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Home My WebLink About6999-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy THIS CER~IF~S that the building located at 2rO~ .& 9¢h. 8.~ ..... Street conforms sub~t~tia~y to the Application for Building Permit heretofore filed ~ this office ~ ~c~ ~ 19. ~., was issued, ~d conforms to all of the require- dated "'i ......... ' ments of t~e applicable provisions of the law. The occupancy for which this certificate is ~( (owner, lessee or tenant) of the ~(oresaid building. Suffo~ County Department of Health Approval . Ap~l ~9.. ]~. by R.'..~il~.~. H~SE ~8~BER .. 13~ .. Street ..... 9tk.St~ee~ ......................... Building Inspector ~Oll~I NO. :~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6999 Z Permission is hereby granted to: ......... .Gzt~,~.~ ................................................ at premises located at-..~.~..~...2.....G~.e.~;ilJ~.~Z.~..J~I,~.,~I~..~t~ ................................... '. ................ ............................ ~....s.~..~..~.,...~..S~ ........ :~.,.~...,.~....~.,.~.,. ...................................... Building Inspector pursuant to application Building Inspector. Fee $....~..~, ..0~,.. ........ Bo FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This apphcation 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 ~nstallat~on 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 ex~sting buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property hnes, streets, buddings 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. 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 ......... New Building ......;.. '~l · · Old or Pre-existing Building ............ Vacant Land ............. Location o roperzy ....................................... .~¢-,~.~. ................. House No. . ~ Street ..'~/ Hamlet Owner or Owners of Property..~. ~.~.-~. ~..~'/~. ,~_~.~ .................. County Tax Map No. 1000Section ...........-- ~' .... Block ....' --. .......... Lot ................ Subdiwsion ................................. 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 .. ~.'~. ........... Fee Submitted $. t/. ~ ..................... Construction on above described budding and pe, r4~it m, eets al~.applicabI, p,~des~and regulations. Applicant .~. ~~. ~..~ ............ Rev. 10-10-78 FORM~ NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southoid, bi. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcatmn must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector w~th the following, for new build~ngs or new use. 1. Final survey of property with accurate location of all buildings, property hnes, streets, aha 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. Commeroal buzldmgs, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect ar 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 buddings and "pre-ex~stmg" 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 $§.00 3 Copy of certificate of occupancy $1.00 Date ..~...P..~...!...J~.. ....... /..?./.../.~..? ~/' ~ Addition Old or Pre existing Building Vacant Land New Building;~;~;~; .... ~ ~;4;..~.....~C)(.~//~.~ ,~ / .............................. Location Of ............................................................................................................................... ~ner Or Owners Of Prope~y ..................................................................................................... ,,oc ............. ,ous ,o ............ Permit No .~.~.~ Date O{ ~ermit~Z.~.~~ic, nt ..~.~.~ ...... ~.~.~~ Health Dept. Approval X :~- / ¢ g Labor Dept Approval ~/ ~ Request For Temporaw Ce~ificate ........................................ Final Certificate .......... ~ ......................... Fee Submitted $ ..~....~.......... ....... Construction on above described building an~o r~ee? Qa~pp~abl~ ~J:~egulations. Applicant ....... ~.Z..'....'...~ ........................... Sworn to before me this ~, n U ........ ....... (stamp or seal) Notary Pubhc ............... ~ ................. County L~vmg Area ~4',!/~ / Plan 1 or 2 - 912 Sq Ft.~ ~ ~ ~/ '~ m P~ WITHOUT BASEMENT ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS a~:. BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 ,,..,. ,,,,r,.1 ,p,,c.,,o. 70.,-,7,, N 153389 THIS CERTIFIES THAT only the el~ctrlcal equipment as described below and introduced by the applicant named on the above application number in the premises of Mazza£erro, e/o f~th St. ~ Brown St., Oreenport, D.I. inthefollotvinglocation; [] Basement [] lstFI. [] 2nd r~. outside Section Block Lot was examined on t~p r ~ ~. ~ · ~- 9 7 Il and found to be in compliance with the requirements of this Board. 11 23 8 11 DRYERs I FURNACE MOTORS I FUTURE APPLIANCE FEEDERS AN~T, K.W. OIL H, P, GAS H.P. AMT. NO. A. W, G, RANGES 't 9~ ;PECIAL REc PT 1 ]o SERVICE DISCONNECT I NO. OF ] S ~ 1 200 CB METER. x A/.~T A~P. TYpE mUlP I,~2W '.,~3W 3~'3W 3.*~4W OTHER A~ARATUS: R ICOOKING DECKS I OVENS DISH WASHERS TIMECLOCKS BELL UNIT HEATER , MULTI*OUTLET ,,.,. ~,. T.A.S.~ .