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Home My WebLink About13965-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...g ~ .4.1.8.9 ........ Date ..... .J.a.n.....2.9 .................... 19 .8.6. THIS CERTIFIES that the building .~.n. gFg.u.n, cl.. P.qq .~..&..f.. e..n.c.e... ..................... Location of Property . 2..6.0 ........... .~.a.v.d..e.n..C. 9.u.v.~' ........ .5?.u.~..h.o.kd.. House NO. Street .... County Tax Map No. I000 Section .0..~.~ ........ Block ... 9.~ .......... Lot ....1.7...~. ......... Subdivision .~9~.~.h.q ~..~..~.~.r. ~.e.n.~. ...........Filed Map No. ~..~.~ .2 ....Lot No .... ~. ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... O.ay..~.6. ......... , 198.5.. pursuant to which Building Permit No .... 1.3. 9..6.5.Z. ........... dated . .g.a.y.. 2..~ .................... 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 ......... · .~.n.g .vp.u.n.d.. pp.q~.,..3.'..v.a.l.k...aF.qu.n..d' p.o.?.l .a.n.d...f.e.n.c..e.. .................. The certificate is issued to WAYNE A. DEPETRIS ..................... io¥.' ;,3ti gaJ(iiiaith$( ..................... of the aforesaid building· Suffolk County Department of Health Approval .............. .N./?. ........................ UNDERWRITERS CERTIFICATE NO ...................... t!.N.6.9. 7. .2.7.7. .................. Rev. 1/81 Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~3965 Z Permission is hereby granted to: (..~..i.liil.;..~..ii~il....iii.iill ...... iiiiii.ii ...... iiiiiii ..... ...~.~...~..:.~.....!.:...~-..~... ...... ..~.~ ................. ~.~ .......................................................... ~,~,,~,,,,~,,~ ~,.~.~.~.....' ~ ~~..~......~~ .................... ~..-~ ................................. ~ .......~ .............................................. . ................................... ...~..~...~.~,.~..~...~...~ ...... ~.~..J. .................................. Co~,~ T,~ ~,~ ~o. ~00o s~,o, ...... ~..2 ...... B~ ....... ~.] ....... Lo~ ~o....J~.,.~ ......... 5uildln~ Inspector. ~~.~. ...... ;= .......... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIF~CATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m mm,a~Jm 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. 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 featu res. 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 2. Certificate of occupancv on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacan~a Land C.O. $5.00 $15.00 Date .......................... New Building "~ Old or Pre-existing Building Vacant Land Location of Property ~q~'~ .~_~..~...~..C~. ?-..J~..~..~..L;LJ~. --.~' ¢--'~'3(_~ ~ House No. Street H~mlet Owner or Owners of Property ....... ~. · .~. ~..~. £~ f~ County Tax Map No. 1000 Section .... .C).~. :'.~- ..... Block ...O.~. ......... Lot.. ?. ! .q.v..~ ....... Subdivision ................................. Filed Map No ........... Lot No .............. ..... ~ ~ 2~. ~,. ~. ,~..~), ..... Health Dept. Approval ........................ Labor Dept. Approval ........................ /~nde~riters Approval ~. ~. ~..~,Q ........ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...... ~ .......... Fee Submitted $ ............................. Construction on above described building a~l-~t~rmit meet~ll/~able codes and regulations. THE NEW YORK BOARD OF FIRE UNDERWRITERS 1000'/[9 BUREAU OF ELECTRICITY ~J~ 85 JOHN STREET, NEW YORK, NEW ~ORK 10038 ..,,, ~ 20,1985 .~,,.,,li,;,,io,~,'o.o,,..m,~ 33s54s/8 N 697277 THIS CERTIFIES THAT only the electrical equipment as described below and irttroduced by gke applicant r~amed on the above application rt~m~er [~ the premises in the following location; ~ Base,nent ~ 1st FI. [] 2nd FI. {~i~O Section Block Lot was examined on ~t]l~ 17 ~ and found to be in co~npllance wlth the requirements of this Board. FIXTURE FIXTURES RANGES OVENS DISH WASHERS FANS OUTLETS SWITCHES NCANDE$CENT FLUORESCENT DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIMECLOCKS ~NIT HEATRRS MULTI-OUTLET DIMMERS SERVICE' DISCONNECT' S E R V I C E OTHER APPARATUS: Panelboards~ 1-2(cir,) 60amps. , G.F.C.I.- 1 (~ Pool) T~is certificate co%~c8 cc~oliance at the date of /ns~ct/c~ only becath~e of Unusual environmen~ it is sdvlsable to have frequent test and/or r~palrs mad~ by a q~alified per,on. R. C. Electric 4 T~scho l~ne Co,mack, N.Y., 11725 lic. #1610E certificate must not be aJtered in nny manner; return to the office of the Board !f incorrect. Inspectors may be identified FIELD INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined....