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Home My WebLink About6907-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMF, NT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z~.l.~ ....... Date ...........~et~.t... 2~ ...... , 19. THIS CERTIFIES that the building located at . .S...oAz~d..A~I ................ Street Map No. P.e. .c :..~.h..o.r.e.~Block No ........... Lot No?&.8. .. p.e .c.o.n..i .c... ~..: ['.: ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............Oct.....~...., 19.7.~.. pursuant to which Building Permit No..~.~..07.Z.. dated ...........0.c.t....~. ..... , 1~..., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to .J..a~..e.s..L...~z~l~... .......... . .0jeAn. ~ .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .E.:~: ............................... UNDERWRITERS CERTIFICATE No..B.. ~ ~ ~.8.....S.e.p.t...1 .8...~97~ ............. HOUSE NUMBER ..... 3.80 ...... Street.. ~0~u'~d. A.v.e ............................. ~ORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P]~EMJSES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 690.7 Z Permission is hereby granted to: ,t'o,,~..~ ........ ~..¢....4'..~..~.~.. ~ ............ ...k~.....~__&',i~ .................................................. :....~e,,y...~ ............................. ~ ................ ,o ...~..,~..~A~_~,~...~?.~.~-,,~,..~~ ........................................................... pursuant to applicatiori dated 0~ {~ 19, ~3 , and approved by the Building InSpector. F~e ~,.~ ............. FOP~M NO. 6 TOWN OF SOUTHOLD Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A Th~s applicahon must be filled ~n typewriter OR ~nk, and submitted ~n DUPLICATE to the Building Inspector w~th the following; for new buJIdmgs or new use' Final survey of property w~th accurate location of all buildings, property hnes, streets, ann unusual natural or topographic features 2. F~nal approval of Health Dept. of water supply and sewerage d~sposal--(S-9 form or equal). 3 Approval of electrical installation from Board of F~re Underwriters 4 Commercial buildings, Industrial buildings, Multiple Residences and s~mflar buildings and installations, a cemficate of Code comphance from the Architect or Engineer responsible far the building. 5. Submit Planmng Board approval of compleled site plan requirements where applicable. B For existing bufld,ngs (prior to April 1957), Non-conforming uses, or bu,ldmgs and "pre-extsting" land uses: Accurate survey of property showing alt property hnes, streets, buildings and unusual natural or topographic features. 2 Sworn statement of owner or prewous owner as to use, occupancy and condmon of buildings 3 Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation requJred to prepare o cerhficate C. Fees' 1. Certificate of occupancy $5 00 2 Certificate of occupancy on pre-existing dwelhng or land use $5.00 3 Copy of cemf,cate of occupancy $100 ~ ..~...~./ /?.t Date .................. ~ ........ New Building .............. Addition ...... ~OId or Pre-existing Building ............... Vacant Land .............. Locat,on Of Property .,..~.~.~. ...... .,-~/..~...~.~..".~. ......... ~..~,~. ...........~..~..G .~...~..~4'...C~.7../.~/..~...,/~...~/....~'::'::'~ Owner Or Owners Of Property ...J~'x~.-~../~,/.C.~ ......... ~. ........ ..~..~..~../~...~.... .................................... / Subd~v,sion ....~...C:./2. ZIZ./...C~ ..... .3...~..~.~E.~. ........... Lot No..~..~..~.. Block No ..... ~ .. House No.....~...... Permit No ~,..~.~Z...Z-... Date Of Perm,t ./.~../...9'/.7.~.. Applicant .....~. ..... ~,.~..~..~../~. ........................... / Health Dept. Approval ............... .../~.....~..!..~... ............Labor Dept Approval ............. (~..:.!..~.. ....................... Underwriters Approval ....... ,..~,...L.( .~.....~...