HomeMy WebLinkAbout5187-zFOEM NO. 4
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificnte Of Occupnncy
No...~..~.6..~t .... Date ......... 0..0.~0.b.e.~' .~.6.! ...... , 19 ?~.
THIS CERTIFIES that the building located at ..... It&]r~re~,ez, s .l)z'JLve .....Street
Map No...j~ ........ Block No... 'X~ ..... Lot No... 3~ .... ~l~t~el~e ..............
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ..... l~'ah. '29~ ...... , 19~j~. pursuant to which Building Permit No. ~3.87~...
dated ..... 14~1~. 29! ....... , 19.7.~,., was issued, and conforms to all of the require-
.--~--~--ments of the applicable provisions of the law. The occupancy for which this certificate is
issued isla~J, vaf, e .one .£am13.¥. &~e3.].~Jlg ........................................
The certificate is issued to ...Lou~.~ .J.. P. aye~ ....................................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval ...N. ?.R.. .............................
UNDERWRITERS CERTIFICATE No. PENDII~G
HOUSE NUMBER . ~ ......... Street ... ~&.t.e.~.$. ~.~. e .....................
.............................................. og. e. .......................
Building Inspector
FO~ NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
~ SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
lq? 5187 Z
Permission is hereby grouted to:
ro .... ~.-.e~ .-a~,-t,,,t~.-oa ..e~.at,-~.~l;.. M~.~ ..................................................... ;:...
at premises located at ............. j~telq~,~rj~..~/~ .................................................................................
............... ' .............................................. e~dmmlae...:...-.t!,,.~ · ..........................................................
pursu~n~ to application dated ..................................... ~ ............~ 19..~.$., and approved by the
BuJldJng Inspector.
Building Inspector
TOWN OF $O~THOLD
Building Department
Town Clerks Office
Southold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building
Inspector wxth the following; for new buildings or new use:
I. 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 dispcsal--(S-9 form or equal).
3. Approval of electrical installation from Board of F~re Underwriters.
4. Commercial buildings, Industrial buildings, Multxple Residences and similar buildings and
installations, 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 oil property hnes, streets, buildings and unusual natural
or topographic features.
2. Sworn statement of owner or previous owner as to use, occupancy and condit,on of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in-
.formation required to prepare a certificate.
C. Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use
3. Copy of certificate of occupancy $1.00
$5.00
New Building ................... Old or Pre-existing Build,ng ~.~.'~../.~...~. ...... Vacant Land ...~.~ .................
Location Of Property ....... ~..~.~"~,.~ ........ ~)~'~//.. -~... ......... ~..~'..~..~--¢,~.~,r.~.. ...........................
Owner Or Owners Of Property ....... ~.~.~r~.....~..'~.....~4..~.. ...........................................................
Subdiwsion ................................................................ Lot No ............. Block No ............. House No
Permit No. ~./.~..~...Z. Date Of Permit ~J~..~....Applicant ..~.~/r/¢.,~. ..... ~.~...~..~..~.~..-.
Health Dept. Approval ../~.~.~.'~.. ........................ Labor Dept. Approval .... ~f~.O..~.~"~.. .........................
Underwriters Approval ..... ,~.~..~.~..--~.. ....................... Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate .,~. .................................
Fee Submitted $ ...... ..~..'..~ ................
Construction on above described building and permit meets all applicable codes and regulations.
p, cant ...................................
Sworn ,o before me this
....... ~ day of ...... ~..($.~ .......... (stamp or seal)
~0~ NO. ~
TOWN OF $OUTHOLD
Building Deportment
Town Clerk~ Office
Southold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building
Inspector with the following; for new buildings or new use:
1. Final survey of property with accurate location of oil buildings, property lines, streets, and
unusual natural or topographic features.
2 Final approval of Health Dept. of water supply and sewerage dispcsal--($-9 farm or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and
installations, 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 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 buddings or premises, or other pertinent in-
formation required to prepare a certificate.
Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelhng or land use
$5.00
3. Copy of certificate of occupancy $1.00
, Date .......................... ~ ..............
,,~[ew Building ................... Old or Pre-existing Building/.~...'.~)..~'~.?2-?~''~1 Vacant Land ...;~...01.. ..................
Location Of Property .......................................................................................................................
Owner Or Owners Of Property ......... (...~..~.~.....~...~ ............................................................................
Subdivision ................................................................ Lot No ............. Black No ............. House No .............
Permit Dote Of Permit ~....~/...?'~.....Applicont
Health Dept. Approval .:..~..6....~'...47....'~. ......................... Labor Dept Approval .... ..A~...d....~..~,~..'~.. ..........................
Underwriters Approval .... ?..~.../~....~.~ .......................... Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate ~. ..................................
Fee Submitted $ .............. ;:%; ..................
