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HomeMy WebLinkAbout6668-zNO. 4 TOWN OF $OUTHOLD BUrl.DING DEPARTMENT T °wn Clerk'~ $outhol~, N. Y. Certificate Of Occupancy No. :~72~-? ...... Date .....,~pt. 22 .... 1976. ...... ,19 .... THIS CERTIFIES that the building located at . Deep. Hole. Dz'... ........... Street Map No. xx ......... Block No.. ~c ......Lot No. ~...~a.t%it~lc .... ........... conforms substentinlly to the Application for Building Permit heretofore filed in tbi~ office dated ...........&l~r..18..., 19.7.3. pursusnt to which Building permit No.. 6668Z. dated ............. Apr,.. 1 ~ 19.73., 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 ...Private..one. £amil~ .dwalling. with. addition .... (apT~-ove~ .by, ~ Appeal T~e certificate is issued to . .~. $ .h.o.n.lr. .a.a.m.b. ;ti~p .~. }~.l.~e. .... .0.Wi..e.r.s.,, ~ ............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .N. :~.. .............................. UNDERWRITERS CERTIFICATE No. 1~3009lL~.... Aug.. 30...1.976 ................ HOUSE NUMBER .... 1.t~00 ...... Street ....D. ee~. ltole. 9.rilre .................... Buildt,g Tn-~COr ~ FOKM 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) N? 6668 Z Permission is hereby granted to: H.R~Bee.~e...&..S~ns...Z~e.....~.C.....Anthony..G~b~no .... Ea~tl..tuek ...................................................... to ..~,~..~.~di.ti~n..£u~..ex& s.ting., d ~ell-~ ng ............................................................... at premises Iocoted of ....~/..~.....~/e~...l~op..J~e~p..~[o&e..~'.~.v~ ................................................ ............................................ ~..t..t..$.~ .............................................................................................. pursuont to opplicotion doted .......................... A~.~.....~I~ ......... 19 ........ , ond epproved by the Building Inspector. ~0~]~1 Ipproved by Bd appeals Fee $.~. ~?. _0~.,. ............ Building Inspector THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY i~PJk 85 ,JOHN STREET, NEW YORK, NEW YORK 10038 ..,eAUgust,,~B07,1976 ~...c..o. No.o./.. 874787 N300982 THIS CERTIFIES THAT only t~ electrical ~q~ipmenE aS d~scrlb4~d ~low and introduced ~y t~e applicant named on ~e a~ve appl~catio~ number in s~e premises o/ Anthony Oambino, Deep Hole Drive, off New Suffolk Ave. Matt ituck~ L.I. FIXTURE ] I '~' I ~ FIXTURES OUTLETS IR~EPTACLES SWITCHED1 r~CANDESC~NT RUORE~CENT ~WR~~Y DRYERS ~ FURNACE MOTORS ~ FUTURE A~ANCE FEEDERS ~RVICE DI~ONNE~ ~ NO.c S RANGES E R COOKING DECKS OVENS DISH WASHERS AMT. K.W. AMT. K.W, a MT. K.W. TIME cLOCKs BELL IUNIT HEATERSUNIT HEATERS ~ MULTI-OUTLET A~. AMeS TRANS. .~ SYSTEMS NO. OF FEET V I C 1 ~,~ 2W I ,~' 3W 3 ~ 3w 3 .~r 4W NQ. O,~EC~C,~CONO. OF CC. COND. EXHAUST FANS ~IMMERS Elec.room heaters: 1-1.5kw Glenn R. Bradley, Horton Avenue, GENERAL MANA~IJR. -- ~l Mattituck, L.I. 11952 Lic.1227 P41 ~nt(F~e~r~bny~dee~Th~s ced,flcate must not be altered m any manner, return to the office of the Board if incorrect Inspectors may be identified by th ~redentials. FORM NO, 6 TOWN OF SOUTHOLD , Building Deportment 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 disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, /V~ultiple 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: 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 $5.00 3. Copy of certificate of occupancy $1.00 New Building ................ Addition ................ Old or Pre-existing Building ................ ¥ocant Land .............. Location Of Property ...~...~...~.~........U..~....~.,.~......~,.~.../..~'.~ .......... ~..F.~..,..~.~.,~,,,...~...~...,,~..~..~..L.~.U.~ Owner ~r Owners Of Property .....,.~,_.~..~...~....~....,~,~.~7 .......... ~.,.~,. ,~...~,.,~,.~?~.......~....~.....,/~,...~. ,~.,,z~..,.~, ........... Subdiv's'on ................................................................ Lot No ............. BI~ No .......... House No ......... Permit No..~.~.~.. Dote Of Permit ~Z~..Applican, Health ~p,. Approw, ............. '/-~Ze. .................... Labor ~p,. Approval .......... ~Z~ ........................ Unde~riters Approwl ~.. ........................................ PlQnning B~rd Approval ...~ ........................ Request For Temporo~ Ce~ificote ........................................ Fin~ Certificate ...~... .............................. Fee ~bmitted $ ~...: ......... .................. CO~Str~tio~ On above described b~ildin~ ~~ ~11 ~o~ and regulations. ~pplicont ....~.....m.~ ............. ~.