~%'r,R",:T V I C E EXHAUST FAN! DIMMERS AMT. WATTS 1 60¢ NO. OF CC. COND. A.W,G. t40. OF HI-LEG A.W,G. NO. 0F NEUTRALS A.W.G, ~R ,~ OF CC. COND. OF HI.LEG OF NEUTRAL 1 4/0 i 4/0 Water heater:l- 4.Skw Elec.rOom heaters: 2-2.0kw, 2-1.Skw, 1-1.25kw, l-.75kw O & S Contrasting, P.O.Box 215 Southold, L.I. 11971 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ...... a. This application must be completely filled in by typewriter ~ in ir, K or~ ,uu,,,,;;;_ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. · b. Plot p!an,~ng location of lot and.of buildings on premises, relationship to adjoining premises or pu.blic streetsdl~ area~, ai~cl ~ivJng b detailed description of layout ofpraperty must be drawn on the diagram which is part of th~s application. c. The wark~O~eredby this application may not be commenced before issuance of Building Permit. J-~ d. Upon appr~a! of this application, the Building Inspector will issue o Building Permit to the applicant. Such perm~ 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 a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable ~L4~ws.: Ordinances or Regu ations, for the construction of buildings, additions or alterations, or for removal or demOlition, as?~min.described. The aPplicant agrees to comp y with a app icab · aws, ordinanc'ee, bui ding code, housing code,.and, re~ulatiorts, and to admit authorized inspectors on premisesl and in buildings for ,, . ......... ........ ........ (Address of app i ~ Y~ State whether applicant is owner, lessee, agent, architect, engineer, general conffactor, electrician, plumber or builder. .... ........... ..................... ........ :': ..................... Name of owner of premises ..... .~...~.....~....~. ........................................................... i ............ ,~-........: ........................................ If applicant is a corporate, ~ignature 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 ............................................... 1. Location of land on which/~IDpr~c~ork ~ be~:~a.~c~e. Map No.:~....~...~... PC '~ Street and Number .... I~,l.r~, ........................... .~'.~e....' ................................. ~ ...... '~~.~......' ................... Municl~li~ 2. State existing u~ and ~cupancy of premis, and intended use and ~cu~ncy of p~ construction: a. ~isiting use a~ ~cupancy ..... ~~ ................................................... ~ ................. ................................. b. Intended use and ~cu~ncy ...~~~ ........... ~ ....~~ ....................................... ~ ~m ~cJ~lmlJR -~el' ~ew ~ng~ .................,q~tion ... Altermion ............ ' ~ / ~moliti~....~' ' ~ ..... Re, ir ............... ~m~...~.....~-...~ ............... ~her Work .................................................... ~ ~'~ .~~:' '~ ~:~ __~ ~ (D~ription) " ~timated C~ · ~. ......... ~;. F ~' .~ .~ ~ 8. Dimensio~a~ntire ...~..~...~... (to be paid on filing this application) If dwelling, number of dwelling units ........................... Number of dwelling units on each floor ............................ If garage, number of cars ............................................................ If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ Dimensions of existing structures, if any: F~ont ............................ Rear ................................ Depth ........ ..,0,, ........................ o, ..................................................... ;;:;;;;;; .... Dimensions of same structure with ~lterations7ajl~it~,~4~ll~, ,..~. ............................... Rear .......................... Depth Height ~,~u~r~ b.e r .............................................. z. ....... , of Stories ...... ........... 7"' new construction: Fmn~lj~.j~ ........................ Rear ............................ Depth ........................ He ght .. . Number of Stbr es .............. ,.' , . ~ .~, ............................... .~ ............................... .~......~,. ~?,,, of'lot: Fr,on.t .....~:,~4~t~.: ......................... ~... Rear .~...q~.~.. Depth ~ ~ ~)ate: ~f P~urch~.e ~_~..~..~..;~.?......,t .~...?.,.~... N~fne of ,.F. ormer Owner~......~.~....~ ...~.,.~~d~.~ 11. Zone or u~s~. ?strict in which p.rqmises are situated ....~. ...... ~.:..~..~ ................................................................. J2l Do~S .~)~ con~structjCLm',vJolat, any zoning law, ordinance or regulation: ~.~. ~. 13. Will Iot~bewegrade~l-..L~..'~....~..;r.............. W excess f be rem0ved., from p..rem ses'~Yes ( ) No 14. NameofOwnerofpremises.'~;.~...~......&~...~..~Z~...~._~.~;. ~______~jI3~ . Name of Ar&hitect .............................................................. Address ................................ Phooe No. : ' Name of Contractor ....................................... Address ............................... Phone No ....................... PLOT DIAGRAM .,~ Locate clearly and distinctly all buildings, whether ex st ng or proposed, and indicate all set-back d mansions from '~perty-lines. Give~ stree~ and block number or descri~t on according to deed, and show street names and nd cate whether interior or comer lot .... ~...a~.~ ................................ being-duly sworn, deposes and says that he is the applicant ~ (N. ame of 'in~rv~'s'~gning contract) above named. He is th~ ............................................................................................................................................................... .. ~ (Contractor, agent, corporate, o(ficer,, etc.) of s~d OWner or owners, and is duly authorized to perform or have performed the sa d work and to make and file 'this application; that all statements confained ~n this aP~lic0tion,,ar~ tru~ to the best of h s knowledge and belief; and · th~3t' the work will be performed in the manner set forth in the application filed therewith. Sw°m t° bef°re me this v...,.,,~ ...... ......... of .............. , Notary Pu ..... County .. ~...~..../.....~~ . - KEOGH ~/ '~- '.~, State of New ~ NOTARY/PUBLIC, NO. 52-2093890 Qualified In Suffolk County..~ ~ · ,Zer~ F.,xRIr~ Ma[ch 30, ~