Construction on above described building and permit meets all applicable codes and regulations.
· ~1-'1-.' ............................................................... ? .................... ~ ........
................ day of ............................................ (stamp or seal)
Notary Public .................................... County
FORM NO. 6
TOWN OF SOUTNOLD
Building Department
Town Clerks Office
Southold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted m triplicate to the Building
Inspector with the follow~ng; 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 dispcsal--(S-9 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buddings, Industrial buildings, Multiple Residences and similar buildings and
installations, a certificate of Code compliance from the Architect or Engineer responsible for
the building.
5. Submit Planning Board approval of completed s~te 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 features.
2. Swam statement of owner ar previaus awner as ta use, occupancy and condition af buildings.
3. Dote of any housing code or safety inspection of buildings or premises, or other pertinent in-
formation required to prepare a certificate.
C. Fees: ~;)/~/~
1. Certificate of occupancy $5.00 '~
2. Certificate of occupancy on pre-existing dwelling or land'use, $5.00
3. Copy of certificate of occupancy $1.00 /~j)~///~'7'~! )yr_)
New Building .................... O or ..,.- 'st,lng Bu~llng .,~ .............. u ......... Vacar~ Land ............................
Location Of Property .....................................................................................................................................
Owner Or
Su~ivision ...................................................... ~ ........ Lot No ............. Block No ............. Hou~ No .............
Permit No .................... Da~e Of Pe~it .................... Applicant ..................................................................
Health ~pt. ApprovaJ ............................................ Labor ~pt. Approval ...... .~ ...................................
Underwriters
Approv ........................................... Planning Board ~proval ........................................
Request For Tempora~ Ce~ificate ........................................ Final Ce~ificate ..........................................
Sworn to before me this
Notary Public .................................... County
(stomp or seol) /~/~' ': ?
BUILDING DEPARTMENT
TOWN CLERKI OFFICE
Approved ' ~' 19....*.(... Permit No...~.../., ~' ~ .~
Disapproved a/c .......
(Building InRoector)
APPLICATION FOR BUILDING PIERMII
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in Ink und submitted in d~pllcate to the Buildlng~
Inspector. . .
b. Plot plan showing location of lot and of buddings on premises, relationship to adjoining premMs or public streets or
areas, and giving a detailed description of layout of property must be drawn on the diagram whlch II part of t~l~ application.
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 Issue a Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection throughout the progress of the work.
e. No building shall be occupied or used in whole or in part for any purpose whatever until o 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 pUmuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, Gnd other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or al.terations, or for removal or demolition, as herein d~crlbed.
The applicant agrees to comply with all applicable laws, ordinances, building code, h~ousing code, and regulations.
--- ....... .........................
(Signature cf applicant, or name, If o corporation)
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ~r~'~S...'m~.,....../~.~..~-~x~.. .......................................................................................................
If applicant Is a co~omte, slgna~re~f dul~authorlzed officer. ~
"~'"~;;;';;d tltle 'of :;;;;;;~:";ffl;;;~ .................. ~
1. L~ation of land on which p~ed work will ~ done. Map No.: ...... ~ ....................... ~ ~t No.: ..~.~). ....... ~.~
Stre~ and Number ..~...~..~.....~(.~ff~..~..~ .......... ~ ................................
Munlcl~ll~ ~~
2. State exi~lng u~ and ~cu~n~ of pmmMs and intended use and ~cu~ncy of p~ c~l~:
ai,t, .se .......................................................................................
b. Intended use and ~cupon:', .....~~ ..................................................................................................
3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .........~.~ .
Repair .................. Removal .................. Demolition .................. Other Work (Describe) ......................................
4. Estimated Cost .......~.....~..r.~ ............................. Fee ~..'..~.. .................................................................................
(to be paid on f'Fng this application)
5. If dwelling, number of dwelling units .............. ./. ........... Number of dwelling units on each floor ..... .~J~.~.. ...........
If garage, number of cars ~..~.~.~ . ..
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................
7. Dimensions of existing structures, if any: Front ..... ~.,e~. .............. Rear ....~.....:~ ................... Depth ..~O ..........
Height .....~.A/'~..~ ....... Number of Stories ....... ~..[ ..................................................................................................
!
Dimensions c('rsame structure with alterations or additions: Front .... .~.~r... ......................... Rear ....~.. .................
Depth ........ .~.~ ................ Height ....... ~.~..../. ........... Number of Stories ..a(.. ..........................
8. Dimensions of entire new construction: Front .................................... Rear ....... ~ .................... Depth ........................
Height .................... Number of Stories ......................................................................................................................
9. Size of lot: Front ....... ./.'w~. ............ Rear ........ ./..¢~ ................... Depth ...././.~.....'. ................
