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Home My WebLink About14237-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ..... .Z.1.~.5.1 0 ...... Date ........ .J.u. qe...1.3 ................. 198.6.. THIS CERTIFIES that the building ......... g d..d j..t.J, 9 D. ' Location of Property ~.. 5.1.Q .............. ]B.a,y.l~.r.r.y.. ~.d... ............. ~utcbogqe.. House No. Street ....... I]la~let County Tax Map No. 1000 Section .... .1.1.1 ..... Block ......... 1. .~ .... Lot ....... 3.6. ........ Subdivision...§~.~. ?.q~,~ ~ .............. Filed Map No... 1. 5.6...Lot No .... 2.1..6~.2.1.~.. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·. A.~g U ~ .1;.. [ .........,19 .~ ~ pursuant to which Building Permit No....1 .~.2.3. 7 .Z ............ dated ....... $ ~ p.t.~ m~.e.r.. 5 ........ ] 9.8.5, was issued, and conforms to ail of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ....R.~ ~i;L.t.~,qo..t.q .~S~-.s.~$p~ .c]¥.e.l.~, J~L~ g ............................... ~': .......... The certificate is issued to .............. F. ]~ g~;.h ~,~T ~..~,. ~.~ D..E ......................... (owner,y/~ ~[q~g~X of the aforesaid building. Suffolk County Department of Health Approval ............... I~ /~. ........................ UNDERWRITERS CERTIFICATE NO. N 73 63 7 0 Building Inspector Rev. 1/81 FO~ NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLDo N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NB 14237 Z Permission is hereby granted to: ..... ~,r..~. ............ Z./.. .................................. ..z~4.~ ....... ~.~.v.,.~.~.~.~...,~,~ ........ .... .0.~.~.bI..~.~..~.,...~.~..;¥. ......................... ~o . ,,~P. .~.~r.~.~.. .~..~.~.o~........~.... -~-.~.~.~,~.~.....~~P ~ ................ ............ ~ ......................... ,=~ '~ ~.. . . ...~ ~; .............. . ~ ...................... ~ ' p~"~' ........ ~..~..... ~ ~ ~.~ ~ ~'~'~" ~ .......... ...... "~I'""I ............ ~ '~"~' . ~ . vs ~ ..... ~ ~...~ ~ ~..~..~ ....... ...~~....~.~ ...................... ~ ................................... ~ ..... c~ ~ ~ ~. ~ ~,on ...~{.[ ........... ~ ...~..~ .......... ~ ~. ..~.~ ......... Fee $.....~...0...~.. Building Inspector Rev. 6/30/80 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12900 Z Permission is hereby granted to: .......... ..~'..~.,~.~.....~..~..~. ....... .......... ...................... ........... ~.-~,~..~/..~.~.~.~...=~:..~ ........... ~o ...... ~Z~z:~.. ~/~ ...... ~.~.~:.~...~:.~~~ ........ ~../ at premises l=ated at ....... ................................ ~......~ ............................ ...~,z.~z~z ............ ~...z~..~ ................ L...~....~.~.~=.:~.....~.z... co,,~ ,~ Map No. 1000 Sec~o, ..... ZZZ .......... ~=k ...... .~.~ ........ Lo~ No ..... ~.~'(:,.Z.. pursuant to application dat~ ......... ~.~.~ ......... , 19 and approv~ by the Building Inspector. ~I~ Fee $..L~.. ................. 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 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, s~reets, 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. B. 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 bu ildings. 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 occupancy 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 New Building ............. Old or Pre-existing Building .. ~'. ....... Vacant Land ............. L°cati°n °f Pr°perty '~'-/'~' '~'d~:"~' ~'~'('×'¢' '~' ' ' '/'/~'J'House No, .... ~ ' ....... Stre't ~.~~~/~[~5'~ /~'~ ...... Owner or Owners of Property. ~.~ ~¢,~.~..~..~ ~'.~. ~¢.~...~.(~ ........... County Tax Map No. 1000 Section . .~/ .......... Block ./¢~. .......... Lot. ~ Subdivision... ~,~...¢0.;~: .......... Filed Map No. [ ~(¢ ..... Lot No ............. o.t ......... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval.. ~..~ ~..~ ~o).~. ~ ....... Planning Board Approva) ...................... Request for Temporary Certificate,. .................... Final Certificate ....................... Fee Submitted $. ~'-~ ~.~.2 ~ Co~struqtjon on above described building and perm~it meets all applicable codes and regulations. ~ O,~r IL~ ~ Applicant ~,~.. ¢~ . . b ........ .................................... Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 THI~ CERTIFIES THAT only the electric~ equip~nt as ~crlbed beJow and introduced by the applicant named on the able application t*umber in rhe premis~s of in the followin~ Iocation~ ~ Basement ~ Ist FL ~ 2nd FI. Sect~ Bl~k Eot was examined on ~I~'~~ ~ ~ ~.9~ and found to be in compliance with the require~ne~ts of this Board. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS 9 12 12 9 DRYERS FURNACE MOTORS FUTOI~E APPUANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS S~RVICE DISCONNECT OTHER APPARATUS: ~otor~ ~ 1-1bp., 1.-3/4hp ~, I-.Smoke dete. cto~ S E R I C A, W G. NO OF HI-LEG NO. OF NEUTRALS A, W G. .o %~co.,),1 OF HI-LEG Dorosk£ Lane ~ 11935 , GENEliAL MANAGER ~ic#2941E ,,,, ,,? P e r----~/~_ 11 certificate must not be altered in any manner; return to the office of the Board if incorrect, inspectors may be identified by their credentials. COPY FOR JILDING DEPARTMENT. THIS COPY OF CERTJFIGATE MUST N0'Y BE ALTERED IN ANY MANNER. BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING ~ FINAL REMARKS: ~ WELD INSPECTION DATE COMMENTS FOUNDATION (1st) FOUNDATION (2nd) BOUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ~DE -- '' ............. ADDITIONAL COMMENTS !...FIELD I~$PEC~ION COMMENTS ~ FOUNDATION (1st). FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING IN3ULATION PER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL,: 765-1803 xamined/~,~J~°~. ·~· ~.., 19 .~. 19... Permit No.}. [sapproved a/c ..... ~. · ~'. ........ ..~/./~./ ~ "~(Building Inspector) APPLICATION FOR BUILDING PERMIT Received.'..~.~. INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 s~V;s of plans, accurate plot plan to scale. Fee according to schedule. I b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets of 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 st~all 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 sqall 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 B~ilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or R~gulations, 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 a4mit authorized inspectors on premises and in building for necessar~jnspections. ~,~ _.'*~/ ' '~ (Signat;fre of applicant, or name, if a corporation) . ..... (Mailing address of applicant) tare whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. I~ame of owner of premises ...~.~..~..~%. ~.k~.g.4..S.<. ~.mT~....~... ~5~4~} .............. (as on the tax roll or latest deed) applicant is a corporation, signature of duly authorized officer. Builder's License No .......................... Plumber's License No ......................... Electrician's License No.. ~ ~ ~ Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. ....................s? o b ...... ....... & .... ..... ~ ~e Hamlet . -. ' House Nu~nber ~ ~S .~t~. / /~- County Tax Map NO. 1000 Section ',. ........... ~o~ ..... ..., ........... ~o~..~ ..... : .... Subdivision./V~../~ ............. Filed Map No. /~ Lot ~C~ .~, (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. [xistin[ us~ and o~up~noy ...................................................................... b. Intended us~ and o~upaney ...... /.s. ~y,: ~ .~ .............. LV..'?....:.: ;[: :'.;:., ~,. .............. 3. Nature of work (check which applicable): New Building .......... Addition. ~ Alteration ' liti Oth rk Repair .............. Remqval .............. Demo on .............. er Wo ............... 4. Estimated Cost ............. ~ ......... er;.... Fee ........................ ' (to be paid on filing this application) 5. If dwelling, number of dwelling bnits ............... Number of dwelling units on each floor ................ If garage, number of cars ..... 1 ................................................................... 6. If business, commercial or mixe~ occupancy, specify nature and extent of eaqh type of use ..................... 7. Dimensions of existj~g?structures, if any: Front... ~..X-, ...... Rear :..L/. ~ ...... Depth ./P.C~. .......... Height ....... ~/. c"~. .... Number of Stories .... ~. ~.:~.