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Home My WebLink About14260-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ....Z.!4..3.2.6. ....... Date .... March 31 ., 19.8..6 THIS CERTIFIES that the building ..... Add£t~ioB .................................. Location of Property . .272.5..~Ilq~E..~J$.C.K. RD SOUTHOLD House No. ' ...... 's't~i ....................... h~/ei County Tax Map No. 1000 Section .q?. Q ........ Block ..... .0.6 ........ Lot 02 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. ALt G...7., .......... 19 .El5 pursuant to which Building Permit No ..... 1.42. .5.0.~. .......... dated ....S.e.p. ~. :..1.1 ................ 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 ......... ·..A~dJ. tion..to, s.aas or~al. O~La. far~ily..d.w~ ~ ~..~,r~g ............................. The certificate is issued to ..... OA~IEL .0 ' BRIEN . ............ io'd.~;, '~ ~.,~.; ................... of the aforesaid building. Suffolk County Department of Health Approval ............ ~ ./3 ........................... UNDERWRITERS CERTIFICATE NO .................... ~ 7.3.5.~ 4. 7 ...................... Building Inspector Rev. 1/81 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14260 Z Permission is hereby granted to://. I ~ ' ~.~...?~....~.~ ........................... ,o .... ~ ".,.~...~~...~. ':.. i...~. .......... ' at premises located at ..................................................................................... County Tax · C~'~ O ~ o ~ ~ Mop No. 1000 Sect~,~ ....................... Block .......... .~. ......... ~ N ......................... pursuant to application dated ...~~....~.....~. .................... , 19..~...~..., and approved by the Building Inspector. Building Irts~ector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD 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~mperty 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 5. Updated C.O. $15.00 Date. o New Building ............. Old or Pre-existing Building ....,/~. ....... Vacant Land ............. Location of Property Z- 5"' ~/~. c o/~ House No. Street Hamlet Owner or Owners of Property ............................................... County Tax Map No. 1000 Section ... ,~.O. ........ Block ~o Lot Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./4~ ~.~o0 'Z- Date of Permit ].~,4/, Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...~..qZ~.~ .............. Fee Submitted $ ........ ~.e~_~,..0. Construction on above described building and per~i~meets all,,~l~ble~codes and regulations. Applicant ..... ~.~ ........ ¢...,¢~/~'~.....--77~,. ..................... THE NEW YORK BOARD OF FIRE UNDERWRITERS 950~. BUREAU OF ELECTRICITY ], 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~ate ~ebr~a.~.y 18,19~ 37~31/86 N735947 THI~ CERTIFIES THAT only the electrical equipment as described below and introduc~ by the appllcent nalned on the above application number in t~ premises of Dan O'Baien, 272S Pine ~eok in the /ottowing locatiqn; ~ Sa~ment ~ 1st Fl, ~ 2nd Ft. Section Block Lot Feort~a~' 10,19~6 FIXTURE OUTLETS RECEPTACLES SWITCHES 14 2 DRYERS FURNACE MOTORS FIXTURES RANGES OVENS EXHAUST FAN FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: S E R V I C E NO, OF CC. COND [ A W G NO OF HI.LEG A W. G PER ,iF OF CC. COND OF HI-LEG 199 Wavecrest Dr. ~a~%ic Deach, N.Y., 11951 Per ll c~rfiflc~f~ mus~ nol b~ oB'~r~d in any monn~r; returo to lh~ offic~ of lhe Board if incorred'. In*p,al'ors mo), b~ identified by their crod~nfiols. iELD.INSICTION o o_~ D!T I~N _ (1st) OUNDATION (2nd) COMMENTS )UGH FRAME & PLUMBING NSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: Examined . _~ ....... , 19~.$. ·/ Approved~..~'..-~.., .~.' .1 !.., 193..~. Permit No ............ Disapproved a/c ..................................... 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OU,THOLD, N.Y. 11971 TEL.: 765-1802 Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... 