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Home My WebLink About6969-zTOWN OF 80UTHOLD BUrLBI~g DEPARTMENT Towa CJ~rk'~ Office $oathold, N. Y. Certificate Of Occupancy No. Date IQ OCT 1~?..~'. ~IS C~T~S ~at ~e b~g loca~ at ............................ ~ Map No. ~e ~ ~ ~ ~ ............ Blo~ No ........... ~t No. ~ Z - ~ ~ conforms substantially to the Application for Building Permit heretofore' filed in this office I ~ 7~ ~ated ...................... , ~ .... p,~an~ to ~,hich e~d~ ~e~ ~oP.?.~. ~ ~ dated ......................., ~g .... , wa~ issued, and. conforms to all of the requi~e- ments of the applicable provisions of the law. The occupancy for which this certificate is · '~ 3:~E'~t/~-T~. DNa_ F/3,. t,~ ~ L.~ 't~/E L L. ~ N ~,,..' issued is The cerf~icate is issued to ......................... ~ ........................... of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No ............................................. HOUSE I~V6IV~ER .............. Stzee~ .......................................... Buildin~ Inspector FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT C1;HIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6969 Z Permission is hereby granted to: . at premises located at ./,f~.lL.,~,33,_~35....~azmm~..~at,..es~l~ ........................................ .......... : ................... ~.a.~a~..~.as~t..ao~a .......... c~teaee~ ...... :.[ ....................................... pursuant to application dated ....................... ~lOlt ....... .$ ............... , 19~.,., and approved by the Building Inspector. Fee $:e.~eO0 ............ Building Inspector FORM NO, 6 TOWN OF $OUTHOLD Building Department Town Clerks Office 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 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 disposol--(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 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: I. 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 $5.00 3. Copy of certificate of occupancy $1.00 ~ ~ ~. Date ...... ~.:~ ............ .~...~'.. ...... New Building ................ Addition ................ /Old or Pre-existing Building ..... .~.....~!/... Vacant Land .............. Location Of Property .../~.?,...~...?w..~.~..,.~.~..,~;~ ........... .~.,~s;..x...~..r.c..~.;.....Z~...~/~.~.,~.~.../..~...x'~.....4~....,~.. .......... Owner Or Owners Of Property ......... ~!.,~'./'~....~...~..(.-~.4~ ............ Subdivision 2 ./. /. ~"z~---z~ Lnt Nn~''~ Rlnrk Nn Idn.~, kln~-~J~ Health Dept. Approval .................. ...~....,.~... .............. Labor Dept. Approval ................. ..'~...../..~.. ................... Underwriters Approval ../~....../..~..i..~....~.~....~.. .............. Planning Board Approval ...... ...~...../...~. ..................... Request For Temporary Ce~ificate ........................................ Final Certificate .......................................... Fee Submitted $ ......~ ......................... Construction on above described building and/~mit meets all appi'Fc~a~le codes and regulations. Applicant ...~?,~.7/x~_(.~.~.~.f'~..~.~.~~~"~ '~'x/~'~ ......... 7'/// .......... .~.k/?day of .~..~J..~.../...../...-?..~./...~.. ................ (stamp or seal) ~' ,<'~ ~ Notary Publi~.~?:x.~,.....~::~.....,.~ ..... C~unty"'x__ ~ F,'e 52-03~4963 Sul!cik Cc:,~t~, '~' THE NEW YORK BOARD OF FIRE UNDERWRITERS I~UREAU OF ELECTRICITY,, * ' 0otober 2 197~E5 JOHN STREET, NEW YO~ NEWJY~K 1~OO3'8'~ ' ~.~io. ~o ..~ 720728. '.~ "' ' · - ' - N 185626 FOCTURE LECEPTAO~ I w I RXTURES o~..~s r' .is ,T~:... i,~.I~.~ j ~ 33 / 3q 21 33 DIIYERS I FURNACE MOTORS RJTURE AFPlJANCE FEEDEIIS AA~T. ' K.W. OIL H.P. GAS H.P. A~T. NO. A, W, O. 1 200 CB x 1 ~/0 RANGES COOKING DECKS OVENS 01~1 WASHERS KMT, K* W* AMT, K.W.IAMT, K.W, MT. K, W. SI~TJALREC'PT. TIMECIOCKS ~ BLEU. [UNITHEATERS MULT1-OUTIrr Elec.room heaters: 1-5.0kw, q-2.0kw, 2-1.Skw, 1-1.Okw Panelbdill-ds/: 1-gott. 100amps. EXHAUST FANS DIMMERS ~ ~oo OF NEUTRAL q/0 Howar~ Dillin gham, R~D fl, Woodoliff Drive, Mattituck, L.I. 11952 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MuST NOT BE AL? IN.~AN~~ MANNER. :, TOWN OF SOUTHOLD ~/~ ~/ BUILDING DEPARTMENT TOWN CJ.F. RK'S OFFICE SOUTHOLD, N.Y. . ......... ......... ....... App' 'o N .... ; .../.....~ ........ ,... Disapproved o/c "i ........"'-"~' ............................................. ~ · AP %9 Date ..... ~.6.~.:...~.. ........................ , 19,7..