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Home My WebLink About7003-zNO. ,& TO~N OF SOUTHOLD BDn.nlNG DEPARTS~T Town Cl~k% O~i~ Southold, N. Y. Certificate Of Occupancy No. Z~52 Date M~.oh ~ 19..?.9. THIS CERTIFIES that the buildLng located at . .~.0, .~..N~..~vf;f.~k. Av.e ~ Map No ............. Block No ...........Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in thi~ office dated .Nove~ba~..27 ....... , 19.7~. pursuant to which Building Permit No...?00~Z dated . .November.27 ........, 19.7~., was issued, and conforms to all of the requh'e. merits of the applicable provisions of the law. The occupancy for which this certificate is ~,ued is ............. .~..~.v.~. ~.e..~.e. ~ .~. $%~,...~.e. %~An.S ........................... The certificate is issued to ......... .H.e?.b..e.r~...H..e.~..~. ............................... (o,,,er,~) . of the aforesaid building. Su~o~k Counts Depa~nent of He,~th Ap~,ro,~,! . .~.~.o?'..S.:. ?..W.S... ?.0..?? .... UNDERWRITERS CERTIFICATE No .................. ....: ......................... HOUSE NUMBER..~.O, .~.0~. ..... Street ...... N~...~Vf.f.o.% .k..A.v.~ .................. ............................................ Cu..t.~.b~,a%te.,.New ...................... ¥o.r.~ BuiMing In~'~'tor 1000-116-06 001.002 BUILDING DEPARTMENT TOWN CLERK'S OFFIGE~:~ SOUTHOLD, N. Y. ..... ................. . ........... ................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS (3. This application must be completely filled in by typewriter o~, in ink and submitted in triplicate to the Building 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 streets o~----~' 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.J~. '--'~ 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 work. · -'"~'~ lfl~ bdilding shall be occupied or used in whole or in part 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. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ame o ow e o~ p em~ses ........................................................... ~. ........... z ........................................................ :j~ ............. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) -- ~ ~ ~' / ,~'J~- '; ~. Builders License No ..................................................... ~,7'~r Plumber's License No ................................................. -7~ / 2- - -~ Electrician's License No ............................................. /~r/~,-- il~'.oo-~6,od d~l.o~_ Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No: ....................... Lot No ................... Street and Number .......... ...~..~../*/ ~-'1/P~ ~ ~ ¢? ~//~- ~.~_____ ...... Municipality State existing us~ and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ,'' ' - ' , b. Intended use and occupancy ............ ./......~ ........ ~..:'~ ......................................................................... 3. Nature of work (check which applicable): New ~u~din~ .............. L... ,A~clition .................. Alteration .................. Re'pair '~ Removal Demolition .................... Other Work '"/~ / /, (Description) 4. Estimated Cost ..................... ...; ................ ~. ................. Fee .......................................................................................... (to be paid on filing this application)/ 5. If dwelling, number of dwelling units ......... ~...[...~. .......... Number of dwelling units on each floor ............................ If garage, number of c~rs ................ : ......................................................................................................................... 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 ............................ Nucnber of Stories ........................... ~... ................................ , ,; ~ , '/ 8. Dimensions of entire new construction: Front ........... .~ ........................ Rear ............................ Depth ........................ Height .... t /~ ' Number of Sto,[ries '~ 9. Size of lot: Front r Rear .............................. ....... Death .....,.~ ............... 10. Date of Purchase ........ ~....: ......... ;. ........................... :....Name of Former Owner ......................................~ .......... 11. Zone or use district in which premises ore situated ..................................................................................................... 12. Does proposed construchon v~olate any zoning law, ordinance or regulahon: .... .A..,.~;~ .................. ~..~......'/. ....... 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) N9 ; ,, 14. Name of Owner of premises / ' r' ~ " Address .... ....................... Phone No ....................... Name of Architect ' J Address ............... ~' .............. Phone No. Name of Contractor ........ ./...!...~...'.....~ ................................. Address ................................ Phone No ........=~ ....... PLOT DIAGRAM ._~__.. ., Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicafe whether interior or comer lot. STATE OF NEW YORK, I ¢ c COUNTY OF ................................ ~' ~"~ ............................................................................................... be ng duly sworn, deposes and says that he is the applicant (Name of individual signing contract) 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 before me this ........................ day of ....................................... ./:..'.,~ 19 ........ " Nota~ Public, County (Signature of applicant) FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor 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 disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, 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 peoperty showing all property lines, streets, buildings and unusual natural or topographic 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- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $§.00 3. Copy of certificate of occupancy $1.00 Date . .~..~.~..~.~..~..a?.., .~..o~..~?.~..~.. New Building .... ~. ..... Old or Pre-exi~ing Building ............ Vacant Land ............. Location of Prope~y~. ~.. ~ .~..~ ?F~. ~ .... ~.~.~ ~. ~'.~, Hou~ No. Steer Hamlet Ow.e o O n.rso Pro..r ff ny C~nty lax Ma~ ~o. 1000 Section ...[. ~ ~. ,. ~.~ .... Block ....~ ~.~. ~.~ .... kot.. 0.~[~.~. ~.. Subdivision ................................. Map No ............... Lot No ............... Permit No. ?~.~j~ ,.~... Date of Permit ./l~.o.v! ./~..~ .Applicant.../~/.~'..~..~.~.,~'/~....'~.'../.~-.~'..~. ....... Health Dept. Approval ..... ~ ............. Labor Dept. Approval ........................ Underwriters Approval../~o .u/.~.·. ~../~7.~. ......... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .. ~ .............. Fee Submitted $. ,~. r/z) Applicant . .//..--: ~.~. ~,..~,~.... ~..(..../. ~. __ H~ ............... Rev. 10-10-78 THE 'THIS CERTIFIES THAT NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 latFl. [] 2nd FI. out;side Section Block Lot and found to be in compliance with the requirements of this Board. in the following location; ~J~ ~ .~.....i,.,~ o. August RXTURE ~WiTCHES FIXTURES RANGES OVENS OUTLETS FLUORESCENT 3~ 37 23 32 EXHAUST FANS DRYERS FURNACE MOTORS RJTURE AFN/ANCE FEE~ERS TIME CLOCKS UNIT HEATEES MULTI-QUT~T ~IMMBRS SYSTIMS NO. OF RILtT SERVK;E DISCONNECT OT ,~otor'/? ~ ~.-1/2hp 5 E R V I C E A, W.G. HO. OF I~-LEG A.W.G. A.W.G. ei~,-15Oamp. I 2/0 2/0 This certificate n ~4 be altered in arty manner;, return to the office of the Board if incorred., Inspectors may be identified OF P~OPE, qT£ 42!0 I&" xS' (...out.. ,/ ~I'OP OF GARAGE AND MAIN FOUNDATION WALLS TO BE LE"VEL FINtCHiB F; C,C,~ OF GARAGE TO ~'OE OB [OUNDATtON WALLS, ,f LIVIM~ 'i4':4' APPROVED AS NOTED FINAL WHEN JOB COMP~ET[D !i , ITE IVl GIRDER CEIL. JOISTS ROOF SHEATHINg_ FLOOR " WINDf3WS FIN. WALLS LOUVERS RAKE O/H_ CORNER P~?q GARA~E C-G- HT sis 12. }YPICkL %~:C3 ~ o kL, NOTE s~:~: ~/¢'--,'-o" NDE SCALE OWG O!MENSIONS SHF)WN ON PLAN, FAIRFIELD ]4OME$ ~'RUM f~,u LL