The URL can be used to link to this page

Home My WebLink About14482-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificete Of Occupancy No .... ~J.4.5 9 5 ....... Date ........... 4U,2-3r. .~ .............. ,19~36. THIS CERTIFIES that the building ..... p.n.e. ~ .f.a.nt~ ~ ¥..d.~. e. ~ 3.~.q g .................... Location of Property .... I.Q 1 5 ................ Y;[,c.kq p. j- ~..D. t2., ............ ~.qU t, b p.Lcl... House No. Street Hamlet County Tax Map No. 1000 Section ....7.8. ...... Block ........ 9 ...... Lot .... 5.6. .......... Subdivision ........... X .......... . ........ Filed Map No .... ~( .... Lot No ....... ;( ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ·. ~o.¥fitn. b.e.p.. 5 ........19 .~3 5pursuant to which Building Permit No ...... q. 4..4.8.2. Z. ......... dated .... D.~ C e rn.b.q ~'. 2.4. ...........1 9 .~ 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 ......... ...~.~y.a.~, 9p.o.-~ .F~/RJ,~y' .d.w.~ ~.lj_.~g, ............................................ The certificate is issued to ............. TU 9MA~. ~..~ O .13.0.T)I ¥. ~/.fi. hI~ ..................... (owner,~ of the aforesaid building. Suffolk County Department of Health Approval ............... [3 5 .-.a Q .- ~ .02fi ................ UNDERWRITERS CERTIFICATE NO ....................... ~.7B.¢ 5 7 3 ................... Building Inspector Rev. 1/81 FOU~ NO. ~ TOI,VN 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) 14482 Z Permission is hereby granted to: ...... ~.~..~o....~.....kkf../.L~.!../.~.~ ~ ...I...~...O......~..e..~..o..~...~.......~ ..... .:..D.~L~.~.~....~.~!:..~:. ............. ...... .~.~. ........... ~c-~. ~ ....... ~ .................................... ~ ... ......... . .-eZ...~.Cd ....................... ...~.~.l~..~.~.~.o.'~a~....k.,_~z.~, ................ ot premises located at ...[..~...t..~ ...... . .~....J.~.~.-~....l~':~...~..,. ................................. ................................ ~.~.,,,.l~.. ....... County Tax Map No. lO00 Section ..C~.....~....~. ....... Block .~...~ .......... Lot No.....0....~,..~. ...... pursuant to application doted '..~.....(~......'~... ......... .~. ...................... , 1 .~......~.,-~ond approved by the Building Inspector. Fe, ,.~..~.,..~-.....f. 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 BLDG. DEPT. TOWN OF,,SOUT. HOLD 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 pz~operty showing all property lines, streets, buildings and unusual natural or topographic featu res. 2. Sworn statement of owner or previous owner as to usa, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- Lion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $ Z 5.0 0 3. Copy of certificate of occupancy $I .00 4.Vacant Land C.O. $5.00 /_/.4~../ 5.updated C.O. $15.00 Date .... ,~/.~...~.-- ....... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. · ocationofProperty../.O./. ........ .... .............. ....... House No. -- ,~ ~ Str~et Ham/et Owner or Owners of Property .-~/.~j,_~.O../~/..~.~ ......................................... ~. U~?/~xd~..~7 PU~ County Tax Map No. 1000 Section Block CJT. Lot..-~...~. ......... Subdivisio~. ........ Filed Map No,~ .......... Lot No .............. Perm,t Date of ,erm,t /' ...... Health Dept. Approval .... C ....¢ ............... Labor Dept. Approval ........................ Underwriters Approval ~(...-7.'~.~.,~.7.~. ........ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate . ~ .................. Fee Submitted $ .............. Construction on above described building and p.,e,2mit meets all applicable codes and regulations. ADp ~cant ........ Rev, 10-10-78 76548O2 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [/~ULATION FRAMING [~/J FINAL REMARKS: ...... ~) f /~ DATE INSPECTOR _,, 7GS-1802 BUILDING DEPT. INSPECTION FOUNDATION ~IST ~ ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION RAMING [ ] FINAL REMARKS:~, ' . ~ ~ h . ./', ,'~:,- :.~ ' ,. ' ~' ~. "~ , ~ , . -~ , . , - , ', . : - / /o~' L,'-'%X~ , : , . ,,, ~, ' - f ~.~ , ~ , ~.~,::~ TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 CERTIFICATION TEL. 765-1802 JUN ~ T Ig88 I BI.OG, DEPT, TOWN OF SOUTHOLO Building Permit NO. owner'Vhom ~ ~ (please print) ' (please p ' 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 ~t~ day of ~~ , 19~ /~L~7~f~A'w'N~tary Public Notary Public ,~ County ~,~.~c~NA I~. MATYH~¥/~ ~ / ~/ ~' ,~,~ I/~R¥ PUt~LIC, S~a~e o{ New No. 52-4636665, Suffolk County, Comrnis~;on Expires March 30, THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~¢~ 88 JOHN STREET, NEW YORK, NEW YORK 10038 Oate .~la~ch 13~ 1.906 /lpplicationNo. onfile 374671//~6 T.,s CERT,.,ES T.AT N 739573 only the electrical equipment as described below and introduced by the applicant named on the abaca application number in the premises of Tl~.a~ ~. ~all, V£ctor:La Dr£v~t Co~'~ L/b~rt~ ~outholG, ~y in the following location; ~ Basetnent was examined on 14ar.