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Home My WebLink About13669-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z~3682 Date July 29 ., 19.8~. addition. THIS CERTIFIES that the building ................................................ 7980 Sound View Ave. Southold Location of Property ................................................... County Tax Map No. 1000 Section .. ~.c] ....... Block ........ 9 ...... Lot.. 3 .............. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated January ? 198~. pursuant to which Building Permit No. .~J 3.6.6.9Z dated ...... .J.a.n..u?.?~.. ? ? .......... 1985., 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 ......... Garage and bedroom addition to existing dwelling. The certificate is issued to ~RY R. JACOBI ~ SR. ..................... id. nb;, ~ ...................... of the aforesaid building. Suffolk County Department of Health Approval ......... Nyo2~ ~ 6 UNDERWRITERS CERTIFICATE NO .................................................. 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) N9 13669 Z Dote~......(..'f .................. ~9..~.~.-- ' ~'//' / ~ Permission is hereby granted tq: ~t~ ~ ~/, ,- ....... ...~.:~..o,...:.....~ ...... ~z.~.~..-.. ............... ..... ~,...~.~: ........ ~...,..~.zx ,o ....e~.~~.,..~....~...~..~ ............ ~..:.~....,.~.~-~~ ................... .... .................... o, prem,,,,oc°,,d 0, ...... Z.~~...~'Z ....... ....................................................................................................... Counfy Tax Map No. 1000 Sectionn..~.~... ...... Block ...(~....~... ....... Lot No..~..~')...~.. 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 in duplicate to the Building Inspec- tor with the fo{lowing; 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. Approva~ 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 p2"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 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: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $ :15.0 0 3, Copy of certificate of occupancv $1,00 4oVacant Land C.O. $5.00 Date . ..2.~',, ,~,~. ,~T. , ,~., ....... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ................................................................... House No, ~ ~ , ~Street Ham/et Owner or Owners of Property ./~.~.~.. County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./4.~.4 ~..~. Date of Permit/'/.~.~..~..~'..Applicant...~.../~..~... ~.~. ~/~ ..~..: ....... Health Dept. Approval ........................ Labor Dept, Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate .................... Final Certificate ~. ........... Fee Submitted $ .,~ ........................... Construction on above described building and permit maCs all applicable codes a~d regulation~ Rev, 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~- 0'~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~.,e,~].~, ~, ~S~ ~,,.~.,,o.~o.o.~,~ ~/~ N702116 THIS CERTIFIES THAT only the electrical equiplnettt as described below and introduced by t~ epp[ics~t nemed ~ ghe above application nutnber in the premises of Hen~ J~i, ~dview Ave, (N~ ~ Bz~ d~); ~uthold, ~ was exattdned on July ~, ~ and found to be in co.tpllance with the requiretnents of this Board. 14 FIXTURES RANGES OVENS DISH WASHERS FANS 12 13 14 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TiME CLOCKS UNiT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF I~EET SERVICE DISCONNECT OTHER APPARATUS: Pauelboards 1-Scir, :l~5~rp 1-(~FCI, 2-~ke I~t~tor Elec Rm heaters 1-1.25KW; ~-I.OKW NO OF CC COND PER ,~ AW, G, OF CC COND, NO OF HI-LEG C OF HI-LEG NO. OF NEUTRALS A, WG Charles ~ f~ll Electric P OBox 1~8 So~'thold, N Y 11971 Lic 057 E GENERAL This certificate must not be altered in any manner; return to the office of the Board if incorrect. [nspector~ may be identified by COPY FOR BUILDING DEPARTMENT. THIS COPY iD IflAflY MANNER, ~IEL~D ' ,' · O ~ IN~P~J, CT I N FOUNDATION (1st) FOUNDATION (2nd) 2 o ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY FINAL COMMENTS ADDITIONAL COMMENTS: · . ,, 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 l~, ..