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Home My WebLink About14103-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N.Y. Certificate Of Occupancy No .... ~ J .4Afl6 ....... Date ....... .J.u.n.e...3 ................... 198..6. THIS CERTIFIES that the building ..... .a.d.d.~ .~ .J_.o.n. ................................. Location of Prop erty ..... 2. q 05 .............. D. e..e p..H.o..1 .e..~ r... ........... .N .a.~. fi. ~ .~ .u.c.k.... House No. Street Hamlet County Tax Map No. 1000 Section ..... 1.1.5 ....Block ........ 1. .4 ..... Lot .... .1 .q .......... Subdivision ........... X ................... Filed Map No....X ..... Lot No ..... X. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .... J.. U ~ ~..4. .........., 198.5.. pursuant to which Building Permit No ..... 1.4. ! ,0,3.Z. .......... dated ........... 4g~Y..3. .......... 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 ......... .... A 0 d~_.t~J, or~..t.(~, on.e.-: f ~ra.5.~, y..d?.e. ~ ~,~.n.g ....................................... The certificate is issued to .............. T~.0.MP~ 3..P.... ~..D.E.B..0 ?.A.H...g . .S..5 p.L A.~. S..K.A.S. ..... of the aforesaid building. Suffolk County Department of Health Approval ................. X/. g ..................... UNDERWRITERS CERTIFICATE NO ....................... ~I.7.4.7. 5 7~ ................... Building Inspector Rev. 1/81 FOn, M' NO. JB TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEP, MiT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NB i4i03 Z Permission is hereby granted to: ...~.O..,....../~c....../zz~. ............................... ..... ~..,.1.~.~..-...~..:....V-......~../z ~... ,o ......... .~.O.,~...~..~/Z..o...c~.....~z....~/.O,o......./..~......~.~..J.~.~.....,~....z..~ ......................... ............... ~..~i£~.~.c~ ............................................................................................................. ./.. - ot p.mises Io¢oted at ............. C~C2.O...5 ......... ~ · ~ .......................... .................................................................................................................... ~.~...~:~ County Tax Map No. 1000 Section ... ,/~..~...'~.. ........ Block .../....~... .......... Lot No. ,~../....~. ............. pursuant to application dated ........ .~.~..~.~-.......~... ..................... , 19~....~.,"-and approved by the Building inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN O1: 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 nam ral 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 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancV on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 $15.00 Date ...... ,~, 9. ............ New Building ............. Old or Pre-existing Building ............ Vacant Land ............. ................ .~ o~ ~ ~ ....... Location of Property 2, o~ House No, Street Ham/et Owner or Owners of Property . .'~.~:~ .~. ,c~. ,5,..~... ~..'..~_~...??..r~..~..~......~. i.~.~..~. ?.~..~..~.~ ........ CountyTax Map No. 1000Section .. Subdivision ................................. Filed Map No .... Lot No. ~.I.(¢,Pp.Q .... Permit No.~l~,~.~,... Date of Permit ~J '~'I ~''~' 'Applicant '~:'~'~'-~' ?'' ' '~'~\~?'~ '~'~'~ ........ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Construction on above described building and permit me_ets a,[Lap_p~cable codes and regulations. ............... Rev. 10-10-78 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. I~ ~O~ (please print) Plumber~%.o~.~_T ~ ~ (please print) 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 day of ~/~"/ , Notary Public,~-~c+'e/k County N~tary Public mARGRET RIED NOTARY ~'UBLIC, State o£ New York No. 52 ~4613150 Quahhed ~n SuFfolk County Corarak~ior~ ExF,~res March 30, THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~11~¢~ ~y ], ~[t~(~ 85 JOHN STREET, NEW YORK, NEW3~.~'If~38 .ate Ap,,ea,on ~Vo. o. Si,e N 747579 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant nao~ed on the above application number in the premises of Th~nas &, Do~rah ~idla~%~, 2~)~ D~ep Hole Drive ~ ~at~ltuck, N.Y~ i"theY°"°wi"g~ocaUo"~]tB~.~86~ ~tr~. [] ~nd r~. Section B~o& ~o~ was examined on and found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES OUTLETS SWITCHES 5 15 11 DRYERS FURNACE FUTURE APPLIANCE TIME CLOCKS OVENS DISH WASHERS EXHAUST FANS UNIT HEATERS MULTI-OUTLEt SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: I~G.F.C. Io TraOk Lig3htin~ 4' 0" ;~ Lit~ Pox~e lbo~rds: 1-9~Lro S E R V I C E AW, G, OF Hi-LEG OF NEUTRAL 2005 Deep Hole D~ve Mat~ituck, N.Y~ 115~ This cerfi(Jcate mus~ not be oJfered Jn any manner; return to the o~Jce o( }he 8oard J( ;ncor~ecL inspectors may be identified by their credenfiaJs. MANNER: ~'IgLD ~'NSPECTION DATE COMMENTS , ' FOUNDATION ( 1 st) FOUNDATION ( 2nd ) .... --------- == ----~ ' , ~/~ ,, ~oos~ F~ ~ ~ O~ ~. ~, ,. ,..,,,_ ~ZO~XNS , ," " INSULATION PER N. Y. STATE ENERGY C~ODE ADDITIONAL 7GS'1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND ~ INSULATION FRAMING REMARKS: .,~., FINAL INSPECTOR 'FORM NO. 1 TOWN ,OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Ex.mined. J~.