The URL can be used to link to this page

Home My WebLink About14134-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y, Certificate No ..... g.~.qSJZ ...... Of Occupancy Date ......... J. ~ ¢ .e..~.~ ................ 19~. THIS CERTIFIES that the building ..... .o.rl~ .-~'.&ra~ Cy..c[~q~ J_J,J~r~g,. ' County Tax Map No. I000 Section ..... 1.~ .... Block ........ J ...... Lot .... .p./.. ~. ~...7. .... conforms substantially to the Application for Building Permit heretofore fried in this office dated ·..~.u J-y..1.0 ........... 19~$. pursuant to which Building Permit No ..... ~.~..~ .3.4. Z. .......... dated ...... ~ la.~y.. J .~ .............. 19 .~ 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 ......... The certific ate is issued to ................. S/i L L.¥.. &. ~ .O.q 2~ $. ~.C. Q T ir .0 ................... of the aforesaid building· Suffolk County Department of Health Approval ....... 8 5 -S O- 1 13 UNDERWRITERS CERTIFICATE NO. 5I 729 9 76 Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERJ~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No 14134 Z Permission is hereby granted to: . s~./.... ........ .................................... ....... . . .'/,. . . . . . . . z z. ...... ,o ...... ~z~.iV'.~_z,,c~.....Q~.V......~.~.~./.~.~..../.2r~Z.~r.~..~......,f--,~,a;;..:.':....~. ................. ? . _, /_ ~' _.. / ........ .............................. ~./z~....~... zz2~4 ~ ..... ~'~'//'~'"7~' ........................................ at premises located at ....~..~. ....... ,~.Z/~.~-J. C2'/.../..~---..'~.~..~......~.../~.-~.~,.t,..~.:-~..~*.. .... County Tax Map No. 1000 Section .~..~...~.Z ..... Block ...~)./ .......... ?3 L_~ot ,o....~...~/~...t~.:.Z. pursuant to application doted ........ ~f~,~4~..~......,/..~. ..................... , 1~.,.~.'.., and approved by the Building Inspector. Fee $.~... .. Buildlng 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 A. 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 sih~ilar 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. B. 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 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 4.Vacant Land C.O. $5.00 5. Updated C .O. $15.00 Date ...."?~..~..~.~. ~.o../.I.?.~..~.,, New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ~. ~.~, .~. . , ~ L /~,,~ , ~- Z-~ .~, /4,~ ~-~ House No. Street Ham/et Owner or Owners of Property ............................................................ County Tax Map No. 1000 Section ..... /..~.5.'~. ....Block ..... / ......... Lot ..... ~/.~. ........ Subdivision ..... ~. ~..g~:..~.~.c.~. . ~ .Filed Map No ........... Lot No .............. Permit No, . / c//.~ ~/A Date of Permit .o. Applicant ' ¢/( .~. ? ~.. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ...................... Request for Temporary Certificate ............. Fee Submitted $ ............ .Planning Board Approval ...................... ...... Final Certificate ...... .~.. ............. Construction on above described building and permit meets alJ_applical~le codes and regulations. '~,oj~,~ . '~(~'¢~'~'-~'~ pp ~ .'..z. ¢c .......... ~': t ................................. Rev. I0-10-78 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 CERTIFICATION TEL. 765-1802 TOWN'OF SOUI'HOLO Building Permit NO. /d/ (please print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before n~e this J ~ day of /~i/~/& , Notary Public,.Z~ ~ . . . County .No. $2.$O2a~mn"'~,~..o~ :N~w ~or~ EX~es ~a~ 80, 1~ (plumber' s signature) Notary P~ THE NEW YORK BOARD OF FIRE UNDERWRITERS 1000~44 ~ BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 ..,e ,T~.'~.~. ~ ~(~ .~pp"catio. No. onf. e 37oa~?/~ N 729976 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the prernises of l.~uJ~ ~)tto, 2400 A'l~'J.ch I~m~; L~u~'el~ N,¥, ' int?f~efollowinglocation, A Baseme,~.t [~ ,st. FI. [] 2nd Fl. .~ectio,, Block /Lot was exan~ined on · ~Yl[~.,~,¢/~ ~ ~,~ and found to be in compliance with the requirements of this Board, FIX?UE$ FIX~UEE$ EANOES OVENS OUTLETS SWITCHES DRYERS FURNACE FUTURE APPLIANCE TIME CLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET EXHAUST FANS DIMMERS SERVICE DISCONNECT OTHER APPARATUS: S E R V I C E .