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Home My WebLink About14365-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ..... Ad d ~-.t.~. on .................................. Location of Property .... 1. .47.5.. B.r.o.a.d.w..a.t.e. rs...~.qa..d ................ C..u.t,qh. 9g.u.e' ....... House No. Street Ham/et County Tax Map No. ]000 Section .1 .Off. ........ Block .... ~. 1. .........Lot ....... .5 ......... Subdivision ............................... Filed Map No...1.5. ~....Lot No .... .2.9. ~. ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... 0.c,h,. 9 .......... ,19 85. pursuant to which Building Permit No ..... .1.4.3.~. 7.Z .......... dated ...... .0.q ~.,..1.5. ............. 19 .85., 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 ......... · . ·Add. it, io.n..'¢o., .~X i~.t.J.~g..c[W~ l~[.i~g ......................................... The certificate is issued to . . M~TTH.E.W..JA.q/% .R.U~.q..~I.B..W..IF.E ... (owner, I~,~YoX'~[~X ..................... of the aforesaid building. Suffolk County Department of Health Approval ........ iq./. 1% .............................. UNDERWRITERS CERTIFICATE NO ................ .N. 7.4. .3).7.5. ......................... PLUMBERS CERTIFICATE March 18, 1986 Building Inspector Rev, 1/81 FOR~ NO. ft TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT {THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 ~4365 Z Permission is hereby granted to: ............ ....... ........................ ,Zb C~,gnr D r", .................. ~. ........................... ~...± ............................................... ~. ......................... ~ ..... premises located at ....................................................................................................... ~. ......... County Tax Map No. 1000 Section ...... Z.~...~.. ........ Block ......... //. ........ Lot No......~... .............. pursuant to application dated ........................./..~. .......................... , 19,...~:.....5'~', end approved by the Building Inspector. Fee $ ........................ 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 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 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 o 0 0 3. Copy of certificate of occupancy $1.00 o.o. $2.00 ./.¢ 5.Updated C.O. $15.00 Date ................ New Building ~J~;~.5 '~ ~.O.. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ./. ~'7~'f ~°~ r~?/~FJ ~ .~.~.~.~dq~.~(./../~.~.~. House No, Street Hamlet Owner or Owners of Property ./~. ~'~(/~ ?. ~q... d..~, ~.~'~. ~( ~: .o.. g.../~,, ./~. .................... County Tax Map No. 1000 Section ..,/.O, Z ..... Block ...,//. ......... Lot .... ~ ........ Subdivision ................................. Filed Map No ...... Lot No ........ PermitNo. ~.~..d .~?-. Date of Permit ./.~..5~.Applicant. ~.,..~,,...~/..~/7,'; .~ ............. Health Dept. Approval .. ~. r,/~.~ ................ Labor Dept. App royal ...z¢), ~.z.~?.~. ............. Underwriters Approval...~...~. ~ 2'. ~. ..J..'~. ...... Planning Board Approval ...~), .~?~. ~. ........... Request for Temporary Certificate .... J~.~..h..~ ........... Final Certificate .., .~f .~.-~'; .............. Fee Submitted $ ............................. FIELD INSFECTION 1. COMMENTS FOUNDATION FOUNDATION 2. (1st) (2nd) ROUGH FRAME & FLUMBING INSULATION FERN. STATE ENERGY CODE 4. FINAL ADDITIONAL COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS [O0070~J BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 ,,.,e ~pri~ 9,~gS0 ~,~..on~o.o,,~'~ S~S~/S~ N743975 THIS CERTIFIES THAT only the el~tr~al equipment as described be~w and int~duced by t~ applicant ~med on the above application number in the premlses of Jacaruso~ 1475 Broadwaters~ Cut. cho~e, N,~. in tbefollo~ing locatlon~ ~ Basement ~ 1st FI. ~ 2nd FI, Section Block Lot was examined on ~ ~ ~, j. [~, ~ s ~- ~ ~ ~ and foand to be i~t complta~e with the requirements of this Board, FIXTURE FIXTURES RANGES r'OOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT VAPOR DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SERVICE DISCONNECT S E R V I C NO, OF CC COND, A W.G. rio OF HI-L~G A W,G, NO, OFNEUTRA(S A.W,G, PER ,~ OF CC. COND. OF HI-LEG OF NEUTRAL OTHER APPARATUS: Sal ?rate B1 ectrictan :tic. #1049-~ ~~~"~'~ Greenpo'rt, N.Y,~ 1.194~ /~ , ~[ This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be ident~ed by t~r cred~n}iaJ~.~ ~ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE, MUST NOT BE ALTERED IN ANY MANNER. