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Home My WebLink About6835-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING, DEPARTMENT Town Clerk's Office Somhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at Zone $; .~ol%t.~'al. D.I~ . Street Map No. Capt .K.i.dd.. Block No ........ Lot No. Mattituck conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... ~:u.~ . 31 , 19.7.3.. pursuant to which Building Permit No. 683 Z dated .... .A.u.$...31 .. ., 19.7..3, 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 . . P. ri. ya.t.e., ge. rage ...................................... The certificate is issued to .E. rv..i~... La.P.a.~g.h. .... .o..w~..e.r ............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval 1~,$, ................... UNDERWRITERS CERTIFICATE No. N..R.: ............................ HOUSE NUMBER . .160.~' .... Street . . .C.c..n.t.r.a. 1.. D.r.i..v.o ....................... 600 Zenm FOI~M NO. :~ TO~H OF SOUTHOLD BUILDING DEPARTMENT TOWN C;LERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE P'REMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 6835 Z Date ......................... ,0,~t a.l; ....... 9¢ .....19.~.. Permission is hereby granted to: S~W.,....~.~ ~.~.~...~..~zt.C~:~.c.1;or...~c..... ~ .~..~......B ,. ...... ~..a.~t:Lt~zc~ .................................................. to ...t;.~...~.~;~].t..;e.~...t~z~zLv..a~:e...ga~.a~;e ........................................................................................ at premises located at ....~,....t;.l~....].~..Ll:.,~....1.~.].u.~.....~.~,llt,..J~I~id...~ ........................................... ........................... ;I;11~1[ ..Zmn~ ..&..~ ~,p .t..K,f,¢l~.. a~ ............ M~ti.t~ ....................................... pursuant to application doted .........................~.~ ....... ~.1 .............. , ]9~.L~...., and approved by the Building Inspector. Fee $'J..Q.,.(~.Q. ............ Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southokl, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Ins1 ructions This application must be filled in Wpewriter OF[ ink, and submitted m~ to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate Iocalion 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. Commercial bui{dmgs, industrial buildmgs, 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p2bperty showing all property lines, streets, buildings and unusual natural or topograph m 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- t~on required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.00 3. Copy of certificate of occupancv $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 Date ...N.o.v.e..mb.e.r..1.8.,..1.9.8.6. ...... ~ . ~ Existing C.O.s New Building ............. Old or Pre-existing Building ,u.o?.~.e.s..o.~... Vacant Land ............. Location of Property . .C.a.~.t.Aa.1..D.r.i.v.e. .................................................... House No, Street Hamlet Owner or Owners of Property .~.a?.a.u.g.h, .&..6.o.~.e.~. ............................................ County Tax Map No. 1000 Section . . .~.0.6 .......... Block ...2 ............ Lot..3.2..&..4.3. ....... Subdiwsion ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept, Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... FeeSubmitted$;~...0.0 ......................... Please send copies of the C,O.s that you have for the garage and the addition to the dwelling. Thanks~! Construction on above described building and permit meet~aL] applicable c'od'e's an~l~lu-I~{~c~ns."' ~.~' '~"~,~- - ' Applicant .......... ,(¢~'~..'~../~~~~ ~- .-~.,.~. .......... AbigaiL A. ~ckham, As Attorney Rev. 10-10-78 ~7 9f6 " Adap OF P~aOP~R7~' ' i ~TZV/AI ~ ~S~TI~UD6 L~PAu~ ~. , -! TOWN OF SOUTH(X,D ~ ~,~,~.~_.._ ,,/_~,~,_~., ',~_/~ _ BUILDING DEI)ARTMENT ~,/ TOWN CLERK'S OFFICE SOUTHOLD, N.Y. /~./?~. ........................... App,co,on Ex°mined ,9...7...? z_ proved ..................... Permit Mo ..................................... Disopproved a/c ................ ~.~..._. ............ : .................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT ate ................... L ..L ........z.'..:....'.!....., .... INSTRUCTIONS ~~1 submitted in to a. This application must be completely filled in by typewriter o~. in ink and triplicate the Buil ~ Inspector, with 3 set~ 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 stree os areas, and giving a detailed description of layout ofproperty 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 peffnit.