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Home My WebLink About6381-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~.. ~;~.~.2 ..... Date ..............0~1 .... ~ ...... , 1973. THIS CERTIFIES that the building located at ...l}~m~aa~. l~tlt ......... Street Map No. 01~I1. ~Ol~l~lock No ........... Lot No..~.~ ..... .01¢. ~.~¢ ..... I~., ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..........Fob...28 .... , 19.73 pursuant to which Building Permit No...62181~ dated ............lla~.... ~..., 1973., was issued, and conforms to all of the require- ments of the applicable provisions o£ the law. The occupancy for which this certificate is issued is . ~t.'t~.t,o. ~ .falally. ~ll~mlling ....................................... The certificate is issued to .P~..&. It~J .I~:kLI.~..(tt, bbl .... 0~¢t~ll ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval 0~;...~...~ ~.3.. Dj/.. R:. ?.~J-l~ ....... UNDERWRITERS CERTIFICATE No .... I~. ? ~.~.~ .0.~ .... A~g...30...~.?~ .................. IIOUSE NUMBER..~.37~. ...... Street ...... 61~'O0.llaO~y. ~,t~.$~ ............................ Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT ~"rHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6381 Z Permission is hereby granted to: C ~.~..~ .,....0. r.10.~ ~ k i..... AZC..... ~...GibhL &.. Mile to n~2.l.t ..z~ew...ome...f. af, .¢ .1.y..&wel.t.i.m~ ...................................................................................... at premises located at .-..~t..~ ............ ~.-&~l~ ........................................................ ........... .......................................... ~rr t~enwa3~....~awt ................... Gl,~e~l~ ...................................... ~ ........... pursuant to application dated .......................~13.....~ ............... , 19'ji.3...., and approved by the Building Inspector. Fee $2'~'~,.~-~ ............ Building 1-n~ector / FORM NO. 6 TOWN OF SOUTHOLD Building Deportment Town Clerks Office Soulhold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector with the following; for new buildings or new use: I. 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 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), No~-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 3. Copy of certificate of occupancy $1,00 $5.00 Dat ...~.. · ~.. ' ...~'./~....~... ...... New Building ...... .'~ ......... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ........................... ! ....................................................... 7' ............................. ~ner Or ~ners Of Prope~ ..... ~..~..,~.~...~.~..~ .......................... ............. .o,, ,o ............. Permit No..~..~..~/.~Date Of ~it ~.~plicant .~......~g ....................................... .~,,~ ~,,. *pprov., .~.~/~.~ .................. ~or ~,,. *,,row, .............. ~ .............................. ~od~.,,e., *pprov., ..~.~.~./.~.~~ ............. ,,...,., ,o. rd ~,ro.o' ........ ~..~ ................... R~uest For Temporo~ Ce~ificate .................. ~ ................. Final Ce~ificate ...... ~. .................... F~ Submi~ed $ ...~.~...~ ................. Construction on above described building and pe, r~it meets all 9ppli~,able codes and regulations. ~q:}pli¢ont .............................................. Sworn to before me this ............ .~' day o ......................................... Notary Public .................................... County THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY STREET, .EW .O.., ,O0 B ~-- ^u~ust 30, 1973 .,.t. ~..,,~.,,.. ~....,,,. N 112109 THIS CE~IFIES THAT only t~ el~tdo~ equip~nt ~ ~scdb~ ~ a~ int~u~ by t~ ppplic~t ~ on toe a~ a~plicpt~n ~m~r in t~ p~mises of William Gibbs, w/side Greenway East, 500' ~o ~a~Rvlew ~ane, (Green Acres), Orient, N.Y. in the followlng location; ~ B~ement ~ 1st Fl. ~ 2nd Ft. 0 ut SIde S~tion Bilk ~t w~exami~don A~US~ 2~ ~973 andfoundtobeincompliancewlththerequirementsofthisBoard. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT 25 22 DRYERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET OTHER APPARATUS: Water heater: 1-4.Skw .... or/.~. ]-l/2hp ~=;1.? c. room heaters: 1-2.5kw, E R V I C A. W.G. NO. OF HI-LEG A, W.G. NO, OF NEUTRALS A, W. G. PER ~' OF CC. COND. OF HI-lEG OF NEUTRAL ! 3/' o t 1/o 4-1.5~, 2-1.25kw, 2-1.Okw, 20,75kw, 2-.5k~ W.B.Ruland, Mattituck, L.I. O~NEIIAL MANAGER ~ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. X~O~ NO. 6 TOWN OF SOUTHOLD Building Deparlment Town Clerk~ Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of oil 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 fram 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: 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 3. Copy of certificate of occupancy $I.00 $5.00 Date ...... ' ..~-~..:....~. ~....~...~ ......... / / New Building ........~ .......Old or Pre-existing Building ............................ Vacant Land ............................ Owner Or Owners Of Property ..~.~..~,......~.....~...~ ....................... Subdivision ~...~...~-...~ot No...~....~... Block No.....~ ..... House No...r.~ ....... Permit No...'~.. ~......~'. [..... Date Of Pe rm. it~. ~'/'). ~.Applicant .... .~....~....~ ................................ Health Dept. Approval .~..~..~. ................. Labor Dept. Approval ................................................ Underwriters Approval .~...~.l.~..~ ............ Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .................. : ....................... Fee Submitted $ .....~..'~...:..~ ................. Construction on above described building a~nd_permit meets all applicable codes and regulations. Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County TOWN OF SOUTHOLD ,~n.,-,~ . ~ ""~' . , BUILDING DE,P, AoRTMENT //~,~ /.~ ~J ~.-/,~-~.~._ TOWN CLERK S OFFIC, F~ ~ /~(~ / ~ ' ~5/~ ~ ~ / ~ ~ ' ~. ~ ~ C ................................ ...... (Suildi~ In~or) ~ DQte ................................................ , ~9 .. INSTRU~IONS a. This sppli~fion mus~ ~ completely fill~ in by ~wrJ~er or in ink an~ submi~e~ in ~ripli~e ~o ~he Buil~i~ lns~or, wi 3 ~ of plans, a~urs~e plo~ plan ~o scale. Fee ~ing ~o ~dule. b. Plo~ ~a~ ~w~g Ia~fion of lot and of ~il~i~ on premiss, relationship to ~joi~ing premiss or public s~ or giving a ~il~ ~i~ion of IWou~ of pro~ mu~ ~ drawn on ~i~ram which is ~ of ~his appli~fion. ~. T~ ~ ~m~ ~ ~his appli~fion may n~t ~ com~n~d ~fore i~uan~ o~ Building P~rmit. 6. U~n ~roval of ~b s a~ ~ on, ~he Building Ins~c~or will i~ue a Building ~rmJ~ ~o ~he a~li~m. Su~ ~rmi~ ,shsll ~ k ~ pmmi~ availsble for ins~fion ~hroughou~ ~he work. e. No ~il~i~ shall ~ o~pie~ or u~ in w~le or in pa~ for any pur~ whatever until a ~ifi~e of O~u~n~ sh~ll h~ve ~n gran~ by ~ Building Ins~or. APPLICATION IS HE~EBY MADE ~o ~he Building Depa~men~ for ~ i~usn~ o~ a Building Permi~ ~u~uam ~o Or~inan~ of ~he Town of ~u~hol~, ~uffo~ ~un~, New Yo~, an~ o~her appli~ble ~, O~inan~s or ~ls~es, for bui~in~ ~ditions or alterations, or for removal or 6emofifion, ~ heroin descri~. ~e ~li~n~ ag~ ~o ~mply with all or~inan~s, building ~, housing ~6e, ~n6 regulations, and ~o ~mi~ au~horize~ ins~ors on ~emi~s an~ in ~ildin~ for m~ n~ .............. ................~ ,~,.[~'~"~ ............ ~ .................... Name of owner of premises .~:ul,.'..~....~i.~...~...~..%..,~ .......................................................... If applicant is a corporate/signature of'duly authorized~officer. (Name and title of corporate officer) Builder's License No ............. ~ ......................................... _, Plumbers License No.....~...~..:..~.;...-.../-.'. ......................... *-' . . Other Trade's License No ................................................... Location of land on which PrOp~)sed work will be done. Map No ............ ~ ................... ~ ...... Lot NO,. ;..