~...o~.. ............ Planning Board Approval .... ..~....~...~., ................... Request For Temporary Certificate ..................................... F~nal Certificate .......... ~ ..................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulahons. Applicant ..., ..~..~.~.... - .~..~~ .................................... Sworn to before me this~_, '~'/~// ~//c~ f/~'~----~c'~'(,,~ _ .~...~dday of ~- /.,~.Z '~ (stamp or seal) l'~ ~,~ ~ ~,0 ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS ~;&b BUREAU OF ELECTRiCI~ [--- 85 JOHN STREET, NEW YORK, NE~V'<YORK 1003~ THIS CE~IFIE$ THAT EXHAUST FANS DRYERS FURNACE MOTORS FUTUIm AF~JANCE FEEDERS UNIT HEATERS MULTI-QUTEIT SYSTEMS DIMMERS SERVK:E DISC, CX4NECT S E R V I 1 2/0 OTHER AI~AEATU~: Eleo~t~i.c ~IZt,: 1-2.§KW 1-2.0EW 2-1.51~/ 1--1.OE'W 1-.751~/ 2/0 B,J.glec, Sttllwate~ Ave, Cutchogue, L,I,119~ · COPY FOR f TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ........................................ , 19 ........ Permit lq .............. DisapprovecJ~a/c .................../' ~ ~.~.,... ~ u~ ding Inspector~ Application No ................................ ,APPLICATION FOR BUILDING PERMIT c~)~ Date ................ ./...~ ~ ................ , 19...?..--~... INSTRUCTIONS a. This a~cation must be completely filled in. by typewriter o~ in ink and submtted in triplicate to the BuildingS. nspect,er, wit~h~3 sets of plan. s~ accurate pot p an't~,sca e Fee~accordJng to schedule b. Pl~t,~n showing location of lot and ef buildings on premises relationship to adjoining prem ses or pub c streets of areas, and giving a detail ~e~l descripti(~n of lay0~t ofproperty must be drawn on the diagram which is part of this application.~- c. ::[be W,°~k coverall by'fls~ appli~ation,.~y not be ~:.clr~l~enced before issuance of Building Permit. cl. Upo~ ~pproval of th s aPp cati°n, t.fi~l~i d ng n~j~ec'~o~r w issue a Building Permit to the applicant. Such pern~it shall be kept. on the premises available~for in~oection throughout the work· e. No building shall be occupied or used in whole or Jn 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 Buildihg 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 ~ap,Dl~¢cint agrees to comply with all a~.,~,li~a, ble laws, ordinances, building code, housing code, and regulations, and to~ admit authorized.inspectors on'pre~s~ anc~'~r; ~u~ c]~ng~ for' 'necessew inspections. - - ~ ,~ ,~ ..'.-.~, ........................ : ............................ ~. ............................. · / '/{Signature of ap.p. licant~ or namee~f~ a_ corporation) (Address of applicant) If plicant is a orpora signat re of duly, ut r' i5 icer. ~ame a;~*~~i ..... '~i" V {~ilder't License No. ,....::,.:..~..., ................................... Plumber's License No .... F-'~'..~.L~'., ..,~... Electrician's Lice~e';~." :..J~..~ .~.~....~ .......... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............. i:;i ........ .................... ........ Name of owner of ~rem ses ' ~ ...................................................... .· ........... .................................. . . ................ Other Trade's License No ............................................... Street and Number ,.~...~.,,,d~,, .... .~,',~,~.~.,.~....~,,....~,...:...~,....~....~... ....... '.~....~....C~...~...~...2'C~ .... , , ............ ........ State existing use and ~cu~ncy of premises and intended Use and ~cupancy of pr~d c~ruction: ~,siting use a~ ~cupancy ~ ~.~'~ ~'"~'~"2~:.'~...._..... '~ "~'~;;'~ ........ Intended use and ~cu~ncy .............................. ~ ~.~ ...... ...................... 3. Nature of work (check which applicable): New Building .................. Addition .....~ ...... Alteration ................ Repair .................. Re~ova, I .................. Demolition .................... Other Work ................................................ ..... 4. Estimated Cost ................... /...~...i ................ Fee l-J~' o? (Description) (to be paid on filing this application) 5. If__._ .._...__.~nWrenlling'nz~n~re, rf°f dwelling units ....... t .................. Number of dwelling units on each floor .......... .?... ............ ge. b o ........................... ............................................. ' 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 additions: Front ........... '~..'~. ................ Rear ..~..~ ................. Depth ....... ./.~ ................. Height ......~..~.. ............. Number of Stories ......... ~... .................. 8. Dimensions of entire new construction: Front ........... ~,.../',~.. ............... Rear ............................ Depth ../~. .............. Height .~.~. Number of Star es ~' ...... 9. Size of lot: Front,. ........... '. ~...~. .................. 10. Date of Purchose~..4.~,~ ................................................. Nome of Former Owner ........................................................ 11. Zone or use district in'which premises are situated ........ ~. ...................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...~.......~... ......................................... 13. Will lot be regraded~ ..,~..~,~ .............Wil! excess fill be remo, z~d fro_rn premises: ( ) Yes (~ No 14. Name of Owner of premises~,~t.~.~'~.......4. .~/.. ./'l?....)/~'../.~....,~..e~.... A~e~ .~.~.~...~.. ~?,hon, No .'~...~....?....~....~.."~"~ ~'~ame at Arch tect Address ..'. .... ................... ;~ ...................................................................... Phone No ....................... Name of Contractor ...~....~...~ ........ d...~..~......,,~.~...:....~"f....O..~.. ~,ddress ~.~......~......~.'~....~...../~. Phone N o.~r~. ~...~....~.../'.~~''' PLOT DIAGRAM ~/J~'//~14~, ~ Locate clearly and distinctly all buildings, whether existing or proposed, and ndicate al set-back d mens OhS from property lines. Gi~e street and block number or description according to deed, and show street names and ind cate whether interior 0F~:orner lot. COUN:r~ OF ,~..~..'~. ,.4-~.......~.~TT..~'~'~ ~ .......................... ~~~~ .......... : ....... ,~b~ing dul~ sworn, d~oses and soys that he is the applicon, (Name of~ ~dlV~P~n~g ~gntracf) above name. :,~ ............ ........ ................................................................................................... (Co~a~[, co~o~pte officer, etc.) of said owner or owners, and is duly authonzea to perform o~ have performed the said work and to ~ke and file this application; that all statements contained in this app3icatibn are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the applicon filed therewith. Sworn ~e me this ~ - . ...... ........ ............ mota~ Public, State of New York No. 52~0344963 Suffolk Coun~ ENCLOSED ADDITION ,SCHEDULE OF MATERIALS NAME MATERIAL SIZE NAME MATERIAL SIZE ROOF SHEATHING.' ~/,~' ~'~)~,~/.e/~ ~,,~',~/~ SILL /~' WALL COVERING ~ ,~ ~/~ ANCHOR ~LT ~-~ CEILING JOIST "~ -'' /~'/ FOUNDATION ~ ~'.~ ~ ~~ su~.~oo~ //~/~,~ ~ w~ow ~ //~. ~ ~ F~N~S~FLOOR~ / I .... t ~~'~ 'V' FOUNDATION ELEVATION ROOF SHEATHING CRAWL SPACE SIDE ELEVATION AND SECTION VIEW ,.' t I~XISTI NG WALL NOTE; ?. INDICATE ON PLAN VIEW ALL NEW WIN. DOW AND DOOR OPENINGS AND THEIR RESPECTIVE SIZES. 2. INDICATE ALL EXISTING AND NEW OPEN- INGS IN EXISTING WALL. 3. IF ROOF IS OTHER THAN SHOWN--SKETCH BRIEFLY TYPE IN SPACE BELOW. PLAN VIEW I certify that I have completed and checked Fne above dimensions and ma- terials and they are an accurate representation of the structure I propose to erect on the premises located at ................................................................ , Streel Vdlage Signature of Applicant