTMENT TOWN HALL ,, $OUTHOLD, N.Y. 11971 TEL.: 765-1802 ..... Approved.. . .... Disapproved a/c ..................................... Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... 19... 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 code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. . .......... (Signature of applicant, or name, if a corp_ora~tion) .... ............ (Mailin~ address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, pluml~er or builder. Name of owner of premises . .~..~..~.F..~ ./~ .ff .... .~..o.~..47....zT-.~./.(0.~..~......~..~.~..t..7~.Q..Lr .................... (as on the tax roll or latest deed) If a,l~li~ant is a corporation, signature of duly authorized officer,,._ ,~ AFPI10¥[I) AS NO?El) ~[~'~~ ~' NOTIFY BUILDING DEPARTMENT AT Builder's Liccnse~t~b[~t~.~.~. ~...'~:'.".:.~ .... 7654802 9 AM TO 4 PM FOR THE ,t~,~,~ ~ t~r~ ~!!'~/ FOLLOWING INSPECTIONS: Plumber's Licensi~4'lJP' '%g ~,; :, t, ?, '~,'::" '. ' !},'[' :,"~i!~,'/JJ~'~'~:¢~M~% [~'~r~'~ l. FOUNDArION - TWO REQUIRED FOR POURED CONCRETE Electrician's License,~i~;}..'.:.'.:,i'..frt'e?t;.~).[~.~Ug-~ ~1 I~ 2. ROUG',--FRAMING & PLUMBING Other Trade's L]cet~ ~o ........ fli.,,,.~,. ',,~i~','t%~ .... 4. FINAL - C~,~'?FqU' r!qN MUST l. Locahon of land oi~c~}bm~l~o~ done ................ ALL. DO~Sq ~U~¢!ON · 8H.AM,. MEET. · ·. TNE RE~ Rrt% NTS OF THE N.Y. House Number -- Street COD~ml~OT RESPONSIBLE FOR DESIGN OR CONS-rRuC~O~ County Tax Map No. 1000 Section ...1~.~: Ce ....... Block ..... Q(: ~ ¢ ....... Lot .... ~([': ~ .'~ ..... ~ pN Subdivision ..................................... Filed Ma o .... ~ ........ Lot .... ~ .......... (Name) 2. State existing use and ~ccupancy ~f premises and intendedgs~and ~ccupanc~ ~f pr~p~sed~ c~nstructi~n: a. Existing use and occupancy ;. ~3Z~' ..~... r~.(~:~ :~J~..~..'~'.'. ...... ; ........... b. Intendeduseandoccupancy' ' r/ ~' ~ ~o~s~/~ ~, 3. Nature of work (check which applicable): 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 pnits .... .O .......... 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 ~dS/~.~..~..~.~..~.~c. ¢.6... 7. Dimensions ofex~st~ng structures, ~fany: Front ............... Rear .............. Depth ............... Height ............... NuN her 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 ............... Rear ............... Depth ............... Height ............... Number of Stories ........... a ............................................ 1 I. Zone or use district in ,which premises are situated ..................................................... 12. Does proposed constructi, o? vioiate any zoning law, ordinance or regulation: .. ~v~]~ ......................... 13. Will lot be regraded .. t~'..~....i'. .................. Will excess fill be removed from premises: Yes No Name of Architect i t, Address Phone No Name of Contractor ......... i .... (~ ............ Address ................... Phone No ................ 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 gumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YO K, S S COUNTY OF ~ ..... i ' · (Name of individual signlng contract) above named. ! ............. being duly sworn, deposes and says that he is the applicant He is the .~A/,~7~ .~./.C:'. ~.~ .F?. ~..~'T. ~ ~/D~ ~ .............. (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is dul~ authorized to perfom or have perfo~ed the said work and to m~e and file ~is application; that all statements cont~ned ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~ner set forth in the application filed therewith. Sworn to before me this .................... y ~ ......... ~.%.~.., ,~./. lO TITL'~ INSURANCE COMPANY ~16) - 7?7-445§ 9 TITLE NO ~ F~ ~I~ER AND ~ NOT ~