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Home My WebLink About5970-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~.,~l~ ...... Date ........... ~t ..... 1[ ......., 19..73 THIS CERTIFIES that the building located at . .l~&~t~'®ll..I,~1~ ........... Street Map No.B~ .ltaY~ellt.. Block No ........... Lot No..1,~ .... Bo~fl;hc~ld...};,~/.o .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ,l~m®.. 19 .... , 19..~ pursuant to which Building Permit No. '~9'~)~ · dated ........... ~ille. 26 ..., 19.~.2., 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 is . l~4'ivat~, one. Sa~kJ.y. d~elll~g. ...................................... The certificate is issued to .... l~;h..~/el;I.~ .... ~el'. ............................. of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) . Oc~:.. ~. ' '197~' ' 'b}'. {{ .V~i-ia ...... UNDERWRITERS CERTIFICATE Noll~O~'~'~. .... l/~,-1~. · · 28. · 'l 873 ..................... ttOUSE NUMBER .~1'~ ........ Street ...... ~il.~'. J:l,~¥e~ .1.~,I10 ........................... FORM 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) N? 5970 Z Permission is hereby gronted to: ..................... .................. ,~ c~uf~.o;~ .......................................... to .~.~1~ ..~... coa~...f~n~'...~.~l~Lug .................................................................................... at premises located at ........ .L9.?~..~..~, ......... ~a.7..~d&vel~: ................................................................ ......................................... ]).~3r..~..~.. ~..zx~ ................ I~.~i,~:~i, ................................................ pursuant to application dated ............................ ~lZlaf~......1..~l ........ , 19..~., and approved by the Building Inspector. Fee $...~-~,~.$.(~ ......... PE'2, MPF INCLUDES APPROVAL TO REMOVE EXCESS FILL FROM ABOVE PREMISES BY REGRADING LuT I// r) pdV[:vv ~Y CONfTRUCTION ~ CESSPOOL CONSJ RUCTION / CELLAR. CONS]' RUCTION OTHER FOBM NO. 6 TOWN OF SOUTHOLD Building Depa.ment Town Clerl~ 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 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 buildings, Industrial buildings, N~ultiple 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 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 October Dote ................................................ New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ..................................................................................................................................... tbi%h Ir. Owner O~ ~ners O~ ~ope~ ....................................................................................................................... at u old Permit No ..................... Date Of Permit .................... Applicant .................................................................. Health ~pt. Approval ............................................ Labor ~pt. Approval ................................................ Underwriters Approval ........ ; ..................................... Planning B~rd Sproval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... E,00 Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me this ~th O~teber, 1~73 ................ day of ............................................ Notary Public .................................... County N~fy Public. S~te (stamp or seal) SOUTHOLD, N. Y. Examined ...... ,~, ......... , 19.?..,1~, Approved ........~/..../..~L ......... .( ........... , 19..?....2TPermit No...,,~,.?,..,~..~...~ ...... T~N OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE Application No. '~'..~....~..~ ................ Disapproved o/c .~.._..~...; .............................. ~. ............................... ................................. APPLICATION FOR BUILDING PERMIT Date .............. ~'...~t...e.....].~9~ ........................... , 19..~, .......... INSTRUCTIONS a~ This application must be completely filled in by typewriter or in ink and submi.tted in duplicate to the Building "Inspector. 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 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 pa rt for any purpose whatever until a Certificate of Occupancy shaft 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 and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Butlc~er If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Loccrtion of land on which proposed work will be done. Map No: ..... .2..~.~..0. .............................. Lot No: ......J4.~ .......... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy ................................................................................................................................... use occupancy ............. ~. ~',$.T~.$.e...~.._-I.'~ Intended and 3. Nature of work (check which applicable): New Building .......... .Z. ...... Addition .................. Altero¥ion ........... ;, ..... Repair .................... Removal '. ................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ...... .~..]:.~/~.0....C~....0~.. .................................. Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............6. ................. Number of dwelling units on each floor ............................ If garage, number of cars 6. If business, commercial or mixed occupancy, specify natureand 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 additions: Front ................................ Rear ................................ Depth ............................ Height ................................ Number of Stories ........................................ I 8. Dimensions of entire new construction: Front ....... ~ ..................... Rear ....... .6,~ ................. Depth ....2~.&.~,8. ......... Height .......... ~.~.~. ............ Number of Stories .......... 1 ..................... 9. Size of lot: Front ........ ~ .................. Rear .......... ..~-.~. ........... Depth ......... ~/~S ......................... 10. Date of Purchase ...... ~u~...e.....6.~....l~..~.. ......................... Name of Former Owner ...... .~.~.'l.]~..~.....~..e....~...~. ........................ 11. Zone or use district in which premises are situated ......... ..~..~.cl:...e~...~.m:.~ ........................................ 12. Does proposed construction violate any zoning law, ordinance or regulation? ............ ~.0. ...................................... 13. Name of Owner of premises ...~..~..t...~...~......~e...~....e. ............ Address .~.~..~.e.~..~..o~...t.~g!~l-~. ....... Phone No....7..6~..-.~.7h~9.. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ....~T~,,I~J,~II..~ ...................... Address .r~:~l...~,ne~..~qmz~l~ ....... Phone No....?.6~ 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 numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEVi_ YORK. ) COUNTY OF ..~).~ ............ ) S.S. ..... : .................. ..~.~.:~...~....~/.~.~ ............. :......'.....,'. ........ : .......... -being duly sworn, deposes and says that he is the applicant (Nome of individual signing application) above named. He is the Contractor (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 ckoplication; that all statements contained in this ~a~&!i.c~/illr], are true to the best of his knowledge and belief; and that the work will be performed in the manner ri~l~i~.~e/ application filed therewith. Sworn to before me this 197,h Ju~e ........................ doy f ...................................... ,.-... .... ............... ............ ...................... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ' T--- mm EB JOHN STREET. NEW YORK, NEW yORK 10038 THIB CERTIFIES THAT onl~ the electrical equ~ment as deecr/~ed ~ and i~troduced b~ thx~ applicant no.n~ o~ ~e Wm. Wells, Bay Haven Lane (west side) Main ~ayv~eY old, L.I.~ inthefoHowi.glocation; L~ Beaemen, ~ z, rt. [] ;.d rt. o~Aside ~,o. e;,~ ~,,~ 29 ~exami~don AU~U~ 27, 1973 a.dyoundtobeinco.plia~e~iththerequ;~men~ofthlsBoard. FIXTURE /ECEPTACLESI SWiT E ] RXTURES / * 1 ~ 10 RANGES SE*VIC; OlSCC~NECT NO. O~ 1 100 CB METER S E R COOKING DECKS OVENS DISH WASHERS AMT, K.W. j AMT, K.W. , MT. K, W, MULTI-OUTE_L'T SYSTEMS NO. OF FEET TIME CLOCKS BELL UNIT HEATERS OF CC. COND. OF HI-U~G 2 EXHAUST FANS AMT. H, P. DIMMERS Furnaces: 1-1/ShP, 1-1/12bp NO, OF NEU ALS OF NEUTRAL Ted Eapela 1~ Newport Drive Port Jefferson sra., N.Y. 11776 Per_ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. I O,ID. DN Pt,PE ,q 4roL4" GL 0I~ 8'-- Io' f"2' 4"' 't '19Lo'~ Iz' g'~