~.' TEL.: 765-1802 Examine~...//.... ,1 .9~..'''~ ~s[~o~e~df''t'/ ..... i~ermit No. (/. ~ .~..~...~..~ ................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ,19.~ Date O9 cT~qa.~.~., 19 .~.,~.. a. Tkis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets 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 or 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 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 Occupancy shall 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 Building 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 removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary ~,nfipecti~fls),~ / (Signature o_~f ap~li~(nt, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... ' ............................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ............ 4./4 ............................... (Name and title of corporate officer) Builder's License No .... Plumber's License No ......................... Electrician's License No.. ~ ....... t.c ............ 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 .....~.Z .......... Block ....... 7.7 ........ Lot.. Y.~. ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ~,v,~ ~' ' a. Existing use and occupancy ~d" ~t/Ja"~- b. Intended use and occupancy 6°'4'~ ~°,~,~4g~.~-~ ..c(. .~...c_~...,~...O..C~... 3. N t ~e.of~w~okk (~ applicable)' New Buildin~ . Addition v'~ Alto. ration' l~'e/p ~i? .............. Rdm'oval .............. Demolition .............. Other Work ............... 4. [ ated Cost.. o-q ii .......................... ee.. ........................ ~~~[ --~~ ~ ./ ~' (to be paid on filing this ap~ication) 5. I~m~~units.. ............ Number of dwelling units on each floor ............... If garage, number of c~s .... ~/ ................................................. .~ ................ 6. If business, commercial or mixed occupancy, specify nacre and extent of each type of use .. ~/~ ............... 7. D~ensions of existing structures, if any: Front.. ~7.[~. ....... Rear .. ~. ......... Depth./~. ~ ........ Height ............ .~.. Number of Sto~es ..... ~ .................................................. D~ensions of same structure with alterations or additions: Front ................. Rear .................. Dept ......... He~t ............. Number of Stones ............... 8. Dimensions of entire new construction Front .. ~ ~ ~. ...... Rear ............... Depth ~ .~. . .. Height .............. Nu~berofSto~es l~'~ ~ ~ ~T~g~ ~~ ..... 9. Size of lot: Front. ~a ~..... .......... 'Re;~: :)k~'.:. ::. ::: ~::::'~;~:h'. ~:::::::.~":: :" 10. Date of Purchase f¢fif~p~oY.~..~d ...... NameofFo~erOwner~t~ ~4'~¢~qf~P [~)" 11. Zone or use district in which premises are situated .~5~.~..( .......... : 7 ............................ 12. Does proposed construction violate any zoning law, ordinance or re~lation: . .~ ........................... 13. Will lot be regraded . ~q...j ........... v ...... Will excess fill be removed from premises' , Yes No 14. N~e ~f ~wner ~f premises ~ ~. ~fq~/ ~ .~ ~.~Address ~ ~. ~ /~ ?~ ~)~. Ph~n~ N~..~/~[ q4 ~:~4~?~ . . Nme of Architect ~ogg~ ~ . . Address ~r .&~. S~uWHO tO ~Phnna N~ Nme of Contractor ~(~ ~. {~*N..~ ............ Address ~. ~ &~P*O. WT. Phone No ...... PLOT DIAG~ Locate cle~ly ~d dist~ctlg ~1 hurtings, whether existing or proposed, ~d, indicate ~1 set-back d~ensions from property Hnes. Give street and bloc~ number or description according to deed, ~d show street names ~d indicate whether interior or corner lot. STATE OF NEW~YO. aRK, ...~.4~q4 i..~.'?.~.~....~.~.,o...~.~: .................. being duly sworn, deposes and says that he is the applicant (Name of individual sig~ing contract) above named. He is the ...................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly 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 b:efore me this ........................ day olf. · · Notary Public ..... IIELEN K. DE VOF NO1'^t,~Y PUB ;, State of New York ,'17071)78, Suffolk; Cour~ ~ Tt:ml [:',q~l(~S M,~rch 30, 19~