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Home My WebLink About6725-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No..Z~.8.1.~ ...... Date ..............1~..~.q.h .... 7 .... , 197.~.. THIS CERTIFIES that the building located at .. Peco]3ic. I:~..Bit*~ ...... Street Map No...x..x ........ Block No ..... .XX. .... Lot No...xx.....1~..t.t.~.t.u..ck...E. !.Y; ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. Jl~.e...17, 19 ~..~. pursuant to which Building Permit No.. dated ..........J.u~..e.....~?...., 1~.~..., 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 . .P.r..i.v.a.t.e.. 9.n.q..$..a~.$.].¥..d..w.~.~..:~.g ...................................... The certificate is issued to .?e.o...F.a.r.r. ..... . .0~n..e.r. ................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval }l.,d~, ................................ UNDERWRITERS CERTIFICATE No..N.. 1. .2 .~.1. 9. .0 .... .0~..t...3.1.., .1.77.3 ............... HOUSE NUMBER .............. Street .......................................... ........................................... ................ ........ ............ I~BM NO. '~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6725 Z Permission is hereby granted to: .... .~.....~zl ........... ~: ......................... ........... ~ ......... .~.~.~ ........ ~..~. pursuant to application dated ...................... ?..Z .......... ...~....~..~...'./..., 197..~...., and approved by the Building Inspector. F, ,...../...~ ..... Building Inspector FORM NO. 6 TOWH OF SOUTHOLD Building Department 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 disposol--(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), Non-conforming uses, or buildings and "pre-existing" land uses: ]. 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 formation required to prepare o certificate. C. Fees: 1. Certificate of occupan~$§.00~ 2. Certificate of occupancy on pre-existing dwelling or land use $,5.00 3. Copy of certificate of occul:x3ncy $1.00 New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Owner Or Owners Of Property ....................................................................................................................... Subdivision ................ ; ....... ; ....................................... Lot No. ~ Block No .......... --~... House No,/~'.~'~ Health Dept. Appr~al ........... ; ................................ Labor ~pt. Approval ................................................ Unde~riters Approval .............................................. Planning B~rd Approval .~ .................................. Request For Tempora~ Ce~ificate .............. ~ ......................... Final Certificate Fee ~bmitted $ ~ Construction on above described building androe)'r~it m, eets~ll ~:z~licable codes ar~d regulations. .... - L_ Z- ~pp~lconr ....................... ~ .......... ..~...~ ......................... ~ .............................. Sworn to before n3e~'h~s ............ o, ....... Notary Public .................................... County THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY,. 85 JOHN STREET, NEW YORK. NEW YORK lOO38 il, l!)73 ~pplicatio. No. on file THiS CERTIFIES THAT 124190 only the electrical mluipment a~ d4mcribed below and~ introduced~% by the apld~cant .n~m~,. o_ oR the~bo~e ap~ieatlol~ number in l~$h~ er~m~ses. 3. ' of G. F~%rr, s/s Peconl~ uay Blvd., e/o Si?~soee Dr., ,,a~l~uc~, . · in thefollowing I~ation; ~ B~eme.t ~ 1st FI. ~ 2nd FI. OUt S i de S~tio. Bilk ~t wasexami~don Oc~o~e~ 2~, !973 a.dfoundtobeincompliancewiththerequirementsofthisBoard. FIXTURE RXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT 2 UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF F~RT OTHER A/~ARATU5: E R V I C NO. OF CC. COND. A,W.G. NO, OF HILEG A.W,G. NO'OFNEUTRAI~ 2/^'w'°'0 PER ~' OF CC, COND, O~ Hl-I~O OF NEUTRAL 1 ~t/0 1 ]~oni~.ld P2nnis COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. SOUTHOLD, N. Y. ~. ~min~ ................. ~ ....... .~,., I~.....2, ~ ~ .~ ~:~ ~pli¢~p~ ~..~,.~.~.~: ........... - ....................... ...... ................ .................................................... , ........... .......................... ~,~.~.~.,: ................ :~-..C:~ .................................. ~qt ., 1 , *PPLI~TI~ FOR BUILDING PEm.~ ~ ' ~' . ~' - /, ~ =~ ~-~- 77"'"~'"~'~'~"~-'~' ~"~ ~. This ~li¢oti~ must be e~l~t~ ~ { I ~ n b~ ~wr t~r o~ n In--tar, ~ith ] ~ of pl~, ~ocu~t~ pl~ ~lon to ~l~.-'~ee ec~o~ing b. Plot plan s~owlng I~ion of I°t and of buildings ~ pr~mises, relationship to ~dioining promises or publiC ~tr~t~ o~ ~r~s, and ~ivi~ ~ ~i~ d~ripti~ of l~yout o~r~ must be drawn on th~ die,mm ~hieh is ~ ~f ~is ~li¢~ti~.