~h 0,%~ 1986 FIXTURE OUTLETS ~ECEPTACLES SWITCHES ~: 4O 30 ~ 1st FI. [] 2nd FI. Section Block and found to be in compliance with the requirements of this Board. Lot FIXTURES RANGES COOKING DECKS OVENS EXHAUST DRYERS FURNACE MOTORS FUTURE APPLIANCE TIME CLOCKS UNIT HEATER MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: S E R V I C E NO OF CC COND. A W. G, PER ,~ OF CC COND, NO OF HI-LEG A W.G NO. OF,~NEUTRALSA W.G OF Hi-LEG OF NEUTRAL ~/0 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by ILDJNG ENT. THIS I their credentials. NER. FIELD IN~FECT{ON FOUNDATION (lst)~ COMMENTS FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N, STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS BUILDING DEPT. INSPECTION" [ ] FOUNDATION tST [ ] ROUGH PLBG. ~FOUNDATION 2ND [ ] INSULATION []FRAMING []FINAL REMARKS: ~~~,~~__~ DATE,/~::~/~ -.~i ,INSPECTOR .,,,~ ~ ,i 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 BLDG. DEPT T(~tt. mJ ~'~r: c'c)l ~TH~LD Received ........... ,19... APPLICATION FOR BUILDING PERMIT Date ............ i 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 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 inspe~'~,s. , .......--, ............ (Signature of applicant, or name, if a corporation) ..... /.~.e..5..~..~.o~.. ~.~. 5:ou~,/o.5(. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............... ~.,. ~.~.,~(... ~o.~,.<.~.~,c~¢. ................................................ Name of owner of premises . .'~.~.o?/1.8 5..~...~.o. ?._.'dj..~..~.....(.~. 5.15 ........................................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No. ~.~./.b..~ff.c..~.o.~... Electrician's License No..~.~q./...~. ?./.~./.~.51 ...... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ................. .................. House Number Street Hamlet County Tax Map No. 1000 Section . .~...~.~. .... Block ..... T ........... Lot. '°c~'- Subdivision ..................................... Filed Map N~ Lot .~ .......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy ...... ~t,..,. ....................................................... b. Intended use and occupancy .................. ~ ~ ,~' ~:~ ................... 3. N~t~/'~'~'*(~i/~c~ whirl{ ~pplicable). New Bufld~g ~ 'Addifi~- .... ~ par Removal . Domoht~on Other Work . , ! ' · .......... "· .......................... ' ~ '~ j_~, - ~ ~ ~ ~ (Description) 4 Ei{ atedCost ............... Fee ..................... ] ~' (th be paid on filing this application) 5. If dwelling, number of dwelling units . · · ~ ........ N r o we lng u u. ~auh fluor ............... ~~ber of cars ~ 6 ~us~n~ comma! or ~~~atu~t 7. D~~sfing stmctgres, if an~ ..... ;., ~R~-.. ' ....... ~ep~ .............. ~ ................. -~..; .-~t ........... ~ ......... Number~to~es..-,.. .......... D~ensions of~ntire new con~tmction: Front..~.., .... Rear . .~2 ......... Depth~( ........ 9. S~zegflot: Front .. .... /.~ ............ · b~ ........ ' ')'.~'/~/ Re~...~O. ............... Depth .Z~ ................. 10. Dat~ of Purchase ......... ~ ................... Name of Fomer Owner ............................. 11. , Zone or use district in which premises are situated ............ ~ ........ : 7 ......................... 12. Does proposed construction v~o~te any zoning law, ordinance or re~lation: ..... ~P ..................... 13. Will lot be regraded ...... ~O ........... Will excess fill be r~moved from premises' Yes 14. Nme of Owner of premises ~q~ .~/( ......... Address .~g&~.~/~.. Phone No '? ~/- ~/.~ Nme of Architect ........ : .................. Address .... Phone No ............... Nme of Contractor ......... Address . .~ P. ... Phone No. .. ! PLOT Locate cle~ly ~d dis~ctlg ~1 bu~d~gs, whether existing or proposed, ~d, indicate ~1 set-back d~,nsions from prope~y ~nes. Give street ~d block number or description accord~g to deed, ~d show street nines ~d indicate whether ~tefior or corner lot.. STATE OF NEW YORK, COUNTY OF .......... S.S ........................... ~ ............ being duly sworn, deposes and says that he is the applicant (Name of individual Slgmng contract) 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 If copper lubmg ~ use. : for Water di~tributlng s~ts~em~ piping shalt be , , hr'typeS K,Or L only · $OLDE~ UE~ ~,r WATER SUPPLY SYS'I'EM CANNOT _PLUMBER CERTIFICATION' ON :LEAD CONTENT BEFOR~ CERTIFICATE OF OCCUPANCY OCCUPAHC¥ OR. LISE IS'L HLA VFUL ""'1' C :RTIEICATE WITii OF OCCUPANCY NOTIFY BUILDING D~ 765-'1802 9 AM TO 4 PM FOR THE FOLLOWING iNSPECTIONS: ~. FOUNDATION . TWO FOR POURED CONCR~E 2. ROUGH - FRAMING & PLUMBI~ ~. INSULATION 4. FINAL - CON~TPUCTION BE COMPLETE FOR C.O. ~LL CONSTaUCT[ON 5HA~ THE REQUIREME~S OF ~E ~ATE,'CON~RU~iON &' ~ ' ~ODES. NOT RES~NSI~ D~IGN OR CON~Ru~~ ~s. '3 I. ]:::: r',O t'l Iff' ~'~" - ~L'I'ET;'..'hrh-T .~ ,, ..eLK'B, FLOO'iK