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Home My WebLink About12827-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.g.q.3.. 6..8.7 ........... Date ....... .d.u.n.e.....3 ................... 198.5. THIS CERTIFIES that the building Addition & ~lteration Location of Property ~790 PVT. #7 (Diedrick's Road) Orient House No. Street Hamlet County Tax Map No. 1000 Section .0. ! .8 ........ Block .0.3. ............ Lot . .0..0.5 ............ Subdivision ............................... Filed Map No ......... :Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... D. ?.c.... ! .5 ....... ,19¢.3.. pursuant to which Building Permit No. ] .~.8.2.7. Z. .............. dated ..... a.a.n. :..5. ................ 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 ......... for addition and alteration to existing dwelling. The certificate is issued to ....~ 9.~.qT .~Y..~.... 3.~.~.0. ? ?..a.. 43.~.~.T' 7....s..~37.s.°..~ ............. (owner, I~l[ l[tX~q~l~ X of the aforesaid building. Suffolk County Department of Health Approval .. iq/A UNDERWRITERS CERTIFICATE NO ............... {) ~I.6.~ ~ 7.4.2. ......................... Building Inspector Rev. 1/81 FOlt~ NO. ~ TOWN OP $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO 12827 Z Permission is hereby granted to: at premlses located at .......................... ~ .......................................................... ~ ...................... ~ ........... ...................................... ~..~.~..... ~:. ~..-./. ...... ~.~ ~. ~ ~... ~ ~ ........... ..................................................................................................................................... ~..~.. /~ ~ Coun~ Tax Map No. 1000 Section O/~ Bilk ~ ~ Lot No. ~¢ 5 pursuant to application dot~ ~~x~..~ ....... , 19. and approv~ by the Building Inspector. Fee $..,~..~7. ........... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate 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 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. $5.00 Date .... ~.l~t~..'~...I.~...~..'~. ..... New Building ............. Old or Pre-existing Building ....1,~. ....... Vacant Land ............. ........... ... Location of Property . [.'7~jo .'~.r',!,'.~...'!??.~..?~.7 ........... ~ ............. ~ House No, Street Ham/et Owner or Owners of Property ~..~.~.~..T~. ~...~....~.~..l~p..1~. ....... .~...~.10.~...~....~..~.~..~.~.~, .~.~. ......... County Tax Map No. 1000 Section ...~.[~. ....... Block .....~ ......... Lot....~..'~, ......... Subdivision ................................. Filed Map No ........... Lot No .............. p ' JZ~7~-' Permit~.~.~,, .I.~,~..Applicant ..~.¢...o~.. h.l~"~,~,e,"~,. ermit NO ........... Date of Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approva~. ~ ......... Planning Board Approval ...................... Request for Temporary Certificate .... Final Certificate ee bmi te '/' 0,~ ~.;f~/7 F Su t d$..~.; ....................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ..... ~ ......................... nev. a- 0- a FIELD ~SBE~TION COMMENTS FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CeDE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 / TEL.: 765-1807~,, .... ,:/ .......... Approv ~..~ ..... , 1~¢: Pe~it No.~'~. Disappr~d a/c ...... i CW. ...... ........ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .... ~ .1.~ 19 ~.~ INSTRUCTIONS a. Tins application must be completely filled in by Wpewriter 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 applicau~ agrees to comply with all applicable laws, ordinances,~building cgde, housing code, and regulation__s, and to admit authorized inspectors on premises and in l~u~ilding.f~or necessary inspectiqns. ...... .......... -- (Signaturg/of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect,, eqgineer, general contractor, electrician, plumber or builder. of owner of premises~'~ ~[{~._~-.t'.,-.,..-,t .r-. ........ .... : ....... ~ .......................... Name (as on the tax roll or latest deed) ff 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 ....... i ........ '}.. 5 .. ............................ Street House Number Hamlet County Tax Map No. 1000 Section ...q~).[~. ......... Block ...~. .............. Lot...~'~ ............... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of promises and intended use and occupancy of proposed construction: ..... . a. Existing use and occupancy .O.~..~.. F.&.?!~.~.Y....b..~.~.L.~.!¥..~.. o. .. ' ....................... b. Intended use and occupancy .... .~P.?. ~.-....V?. ~.T ?... ',~.~.LLt... ,F.~.C.~.-. ,..~..~...C.T.I~..~'T??.' .?...-r.~.~ ........ Nature of work (check which a~plicable): New Building .......... Addition .......... Alterati~ .~ .o.~.~.kW'(.~. Repair .............. Removal .............. Demolition .... }: ....... ,. Other Work. i~gg_: .... /~ t"$ . -- ~-,x ~ _~ /,~ ~O ~-~-- ' . (Description) Lsumarea uosr .... ¥. · .[: ~'. ?...~. .................... Fee . .-r: .................................. ~ '/ ' (to be paid on filing this application) 5. If dwelling, number of dwellinglunits ............... Number of dwelling units on each floor ................ If garage, number of cars .... i ................................................................... 6. If business, commercial or mixe~ 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 .................. ~-'x Depth ................... ~.. Height ...................... Number of Stories ............... ~ Dimensions of entire new construction: Front ............... Rear ............... Depth 12.~.'~ i ........ · h t * -~' ~ .~. f:. Helg ............... "N~.::: u ~ ¢" "qT.~. ---- ,' ......... ~3; .......................... 9. ~lze of lot: Front . .qt. IS~ .......... Rear ...... ~/pth . ./..Z~..o..~ 3 ............. 10. Date of Purchase ti: ' · ~ .................. Name of Former Owner ........................ (~ Zone or use district in which premises are situated., t~¢¢ ............................................... 12. I)oes proposed construction violate any zoning law, ordinance or regulation: ................................ 1~.. Will lot be regraded ........ ~' · .................. Will excess fill be removed from premises: Yes No Name of Owner of premises ~.~/q.o.~/.~.~.~'A~ .. Address~'O~..$09..C..~.~.~..o .~. Phone No. 7~.d. 9.,.~(. Name of Architect ~ .~.' ~>'¢t .,~ .~','~.' ...... .... .'3.~ ~'..~:.f..~. ............. Address ............... Phone No .... Nazne of Contractor ........ i ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly al~ buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether interior or corner lot. { / , STATE OF NEW YORK, S.S COU,N/ OF ....... (Name of individual signing contract) above named. .......... being duly sworn, deposes and says that he is the applicant 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 apphcahon; that all statements contlmned m th~s application are 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 ' ...... ...... ......... ..... Nota~ Pub,lic~4~ .~~ ...... ~ t / ] / / ; .. NOTAI,YPU LC, State I ~ , ' ~v : ........... .... ........... ,7~ · (Signatu~apphcant) Qttalifie~ in Sul~olk County Commission E;qpires March 30, 198~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY Oc'~o~1oor 0~,~ 1~,[ 85 JoHN STREET, NEW YORK. NE~O~8 ,.,~ ~,,,,~.,,0.~..~..~,,. N 662742 THIS CERTIFIE~ THAT only the electr~al eq~jp~ne~t~ described belo~ ~d introd~ce~_~c~ed on ~he ~e ap~%atlo~ nulgb~7 in the premises of in the following location; ~ 8~,ne~t~ 1st Fl, ~ 2~td FL Section Block Lot was examined on 0~0~ (~': A~'~ and~ound to be in con~pliance with the require~nents of this Board. FIXTURES RANGES OVENS DISH WASHERS FIXTURE DRYERS C NO. OF HI-LEG OF HI-LEG OTHER APPARATUS: Arthur ~u P~ad L~C#~3~ This certific<~te must not be ahered in any manner; return to the office of the Board if ipcorrect. Inspector~ ma), be identified by COPY FOR B~iLDING DEPARTMENT, THIS,COPY. OF CERTIFICATE I1 ~J ANY MANNER. / 9 rq 0 0 0 b [? / f-