~. ................ .4 ............ ~ .............. Dimensions of saqae str~cture with alterations or adciii~ons: Front ..... ~7. ~. ....... Rear.,-~.c~..( ........... Depth ........ .~. ~. ........ :.. Height ...... [.~z.('. ........... Number of Stories.../.'fS?,~.~..~ ........ 8. Dimensions of entire now construction: Front .... ~_] ¢ ...... Rear ...fi.~ ......... Depth ~.~'] ......... Height ~ ~ ' u e of Stones , . ....... ............. .... ......................................... 9. Size of lot: Front ....... ~.,.~5L.~; ......... Rear ..... ~ ~.0,, .......... Depth ..~.<Td~ .............. 10. Date of Purchase ...... 1.~:7.~ ................. Name of Former Owner . ~r~.~.ot~..~.~ot~.~. ....... 1 1. Zone or use district in which pr6mises are situated .................. ................................... 12. Dogs proposed construction v~o!~te any zoning/aw, ordinance or regulation: ... P>].0' ..................... 13. Will lot be regraded ....... I~'~J;.0.t ................. Will excess fill b.e removed from premises: _ ,Yes INo) 14.Name 6f Owner of premises . .~.,V.~..L. ~lld¢ Ocr rrdress .e_. .... Phone No. !/.&q. ....... ..'77.. Name of Architect .......... i ......... ... .....Address ............ ~ ..... Phone No ................ Name 9f Contractor. ~,-~e-P.~. ~ :,e_...~.qi~7![~c>.. . Address ~. l,~c.-~¢.°.~ ~.. ...... Phone No. ~.~ PLOT DIAGRAM Locate clearly and distinctly all property lines. Give street and block interior or corner lot. buildings, whether existing or proposed, and~indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether STATE O F NEW ~3 RI~.,,~. COUNTYrY OF,.~ ~ OF ~,~ ..... --.,~..~ .~..~ ........... being duly sworn, deposes and says that he is the applicant //-- ~' "'(Name of'individual sig~ing contract) above named. He is the .................... ,: ~ ................................................................... i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duiy 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 ............... ..d o . , 19 Notary Public, ,~~ .c-~..-,.~.~.~y ,~ ,,,~ ,__~- ~ JUDITH T. TERRY Notary Publlo, State of New York ~ /... . ~p,~,,/5-~.....fl/-~.. ................... No. 62.0'd44~31 $uffolk CounW~.~t'"-'- ~' f~ (Signature of applicant) I Comn~on F.x~ms Maroh aO, 15.~.'~ 'FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined..~./. :'07. ......... 19 ~ Approved 2/: ;isapprove~'a/~' }i}i i i.~."5..i...:_~ .............. <~2~ ' (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 ~ts 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 promises or public streets · 9r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ation. 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 ~tall 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 hall 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 tuilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ',egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as heroin described. 'he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to building for necessary i ections.. dmit authorized inspectors on premises and in ,(.... ~~ ...~~ ............ (Signature of applicant, or name, if a corporation) ........... ihahi ~fidress of applicant) '~i ~' ~'~" ' ' ~tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. iame of owner of premises' ...... ''''' ...................... ".~(L g'~ e..]..' .~.~'.2d.~. ....... /i' .......... .~.d~/,'~' /~-" .................................... (as on the tax roll or latest deed) f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No...~&'--~.. 2~l &)..c.). ...... Plumber's License No..7~. ~...-,4.~.C.~.~.'/. .~.~'. · Electrician's License No. tz. ..... .... ............ Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. · .s:/.o.,,, .:. ................................. House Number Street Hamlet ~7 - County Tax Map No. I000 Section~ .... ,~.t(././. ...... Block ..... ./.~./...~ ...... Lot..~..~. ............. Subdivision....~."~.~..~.-'f../~../¢/~. .tSdfi. .............. Filed Map No. /..~.~. ........ Lot .¢./.~...'".¢./.