19... IN STRUCTION S a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ;ets 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 areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appll- :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 ;hall 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 g Certificate of Occupancy ;hall have been granted by the Building Inspector. ihAPPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the uilding 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 herein- described. e applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to dmit anth°tized inspect°rs °n premises and in building f°r necesi?~tv'Pe~..~.,. (/~.~..~ ........... (Signature of applicant, or name, if a corporation) (Mailing address of applicant) Itat~ whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. qam¢ of owner or premises [¢i t, t¢.. . . .*. . ¢. ./X. .............................. (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.. ?¢..~.~...~./g .~.~.~. ~.~..~ ..... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done...~-. House Number Street Hamlet County Tax Map No. 1000 Section ...... .~...t?. ........Block ......... ~. ........ Lot ...... .~. .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............. ~'.'~-~. b. Intended use and occupancy ............... , ,~,~¢ A¢:~: .~.~ .~. · .... ' ':r4 ' · ....... · · ~ · 3. ~I~{p of work (check which applicable): New Budding .......... Addition .... .~ .... Alteration ......... ;it~Shir .~,~.... ~. Rdmioval ,~. ....... Demolition . Other Work .............. 4. l~~.~.,~;~. ] .......................... Fee .......................... ~ ~ , . . ' [ ~~{~a~.!9~,~..' ~] ,~ , " (to be pa,d on al,ns this application) 5. ~;f dwelling units ..... ~ ........ Number of dwelling units on each floor ............... If garage, number of cars 6. If business, commercial or mixdd occupancy, specify nature and extent of each type of use ................... 7 D~ensions of existing structures if any: Front SEn ~ k~ Rear Depth Height .... Number of Stories O~g --, ,. . D~ensions of same structure W~th alterations or additions: Front .... fgq~. . Rear ................ ,Depth .................. ~.,. HeiSt ..................... Number of Stories .... O~ ........ 8. Dimensions of entire new construction: Front.. ~ .~..5 .~ ./. ~. Rear ............... Depth ............. Height ~. ~ x~umb~, e St~,,, ~ ~iz? o~2t: ~ront ...~.:~.a ~.~.i~.z ~" Rea~ ......... ~ .......... peptn .. ~ ~ ~ .... ~: ...... ,t~a;e m eurenase ...t7~. ~.,. (~t...t.l .'g .< ....... .: Name of Fo~e~gwner x~.t~ ~.~ d. ~ ~.~fl.~ · · Zone or use district in which premises are situated.. $:a ~.~.~o L.d. ~. ~/~ /~ . . . Does proposed construction vidlate any zoning law, ordinance or regulation: ..... ~.~ ....................... Win lot be regraded ..... ~ · .~.~ ~$~... Will excess fill be removed kern premises: Yes No N~e of Owner of premises . ~ ~.t.~k.~. P. ~. ~Address .. 9~. ~. g~none No.. N~e of Architect ....... g& ~ K ............. Address .. Pa.a ~. ~FAs¢~Phone No. N~e of Contractor ...... 5~.~ ~ ............. Address ,, ~¢~, ~ff~a'~yo~Phone No. ~/b.c .q.g~ 10. 11. 12. 13. 14. 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. ~'~/,~ A/'7- ]- ,~-C ]-/L'-~ t~'///'~'~ STATE OF NEW,YO,R,,K, ,, - COUNTY/2F ~. 2~; L~_~ -" '" £/~ ' ........... '= .~.~.?).~. [/:~ .(~.. (r~ ..... ..d</ ............. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ........ .~. .............. ' _ ..: .... ~ (,4~.&/..~f'~ ........................................ ! (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 con~tained 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 ...... ~. ~ff,~¢ ......... day df..~'~ ,~.~5 .......... 19~~-- ' Notary Public, . ..]...: County rq ..~... ~.~., _ · [ igna ute ofapplican ) Term L,q)ll~ M~rah i/// ~ / OCCUPANCY OR USE IS UNLAWFUL w mou CER m^TE /' APPROVED AS NOTED ZXIo '~ F~NAL CLIX;5~L:'X',TtO;~MUST ALL CONSTRUCTION SHALL FHE REQUI~MENTS OF THE ;'~TATE CONSTHUCT~ON & ENER~ ~L~3ES. NOT RESPONSIBLE FOR ' '~'~ O~ ~L:q~'~UCTiON H~ Sc,t