~.. ..... INSTRUCTIONS ', a. This application must be completely filled in by typewriter o~. in,ir~ and submitted in triplicate to the Building Inspector, with 3 set~ of plans, accurate plat plan to scale. Fee according ~ schedule. b. Plot plan showing location of lot and of buildings on premises, relati6nShip to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofpraperty 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 permJt~ shall be kept on 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 been granted by the Building Inspector. ~ APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ord .immces or, Regulations, for the construction of buildings, additions or alterations, o.r for removal or demali'tion, as heraJn described. The applicant agrees to comply with all applicable laws, ordinances, budding code, housing code, and regulations, and t~ admit authorized inspectors on premises and in buildings for nec.~,q~y inspections. ' "'~' ..... 7'"'"'~'A~ress of applic'"'°~;~i ............................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .......... ~....../.~.....~..~...~.~- ..................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No .......................................... ....'; ~/'E--~-~ ~ Location of land on which pr~osed work will be done. p m.~: ...... ~ ................... ~......, ..... Lot No ......................... Street and Number ..... ~...~....~....~...~........~....~..'~'....~ ......... ~~ ............................. ".. Municipality State existing use and occupancy of premises and intended 'use and occupancy of proposed construction: a. Exisiting use and occupancy ...... ~.?/,~A~'.~.~;.~ .......~....x~..~.........~....~..c~..~ .......... ~ ................... b. Intended use and occupancy .......... .~...~..~'~.......~.....~..~....~..~.~.~.. Nature of work (check which applicable): New 1~dfldirig..; ............... Addition ....... ..~..~.,~ Alteration ~ ......... Repair ...~. ........... Removal .................. Demolition.:; .......... ~ ...... Other Work ................................................ .....~, (Description) 4. Estimated Cost ........................................................... F=, ......................................................................................... (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 cars ........................................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each t~pe of use ............................ 7. Dimensions of existing structures, if any: Front .........~...?. .............. Rear ....... .~...7.. ................. Depth ....~..~. .......... Height ....... ~..'/..~. ....... Number of Stories ......... ~...?.....~.. ........................................................................... Dimensions of same structure with alterations,~r additions: Front .......... ,~.....?..: ............... Rear ...... .~....?. .............. Depth ..~..~.. ...................... Height ............................ Number of Stories ....................... ~......~ 8. Dimensions of entire new construction: Front ...~....?. ......................... Rear ......-~....?.,L..:.~L ........ Depth ........................ ':~ Height .~....~...'/'.~.. .... Number of Stories ....... ..~....~.....~... ........ .~.~.~-C..'~........~..'~.~.~....~.~. ............................................ 9. Size of lot: Froot ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ................. ~ .................................... '..Name of Former Owner ' 11. Zone or use district Jn which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regradedl ......~ ..............Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .. ~...,.~..~.~....~.. ..................... ^ddress~.,~r~'.~'....~.e..../..~.../'--...... Ph°ne No. ~....~..~...T~...~.,~ Name of Architect ...... ._..~.......~ ....................................... Address ................................ Phone No ....................... Name of Contractor ....~.~..4~.~.?~c.~'.~.,~- '~/~ .................. Address ~.,~...~..~'..~...~.~..~..~'. Phone No.~,£~...'.~.~.....~Q, PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or propased, and ndicate a set-beck d mens ons from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. . .............. ~~ ............. ; ......... Ning duly sworn, d~oses ~nd s~ys t~t he s the ~pp (N~ ~f individuol signin9 ~troc~ · ' above named. ~0~ 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 al~lication filed therewith.' Swom to before me this JUDITH T. BOKEN of/~pplicent) ~ofoly Public, Store of ~,lew Vol~ No. 52-0344963 Suffolk Couni'~ ~ Commlssio~ Expires March 30, 19._~L ~.) ~