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 76.5-1802 CERTIFICATION Building Permit No. /~3~ Owner ~ ~l~a~.e print) Plumber/~(( ~ ~ ~d"~'~/~'/J ~lease print) I, certify that the solder used in thor supply system contains less than 2/10 of 1% lead. / ~ (plumber' s signature) Sworn to before me this /~ day of 19 ~_~__. Notary Public, County Notary Public 765-1802 BUILDING DEPT, INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND ~ INSUI.ATION [ ] FRAMING. [ ] FINAL DATE iNSPECTOR, ~/~/'/.,, 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-180:~ Disapproved a/c ..................................... Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 hrspection 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 inspectio, n,s.,~ ~, / .................... (Signature of appli me, if a corporation) ........ c.. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....~. q.~./~.e/dJ ..... . .J~.a-.G~t.p. td.,.~i9 ..... .~.d/~..~·. ............................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of co,orate officer) Builder's License No... ~ .................. Plumber's License No..~ff ~C... ~c..~/~. Electrician's License No..~.f...~. ~ ......... Other Trade's License No. '~-'-~ · .......... 1. Location of land on which proposed work will be done .................................................. .../f..7.J: .... ....... ........... ....................... House Number Street Hamlet ,*c County Tax Map No. i000 Section ..... /...~.4pr. ....... Block ..... 7/ .......... Lot .... ~...~..7 ..... Subdivision ..................................... Filed Map No .... ./.o'-.~. ....... Lot ... ~7~/.' ....... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: / a. Existing use and occupancy ....... ~ ..................................................... b. Intended use and occupancy ' ' '/" ' ~t/ ................. ~,~'~ &~;.~M'~c:9'~: ' '. ' ..... ' .... 3. Nature of work (check which cable: New Building ..... 'i .... Addition ......... Alteration ' Repair .............. Removal .............. Demolition .............. Other Work ............... ~ ,~ (Description) 4. Estimated Cost ~..j. ~...~., ............ Fee ,.~O, OO , '~ (to be paid on filing this application) 5. If dwelling, number of dwellin~ units .... ~ ....... Number of dwelling units on each floor...~../..~..,~'.,'~e .~' If garage, number of cars ... i 1~ .................................................................. 6. If business, commercial or mined occupancy, specify nature a. nd extent of each type el'use .................... 7. Dimensions of existing structuies, if any: Front .... ~.~...~./7 .... Rear ... '.ff~.' .~t~. .... ' Depth .... .~.~...,~..,~... Height .... ./.~. ........ Number of Stories ..... { ................................................. Dimensions of same structure ~vith alterations or additions: Front .... .~.~. .......... Rear .. ~'.~ ............. Depth ..... 'trt~ i Height /~7. Number of Stories /. - Dimensions of entire new consltruction: Front ............ Rear ............ Depth ........... Height .... ./~. ........ Nurnber of Stories Size of lot: Front ... ~-t ................. Date of Purchase .... ~.(/f. ~./ ................. Name of Former Owner .. a..- ~/*"~' .Z~.~ .~'. 1 1. Zone or use district in which p'remises are situated .................................................... 12. Does proposed construction vibl. a, te any zoning law, ordinance or regulation: . ~ ......................... 13. Will lot be regraded ....... ~ .................. Will excess fill be removed from_oramises: Yes PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, an& indicate all set-back dimensions from property lines. Give street and bloc ~ number or description according to deed, and show street names and indicate whether interior or corner lot. 9. 10. STATE OF NEW YORK, ~ S.S COUNTY OF ................. i (Name of individual signing contract) above named. being duly sworn, deposes and says that he is the applicant He is the ..................... i .................................................................... ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~ly authorized to perform or have performed the said work and to make and application;that all statements coatained in this application are true to the best of his knowledge and belief; and that the work will be performed in the mantlet set forth in the application filed therewith. Sworn to before me this Notary Public, .. County (Signat~d of applicant) ._ , j3. COi,.~TRUCTiON:E~oRS-J' 1'6, ~. L~ SOLDER USED IN WATER SUPPLY SYSTEM CANNOT .IP, XCEED 2/10 of '- .{