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HomeMy WebLinkAbout6410-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerlificnte Of Occupnncy No. Z. ~272 ..... Date ~ ............. J.~ll~....~....., 19~. THIS CERTIFIES that the building located at . .l~ll~l~weta .l~a~ ......... Street Map Nolq~ss,. 1~... Block No ........... Lot No. ~!~. ~; .38~....~;.e. h0K,~e....N.o.Y.: conforms substantially to the Application for Building Permit heretofore flied in this office dated. ........... I~1~- · .~6., 19. ?.~ pursuant to which Building Permit No.61~l 0~.. · · dated .......... l~a~-ch...~6.., 197.~ ., 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 . El~:iva.te. o11~ .falatly. dl~].l;l~g .... :[. .................................. The certificate is issued to . LI©~I. · blo~,ga~ ....... ¥~e~ .......................... of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) UNDERWRITERS CERTIFICATE No .... HOUSE NUMBER. ~) ....... Street... 1,/13z~ev~'~;a. I~d ............................. Building Inspector / FOB,M NO. ~ TOWN OF SOUTHOLD BUILDING DEFARTMENT 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? 6410 Z Permission is hereby granted to: at premises located at ....~d~l.~ll..,,~8~...~,..~. ...... ~l,~a:Lt..[:~ol~t~..]~.z3~ ..................................... pursuant to application dated ..........................~. ~......~.6 ............... , 19~..., and approved by the Building Inspector. Fee S.a.S.e. ........... THE NEW YORK BOARD OF FIRE UNDERWRITERS ~!: BUREAU OF ELECTRICITY ~ 85 JOHN NEW NEW YORK 10038 STREET, YORK, THIS CERTIFIES THAT only the electrical ~quipment ~s d~scrlbed beio~ and introduced by the applicant named on the abo~e application number in th~ premises of Lloyd Ho~gan, w/side Wunneweta R~ad, 200' n/o Carrington in the following location; [] Basement [] 1st FI. was examined on September K, 1973 FIXTURE OUTLETS IECEPTACLES SWITCHES 12 I~ RXTURES [] 2nd FI. outside Sertion Block Lot and found to be in compliance with the requirements of this Board. RANGES COOKINGOECKS ~)VENS DISHWASHERS EXHAUST FAN! FLUORESCENT DRYERS TIME CLOCKS SYSTEMS NO. OF FEET E R V I C NO. OF CC. COND. A,W.G. NO. OF HI-LEG A.W.G. NO, OF NEUTRALS AW.G PER ~' OF CC. COND. OF HI LEG OF NEUTRAL OTHER APPARATUS: *Furnaces: Oil # 1-1/Shp, 1 Post liMht ~2-]./12hp ~attit uck, L.I, G~NF,~AL MANAGER il Per_ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FOB~ NO. $ TOWN OF $OUTHOLD Building Department Town Clerkl Office Southold, N. ¥. 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 topacjrophic 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 proper~ 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 ~ .~.Z.,-~... 3. Copy of certificate of occupancy $1.00 Date ......................... New Building .................... Old or Pre-existing Building ~/' ................... Vacant Lend Location Of Property ....~..~~ ......................................................................................... Owner Or Owners Of Property ..z.~.~/.~. ~.~z~.....~'~¢-~c.~-7~ .................................................. Subdivision ......~...~~...~....¥..-(, ' I ..................... Lot No~....~....~.v..-- ~BI°ck No ............. House No ............. Permit No..?.....O...~..~. ..... Date Of Permit ~...~.:.../.~.~..~,~pplicant .~..~.~..~. ........................ Health Dept. Approval ........... .~....! .~... .................... Labor Dept. Approval¢ .............~..:.!i.~. ........................... Underwriters Approval ............ .~..?...~..~.r...~...~. ............ Planning Board Approval ..... ..~..../...~ ...................... Request For Temporary Certificate ........................................ Final Certificate ....~... .................................. Fee Submitted $ ..... ~..,~. .................... Construction on above described building and permit meets all applicable codes and regulations. Applicant .... ~.~....~,~. ............. ,~,~ ~, .~. · .,~, ·../'~. ~. · · ........ Sworn to before me th~L~,_~, (~f~( ~ [-~--~'~> .:/dayof (stamp or sealY~,~ ~,~-~ / z'~- Notary Public ........... t / --~ ..................... County /~ ~-'~ ~' ~ I~P--M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved .................... :L......~..! ........ , 19...?.~. Pemit No.~...~.~..~....~ ......... Application No.....~...?...(...O.. ........... Disapproved a/c " _ .......................... .............................. ' APPLICATION FOR BUILDING PERMIT,/7. C~ ....... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, 3 sets 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, an¢ giving a detailed description of layout of property must be drawn on 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 permit 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 beer granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zo Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all al)plicable laws. ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (~tgnature df~pl~licant, or name, if a corporation) (Address of applicant) c~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· Name of owner of premises .... ~...~,.....~..~ ................................ i ........................................... i r" 'r re auth°rized °"icer' · (Jlame'~'nd title of 1. Location of land on which proposed work will bedone. MapNo.: .....................................................Lot No.~..~ M~nic ipa!ity 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................. =s~.....~).~: ................................................................................... .o . . .. · b. Intended use and occupancy .... ~ ............. ~. ........................................................................... 3. Nature of work (check which applicable): New Building ....................... Addition .....~...~. ......... Alteration....: .......... Repair ...... . ...... Removal Demolition ........................ Other Work ......................... *'. .......... ...................................... (Description) -- ~- ~ F,..,i .............................................................................. , .............. 4. Estima~d Co~L ......-~-~.....~ ................................ . (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits~.: · ...... ~.. ..... Number. _°f dwelling units on each floor. ..._- ......................................... If garage, number of cars ...................................................................................................................... .-. ..................... 6. If business, commercial or mixed occupancy, specify na~Are and extent of~ each type of use ..................................... 7. Dimensions'of ex~st~.ng, structures, if any: Front ....................."' ' Rear ........................... Depth ................ ;. ................. Height ................. ' .... Number of Stories ................................................. ~ ........................... Dimensions 'of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ................... ; ..................... Number of Stories ........................................ 8. -Dimensions of entire new construetion: Front ............ Rear ............................ Depth ................ Height ....... ~ ......................................... Number of Stories ......................................................................................... 9. Si~ze of lot: Front ...................................... Rear .......................................... Depth .................................................. 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11 Zone or use district in which premises are situated ................................................... !_2. Does proposed construction violate any zoning law. ordinance or regulation: ............ : ............................................... ~ot be. regraded ..... · _..~. ........................ Will excess fdl be removed from premises: [ ] Yes ~l~..No ~ of Owner of prem,ses ...LJa:~J....~...~...~.~.. ....... ~ .............. ..c~: ...................... ~ ........ =..-1.....:...: .......... ~~ (Address) · ~none r~o.! Name of Architect. .................................................................................................................................. ~ ................. (Address) -- (Pho .) of Contractor ~E{:~.~:.~;t~..~.~,,~..'~w,.t~.~.~...~......~;ia~s~ss.)......~ ...... .% ...... ..~".i~l~.~.~l;~:i~ ............... Name PLOT DIAGRAM I.ocate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from propert~ lines. Give street and block number or description according to deed, and show street names ana indicate wheth- er interior or corner lot. STATE OF NEW _YO,[:IK, ) COUNTY OF ..~.~..~...?..~..~. ............................. ) SS ,'~' ~ ' ',~- , .~,~..,..,~]~.-.t.~,..L:~....~:.~.~.~,. be Q~ s~rn,~as anLs~ys thlt ~be is the appliant abo, named. ..................... ~.~,~,~~?,.. ~. ~~*~ . : He is the .................. 7 ................................................................. ' ' --- ' '-' ' ' ~---- ~ ~'~:..::..'../.:;::'..::"~.....'./~.:';.:;:..:-.:~ ..................................................... (~nt~tor, a~t, co~m~ o~r,~.] of said owner or owners, and is duly authorized to ~Horm or have ~d t~'~id ~rk and to make and file this appli~tion; that all statemen~ ~ntained in this appli~tion are true to t~ ~st of his knowled~ and ~lief; and that the work will ~ ~dormed in ~e ~flner ~t fo~h in the appli~tion fil~ t~mwith. TERRI ~[ ~ j~ ~Y ~LIC, State 0f ~ ~ ............. .................... o, ....... ................. APFR, OVED AS NOTED NOIlFY BUILC~NG DEPARTMENT ~f 765-2660 9AM TO 4PM FO~ REQUIR- EU INSPECTIONS: ~. B~FORE BACKFILLING FOUNDA- TION OR START CRAMING ~, 5EFOA~ COVE~NG PIPELINE ~3, ClNAL WHEN JOB COMFLETEO