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Home My WebLink About6611-zFOKM NO. 4 TO~N OF SOUTHOLD BUrLDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .Sunset. ~lay(Fr. Xv&~ ... Street .... Park Map No..~9.a.a.r...~.e.a.c. qSlock No ........... Lot No..i6~ ....... aouthold.. ~N ,~/., ..... conforms substantially to the Application for Building Permit heretofore filed in this office i . .. 29, 197.3.. pursuant to which Building Permit No..66.1AZ. dated ............ i a~. dated ........ liay ..... 29... 19.23, 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. £amily. dw. elling ....................................... The certificate is issued to . .. ~.i.c.h. ~.e.1...R~.~D.o. ......0~QI' ....................... (owner, lessee or tenant) of the aforesaid building. , Suffolk County Department of Health Approval ~ ~P~ ............................... UNDF, RWRIT~,RS CF, RTIFICATE No. l~..~ P_ .... f3.~g.. ~X.. ~,~7..3 .............. I-IOUS~,, NU1VIB~,R . .6.0~. ......... Street .... S..u~..s.e..~. ~.~.~r...(..P~.....R~.) .............. TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUT~HORIZED) N? 6611 Z Permission is hereby granted to: J~' ~J/,ee .i. · · t~S ~et~ ........................................... ...... 260....5/a lltng ~at~.3~L .............................. ........ [~eo-t.a ....... .N.~.~'~ ...................................... to .....B..~il~..aa..~d~i.%ion..~n.. ~xis ~.!ng..Rw.e ll ~,~g ............................................................ alb premises located at .......~..0..~..,..~...~/.. ...... ..q.e.~.~...~....~..e...~.g..~....?.~..~..~. ........................................................ ............................. ~S~.t,..~a~t. .............. ~.~t~Z~L .... ~I.,3~ ~ ........................................................... pursuant to application dated .........................~. .......~,~J ............ 19..~..~.., and approved by the Building Inspector. Fee $..$-~,00 .......... FOltM NO. $ TOWN OF SOUTHOLD Building Delmrtment 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 m 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, Mulhple Residences and similar buildings and installahons, a certificate of Code compliance from the Architect or Engineer responsible for the building. .5. Submit Planning Board approval of completed rote plan requirements where applicable B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and 'pre-exist,ng" 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 inspechon of buddings or premises, or other pertinent in- formation required to prepare o certificate. C. 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.CI0 $5.00 New Budding .................... Old or Pre-exishng Building ...~..,,~...p../...?,./...o.,~../... Vacant Land ............................ Location Of Property ................................... /......j ......................................... ~ ................................................ Owner Or Owners Of Property Subdivision ................................................................ Lot No, ./1.6...~..... Block No ............. House No ............. ~' ~ff 7~' .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ~ Fee Submitted $ ........... m ...................... Construction on above described building and permit meets all applicable codes and regulations. Applicant .......... ~j~..~.., ~.~ .~'.~.: ................... ~. .......... S~:~n ,o before me this .~day of .... ..~.....~..~..~.~ ................ (stamp or seal)~'7 ~-/_ Notary Public .................................... County - -, - = ~- - , . -- THE NEW YORK BOARD OF FIRE .UNDERWRITERS ~-- t, ab BUREAU OF ELECTmC~ 85 JOHN STREET, NEW YORK, NEw ~'ORK' 1~i~038 ~,~ O~tobeX' 31, 1973 · .,s c.~,.....~. N 124412 M~e ~azzano, n/n Sunse~ WayjqO-O IqXTURE OUTLETS ~3 eB~q'AcLI$ SWITCHES , FIXTURES 2q 11 S~v~m aL*..ueaNRCT ] NO. OF I RANOES K.w. IFlClAI, IIC'P COOKING DECKS OVENS DISH WASHERS AMT. K.W. A~T. K.W. MAT. K.W. ?IMICI~xS ~ IUNITHEATERS MULTI4)UTLET q/o EXHAUST FANS AMT. H.P. DIMMERS NO. OF HI-LEG A, W. O. OF HI-LEG 1 2/O Blec~ric Room Heaterst l"2.SKW 1-2.0KW 3-1.SKW 1-1.25KW 1-1.0KW 2-.?EKW 20 Woodberry Rd. elEIL41, MANAelR ,~_ E.Pa~chogue, L.I.11??2 11 A ~-~ ................ ____, ..... P"*~ ~ BUILDING TOWN CLERK'S OFFICE xom,n ......... . __ ^pp,,cot,on No. ,,pprov ............ '.'. ......... .............. . Perm,tNo. DiSapproved ale ..... .~,~..~,~-...-.~.._........_....... APPLICATION FOR BUILDING PERMIT Dote .....~....~....~........'?..?.. ................... , '9.7..