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Home My WebLink About13976-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ..... .~.'1~.8.~..~ ...... Date .......... September 3 19 85 THIS CERTIFIES that the building ..... .~g..ri. cultura.1..l~.1..d.~... .................. Location of Property .... ~.~.'J. 7.0. Rte. ti8 . Peconic County Tax Map No. 1000 Section ..... .~.? ....Block ........ ~ ...... Lot ......... ? :.2. .... Subdivision ............ .X. ................. Filed Map No ..... .~...Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... Fi..ay..~. .......... ,19 .~.~pursuant to which Building Permit No .... ~.~.~7.~.g. .......... dated ...... H.~y..2.3 ............... 19 .~.~., 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 ......... ~g~.icultural buildin . The certificate is issued to ........KS~I~...t~T.O.B..I4)C.H. ........... /own, j ...................... of the aforesaid building. Suffolk County Department of Health Approval ................ ~,/~ ...................... UNDERWRITERS CERTIFICATE NO ...................... ~70.~.~Q 3 .................... Building Inspector Rev. 1/81 ~OB,~ NO. ~ 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) 13976 Z ............ 19.~...~.., and approved by the % Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted is IIII1~1~ 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 appl~icable. 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, occupanc,/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 Date ... New Building ~ Old or Pre-existing Building Vacant Land Location of Property . ,~t'~"'. ,1~. ~I, .',~.."~.C~¢~'~- i~' ¥ ................ House No. Street Ham/et Owner or Owners of Property .... .~.~.',.~ .... ~..O--~1~ ~ ................................ County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. I.~...~ ?.~..Z~.. Date of Permit .......... Applicant...~t.~ ~ .... .~.Y3O.~.IO~. ....... Health Dept Approval · -- ' Labor Dept Approval " Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building aj~rmi~4*nee.1;s all applicable codes and regulations. ~A ,- -~ Applicant...~. ~.. ~ ...................... THE NEW YORK BOARD OF FIRE UNDERWRITERS iO00L?.I BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK '1OO3~8 ~at~ ~m]~t~ ~8, 19~5 343732/85 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the able application number in the premises of ~vin K~b~ ~u~ 48~ P~n~ N.Y. was examined on and found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES ~OOKINGDECKS OVENS DISH WASHERS EXHAUST FANS ~0 [3 9 ~0 1 20 I ~0 SERVICE DISCONNECT NO. OF S E R V I C E AMT' ~P ~PE EQUIP. 1~2W l~3W 3~3w 3~4w N O~E~COND OF~C COND. NO OF HI-LEG NO. OFNEUTRALS 1 lO0 ~ X 2 l ~, N.Y. 11971 Lie. 282 rhis cerfificote must not be olfered in ony monner; return to the office of the Board }~ incorrect. Inspectors moy be identified ~y their credenfio[s. BUILDING I S COPY I ! ALTERED IN ANY MANNER. F1ELD INSPECTION COM~ENTS FOUNDATION {1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CpDE FINAL ADDITIONAL COMMENTS FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL Date ............... , County Tax Map No. 1000 Section ~ Street 7 Budding Inspector RV 1/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOL. D, N.Y. 11971 TEL.: 765-1802 ~,pproved . .~.., 19~.¢. Permit No ..... -Disapproved a/c . . ,. ~..,,~.I, ................ , , i ' ' (Building h~spectpr)' , APPLICATION FOR BUILDING PERM,IT INSTP, UCTION S a. This application must be completely filled in by typewriter or in ' .' ttie Building Inspector; with~..3__ and submitted'to ,:ts of plans, accurate plot plan to scale. Fee according to schedule. · '" ~o adjoinh{g premises Or public streets "~plan showing location of lot and of buildings on premises, relahonsh p . ~r areas, and giving a detailed description of layout of property must be drawn on [he 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 Bu'ihling Pcrmit tqtbc 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 purposle wlmteve', unti, l a Certificate of Occupancy .hall have beet~ granted by the Building Inspector. APPLK'ATION IS HEREBY MADE to the Building l)epartment for the issuance of a Building Permit pursnartt'to the hdldiug Zone Ordinance of th¢ Town of Southold, Suffolk Countyl New York, and othcr applicable Laws. Ozdinanccs or iLegutations, for the construction of buildings, additigns o~ alterations, or for'rem,oval or demglition, as llerein described· l'he applicant agrees to cmnply with all applicable laws, ordinances, building code housing code, and regulations, and to ~dmit authorized inspectors on premises and in buildin'g for necessary inspectio, ns._ ;-~-f' ~ , (Signature 61Xapblicant or,name~ if a corporation) (Ma ng address',of apphcant) State whether applicant is owner, lessee, agent, architect, engineer, general ~ontractor, elec, trician, plumber or builder. ..... ; (r_) k ~29.