~...~..2 ~......: ..~ ................................. Sworn,~o, before me thi, ~ Qualified ~ ~e~ ~oun~y .. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building 'lr~pe~or, wi 3 sets of plens, __~__,rate plot IMan to mcale. Fee according tO ~chedule. b. Plot IMm Showing location of lot and of'belldings on Premim,~rehKiollship to adjoining prem~as or pubic streets or m, giving a detailed de~,iptio~ of laYout of propertV must be drawn on dllgr~m wh ch s pert of this apiflication. c. The wo~ covered by this application may not be commenced befiyre issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit,shall be kegt the premises available for inspection throughout the work. ~ ,~ e. No building shall be occupied or used in whole or in part for any purpu~e whate~er until a Ce,rtificate of Oecupency shall heve granted by the Building Inspector. ~ .A. PPLICA.TI.ON_IS HEREBY MADE to the Building Depmtment for the i~uenca of a Buitding4~rmit pursuent to she Building Zone ou~mmg~, coo~mm or alterations, or ~or removal or demolition, as berem described. The applicant agrees to comply wl~ail al~licaMe o dencas, building code, housing coda, end regulations, end to edm t authorized inspectors on premises end In bud nge for neae~a~ Other lr~d~'$ I.i~n~ No ................. 1. Lo~tion of I~,nd on ~hi~h ~ro~:~ ~rk will t~ don~. ~ No ........................................... ..Lot No ......................... :2. St~t~ ~xi~ting u~ ~nd o~upan~¥ of ~mmi~ and in~nd~d u~ ~nd o~upan~lL of pro~l ~on~truotion: Existing use and occupancy Intended use and occupancy ................................................................................... ~..~:;~t-x~.... ............................ 3. Natbre of work (check which a ,): New Building ....................... Addil~ ..... .t~ ........Alteration...."";. ..... · 'l~epair ......................... Removal ...; ..................... Demolition ..................... ~..-7OtherWork .................................. .', ~ (Description) 4. Estimated Cost ..........~.~..~..?...~.. ?.....'¥. ............ Fee ...................... I.'~.~...'~... .............................................................. (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 ................ .~w ..................................................................................................................... 6. If business, commercial or mixed occuoancy, specify nature and extent of each Wpe 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 ................. 11..~. ................. Numb~.[ of Stories ........~.~. ....................... 8. Dimensions of entire new construction: Front ...... ~,~.~ .........Rear ......... .t....~.. Depth ...~."] ..................... Height .................. .1[.~.~. ........................ Number of Stories ..... r ..... .~..~.~. ........................................... 9. Size of lot: Front ........... ~.I ................... Rear ........... .~.~ ....................... Depth ........... ~.~..~..~. ........................ 10. Date of Purchase ..................................... Name of Former Owner ...... ~...~...~.L.~.,~ ............................................ 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 reo_raded .........~.!~ ................. ~ -- __~ ~ ~Will excess fill be removed from premises: [ ] Yes ~ No 14. Name of Owner of premises ........ ,~l,~.l~,~le2..~..~.l~X~.~l....~."~'.~.~,..4].....~...~..~'a..~Z.....~.~ ............ (Address) (Phone No.) Name of Architect . . -- ~ /~ ~., el _(Address~ (Phone No.) Name of Contractor .[I~t..~. .~,~.....t.~w.,.~,~..~..~..~..~.....~.Li...~.~,..~.~..L..~..~...~ .~...~.....~.~ ....... {Address} (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. (.5 STATE OF NEW YORK, _ ) COUNTY OF . .~..~.. ~'.~..~ ~.~.. ................. ) SS ............................. ~/a~'me o'~ ~.v~t.d~ .~'-- ....... ~.~- .~.~...~-~ being duly sworn, deposes end says that be is the applicant abo~e named. { f indi idual signing contrac't) ...... the .............................................................................. ~. i~,~ .~ .--"'~k/~m...~ ~, ,~..4~1~ .¢~,?.¢~ ........................................................ He is (Cont~ctor, 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 fife 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. /,~"'- TERRI LEEc3~!~ ~ ' ~ "~ '~ ~ ~,~ ......................... .............. q ' n,y "otary Public, .~,,~.... County ....................... ..~ ~ ...~..: -. ..................