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HomeMy WebLinkAbout6334-zFOB~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy Date ........... l~a...1.0 ........ , 19. THIS CERTIFIES that the building located at . .11~o1~1~I.. p~ .1~[ ....... Street Map No .... ~ ....... Block No.. ~ ..' .... Lot No. ~ .... lle¥..ff~ft'o~ ............ conforms substantially to the Applicatio~ for Building Permit heretofore filed in this office dated ........ .Jail...~ ...... , 19.7 ..~/pursuant to which Building Permit No. dated ............ .J~.. 9...., 197~., was issued, and conforms to all of the require- ments of the applicable provisions 6f the law. The occupancy for which this certificate is ' (owner, lessee or tenant) of the aforesaid building. / Suffolk County Department f5~ Heal Approval .N,R~ .............................. UNDERWRITERS CER ATE ~o. N12~1.~ .... 1~o~...11~...1.97~ ................ HOUSE NUMBER .... ;/'. i .185.. ,/ / ~,treet ... K~mof,,~l,~au. l~t. lid. .................... · .... FOBM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING IXERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 633~ Z Date .Ta~ 9 1973 Permission is hereby granted to: C...O..~!.o..w.?.~S.......A../..C....~..S?.~e.~..u...~....0..o....,C.~el~) ............... ~..t.~.o..~... ........................................... · ~ to ~uild an addition on existing dwelling (rear & side) at premises located at .........~.~.o..~.e....x~...~.....~...~...~.o..a..~.. ............................................................... , ........... New Suffolk pursuant to application dated Jan ~ 19.?..~.i, and approved by the Building Insp~tor. THE NEW YORK BOARD OF FIRE UNDERWRITERS ,~: BUREAU OF ELECTRICITY r~ BB JOHN STREET, NEW YORK, NEW YORK 10033 Kimlglnor Point Co., e/side Pv~.Road, eot of Jackson St. New Suffolk, L.I. in the following l~ation; ~ B~ement ~ 1st FI. ~ 2nd FI. oatside S~tion Bilk ~ examined on Hove~ber 8, 19 ~ 3 and found to be in compliance with the requirements of this Board. FIXTURE OUTLETS ~ECEPTACLES SWITCHES li BXTURES RANGES OVENS DISH WASHERS EXHAUST FANS DRYERS TIME CLOCKS SYSTEMS NO. OF FEET OTHER APPARATUS: E R V I NO, O~ CC. COND. A.W.G. NO. OF HI-~G A.W.G. PER ,~ OF CC. COND. OF NEUTRAL 1 3 5 C A. W.O. NO. OF NEUTRALS OF HI-LEG 1 W.,q. Ruland, Mattituck, L.I. Peri'iff COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FORM NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. ¥. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, end submitted in DUPLICATE 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, /Vtultiple 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: l. 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 B~ilding ................ Addition... ......... ~ .... Old or Pre-existing Building ................ Vecant Land .............. Permit No ..................... Date Of Permit .................... Applicant ~...~..~ ............ Health Dept. Approvol ............................................ Lobor Dept. Approval ............. --. .................................. Underwriters Approval .............................................. Planning Board Approval ....... ~ ................................ Request For Temporory Certificate ........................................ Fin~ Certificate .....~./~......--. .................. Fee Submitted $ ...~...t. ......................... Construction on above described building and,p~rrffi't meets all op_p~cqbfe codes and regulations. A [ ')/ ' '/~ £/~' ~ / / "' Sworn to before me thi~ pplicant ........ ~ ...... ~~/.~]~. ............................... ...........................................~~. ~ mp or~;~ ~ Notary Public ...... ~.....~,~,¢.=.~%... County TOWN CLERK'S OFFICE Examined ~ ............. , 19.~..-~.... Applicot,on N~ ..~.~..~.~ ........ ~... ~r~ ~ .............. ~.~ ........ ~ .......... , ......................... 19~. Pemit No ~.3.~ ~ ~r~ a/c ~...-......-.-.........~ ........... APFLICATI~ F~ lUlLiNgPE~IT ........ ........... , .... Date INSTRU~IONS ~. Thi~ ~li~tion mu*t ~ ~m~l~l~l~ filled jn b~ ~writ~r or in ink *nd ~ubmi~d b. ~lot plan *ho~in~ Iomtion of lot *nd o~ ~uildin~ on pr~mi~, r~l~tion~hi~ to ~dioinin~ c. T~ wo~ ~vered by this a~ication may not ~ ~mmen~d ~fore i~uan~ of Building Permit. d. U~ ~roval of ~is a~l~ti~, the Building Ins~or will issue a Building Permit to-the appli~nt. Such ~rmit ~1 ~ kept ~ premiss availpb~ for ins~i~ throu~out the work, e. No ~Udi~, shall~ ~ ,o~ or u~ in who~ or in ~ for any pur~ wha~vef until a ~nifi~ of Occupanw shell have ~n~ ~an~ by t~ Bu~ng Ins~or, , ~PLICATIONIS HEREBY MADE to the Bui~ing Depan~nt'for t~ issuanm of.a Building Petit punuant to ~ Butldi~ Z~ ~an~ ~ ~e To~ ~ ~mold, ~ ~unW, New Yo~, a~ o~r a~li~ble ~, ~dd~, ~dmons or al~rat~ons, or f~ r~oval or de~lition, ~ ~rein ~i~. ~ ~i~ ~ina~s. buiMing ~, housing ~, ~dr~l~ions, a~ to ~mit authorized in~cton on ~i~s and in buildin~ ........ ......... ............... (A~ of a~li~nt) State whether applicant is owner, lessee, ageD,t, arc 'h,,~r~t, engineer, general contractor, electrician, plumber or builder; If applicant is a corporate, signature of duly authorized officer. e. Existb~ u~e and occupancy ................ b. Intended use and occupancy 1. Location of land on which proposed work will be done. Ma No No...'~....~,m ............................ Street and Number ....~_~...~..~: ........... : .......... :~ek'f~....~..~, 2. State existing um and cocupanEy of premises and intended u~e ~ occupancy of proposed construction: 3. Nature of work (cheek which applicable): New Building ....................... Addition ..................... ~_ n ^,AIterati°n ....... ~.... Repair ......................... Removal ......................... Demolition ........................ Other Work ..~ .... y (Description) 4o Estimated Cost .....~.......~.....:.....~.. .................. Fee .............. ~. ................................................................................ (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. If business, commercial or mixed occupancy, specify nature and extent of each type of usa .....'~.. .............................. 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 ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................. Height ................................................. Number of Stories... ................................................................. ........ ........... .. 9; Size of lot: Front ......; ......... ~ .................. Rear ........................... ~ ............ Depth ......... ~ ..................................... Height .................................... ~ ............ Number of Stories '"- 10. Date of Purchasa ..................................... Name of Former Owner ........................................... ;-. ............. 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 ..... ~ .................... Will ext,,ess fill be removed from premisas: [ ] Yes [ ] No 14. Name of Owner of premises ...~.....~.:.~~.,...~...~..}~/...~..~. ............. (Address) ~(/ (Phone N~.) Name of Architect .................................................... ~ ~ /t ~ddress) _ , (Phone No.) Name of Contractor ....~..~~..: ...... ~:.~...:..~.. .................................. (Address) (~ / (Phone No, I PLOT DIAGRAM · L~ocete clea~ rly and distinctly all buildings, whether existing or proposad, and indicate all set-back dimensiens from property ~tr~es.' Give ~treet and blo~; number or description according to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NEW YORK, ) SS COUNTY OF ...................................................... ) He isthe. .................................................. j ........ .................. ~ ~, ... (Contractor. agent, corporate officer, ~,of ~d 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 c~ntained in, tiffS aflfllicatien are true to the best of his knowledge end belief; and that the work will be performed in the n-~nner set forth in the application filed tbere~!,th~ ...................................... .................................................. I~ta~y Public ...................................................................... ~ounW ........................................... ~ ,~ ...'~,....n~......7. ..........................