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Home My WebLink About14414-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z14845 Date September 2 ........ 19 8.6. THIS CERTIFIES that the building ....A.d..d.i.t.i.o..n ................................... Location of Property .... ~.7.0.. ~y..~.¥.E.. ........ ~..A.S.~..~ .~.R.X. QN. ........................ House No. Street Ham/et County Tax Map No. 1000 Section ... Q ~ .1 ...... Block ...q 8. .......... Lot ..... 0.0.6. ........ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. $.e.p.~,. o3 .......... ,19..8. Spursuant to which Building Permit No. 1.~4.1.4.Z. .............. dated .... .O.q~. :...3.1. ............... 19..8.5, 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 ......... Bedroom addition to existinq .d.w.e.l.l.~.n.g.: The certificate is issued to ...... .G.E.O..R.G.E..&...K.O.U.I~.b..N.E..~..O.N.I.~. I..S ....................... (owner, of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO ...................... .iq7. 4. Q.0.9.1. ................... Rev. 1/81 ffOR~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION aP THE WORK AUTHORIZED) NB 14414 Z Permission is hereby granted to: ......... ~/~-~.~.-~..~../~.... ~. ~.,. ........... .......... ......................... ,o ........ ~.~.~.....~o.~.....~z~a~.....~O...~.~... .... ,~=~.~ ....... ~ ....... ~ .......... ~o..~..~ ........ ~...~~ ................... . /~ ....... U ........... ~, ~,~,,,. ,~.,~., ........ ~Z~ ................... ~ .~ ............................................. County Tax Mop No. 1000 Section ....~.......~.../. ........ Blcx:k ....~..2. ........ Lot No..~..~..~ ........... pursuant to application doted ...... ~. ~...~.~..~......~.. .... 19~.....~and approved by the Building Inspector. Fee $......~.CQ.. · .~..'~.~.. 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: I. 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 5. Updated C.O. $15.00 Date. NewCons truc lion ...... Old or Pre-existing Building ............ Vacant Land ............. Locat,on of Property ¢. ....... ............... Hou~ No. $treet Ham/et Owner or Owners of ,rope~y .~*~..~_~.. ~ ~.~.~...~ ~ ~ .~/ ......... Subdivision ................................. Filed Map No .... ~ ..... Lot No. , .r .......... '. .... Permit No. ~.7 [.' ~... Date of Permi ~..Applicant .~. pt App ~ ~" Labor Dept. Approval h' ~', ......... Health De . royal . .' ................................ Unde~ritors Approval . . ~r .................... ~[annin~ Board Approval Request for Temporary Certificate ~ ........... Final Certificate Fee Submitted $...~.'.d, .q .................... Construction on above described building and permit meets all applicable codes and regulations. App,cant.. ............................ Rev. 10-10-78 d.o. 2 /V&V'f- ¢ FIELD INSPECTION COMM~N't'b FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE ~ FINAL THE NEW YORK BOARD OF FIRE UNDERWRITERS ~DO~.07] BUREAU OF ELECTRICITY ~k~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electrical equipment as &scrlbed below and introduced by t~ applicant ~d on t~ able application number in t~ premises of Neomini. t:[s~ Bay Ave. ~ East ~4arion~ N,Y. in tbe/ollowlng location; , ~ Basement ~ 1st Fl. ~ 2nd FI. Section Block Lot wasexamlnedon ~C~ ~(J ~.~]{~ andfouadtobelncompliancewiththerequiretnentsof thisBoard. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES , FLUORESCENT 4 7 DRYERS SYSTEMS NO, OF FEET OTHER APPARATUS: S E R AW, G, OF CC COND. C OF HI-LEG NO. OF NEUTRALS Smoke Box 21.5 Southold, N~Yo~ 11971 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified GENEI~AL MANA'GER 11" ,.? "~h~ir credentials. COPY FO~ BUILD NG DEPARTMENT THIS COPY O~CERT F~ICA~TE ~U$~T NOT B~E ALTERED IN ANY MANNER. BUILDING DEPT. INSPECTION FOUNDATION XST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: ~FINAL FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ........ w...~: ............. (.~...; .... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS i TOWN OF SOUI'HOLD Application No .................. a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 issue 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 buildings for necessary ~nspections. (Signature of applicant, or name, if a corporation) ......... ~..