~..,~...L, ...... St;;et~'nd Number ......i...i ....... ~. ........................... ~.,~;~~ ...... /...~.....i....i.... ' ...... Municipality Sf~;~ e~t!ng use apd occupancy of premises an~ in~nded use and occupancy of proposed construction: a. · E~.x,~,n~ use er,d o~u~,w .....~.~-,.~...... ........................................ ~...,~ ..................................... o.~ Irrte oeo use a a occupancy ..~,,w.....-::.....": ....... ~ ...... ..................... _ ,v.. ,,,- ,,,j7 3. Nature of work (check which applicable): New Building ........ ~, .......... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... ~ (Description) -r-o . 4. Estimated Cost ..........~...~../. ........................ Fee ......... .~...~. :....~... · .~. ·. ................................................................... (to be paid on filing this application) ,5. If dwelling, number of dwelling units ....,..,J ........ Number of dwelling units on each floor ......................................... If garage, numbe~ of cars ....................................................... ~-. .................................................... '~ ............................. 6. If business, commercial or mixed occuoancy, spaci~f nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front ........ ~ ......... Rear ...... .T... ................. Depth .....--.. ............................ .=,~. ....-::.. ............ Number of Stories ....... ..--'.. .................................................................. Dimensions of same structure with alterations or additions: Front ."".~..'~.~ .............. ~ Rear .:~... .................................. Depth -- Height ..... "iii~'.~..-7.. ........................ Number of Stories .....--. .................................. 8. Dimensions of ent re new construction: Fr0nt~ ,..~.~,...~.. .... Rear ..... ~......c:~. ............. Depth ....c~....~.. .................... Height ................... /...~ ....................... Number of Stories ........ ~....-.-~-. ........................................................... · .--.,"~( - ~/ . /~ .. ! ......................... 9. Size of lOt: Front .......... t../;;~.-.~.; .............. Rear ........... /.~,~.~..~.: ...... ~'z ....... Deptl~ ...... g..~_'..~'..':~'c:~" 10. Date of Purchase ..~../..~...~.~--. Name of Fo,[,rm'er, Own. er .~-._/.~~.; ........ Zone or use district in which premises are situated .../.~..~...~........~.-.~..~...., ................................ 11.12. Does proposed construction violate any zoning law, ordinance or regulation: ........~..~ ......................................... Will lot be re~raded ~ .................. Will excess fill be removed fro, m,,orern_ises: J ]r ~Ye~s ~ .No_ _ , 13. N a me of Own er o f pre mi~es L~.. a~j~,~¢,,~:.~., ..:~:,j~ ....~(./_.._.~..... Z/.~. ,C~,~. 1 .~1I,:.~..,..... ~,~/. ~...,~,%~.~y.,(~,~,' 14 ..... (Address) ~t/~-//'~/~ (Phone No.) Name of Architect ..................................................................................................................................................... ^ ~ ~ t~ ~ /~ .{Ad.ess) ~ (Phone No.) ,. ........ ......y ........... Name of Contractor ..~a,,~.....~.~ .~.. ~....."Z 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 wlhe?.~ er interior or corner lot. STA~'~' L: COUNTY OF ...................................................... ) (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. ,. ~-r~- TERRI LEE ELRK ' "~ ~ , ~'~,c~'~ II~ARY pUBLiC. Stst~ of NItw ..~.. ~ / ~ /-~ .......... .~. ........................ day OT ....x..~...~.'~'~-?:~.'.~'-....-..No...§2-~.~,~..., 19. ......... [ Notary Public ..~...~2-~,?!-r'-e,~.~-Of~n~t¥~tg t~ .... (Signature of applicant) ,3 The sewa~;e disposal a~d wa'er su~,~!7 facilities for this le~a%ic,;~ have been tnspecte~ by this department an~ found to be satisfaetor~ ~ ~. ' Services i A~PROVED AS NOTED DATE ~~/N FEE:~BY ~-~ ED INS ECTIONS: TION qtR START EP, AMING 2. BEF RE COVERING PIPELINE 3. FINAC~ WHEN JOB COMPLETED