10. Date of Purchase .(,Z/~. .................................. Name of Former Owner ~ ....................................................
11. Zone or use district in which premises are situated ..~-~a/~;L~7.~.,r~at~,,.......' ..........................................................
12. Does proposed construction violGte any zoning law, ordinance or regulation? Z~'~.------------------~....,~../'~.jf...~,,d(f~/.~-f.,.-?~..~_... ......
13. Name of Owner of premises ~1~..~......~....~...~,1~ .......... Address ..(~.~....~II::;~,~L~.. ..........Phone
Name of Architect ..~::~, ~.. ..................................... Address .~.--~... ........................... Phone No. ~.....' ..............
Name of Contractor ~..~.~.~. ....... ~..Address .~3L,~...~.....~/ ........ Phone No..~:a~'.....~...~..~-,.~
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate o!l set-back dimensions from
property lines. Give street arffi block number or description according to deed, and show street names and indicate
whether interior or corner lot. '
STATE OF NEW YORK,
COUNTY Of ................................ ~'
.... ~.l-~d~,~.....~..,.....~'.~..~..~f~,~,~:-~:t ...................... being duly sworn, deposes and says that he is the applicant
(Name of individual ~igning ~3pplication)
above named. He is the ".~ .f~.., ......... I~.a~./.~.f;a~-~:..... ............................................ ;~ .......................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to Perform or' hove 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
thor the work will be performed in the manner set forth in tl~e bPpl~cation filed therew th
......... . .... .........
~ NEW YORK BOARD OF FIRE UNDERWRITERS
THE
S¥/ BUREAU OF ELECTRICITY
~--~ SE aOHN STREET. NEW YORK, NEW ~O.~ ~oo~
I~ THIS CE~IFIES THAT
]~ only the e~t~ ~ulp~nt ~ ~sc~ ~ ~ int~ by t~ ap~i~t ~m~ on t~ a~ ~pl~at~n numar in t~ p~m~s of
Lou~5 ~. Payen, H~y~aters D~., Bay Ave. ~ Oak ~.~ Cutchogue, L.I.
I~ in thefollo~,ng location; ~ e.emen, ~ 1st FI. ~ 2.d Fl. ~tion Bl~k ~t
]~ m exami~d on ~ ~ ~ ~ ~ ~ ~ ~ 7 ~ and found to be ln complia~e ~ith the requirements of th~s Board.
~XTURE ~[PTAC~SI WIT I FIXTUR~ ~NOE$ C~KINO O~K5 OVENS ~$H WASHERS EXHAUST FANS
o~,.,~ ~ I~ ~""
5 8 6 5 11.5 1 F
,/ t
DRYERSI ~RNACE ~TORS I~TUREA~ANCE ~EDEkS ~KCIALREC'K TiMECL~Ksl BELL JUNITflEATE~ MULTI~T~ ~MMERS
~,. ~.w. ~ ,.~. ~ ,.~. ~,. ~.~.w.~. ~,. ~. ~,.~.. ,--s.. ~..,. .g%~,. ~,. ~,~
1 ~0o B x 1 31o 1 2In
OTHER
Wa~er Heaters: 1-~.SKW
~ec~ric Room Hea~ers: 2-3.0KW, 2-2.5KW, 2-1.5~, ~-1.25~, 2-1.O~,
Paul R. Burns
'f~mn Harbor Lane
SoutholdB New York 11971
11 . ,
__ __ C~OP~Y F~OR BUILDING DEPARTMENT. THIS C~)PY pF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
THE NEW YORK BOARD OF FIRE. UNDERWRITERS
$~/ BUREAU OF EI-ECTRIClI~ -
~-- 85 JOHN STREET, NEW YORK. NEW.YORK 10038'
N 146836
THIS CE~IFIES THAT
~ly the e~t~ ~u~nt ~ ~cHb~ ~ a~ int~uc~ by t~ ~pH~nt ~m~ on t~ a~ applicat~ numar in t~ p~m~s o~
in the foll~ing l~atlon; ~ B~ement ~ lst FI. ~ 2nd FI. 0~ ~ 8 ~ ~ ~ ~ctlon Bilk ~t
w~ e~ami~d on ~ ~ ~ ~ ~ ~ 7~ and fou~ to ~ in compllance with the requirements of this Board.
5, 6 ~ 5
RANGES
COOKING DECKS OVENS DISH WASHERS
TIME CLOCKS ~ UNIT HEATERS MULTI-OUTLET
SERVICE DISCONNECT j NO. OF
METER
I 100 CB
S
R V I C
; DIMMERS
NO. OF NE UTRAL~ A.W. G,
OF NEUTRAL
Charles ;,Il },,all
Box 1~17
Southolds ~ew York
].1971
QINIRAL MANAOIR
Per
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.