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Home My WebLink About14714-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy z~48~2 Date .... ~ ~.o.t. qr~b~..5, ............... 19 86. THIS CERTIFIES that the building .. Ing~.ound..swimmJ. ng..p.o o.1. ~..~e nos ........ ' Location of Property ,995 D.e,e'~,£oo?,,P,a,6h.~. ........... C.u,t,c,h,o..g,u.e...~,.,Y,.. .......... House No. Street Ham/er 103 04 7 County Tax Map No. 1000 Section ............ Block ............... Lot ............... r' ' Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ~.~.p.c..~..2.5. ~ .......... ,19¢. 6.. pursuant to which Building Permit No...~ .4.7. ~ 4. g ............ dated .. ?. ~..c .h..2. ~.., ............... 19.8. 6.,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 .~ .o.b.e.r.~...D.o.~. o. a..k.~ .......................................... (owner, of the aforesaid building. Suffolk County Department of Health Approval .... ' N/g UNDERWRITERS CERTIFICATE NO ......... N 75 2667 Building Inspector Rev. 1/81 FORM NO, ~ 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) 14714 Z Permission is hereby granted to: ..... ........... ~.~...~,.~...9. ................................................ ~...~....~.:...%..u.~..~...~. ,--~ ,o ..~...~;~,L~.~..~.~.....,....~...¥~...~ .... County Tax Map No. 1000 Section ...... I...~...,.~ ....... Block ...... ..~..,,~. ........ Lot No. ~ .................... pursuont to opplication dated ...~.g~r..~....~.~,.'~.. ............ , 19.~..~., and approved by the Building Inspector, Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted m ~ 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 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), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p2bperty 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 $15.0 0 3. Copy of certificate of occupancy $1.00 5. Updated C~o.~ $15.00 Date '~' NewConSgruct ...... Old or Pre-existing Building ............ Vacant Land ............ Location of PropertyHou~'''¢'~'''No. ..... "~'~~Street ''~~ Owner or Owners of Property ...~ ~~~ ..................... Countv Tax Map No. 1000 Section .~ ........ B,ock ...~ ......... Lot..~ ......... Subdivision , ~~ . . .~ ......... F,led Map No~ ~...Lot ~o .... ~ ...... Permit No.j~Z~ZDate of PermiO~Applicant. ~~.. ~ ~, ..... Health Dept. Approval ........................ Labor Dept. Approval ....................... Underwriters Approval/.~. ~.~. ~,..~. ~...~. .... Planning Board Approval ..................... Request for Temporary Certificate ..................... Final Certificate .. ~ ................ Fee Submitted $ .... .~., .~..~.. .................. -Construction on above described buildin~)~rmit meets a~applicable .codes and regulations. App can .......................... Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS 1. BUREAU OF ELECTRICITY ~T~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~ate ,n'~ 3, ~9a¢. Ap,,lic.,o. No. on/,e 4003C~/8e N 752667 in the following location; [] Basement wasexa~ninedon ~y ]5~ ].~ [] lstFI. [] 2nd FI. O~d~ Section Block andJound to be in compliance with the requirements of this Board, ] 1 '2 Z DRYERS FUTURE APPLIANCE FEEDERS TIME CLOCK UNIT HEATERS MULTI-OUTLET DIM/VIERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R i~ RCC,~ A. WG NO O E COND OF CC, COND. OTHER APPARATUS: 1-Go 1L Co I, I C E NO. OF HI-LEG A, W, G NO OF NEUTRALS A, W, G. HI-LEG OF NEUTRAL Judy ~Rmmt 1 lo Lic. #2300 This cerfificote must ant be oltered in any menner~ return fo lhe offke of the ~oord if incorrect. Inspectors may be identified by their credentials. ~_I~ANY MANNERi COMMENTS FIELD INSFECTION 1. FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & FLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: LOT-~ ~ lq, 7~50~0"~ 125.00 · FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved .~. · .~..~..[..., 19 .~.~. Permit No. ! .~.~. t.~..~.., Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT BLDG. DEPT· TOWN OF SOUTHOLD Received ........... ,19... Date ........... 1 ~.. f}~_~[[~:t;., INSTRUCTIONS a. This application must be compl~f~l,~j~i~..~tp~v typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. F~,a~fi~:~ sched e. b. Plot plan showing location of lot afi~~s on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of la~q[dk..-~_roperty must be drawn on the diagram which is part of this appli- cation. - ~q.~,)% f4' c. The work covered by this application may not~??ommenced 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 tt~e~Building In~p[~ctor. APPLICATION IS HEREBy M~AD.