~ c. The work covered by this application may not be ~emmenced before issuance of Building Permit. d. Upon approval of this applicotion,'}he Building In~;mctor will issue a Building Permit to the applicant. Such permitc ' shall be kept on the premises available for inspection throughOUt' the work. e. No building shall be occupied or used in whole or' in_ pa rt for any purpose whatever until a Certificate of Occupanc~-~ shall have been granted by the Building Ifispoctor. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the BRuildln.g' Zon,e O~inance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o~ I .,.egu otf.o, ns, mr the co~'~truction of buildings, additions or alterations, or for removal or demolition, as herein described.l~ the applicant agrees to comply with all applicable laws, ordinances, building code, hOUsing code, and regulations, and to~ admit authOrized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises 5: ~' ~' ( ! Y-~ ~:~. 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 ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. M.,~p/?0.: ""~".'T';""~ ............... .~",~tL:Ot~NP',:~: ..................... 7~/ (, t_. - . Street and Number ................................................................................................. : ................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ............................ t ......... Y'7. ..................................................................................... . /~ / ' ~ t! ; , 1 b. Inmnded use and occupancy .......... ~ ..................................................................................................................... .3.~ ture-of work (check which applicable): New Building .................. Addition................../ Alteration ............. ~... ., Repair .................. Removal .................. Demolition .................... Other Work ...................................................... Estimated Cost .......................... ~../.:..~..~.. ................... Fee / ~' L~- (DesCfipti°n) (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: 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 construction: Front ............... x/..:~. ............ Rear ................. Depth ..../. / Height .................... Number of Stories ..................................................................................................................... Size of lot: F~"oot ........................................................ Rear .......................................... Depth ................................ Date of Purchase ........................................................ Nome of Former Owner ........................................................ Zone or use district in which premises are situated ..................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes -.~ (. Name of Owner of premises ........ .~../; ......................... ./. ....... /.;~Addre~:' .....:.:. ....................... J>hor~ No ....................... Name of Architect ......................... .~. .................................. Address ................................ Phone No ....................... Name of Contractor .............~'..~ ....................... : ........... ~ Address ................................ Ph0~e N~. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indidOte all set-b~ck dimensions from properh/ lines. Give street and block number or description according to deed, and Showi street names and indicate whether interior or corner lot. 10. 11. 12. 13. 14. /- STATE OF NL%V YORK, ................................................................................................ being duly sworn, deposes ond soys that he is the opplicdn! (Name of individuol signing controct) above named. ..'He is the .; ..................... .~./..~....;....~'....~....~....~;....~......~. ............................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work end to make and file this application; that oil statements contained in this application are true to the best of his knowledge.and belief; and tha~ the work will be performed in the manner set forth in the app)f~ation filed therewith. Sworn to before me this , ( .' ................. ~ ..... day of ......................................... '..., 19 ........ Nato Public.' .. ry , ..~ ..... ~. ........................... ,_..., ~--, ......... , ............. ,~.~-,.,,...,,. ............. ....... ~....,~..~.;.~ ............................. · JUDITH T. BOKEN (Signature of applicant) ROVED AS No'{ED ..~ ~.. ~._~,~__,.~ ~ ~,s**c,~o~s