~. · . (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a' Existing use and °ccupancy ' ' '~'~' ' ~ 'e~'/} ~ .... /' ' ~79 ~ ~ Coo, ¢: ]t..//~d[dO~14~. b. Intended nsc and occupancy fff(~e.~.~.. 9 .................. .~]~¥~:..~::,~.~ '7~:,:','~ .... ~ .... 3. Nature of work (check which applicable):- New Building ..... ' .....'Addition...~./i.... Alteration ....... ,.. Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost... O Fee ~' (to be paid on filing this application) If dwelling, number of dwellin~ units ...~f. ......... Number of dwelling units on each floor ................ 5. If garage, number of cars .... i .................................................................... 6. If business, commercial or mix0d occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front .... ,57 .~. ~ ....... Rear . .~.X .' ........ Depth...~.~.'/ ........ Height ............... Number of Stories .. g, .................................................... Dimensions of same structure with alterations or additions: Front ...... .7· [. [ ...... Rear ...~. J.. ~. ......... Depth ....... ~.,,q. '. ........ ]... Height ............... i:~ ..... Number of Stories ...................... ~' ~ . 8.Dimensions of entire new construction: Front ..../.6. ~ ........ Rear . ./.6. ( ......... Depth /~.. ~. .......... H~ight Number of gtnHes 9. S~ze of lot: Front ...... /.~.,. ~.6. ....... Rear. {~. .... ~ .... Depth .~..~..fl.(q ) ........... 10. Date of Purchase .......... i .................. z, Nam, e of,Forlg~er Owner /t~v.~./...~1~...~r.~..~. ......... 11. Zone:or use district in which p~emises are situated../~ a~./~.~. ~,~('. .................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: too ................... ~ ........ 13. Will lot be regraded . ,4Jo. ·;. .......... ., ......... Will excess filLbe removed from premises: ~ No 14. Name of Owner of premise~ee/.aq? .~(.P,,oa4 ~ ...... Address .6.'~?..(~.~,. P~.~t .g¢'~.. Phone No.g~.~.. 7. .~. ~..~..~q'? .~, : Name of Architect ~O~.(. (qof..i .~./:(./. ............ Address ................ Phone No ................ Name of Contractor ........ i .................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and bloc: number or description according to deed, and show street nmnes and indicate whether interior or comer lot. STATE OF NEW ~-21~K,,,~ ,¢' ,~ ,, COUNTY OF .~,q~..~.... ~'~ · .... .................. being duly sworn, deposes and sa, s that he is the applicant (Name of individual sigtning contract) above named· '0ua e v He is the (Contractor, agent, corporate officer, etc.) of said owner or owners and is drily authorized to perform or have performed the said work and to make and fiig'~this- apphcat~on; that all statements co,tinned m th~s apphcat~on are true to th6 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 : ............. /..{ ...daygf ............. 1 .~.. Nejd. Pu~blic, . .... ~ ...... County ................. ........ i , ELIZ~BETfl AI~ HEVl~ (Signature of applicant) . ~IOTA~ PUBLIC, ~ o~ ~ ~ ' ~ ~12.'~8~0, ~k ~ 2/7 .-9' FEE:~. ~'~'''~ BY: NOTIFy, BUILDING 'AT 765-1802 9AM PM FOR THE FOLLOWl NG ~NS: 1. FOU]biDATION - REQUIRED FOR POURED 2. RoU, GH - FRAM PLUMBING 3. th,~cu'-Am!QN 4. F",? L ICTION MUST BE ~ -,,m 7--- CO. ALL O'~X",$'~T C SHALl MEET THE RE.m~ GF THE N.Y, STATE'CO 'l ~N 8, EbiERGY CODES:. NOT Ri }NSIBLE FOR DESIG~I, OR ERRORS. FEE: ~ ~ BY: NOTIFY BUILDING AT ~65-1802 9 AM FOR THE FOLLOWING 1. FOUNDATION REQUIRED FOR POURED 2 p~GH - F~M) PLUMBIN~ ALL C~,,c,*,, mC ) SHALE MEE~ 5TATE~ CONc~LIC )N & ENERGY ~ cO9 L ~t l I OCCU?ANCY OR U~'~ ~" ~L^WFUL ~F'?-:: ?;'' C~RTiFiCATE OF-OCCUh NC¥ ,SUP LY SYSTEM CAAN07 E.X. rED 2/lO vi' 1% LEAD. 0 T~A ;' CA TIOy NLE ~ , , If copper tubing is used for water distributing sys em; piping shall be of types K or L only :AFP~OVED AS NOTED, 765-1~(}2 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1, q~N~TION - ~0 REQUIRED FOR P~LIR~D CONCRETE ~, ROUGH - FRAMING & PLUMBING 3, INSUI A~ h~N 4, YIN,~1 - n~ ~ BE C ..... ~'-~ ~qR C.O. ALL CON~r~''C~-~ON THALL MEET TH~ REQt't~?;M~'NTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT DESIGN OR CONSTRUCTION ~RRORS.