~... ..... INSTRUCTIONS ng o. This application must be completely filled in by typewriter o¢ in ink and submitted in triplicate to the Buildi Inspector, with 3 sate 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 or 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 ssUance of Bud ng Permit d. Upon approva of this application; the Building Inspector will issue a Building Permit to the appiicant. Such permi~ shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or u~ed in whole or in 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 Building Zon.e Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or LegeUlations tar the construction of buildings, additions or alterations, or for removal or demolition, as herein described. e applicant agrees to comply with all applicable laws, ordinances, building code, housing cede, and regulations, and to admit authorized inspectors on premises~ and in buildings for necessary inspections. 'g ppllc(~rff, or name, if a corporation) ' .... (,~ldress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of' premises ........ ..~..?..C..~...~....~...). ...... .'~. ~, 3. ~....~...4,' o ..................................................................... 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 ............................................. C)the, Trade's License No ............................................... 6 .~....G~.....~.... 1.Location of land on which proposed work will be done. Map No.: ................... Street and Number ....................................... ~.......~.. ............................................ .~ ......... ..~. .................................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. F.~siting use and occupancy · u ~/~4 ~ ~ /-/o,~-4./'=~ . /h/Intended~/ use and ,~,,~,~,~v 3. "Ne'~ure of work (check which applicable): New Building ..~ ............... A~lition ..~ ........ A teration ....~. .......... Repair .................. Removal .................. Demolition .................... Other Work ................................................ . ..... 4. Estimated Cost ..~.~.OO?..~ ~ ........ ' Fee ~' ~-._e~o_ (Description) (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. tf business, commercial or mixed occuPancy, specify nature anti extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ........ .~..Q..~ ........... Rear ................................ Depth ..../.~.. ......... Height ..... ~.~.. ............. Number of Stories ~ ~ Dimensions of same structure with alterations or additions: Front .......... ..~'...O..~. ................. Rear ........ ..~....O...~ .......... Depth .......... .~....~....~. ............ Height /,S' o ~ ..~ ......................... ~..Number of Stories ............................... o' 8. Dimensions of entire new construction: Front ........ ~ ........................ Rear ........ ~...?...'. .......... Depth ......~...~...~. ........... '" Height /,5' / Number of Stories o u ~ ...... 9. Size of lot: Front ...................?.6...'. .............................. Rear ............. /..~...O..~ .................. Depth ../..?..?...-;.../....~....'~..... 10. Date of Purchase .......... /...~..~...~. ................................. Nome of Former Owner ........ .~...~...o...~.?....~...o. ~-P ...... 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 ....... ./~....0. .............. Will excess fill be removed from premises: ( ) Yes ( ~ No 14. Name of Owner of prem ses ..~,/..../.~..~...~...~../...~..,~'~.~,,~0 Address -.~..lUeolA Name of Architect ~' ~' .............................................................. Address Phone No. Name of Contractor ,~. ~ ~ I I /,~'~ $ ............................................................ Address .....~...°.?..?...~....a..JT.~. ..... 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 t° deed, and show street names and indicate whether interior or comer lot. STATE OF NEW_YORE. ,.) ~SS COUN - ................................................ · .~% ............................................ being duly (Name of individual signing contract~ above name. sworn, deposes and soys that he is the applicant He is the .................... C~.:.~......~..~, ...................... (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 thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........................ ~day of .: ....... ~..?~.....~ ................ , 19..?..~. . n ~ Notary Public, .-~-,~,..~~. TERRJ LEE EI~ (Signature of oppli~/) ~ PUBLIC, State of New York No. 52-616~29§ · ,,.~'~lified in Suifolk Coun"c/ ~0~ Expires March 30, 19 ~'] ~ ~cx V .£HJI, ST?4,'~ i TO R MI