%, shall be kept on the premises available for inspection throughout 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 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 buildings for necessary inspections; (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. Name of owner of r- ........................................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... /~I,' ~, '~ I - ~' Plumber's License No ..... u'..' ........................ ~ .............. Electrician's License ~1oi Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................Lot Mo ......................... Street and Number ~'/':' ¢: I- x~ '~ ~- ~ I b ,, v~ t ~q 7_ ~ ~, ,~ Municipali~ 5rate existing use and occupancy of premises and intended use and occupancy of proposed construction: I t ~r". -, ~ I * ~ ' a. Exisiting use and occupancy ........................... ; ................................. ~ ............ [ .................................................... b. Intended use and occupancy ...................................................................... .~...~.:...~..!..~..L..~....:,~ ........................ 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ................. Repair .................. Remo_.v~l( ...... / 'l~ ..... (~ (). Demolition ....... :.:.....:i:~i. (~t~ W~zk ................................................ (Description) ..... 4. Estimated Cost ................................................ f .......... Fee .......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, numbe~ of cars ................................................................................................. 6. If business, commercial or mixed occupancy, speci~ hature and extent of ea~:h type of use ............ ~ ............... 7. Dimensions c~f eXisting structures, if any: ~r Front ............... ................................ DeptF~ .................... Height Number of Stories , Dimensions of structure with alterations or additions: Front .................... J ............... Rear ............................ Depth ............................... Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height Number of S"'tories ............................................... ( ............... Size of lot: Front ........................................................ Rear .......................................... Depth ................................ Date of Purchase ........................................................ Name of Former Owner ........................................................ Zone or use district in which premises are situated Does proposed construction violate any zoning law~ ordinance or regulation: .............................. ~ ................... Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No Name of Owner of premises .................................................... Address ................................ Phone No ....................... Nameof Architect ........... l, ............ ' -~ ........... ~ ' / ~: .................... Address .Y..!~l..'~,..L~,.;...~,Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... ;.. PLOT DIAGRAM ~learly and distinctly all buildings, whether existing or proposed, and indicate o I set-beck dimensions from property~ li~ms. Give street and block number or description according to deed, and show street nam, and indicate whether interior or corner~rlo~. ..... ~/~ .......... ~._~/ 10. 11. 12. 13. '14. STATE OF ~DV)/~f~)RK, ~- 1~ ~ COUNTY OF ,...::.....~... ......... Z...)...F~'~-' ................................................................................................. being duly sworn, deposes and says that he is the applicam (Name of ir)dlyid.ual-si~ni,ng ~ontracf) 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 be~Fore me this ~"' r ', -- ~ Notary Public, .~]~..o.~ ......................... ~ ....... C~t~ ...... / (Signature of applicant) THE NEW YORK BOARD OF FIRE UNDERWRITERS ELk BUREAU OF ELECTRICITY ·, ~ E5 JOHN STREET, NEW YORK, NEW YORK 10038 " 131278 THIS CERTIFIES THAT only the electrical equipment ~s described below and introduced b~ the applicant named on the above appllca~on number in the premises of ~r. LapauEh~ ~9~ B/e/eo~. Cent~a! D~. & Zsna ~att~tuck~ L.I. in thefollowlng location; ~ Basement ~ 1st FI. [] 2nd Fl. OIA~$1d~ Section Eloek Lot was examined on Decembel' 3, 19 7 3 and found to be in compliance with the requirements of this Board. FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS E R V I C NO. OF CC. COND. A, W. G, NO, OF HI-lEG A. W, G. NO. OF NEUTRALS A.W.G. OTHER APPARATUS: #Furnaces: Oil 1-1/Shp. 2-1/12hp especial ~eceptaoles~ 2-15amps., 1-20amps. P.W. Brudi, llgq Waverly Ave., Holtsville, L.I. 117~2 11 Per ~ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANy MANNER.