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Home My WebLink About13170-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .... Z..1.3.7.7.. 9. ....... Date ......... .~.~. $ .u?.~ .~.6 ............. 198..~. THIS CERTIFIES that the building .......... .~?.w..D..w?.l.~..ncj ........................ Location of Property ,.4..6.0.. ......... Colonial Rd. SouLhold t~ouse No. Street Hamlet County Tax Map No. 10O0 Section .... .0.7.9. .... Block 06 .Lot 028 Subdivision ........... .X. .................. Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·...M.a.y...2.4 .......... 19 .83. pursuant to which Building Permit No....1.3.1.7..0.g ............ dated ...... ~...ay...3. 1. .............. 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 ......... The certificate is issued to LEWIS, BURT G. JR. (owner, le~se~er-tena~.t) of the aforesaid building. Suffolk County Department of Health Approval 14- SO- 117 N671666 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 IPOILM bO. :B TOWN OF SOUTHOLD 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? 13170 Z Permission is hereby granted to: , ^ . ..~~~...~.~..~.:....~ ... ...... ~, ,I/.7. . ~.~~.; ........ :.~., .......... o, ,,,mi~, Ioca,ed o, ..~.L..~.~....~........~..~ ..................... County Tax Map No. 1000 Section ...... ..O...-/....ct ........ Block ......... ..~.. ......... Lot No. pursuant to application doted .............. .~ ..~...~ ......................., 19~...~.., and approved by the Building Inspector. Building In,q:~:tor Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 TOWN APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ~ ~ 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" )and uses: 1. Accurate survey of p~Coperty 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 $15.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. '$5.00 Date ....A.u.g... 16,1985 New Building X Old or Pre-existing Building Vacant Land Location of Property 460 ..... Colo.n, ial. Rd.. . ......S°uth°td House No, Street Ham/er Owner or Owners of Property Bur% G. Lewis Jr. County Tax Map No. 1000 Section 079 Block 06 028 .............................. Lot ................ Subdivision ........... .X. .................... Filed Map No ........... Lot No .............. Wind. way ?rp. 1' (Robert: .W. en 1 Permit No .... ,3,1.7.0, Z,, Date of Permit .5,/.3, .1/.8.4. .Applicant .............................. Health Dept Approval 14 - SO - 117 ........................, La bor Dept. App roval ........................ N671666 Underwriters Approval ........................ Planning Board Approva~ ...................... Request for Temporary Certificate ..................... Final Certificate ..... .X ................ . Fee Submitted $......5.0.0 ...................... Construction on above described building and perp~i~'meets all applicable codes and reg,ulations. Rec. ~q tqD Applicant . ..~ .......... c.o~v~qqq THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10036 only ~he electrical equipment as described below and ~ntroduced by the applicant named on the above appllcat~on number in the premises of ~lnds Way ~llding C~z~. E/8 ~lonial ~ad, 5~' N/O ~'s ~ ~utb~ld, N.Y, in the following Iocat~o,,; ~ Basement ~ 1st FI. ~ 2nd Fl. ~eetion Block Lot was examined on ~II~IU ].0~ ][~84 and found to be i,, compliance with the requirements of this Board. FIXTURE FIXTURES RANGES OVENS DISHWASHERS EXHAUST FANS OUTLETS SWITCHES NCANDESCENT FLUORESCENT DRYERS FURNACE MOTORS FUTURE APFUANCE FEEDERS TIMECLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT S E R V I C E OTHER APPARATUS~ i~Jto~; 1-4.5kw. Iht Wate~ IIeatel'. NO OF CC, COND A W, G. NO, OF HI.LEG A W, O 0 NO OF NEUTRALS OF NEUTRAL Rilaud El(:~t tic P. O. Eox 143 I~la"~tltuck, N.Y, 1195~ GENERAL 11 This certificate must not be altered in any manner; return to the office of the Board if incorrect, may be identified by their credentials. COPY FOR B LD NG DEPARTMENT TH $COPY OF CERT F CATE ~U T NOT BE ~LTERED N ANY MANNER TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTO~ P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No.