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HomeMy WebLinkAbout6316-zFO~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificete Of Occupancy THIS CERTIFIES that the building located at .E/it .$k~...~. ~ .......... Street Map No .... XX ....... Block No.. Y~ ...... Lot No ..... ~X...C. I1~;~h.o.s~15 ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... l)eO.~ .29, .... , 197~. pursuant to which Building Permit No. 63J~6$.. dated ......... l)et3., .29, ..... , 19.7.1~., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is .... Pl'l,~al;e..o"e. IalatJ~.. d¥1flAJJ~ .................................... The certificate is issued to ..... Johll .l~;I,J.$y ...... Ol~el~ .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...N;.II: ............................. UNDERWRITERS CERTIFICATE No. l{ ll~)O~ HOUSE NUMBER ~1~ Street ~ ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N; Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6316 Z Permission is hereby granted to: ~.o..P.~...~.~...~.r.:.*....L~/...q.....~.?...~.....~.~.~7.. ..... .............. S~t~hD~.d ............................................... ..................... ~,~..A ................................................. ~o ~..~....z.~..~.~.~ ~ ~.~..n~..~.e..x..~ ~. ~.~ ~. ~. ::~:.e.~].;~ ~ .............................................................. et premises located at ...... ~/~......~[~:~t~..~,~-31~......(~a~...~z~.~ ....................................................... ................................................. ..c.~.~?..~.e.. ........ ?.:..'.L'. ...................................................................... pursuant to application dated .................. -.~o¢ ....... ~.~) ............... , lC)...~.~., and approved by the Building Inspector. Fee $.1.5.'~.~(~ ............ Building Inspector FOU-M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ............................ .~ .......... 19...~.? Approved ............. .'.?. ......... '.( ............ , 19. ?. .. .~.. Pemit No...~....'~.../....~....~m .......... Applicotion No. ................ Disapproved a/c ............................................................................................ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pint plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, giving a detailed description of layout of property must be drawn on diagram which is part of this 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 kol~t 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 granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Z~ Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the constructtolw buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applical:de I~'~ ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspectJoflt. ~ t H~..a. tt I Ro~er nc (Signature of applicant, or name, if a corporation) Southold State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bu .............................................................. .......................................................................................................... Name of owner of premises ...~Jl~,..~&:[,ll~. ................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... ~:lectrician's License No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Mep No ....... ~ ................................ Lot No.:ll~l~ ................. Street and Number .....~../..~.......S..~.22 .~..~.....~A~fJ ........ g.l~.$.C. Jlo. glze. ................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... ~WO,,~,,l,~tg. ...................................................................................................... b. Intended use and occupancy ........... J~i~lie...1~'lf,,h..a.(1,dJ, tJi~l:i, ............................................................................. ....................... Addmon ..................... Alteration ............... 3. Nature of work (check which applicable): New Building ' ' ~ ' Repair ...................... Removal ................. Demolition ........................ Other Work (Description) 4. Estimated Cost ....................... .8..~..0....0~....~.+ ....... Fee ...~[~.~.(~.Q .................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ....o...~.fl. ....... Number of dwelling units on each floor ......................................... 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 .....................Rear ........................... Depth ................................... Height ........................................................... Number of Stories ............................................................................. Dimensions of same structure with alterations or addifiohs: Front ............. :...;,;:...;. Rear ......................................... Depth ............................... ~ ............. Height ...................... ;; ................ Number of Stories ........................................ 8. Dimensions of entire new construction: Front ..~..br.,,...:: ......... Rear ...... 2.b~ ................. Depth ..1_~ .......................... Height ................................................. Number of Stories ...on ............................................................................... 9. Size of lot: Front ..... 2,~...,+., .................... Rear ............... g2_~[...~. ............... Depth ...2.%.% ....................................... 10. Date of Purchase ..... ............. . .................. Name of Former Owner.. ........................................................... . . ........... .. 11.. Zone or usa district in which premises are situated ....... A....~I.:Lst; ............................................. 12. Does propOsed'construction violate any zoning law, ordinance or regulation: ................ ~ ........ . ............................... 13. Willlot beregraded---~tO. ........................ Will exCess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises ...aT..Q}3~..~;LLe[ ......... (~[1.1;¢~J~Gg3;te .............................................................. .~.~.....~, (Address) (Phone No.) '- Name of Architect .............. , ............................................................................................................................. .'....".. (Address) (Phone No.) Name of ContraCtor ....~.O.~.~...]~.~,.~.~..~g....., ............................. ~.~;~L~R~,E~, ....................................................... (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NEWYORK, ) COUNTY OF ........~.~1~. .......................... ) SS Robert L. Hyatt being duly sworn, deposes and says that he is the applicant above named. (Name o/ individual signing contract) Contrac tot He is ~he ................................................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.] of said owner or owners, and is duly authorized to parf~rTh~v~k~e~'formed the said work and to make and file this application; that ell statements contained in this application are true tel~t~qt~l~%l~f' ~ai~0owled~l~rSnd belief; and that the work will be performed in the manner set forth in the application filed therewith. No. 52-0344963 Suffolk C0unk~) Commission Expires March 30~ 197/-./' ......................... ....... day of ........ ..O..e.c. .................................. _7...2. ...... ( ~gna ,f ~ppli~ ] THE NEW YORK BOARD OF FIRE UNDERWRITERS CR BUREAU OF ELECTRICITY r~ 85 JOHN STREET, NEW YORK, NEBN YO[~I~ loo3e October 2 THIS CE~IFIES THAT o~y t~ ~t~ ~ipment ~ ~sc~ ~ a~ int~u~ by t~ ~p!~cant ~m~ o~ t~ ~ application number in t~ premises of John ~aitey, e/s Bay Ave. 100' n/o Eugene ~d., Cu~chogue, L.I. in the following location; [] ~o~ement [] l=t F~. [] =ha rt. out~tde Section ~o~k Lot ~vasexamin~don September 27, ~7~ and found to be in compliance with the requirements of thiz Board. 7 la ? 17 I I I DRYERS FURNACE MOTORS FUTURE APPUANCE FEEDERS SPECIAL REC'PT AMT. K.W. OL H,P, GAS H,P. A,V,T. NO. A.W.G. AMT, AMP, SERVICE DISCONNECT NO. OF I S R ~,~. ~.w.o. Ltectric room heater/s: 1-~.Ok~, 1-.75kw, 2-~ PanelboarB/s: l-4ckt.125amps. COOKING DECKS OVENS IDISH WASHERS I MUL TIME cLOCKS BELL UNIT HEATERS TRANS SYSTEMS NO. OF FEET C A. W.G. NO. OF NEUTRALS NO. OF HI-LEG O~ HI-LEG EXHAUST FANS DIMMERS OF NEUTRAL W,B. Ruland Mattituck, GC'NE~AL AAANAG~ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.