~.~,.¢.l,., 19 ~.~.~' Approved .~,.I.., 19~.4 . Permit No.J. .~..~. ~..~...~. Disapproved a/c ..................................... ....... · ......................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ,19... Date / f..'~(. '., 19... 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 )r 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 ;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 ~ 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 3uilding 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 remova~ or demolition, as herein described. rhe applicant agrees to comply with all applicable laws, ordinances, building code,~ousing code~and resulations, and to t dmit auth°rized inspect°rs °n premises and in building f°r necessary inspecti°n~////Zfw~ .......... ~ ~-/.~~-' - - ~(,~ _ ~. ........ ,(~ignat~e ~Sf applicaB1/,.~Sr nau]e~ ~.~.c. oi~oration) · ........ (Mailing address of applicant) ltate whether applicant is owner, lessee~chitect, engineer, general contractor, electrician, plumber or builder. Iameofownerofpremises ...t~.~..,.Al' '~ ~ s . .~,....!~..?.~.C.~..~.[ .... . l.~:t..~.~.~:~ec~..: .~.~w,~.x, . .[~.'..~.l., ...... (as on the tax roll or latest deed) ...... ~'r m Z co f apphcant ts a corporahon, s~gnature of duly authorized officer. .dJ~ J I- ,v _ D m . · ~ , ku 0 Cv ~J Ix~ ~ ............................................. ~ ~ r;[-~ u_ LU > * ,J .~- ta~ .~ (,Name and title of corporate officer) ~ ~1 "~[~- -~ bi rz [~ ~_ ~ 0 ~ ¢ ~ ~ Z Builder ~ Ltcense ~o .......................... *n :l:l:/m -,t - ~ u ~ ..... ,~ ~0 u P]umbersL]censeNo .......... g3 ~ >¢ ~r~ M[ Y'" ~'2u ~ ................. mZ~z ~ ~ u..F, [~i~) ' .~2 7q~7' C }- ~, ~'--Z Electncmns L~cense No..~.2/ .............. , ~.1 X.= ,,. k- ~ -~ r, 5~,, ~, Other Trade's License No. ~L ............... ~2~g:z~6~-.': ~u o . . . m .Oi--w~OOOz~m Location of ~and on which proposed worg will be done .......... ~..G.~.m.~.~ .~ .~ .m .~ ~ m ~ ~ m ........ ....... ~ .................. ~~ . . ~ ......... ~~ ................. House Number Street Hamlet County Tax MapNo. 1000 Section ...0~5 ......... Block .... ~.~ .......... Lot...[.~(~ .......... Subdivision.~.~...~'~ .......... miledMapNo..~.~... Lot ...¢ .......... (Name) State existing use and occupancy of premis%s and intended use and occupancy of proposed construction: ?. ......................... 10. 11. 12. 13. 14. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Altera~io,n .......... Repair .............. RemOval .............. Demolition ........... Other Work~.. ~.e~. Estimated Cost ' Fee *~ (to be paid on filing this application ) If dwelling, number of dwellinglun.~s ............. Number of dwelling units on each floor ............... If garage, number of cars .... i · ~ .................................................. If business, commercial or mixe,d occupancy, spec/fy nature and extent of each type of use ........ ~.~. ......... Dimensions of existing structuros, if any: Front .... ?.?. ....... Rear . .~.. I~ ........ Depth ............ Height ............... Number of Stories .... ~%~ ................................................ Dimensions of same structure with alterations or additions: Front ...... ~ ......... Rear ..... '-:'. ........... Depth ................... Height ............ Number of Stories. Dimensions of entire new constrUction: Front ............... Rear ............... Depth ............... Height ............... Nuraber of Stories ............... ~. .................... ? .................. Size oflot: Front .... /(..~..~ ......... Rear 0 .,.~. .... e th . 7 .... ..../ .......... ./. ............... Zone 9r use district in which pr~mises are situated ............................................... . Does proposed constructio~ vio~te any zoning law, ordinance or regulation: . .~.~..~. ................... Name of Architect ........ ,.v,. · ',o' "~ .... ~. . . Address ................. Phone No .............. property lines. Give street and blocl~ interior or comer lot. PLOT DIAGRAM Locate:clearly and distinctly all 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 ]0 -Fo '4- ........... · ~~. ~'~. · · ~ ~:.... ........ being duly/sworn, deposes and says that he is the applicant (Name of individu~ghing contract) above named. of said owner or owners, ~d is d~ly authorized to pe~ or have perfo~ed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed in the m~n~r set forth in the application filed therewith. Sworn to before me this ~:~ // Nota~ Public, . ......... County