~. ~....:..., ^..roved. &. .~.~. . . ~ .... l~. . :me~it No../.~:.e~..-~ Disapproved alc ............................ .n ........ (Building Inspector) APPLICATION FOR BUILDING PERMIT "INSTRUCTIONS Date ~.:~,v,~r~_ ..~. ........ 19 .~.'~. a. Tltis 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 necesslk!~y i~nspections.~,u k~'~ _~(~ - (Signature of applicant, or name, if a corporation) . ¢.o. : f .~. .~. ., : .,. ~. . . .¢. . .~ : ~. . ., ~ ½.d. '~ . . ~ : ~. . . . ~: .~ ~. .~. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (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 ..... ,~..~./..~ ............. Electrician's License No .... ~.~'.~.t'..~. ............. Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. o. .o. .o.~. . . .'>.~.~. . i~.t. ~. . ~!,,,.~ ........ ~.o-. ~:k~. ~i~. .... ~:~, . . !~.q. .~. . .~. ................... House Number Street Hamlet County Tax Map No. 1000 Section ... ~. ~. '?: .q? ........ Block . .~./~ ~. 9.f-.: ..........Lot. U..~,~.,?..q9 ......... Subdivision ............ :-.~.:. :~'. ................ Filed Map No ............... Lot ............. (Name) State existing use and occupancy of premises and intended use and ogcupancy of proposed construction: a. Existing use and occupancy.(~,q-.. ~'O.~....~..~.x~.-oa~.ct~. ....................... ~ ......... b. Intended use and occupancy 3. Nature of work (check which a plicable): New Building ..... ' ..... 'Ad Repair .............. Removal .............. Demolition ... 4. Estimated Cost ...... .c~..t p~.o. ....................... Fee ~.. 5. l'f dwelling, number of dwelling~units ...... I ......... Number of dw If garage number of cars 6. If business commercial or mixed occupancy, specify natur, e and extent c 7. Dimensions of existing structures, if any: Front. ~.~..~. ....... Rear Height ............... Number of Stories ... Dnuenstons of same structure wtth alterations or additions: Front Depth:... ~ '2>[,,.' ........... i · · Height . .~.~ .............. N 8. Dimensions of entire new construction: Front ... !.~/ ......... Rear Height ~'.(e .......... Number of Stories ..... [ .............. 9. Size of lot: Front . lC~.o.,.b.q'.,...: ....... Rear..~.~... ......... 10. Date of Purchase ~e~c_. ~..~.,.. 3.ct~i .,~. ............ Name of Former 11. Zone or use district in which prbmises are situated..~.¢,K~/-'o~.. 12. Does proposed construction violate any zoning law, ordinance or regulati 13. Will lot be regraded ...... ~ ........ : ......... Will excess fill t 14. Name of Owner of premises .~7[~n~4a~ .~, ~,c.[[~[~ddress~oS. Name of Architect .... ~o.~44v~44T ..... ~ ......... Address ...... ~ition..~. ..... ~( Alteration }q ........ .......... Other Work ............... ~ (Description) .......................... (to be paid on filing this application) lling units on each floor ................ h typ f feac e o use ..................... ~9,'.7..n pth c~(e ' ~/'~ ............. ............ Rear ~.2-~"" mber of Stories..~ .c~. ............... L~'3.'. [qg~'.. Depth . J.lO~. ...... Depth .L3 1, .~.7 .............. ~n: . .LC~.... .......................... e removed from premises: Yes ~ ...... Phone No~C~ r g..~.G..H ..... ........... Phone No ................ Name of Contractor ....~.vd.'e~t~7. .............. Address ........... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or propose property lines. Give street and block number or description according to deed interior or corner lot. STATE OF NEW YORK, COUNTY OF.. ~.~J-.T.~./~' ..... ; S.S ·.. 2¢ ....~' ......... ~ ....... I ..................... being duly s~ (Name of individual sigging contract) above named. He is the (Contractor, agent, corporate of said owner or owners, and is d~ly authorized to perform or have perfor applicatiori; that all statements contained in this application are true to the work will be performed in the manner set forth in the application filed therev Sworn to before me this' ~ ' ' ........ Phone No ................ t, and, indicate all set-back dimensions from and show street names and indicate whether }rn, deposes and says that he is the applicant ?icer, etc.) ned the said work and to make a[~d ~!e this best of his knowledge and belief; and ~at,l~he :ifh. ' ' '~ Notary Public, . .... ' '.~. .... ' ...... Coun~ (~) NOTARY PUBLIC, State of New,York ' ~.~..A .~ .......... ~,~.' ......... Qualified in Suffolk Coun~ ' , t l Commi~¢on Expires March 30, 19~ ' ~ . '~ ,