~ A' W O. [ NO OF HI-LE~ A W. G, NO. OF NEUTRALS N OFpERCC~,COND, OF CC COND OF HI-LEG OF NEUTRAL Witli~m k~Glnley 780 ,~3uth 8th Street Llnd~hburs-t~ N.Y. 11757 Lie. ~t78E GENEI~AL MANAGER 13, ¢ This certificate must not be o]tered in on), monneo return to the office o~ the Board i~ incorrect. Inspectors ma), be identified by their credenfiol$. OF* IN AN FIELD j'NSp~CTION~ COMMENTS FOUNO~TIO~ FOUNDATION hOUGH FRAME & PLUMBING (2nd) INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: 1/¢:o :" 76~-X8~2 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [~(~ FINAL REMARKS: ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1603 fll_DG. DEPT. TOWN OF SOUTHOLD Disapproved a/c ...... -. .......... r (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .... .....~.q ~y../..0. INSTRUCTIONS Received ........... ,19.. , ., 19g..-C 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 taws, ordinances, building code, housing code, and regulations, and to,~ admit authorized inspectors on premises and in building for necessary inspections, t ~ ~ ,, .,-, ' /] I. (Signature'of applicant, or name, if a corporation) .... rc.z... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................... , ./.~.~.~. . ~. .................................................................. Nameofownerofpremises ........ .A... ~,~-~d LOOt,~ .5.C. (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 ...... .~.. [~./..o°.. ~. ......... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. .. ................. . . . / ............ / ................... House Number Street Hamlet ~/O '~J'-'"~ County Tax Map No. 1000 Section .... /.~..5.~. ........ Block .../ .............. Lot ..... ~ ........ Suhd, ision .... .... iled Map ..... Lot..Z.ff .......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ .~/..~.c.O.,F...~..../~. ¢': .~.f. ........................................ b. Intended use and occupancy ....... i'~.~..r~.,~, .................................................... · Nature of work (chee~ which applicable): New Building ..... · .~... 'A Reply0 ~' l ...... Removal .............. Demolition ... 4. Estimated Cost ....... Fee 5. If dwelling, number of dwellin~ units ............... Number of d, If garage, number of cars .... i ............................... 6. If business, commercial or mixed occupancy, specify nature and extent 7. 10. Date of Purchase .......... i ................... Name of Form~ 11. 'Zone ior asc district iii which p~emises arc situated ................ 12. Does proposed construction vi~lo~ any zoning law, ordinance or regula 13. Will lot be regraded ........ i./(.~..$ ................Will excess fill 14. Name of Owner of premises Name of Architect ~. Address Name of Contractor ........ i .................. Address ...... idition .......... Alteration .......... .......... Other Work ............... ~..~..~.< 0~ (Description) (to be paid on filing this application) ,qling units on each floor ................ each type of use .................. Dimensions of existing structures, if any: Front ............... Rea~ .............. Depth ............... Height Number of Stories Dimensions of same structure With alterations or additions: Front .................. Rear .................. Depth ................... :'... Height ......... : ............ i amber of Stories ...................... Dimensions of entire new construction Front S~. /.~ /,/ Rear · c2 t6'// Denth ~2 /~/t' Heig.ht ]Z. if '( Number of Stories / ........... S~ze of lot' Front . ./,.o: .a./. ........ Rear ....... /~O~.g.~.( ...... Depth .... L~ .~'. 7t P/..J~-. ........ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or propo: property lines. Give street and block number or description according to dee, /~0f ti{ interior or corner lot. 53cocg.. I~ STATE OF NEW YORK, COUNTY OF ................. l S.S ............................. ~ ............. ........ being duly (Name of individual sig~ing contract) above named· He is the ..................... i ............................... of said owner or owners, and is drily authorized to perform or have perfm application; that all statements contained in this application are true to the work will be performed in the man~er set forth in the application filed therex Sworn to before me this , ............. IqOTARY PUBLIC, State o New!Yo~k NO. 4707878, Suffolk Couetv' leml Explms M~rcb ]O, '19~? Owner . .:~nYs.~9..,P.. ~q~,Xl~ .......... ,e removed from. premises ~ No ~. ~ ~dff~one No. ~Z ~... ............ Phone No ................ ............ Phone No ................ ~d, ~d. indicate ~1 set-back d~ensions from ~d show street n~es and indicate whether ~om, deposes ~d says that he is the applicant h ;i,'it;Y " ?" :) " : ' ................ reed the said work and to m~e and file this best of his ~owledge'arid belief; and that the dth. of applic~t)