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Home My WebLink About13781-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...g.'l~..~9 5 ......... Date ................. .~..rog..e..~. ........ 19 .~.~. THIS CERTIFIES that the building-z .-0.d.c~'¢~-.o.~ ................................... Location of Property . fl.2.~..O ............... ~.@3r.~.e.~.~.;7. Road Cutchp.~ue . Hou~ No. S't/~i ..................... h~r~/ei County Tax Map No. 1000 Section . .'lfi.~. ....... Block . ...0.2. ......... Lot ...Ofi. O. ........... Subdivision .... ~ ......................... Filed Map No... 2; .... Lot No...X .......... conforms substantially to the Application for Building Permit heretofore Fried in this office dated ...... .~.~.~9.t~..q5 ...... 19 .~5. pursuant to which Building Permit No.. fi.5?.~J..g. ........... dated ........ .I~. ~. T.e.h' ..2.2 .......... 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 ......... ........... .a.d.d. $.~.~.qn. s...~.o.. ~..n..e.x..~.s.~.i.n.g..one. r.~.~.m.~. ¢7..d.~.e.l.l~n. ~, ............... The certificate is issued to ........ .~.~10-~T4k~ .2~T,~1~2~I9 ................................. (owner, ~ ~ of the aforesaid building. Suffolk County Department of Health Approval ....n.o.~. ?.e.q~..5_.~.e.d. ........................ UNDERWRITERS CERTIFICATE NO ........... ~ .~..~.2~.0.9. ............................. Building Inspector R~. 1/81 l~OB,,~ NO. f~ 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) 13781 Z Permission is hereby granted to: ....~.~.~.~ ...... ~~ ............... ..~.~.~....~..~./..~. ............................................... ~~....~..:~.:.....1./..~..~../. .... ,o ...~.~ ...... ~ ......~.;....,~.....~.,.~.....~ ...... . .... "~,7 ...... ;'71 ............ ~'/Jl ....... · ............................................................................................................ .... ~........~..~..~.....?...~ ........ , ................................................................................................ County Tax /V~ap No. 1000 Section ......... L/...~. ...... Block ......... ...'~... ....... Lot h/o ........... ./.....~.. ...... to application dated .....~.~.....,J..~.. ................... , 19.~..~..., and approved by the pursuant Building Inspector. Building Insl:mctor Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southo~d, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate 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. Commemial 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 property 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. 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 $15.00 New Building ............. Old or Pre-existing Building Va~,~t Land ............. Location of Property ...... %.."~...~?. ....~..~...~.. ~'~.' ~'~ i .~. i .~i i i ....~..~..?.~.1 .,~...~,?. ~ ..... Hou~ No. Steer HamNt Owner or Owners of Prope~y ......... .[~....~1.. ~....~..~..~.~..~ ............................ County Tax Map No. 1000 Section I ~ ~ Block ~ ~' Lot .... ! ?. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.~..~.~.~.'..~.. Date of Permit .~.!%..~. ?..~.Applicant ..... .~..;...~..~..'~'...%~.. ............ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval r ~ ~) ~"3~0({ .Planning Board Approval ~ Request for Temporary Certificate ..................... Final Certificate ....................... Construction on above described building and permit meets all'codes q 4r-5o - . A ,,cant --- · .,,,.. .... ...... BLDG. DEPT. "~? TOWN OF SOUTHOLD ~ FIXTURE OUTLETS SWITCHEE 8 ? DRYERS FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS FLUORESCENT SYSTEMS NO. OF FEET E R V I C NO, OF CC COND. AWG NOlOF HI-LEG A.W.G. NO. OF NEUTRAL~ A. WG. ~R ,g OF CC. COND. OF HI-LEG OF NEUTRAL OTHER APPARATUS: 1-G.F.Z. 1-Smoke de~eo~or Ruland l{lec~.ric Co. P.O. 1~o~ ~43 Ma~t£tuok, MY 11952 Lio{{242 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COI~Y FOR BUILDING OEPARTM ENT. 'I'HI8 GOllY OF CEIIITIFICAI'~ MU~T NOT BE ALTERED IN ANY MANNER. FIELD INSPECTION FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION ?ER N. STATE ENERGY QODE FINAL COMMENTS ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Exam~ncd .,'~ ~W-~..~. ~.., 19 .~ .( Approved . .~...a+.~....at..z..., 19~..f'. Permit No.j. .~..7: ~.1..~-.. Disapproved a/c ....... . ............................. (Building Inspector) ~ APPLICATION FOR BUILDING PERMIT Application No ................ Date '~l iq 19~' INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according tc schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stre,, or areas, and giving a detailed description of layout of property must be drawn ou the diagram which is part of this apF cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon apprc:al of this application, the Building Inspector will issue a Building Permit to the applicant. Such peru 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 Occupan shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance cfa Building Permit pursuant to t Buildin~ Zone Ordinance of the Town of Southold, Suffolk County New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or de~lil&lition, as herein describe ]'he applicant agrees to comply with all applicable laws ordinances, building code, hoq,~'h'~ c)ffie, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspecJ~ions. .. · ..... (Signature of applicant, or name, if a corporation) (Mailing address of aPplicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build~ N.'une of owner ofpremiscs I..0~.~ . f'~*~'~l (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Nalne and title of corporate officer) Builder's License No ........ ! } .{~ .............. Plumber s L~cense No ......................... Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be done ................................................ House Number Street Hamlet County Tax Map No. 1000 Section ..... I ............ Block ...... .q3. ~ Lot. ] ~ Subdivision ..................................... (Name) Filed Map No. . .' ........... ;' Lot .. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ! ~. ~e"~.~ b. Intended use and occupancy t.~ .~. ]. Nature of work (check which applicable): New Building .......... Addition v/ Alteration Repair .............. Removal .............. Demolition .............. Other Work ............... ~. (Description) Estimated Cost q ~ ~ ~ ........ Fee..(9.;~.:/..9 ................ * ........... (to be paid on filing this application) ;. If dwelling, nmnber of dwelling units } Nmnber of dwelling units on each floor. If garage, number of cars ........................................................................ If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structures, if any: Front...~..~i':.3. .aS-. ..... Rear ....G..0.'7.9 .*..... Depth . .'.~. ?..'9..+-. ..... Height ...'~..~'..'~...~. .... Number of Stories ....I..~ .................................................. Dimensions of same structure with alterations or additions: Front . .~'?. ~.*.- ......... Rear . fie..~. 77. ~ ......... Depth .... ~ .............. llelght ...................... Nu nber of S ones ..................... Dimensions of entire new construction: Front ...~..~. ?..~. .... Rear ....~. ?..--.".? .... Depth ...qZ..q'..'~. ~ ..... t~ Height . . . ."tr..'~'..'~...~.... Number of Stories ...... ~. ~ .......................................... i. Size of lot: Front ...................... Rear ...................... Depth ....................... ). Date 6f Purchase ............................. Name of Former Owner ............................. I. Zone or use district in which premises are situated ................................... : .................. !. Does proposed construction violate any zoning law, ordinance or regulation: ............................... L Will lot be rcgraded ........ .O..O ................ Will excess fill be removed from premises: Y~ I. Name of Ov,n~r of ~remis-* t,,,3,,H, r'L~,~,,,~ ,,.3~,.. Address~..~..~..~.m. ZI.Z..o..r.~..-I;.' .. Phone No.'1.%..'rt.'..,?.o.~..-},.. Name of Architect ............... ~...~?.~..~.?..%~....O.. ~ ~i i .... Address ~.&$[t .~,y..~?.. ~?y....f.q..-~. Phone No. '1..~.~..:. Name of Contractor .?...~.,. ~,.~,..u~,~... ?. ~..~....-{~ .... Address~J~..3..a~. fl.J. ~ %.'1.. Phone No. 'I .~."~ ........... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from roperty lines. Give street and block number or description according to deed, and show street names and indicate whether terior or corner lot. rATE OF NEW3ZO,R,K, , , OUNTY OF. ~ .... S.S ....... ~ ./.~P(. ~].~.gv-. ...../~.D../?? .~.F_~. ............... being drily sworn, deposes and says that he is the applicant (Name of indMdual signing contract) >ove named. is the ......................................................................................... (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this )plication; that all statements contained in this application are true to the best of his knowledge and belief; and that thc 'ork will be performed in the manner set forth in the application filed ti~erewith. ~vorn to before me this .... /..~. ................ day of.. ~~ ......... ... otary Public, . .~ ................. County ? ....... · .... No. 4~22~3. Suf~k Cou,,~.. (Signature of applicant) Term Expiree March 30. 19.~