~ ~o [he Building Department for the issuance of a Building Permit pursuant to the Building Zone Or3inance Of th~ To~/n':o~ ~J~t~l.c~vS, u£~folk County, New York, and other applicable Laws, Ordinances or Regulations, for the. construct!bn Uf build~i~[,~'~(~i~p~is or alterations, or for removal or demolition, as herein described. The applicant agrees to C~mply with all l~?p~b~le l'~vS; ordinances, building code, housing code, and regulations, and to admit authorized inspectors oh prem~ses 0~I m ~mldmg for necessary ~nspectmns. :. ' : ~f ...... :., ..................... .- ........ · ........ "~,, ,~ (Signature of applicant, or nam_~e,Xf a corporation) (Mailing address of applicant) ]Y94~l.. State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. ........ .......................................................... Name of owner of premises ...... .~.O11 ~.'gg.T-. ..... i~O..t~.O$.l~. I ......................................... (as on the tax roll or latest deed If apl;flf0gj~t is a corporation, signatur~ 9f duly authorized officer· .......... (Name and title of corporate officer) Builder's License No ....... i/.O. ............... Plumber's License No ......................... Electrician's License No..p-I ~.~JcrtA~...../.~.'~ .~.q ~'Y& C_ Other Trade's License No ...................... 1. Location of land on which proposed work will be done../~.O..~.~.~...QO, q~.~j .... C.~4. ~,./~o. ~.g/~'.. ~.~ ~. ..... .... ?.75 ........... .... ............ C.u ........... House Number Street Hamlet County Tax Map No. 1~)00 Section [ ~-Q> Block ~ Lot ~'] Subdivision....~.:~ .%.~'~ ..... Ct~..~.~.'-'. ............ Filed Map No.. 3.~..3..~ ..... Lot ..... 2 ........ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................... /~...~../~.~..~. ~.t~ to b. Intended use and occupancy ~ ~:~ !/~/L--~O Y f P]X~ 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .. ~' ....... Alteration ......... Repair .............. Removal .............. Demolition ........... i.. Other Work. ~tZ,~.. /J~.~',.¢.~. ~ ~.~..9 ~tdf,~n'tt~v.~ /l~a~. ~ /"-.-'~?Vc~-'- (Description) 4. Estimated Cost .............. '...OXD. ................ Fee .......... ~ ........................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling uniti on each floor ................ If garage, number of cars ............................................ ~ ........................... 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 .................. Depth ...................... Height ...................... Number of :Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear .' ............. Depth ............... Height ............... Number of Stories ...................... , ............... 9. Size of lot: Front ..... /~ ~..~. l ........ 1~;;~ i'i ii i i/~i,~ i ........ Depth . .Y~'.'~/-'. ~.~ ........... 10. Date of Purchase ............................. Name 9_fFormer Owner . .................. 1 1. Zone or use district in which premises are situated .... .... ~/~.¢t~./.~.~:~.~'-./. ~. 9:.. "~'0 ...................... 1 2. Does proposed construction vinlp~te any zoning law, ordinance or regulation: .... i...~..U. ................. 13. Will lot be regraded ....... ..~.~.0. ..... z ........... Will exc_ess~fill be remove-d-from premises:' ~ ° ~o 14. Name of Owner of premises-/t0~.~. T.. ~.~.~a~./.(J... Address .Q' .~.~..~9..~.~.. ,~. i.~.o.. Phone No ................ Name of Architect ........................... Address ............... .... Phone No ....... . .....~. Name of Contractor ~.: ~ .~..¢-~. ~., &.~t. ~ ...... Address .~)'t lfrr-z.~..~,.. 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 number or description according to deed, and show street names and indicate whether interior or corner lot. 0GGLI? N _...,.,,L APPROVED Alt NOTED FEE: ~,a ~.___BY .... · ~ ' NOTIFY ~UiLDING ~EPARTMENT AT 765-180~ ~ /~ TO 4 PM ~R THE 1 FI')UN~A~f(:'~ ~'~NO ~/IUIRED ,7ODE~i NOT R~SPON~tBLE FOR being duly sworn, de >oses and says that he is the applicant STATE OF NEW YORK, S.S COUNTY OF ................. ..... (Name of individual signing con~r~c't) 7" ...... 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 be performed in the manner set forth in the application filed therewith. Sworn to before me this ........ · ~. ~.. .. day of ..... . .~..~ .... , Notary Public, · .~C~--,&v~.. · · ~:. · .~)..4r/.U. ~-- ...... County I~I'NtY PUBL~ ~ d ~'~ ' (Signature/6f applicant) No. 4707878, 8~f01k ~elsl~ Terra Expires 8larch $0, I· '~ ! /