~'3 ...................... , ................................. , ......... 4amc of owner of premises . . ~ ~<'~, · . · ~'CXe,~kW.¢.~.'- ........... ................ ,'. · · ' ': ................ (as On the tax roll or latcs~t deed) ' ' · applicant is a corporation, signature of duly' author!zed officer. (Name and title of corporate, officer) . Builder's License No..~..G....-~5~' .%5:c,~.[. ......... Plumber s Lice xsc No .................... ; .... I:lectr,cmn s LlCellse No ............. ...... ,... Other Trade's License No .................. .... Location of land on which proposed work will ho'done. ........ ~ . ....... ' , .. ·... - ......................... , . ) 'D' ...., '. ;"..., :..' ....................................... llouse Number Strc'ct .... ~ ..am,ct, ,,, , , , County Tax Map No. 1000 Section~ ..... ~.~}~ .... '. Bloc'k' /: ' ..; (Lot .<'. "~ '' I:iled No ' Lot ............... Subdivision ........................... Ma? (Name) , State existing use and occupanc~renlises and intended usc and occu ~m~cy of proposed, constructio:t. b. lntended use and occupancy . c;¢~. .,~*.~ ..... *] .m ~ _ ; ................................... 31 Natur. e of work (check whieh applicable)(Ncw lluildin~ property lines. Give street anti block number or description according to deed, !and show street names in terior or corner lot. Addition ........ .. Aitegation ,. ..... ., ....... Otb'er Work... ......... ' ' (Descriptio i (to be )aid o~ filing this ap>l!qation) 5. ,If dwelling, number of dwelling units ' ' ' Number of dwelling units 'on each floor, '.....' ........ . Ifgarag},numberofca[s .2 ..... c~q.<x ............ ' ...... , 6. ~usm ss, connnerclal or,n~xe occupan y, spec nature and extent o e Ich typ of use ' ' ' ' ' 7. ~m~ensmnsofexistingstructures if any: Frolt /~) ~r "~q" ....... : ........... ~Height Re ,, ' ............... ,..' .... Depth ............... Number of Storms ................ Dimensions of same structure w~th alterations or additions: Front .'. '...~ .... ~'.'~. Rear ' ' ....... ,.. N~mber of Stones 8. l)imensions of entire new construction: Front ' y~ Height I.J, .. Nmnber of Stories 10. Date of Purcrtase . .~c. %.~, ~ .t~ff.. Name of For,mcr Owner ~' ' Zone or use district in which premises are s tt ted ' ~ n ' ' ' Does proposed constructmn vtolate any zoning law ordin c lot be regraded ...... ' ................... . W/II excess fill be renloved ~rom '' p t,n~lses. Yes 14. Nume of Owner ofprenlises . .~ ...Boo~0~ ....... Address ... Name of Architect ......................... Address ...... ~ .... P lone No '-~ - Nmne of Contractor . ..... "· · Address "' '~: ....... r ' ,Phone No.... .......... PLOT DIAGRAM Locate clearly and distinctly all buildings,.whether existing or proposed and./ndka~e ail sebback dimensions and indicate whe woxk will be performed in thc nlanncr set forth in tile apphcalion filod therewithl Sworn to before me this , .,aC' 21fh ;[(y i'll[~! ~r~. Slate 'o~ lq~w Ytir~ ~' : . (Signature ofapphca,,t STATE OF NEW YORK, COUNTY OF ................. S.S ' ................................ , .......... being duly ~wom, deposes and says that h is the applica~ (Name of individual signing contract)l,, ' . above named, i . . : , , (~ontj'actor, age,,i, .corporht~ o?fice:r, etc.) , of saidI owner or owners, and is duly authorized .!.o perfoi'm or.h~ve perlormed the said'u application; that all statements contained in this fipplk:ati0n are true to ttlq bes~ oftus kno vlfidge and.belief and that th ork nmi to Inak'e and file tit t"11DDLE . P. OAD C.~.27 0£ ]. ,CON~ IDJklLI~OAD ,C4JAfe~NTt::.ED /'0 ;HE AS SU~,VEYE D ,, ,r,, VAr,, '/?.Z'. LEFT "F~ ~31,! 7 E&~:¥ATI C N A~:2 ~ ~ AS NOTED ~OTJF¥ BI~)L-~iNG DEPARTMENT AT ~65d802 9 AM TO 4 PM FOR THE ~OLLOWING INSPECTIONS: FOUNDATION - ~O REQUIRED FOR P~URF~ 'CONCRETE 'R~UGM - FRAMING & PLUMBING STA~~, ~. . O~ TH~ N Y, Phone 477-0400 ~ Maia Road LoFT GR£ENPORT, N.~ 1 t944