~~_ Owner ~'~ ~t~ (please print) Plumber ~/~ ~ Z (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber' s signature) Sworn to before me this I~~4~ day of ~ ~C~ , 19~_~. Notary Public,~-~[~ County Notary Public NOTARY pL/~LIC, 9~,~ ~ Now YO~ .I:OUHDATIOI~ (lst) ( 2nd ) FRAME & PLUMBING 3. 7NSU[,ATZON PER N. STATE ENERGY C,ODE ADDITIONAL COMMENTS: 7G5-~.802 BUILDING DEPT, INSPECTION [ ] FOUNDATION 1ST ~)~ ROUGH: PLBG. FOUNDATION ZND [ ] INSULATION FRAMING [ ] FINAL REMARKS, /~, ~ ~ ~ DATE 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined...~4 .o~ .~>[ .... , 19~. ?. Approved ........XV~ . .~ ~J.., 19~fl. Permit No. ! ~ / .~..0..~.. Disapproved a/c ..................................... ................................ ...... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tins 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 insl~cl~ons. ..... ...... (Signature of applicant, or name, if a corporation) ·/.0. ....... (Mailing address of applicant) State whether applicantt~is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nameofownerofpremises glx°~ ~' {~,_~VJ ~ ~x , (as on the tax roll or latest deed) If applicant is.~4%~oration, signatu~authorized officer. Builder's License No .......................... Plumber's Licen'~e No.../~....~..W~...(..~_ '.. ·..~'~'~ Electrician s License t~o.. t.: ................. Other Trade's License No ...................... Location of land on which proposed work will be done ................... ' ............................... House Number Street Hamlet County Tax Map No. 1000 Section ...... .~ .'?.~ ..... Block ......... .~ ....... Lot ..... .~....~ .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: : a. Existing use and occupancy ............................................. .' · "6~: ................... ~ b. Intended use and occupancy ....O./..d.~.~... ,~ ...~..aTL~..tr..,yt.':~Z4:.(~,.~ ~,~,il.l~:~ ~ .'~' ....... ..... ,da~o.~ *"'~'"~'~2':,2:A'~gdg~:~ ....... 3. Nature of work (cheek which apphcable): New Building ..... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ,' (Description) 4. Estimated Cost ..... ;. C9 ~ ......... Fee ...................................... ' '~' (to be paid on filing this application) 5. If dwelling,, number of dwelling!, units ....... O..~.~.. ~..r- ...... Number of dwelling units on each floor ........... Ifg m c s ~ ~11~ arage, nu bet of ar .... . ........................ ' .............. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ........... Number of Stories ........................................................ Dimensions of same structure With alterations or additions: Front ................. Rear .................. pth ~ 'ght ' De ................... :... He~ ....................... Number of St ~.~ orles .................. 8. Dimensions of entir, e new constrUction: Front .~.0.'.~ . Rear ~.1~ / ~ . Deoth ........... 9. Size of lot: Front ...... [,~'-~. ~ ........... Rear ...... ]~.~ .~ .......... Depth .. ~r..~..I ............... 10 Date of Purchase '..-7T77...- i Name of Former Owner 11. Zone or use district in which pr~mises are situated ..................................................... 12. Does proposed construction vioilate any zoning law, ordinance or regulation: .............................. 13. Will lot be regraded ....~...t-~..r~ ..... :.., ......... Will excess fill be removed from premises: y~e~ '(~ Name of Contractor .Name of Architect . '~.-.-, .']~-~J ' ';1~ ..... t~ .,.. ,~ .....Address ................... Phone No .... .~ ........... PLOT DIAG~M Locate cle~ly ~d dist~ctly ~1 bufld~gs, whether existing or proposed, ~d, indicate ~1 set-back d~ensions from ~' r~xry ~nes. Give street ~d block number or description accord~g to deed, ~d show street names and ~dicat~ whether ,~iicllor or corner lot. STATE OF NE~MK.~ ) , / COU~Y OF .5~~.~ .~,~..~ ~ ~ ............ ~ .%~ ~P. ~.W.~ ......... being duly sworn, deposes ~d says that he is the applicant (Na~e of individual signing contract) above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is dul~ authorized to perform or have perfomed the said work and to m~e and file this application; that all statements cont~ined ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~ne} set forth in the application filed therewith. Sworn to before me this .......... ..... dayo ......... ,.. }.~.., 19 Nota~ Publ · ~~. .... County 8 O'og! (,~.N '¢.)¥^ ) '8 '5 0 0