~ .... /...~ 9.'! .... (Mailing artdress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................................... .... ........... ....... Name of owner of premises...~.'..~...~..~ :... ~D4-.~..a.~a.?o~:~.'-~e.~?o. li 'oL'~(~'~d'7 '~' '~/"" '~"O'd~4 'F~' ' ' '~) ....... If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No... ,2..~..~. ............... Plumber's License No ......................... Electrician's License No. Other Trade's License No ...................... 1. Location of land 'on which proposed work will be done .................................................. .......... .7. ....... ...Q. .............. House Number Street Hamlet County Tax Map No. 1000 Section ...... -~. ! ......... Block ..... ~. ........... Lot...~ ............... Subdivision ......... ~-T .......................... Filed Map No ........ '.~ ..... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . ...~L4xA..~B..-c/~,~4....~_-,~7~.~ ......................................... b. Intended use and occupancy '..~.o..~c~..~,~,~J~.g~-~.~... ~: ~ ~; ~ 3. Nature of work (check wti~el~ applicable): New Building .......... Addition .......... Alteration ......... Repair .............. Rernc~val ........... '... Demolition .............. Other Work ............... : ~ ~ - I~,, !,..~,~ .k~ D_(2~) (Description) 4, Esl;~,'~,at~ed~.o,,s~... -/. ~ ~,, '. "' ..' ',,LL ','" '~ ....... Fee ...................................... i .~ J:: - . ~ , (to be paid on filing this application) 5. IFd~wellifig,//umb6r of dwelling pnits ............... Number of dwelling units on each floor ................ If garage, number of cars ..... : ................................................................... 6. If business, commercial or mixe~ occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structureS, if any: Front ..... 2- ~Z-v. .....Rear .... .'~.~ ..... Depth . .5.0.. ~. ........ Height . .. l .it/ ......... Number of Stories ...... / ................ ~ ............................ Dimensions ?.(f same structure with alterations or additions: Front ... 3..~. ......... Rear . .'.~. (o ............ r)epth .... '~..~ ............ i.. Height ...... /..~. ............ Number of Stories .... /. ................ · i . h 8. Dimensmns of entire new construction Front ............... Rear ............ ... Dept ............... Height ............... Number of Stones ........................................................ 9. Size of lot: Front .... /..O-.~[ .I ........... Rear .... ~../.O.q/ ....... Dep~th . './~.~..~2-,-..3.L~.O ..... 10. [?ate of Purchase . .. ]:Q.~ ~g.l .................. Nd,me of Former Owner .~.~,,~}~.&. · .~,,~o~.(~G.~ ...... 1 1. Zone or use district in which pr6mises are situated..~>~,c~,~J~ ..................... ~.d.. ......... 1 2. Does proposed construction ,vioiate any zoning law, ordinance or regulation: . ...~-/C.. 77 ........................ 13. Will lot be regraded ...... 1.~..- ................. W~ll excess fill be removed from premise: ~ No 14. Name of Owner of premises')/hxi,~.~s.,~ddress . .~..c~..,~....~...~... Phone No ............... Name of Architect .......... ~ ................ Address ................... Phone No .......... ~., ..... Name of Contractor ~.~...~.~.,~,,(- ..... Address .~. cJ20- . .~-~%. / )~TPhone No.7~ f.-r ~. ~'.. [~... 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. STATE OF NEW YORK, S.S C~...~~QI~~ '.~~r' ~,~,. · r~ · .. · · · .................. being duly sworn, deposes and says that he is the applicant (Name of individual sig¢ing contract) above named. He is the ............................................... (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 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 man~er set forth in the application filed therewith. Sworn to before me this ................. ~."..(~...day Of .... .......... 19 ?. ~! ..'~.'i.4.~V~/...~::~.. County~.(~~~ . Notary Public, ........ 8[I~K. 0[~ ! ., · .... ~0r~V ~StlC. S~ d~.,.~ ~ (Signature of applicant) No. 4707878, Term Expires March 30,15.~7 i