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HomeMy WebLinkAbout7565-zTOWN OF $OUTHOLD BUrLnING DEPART~O~IT Town Clerk', O~iee Southold, N. Y. Certificate Of Occupancy no. z6~82 Date ....J,q~. .~ .... ,19, ?~ TI~ CERTIFIES that ~e b~i~ 1~ at .. ~th .R~ ............. S~ ~p No.I~,~.~ .~ No ........... ~t No, . ~1 ..... ~e~e.. ~,Y, ......... ~om su~fi~y ~ ~e AppHcafi~ for B~g P~t h~Wfo~ ~ thi, o~ da~ ............. ae~t .30., 19..~ p~t W wM~ B~in~ P~t No. ~.. dat~ .......... ~.~P~.. 3~..., 19.~., w~ ~u~ ~d co,om ~ ~ of ~ ~ men~ of ~e app~cable pm~o~ of ~e hw. ~e ~p~ for wM~ tht~ ~ ~ ~u~ h . .Private...~r~. i~ce~o~ .b~) ................................ ~e c~i6ca~ ~ ~ W . ~. ~. Edl~ .D~ ..... ~ers ................... (o~, le~ ~ of ~e ~o~d b~in~. S~o~ Co~ Depm-~t of He~ A~rov~ . ~ ,~, .............................. ~~ C~ICA~ No...~ ...................................... HOUSE ~ .... ~.~9 ......S~ .. ~. ~ad ..... PeC.~iO ............... FO~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTI.rOLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7565 Permission is hereby granted to: ../-_~e~.,~.....~ ..~...~,~.~ ...... ~~..~.....~...~.......~.....~; ~ . ~~.~.'..%....~.....:.~, ................... ~o....~....~.~ ...... ~....~.~' ..~~ ~. ...... ~~.~.~ ...... ~~....~ ...................................................... at pmmi~ l~at~ at ....... ~.~.....~/~...~...; .............................. .............................. L~;~,~ ........... ~...~ .................................. ~ ................................ ~.~..:.:.....~~..~g...~~ ........ ~.z....~ .......... Buildin~ In~tor. -- Dulling inspector BUILDI~NG DiPARTMINT TOWN' CLERK'S OFFICE SOUTHOLD, N. Y. ....................................... , Permit No . ,.. ,-. D saporaved a/c ' ,~. . .~ · Application No. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sete 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 adjoin ng premises or public streets or areas, and giving a detailed descr pt on of layout ofpraperty must be drawn on the dJagmm which is part of this appJjcatjon. c. The work cavered by this application may not be commenced before issuanCe of Building Permit. d. Upon approval ef 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~l shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Build ng Department for the issuance of a Building Permit pursuant to the Building Zone 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 applicable laws, ordinances, building code, housing code, and regulatior~, and to admit authorized inspectors on premises and in buildings for necessary inspections. State whether applicant is owner, lessee, agent, architect;,..engineer, general contractor, electrician, plumber or builder. Name Of owner of premises ....~..~..~..:t.~.,..~...:....~.L.'~...~iT...~..,.~.~~ ......................................................... If applicant is a corgorate, signoture of duly outhorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Other Trade's License No......-T ............. ~ .......................... 1. Location of land on which proposed work will be done. Map Lot No...~..I ............... Street and Number ....~.~.~)....S.~L..~L~...'~:?.~./~.L~-w. .................................................... - ............... Municipality 2. State existing us~ and occupancy of premises and intended use and occupancy of proposed coastruction: a. ~.-xisiting use and occupancy .....~L~..~...~....~,,.~'~--9~.. ...................................................................... b. I ntended use and occupancy .....~ ~-~-..~.t-~'_...~([;?.....-~....'..'J'"/.~)..~t~j~.~ ..................................................................... property lines. Give street and whether interior or corner lot. 3. Nature of work (check Which applicable): New Building.. ................. Addition .................. Alteration ................. Repair .................. Removal ' Demolition, .................... Other Work ................................................ . .... · J (Description) 4. Estimated Cost ....... .~..~.~.,. ...................................... Fee ./..~. ................................................................................ (to he, paid on filing this application) §. If dwellingl number of dwelling units ..................... , ....... Number of cFg~elling units On each floor ............................ If garage, number of cars .................. ~..~.J.~.. ............ i ................................................ ; ................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............. '~. .............. 7. Dimensions of existing structures, if any: Front ....10..T~;~ ............. Rear ....tQ..~.~ ................. Depth ..J,.~..-...'~.. ....... Height ...... ~.~,...'~, ....... Number of Stories ....... ~.J~J.~-,,; ............................................................................................. Dimensions of same structure with alterations or additions: Front ....'~...-~. ................... Rear .'~dl~..-..~. ............. Depth ....... ..~:.L.-...'~.. ............ Height ....[.'~.......~. ............ Number of Stories ...~.,L~. ................. 8. Dimensions of entire new construction: Front ..... .~.~...-.~. .................. Rear ...... I.]~...-~. ........... Depth ...~..0...7.~. ......... Height ....~..-...O, ....... Number of Stories ......... ~.I~..1~ ............................................................................................... 9. Size of lot: Front ...............~.O1~.,...~. ........................... Rear ......... [1~).,...~.. ................... Depth ...~[~..~...~.. ............... 10. Date of Purchase .......... .~...~.6.O ................................... Name of Former Owner ..,~L~RI~.~-A~.....~.~d3.~.~..~,~ 11. Zone or use district in which premises are situated ...... . .~...~J.~.~...'~'.~(./~'l,~ ...... ~.~. ........................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ I..'~:~ ....................................... 13. Will lot be regraded ....... dO. ............ Will excess fill be removed from Rremises; (t~ Yes (/~No 14. Name of Owner of premise %"I~..~/~'~ .......... Address ..~.~'.C~.4~g, ............. Phone No."][~..~...~.~..~ Name of Archit;ect .............................................................. Address ................................ .Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-back dimensions from block number or description according to deed, and show street names and indicate STATE OF N~ ~ COUN~ OF~ ......... f~'~ . ............... ~ ....... ~; ............................................. ,....,...; .................. being du~ sworn, d~ and says tMt he is the applicanl (Name of i~ividual signing contmc~ o~ove He is the ................................................................................................................................................................................. (Cantractor, agent, co~orate 0ffi~r, etc.) of said owner or owners, and is duly aut~rized to perform of hove perfo~ed the said work and to ~ke and file this application; t~t all statements contoi~d in this opplicoti~ are tree to ~e ~st of his knowledge and belief; and tha~ the work will be performed in the manner set foffh in the .applicatim fil~ ~r~ith. Sworn to ~m me this ...... ..... ......... .o,o ........... .... No. 52-03449~3 surfak Count~ FORM NO. 6 TOWN OF $OUTHOLD 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: 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 Boord 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 $5.00 3. Copy of certificate of occupancy $1.00 ..... New Building ................ Addition ....~"~ ........ Old or Pre-existing Building ..... ~ ........ V&cant Land .............. Location Of Property ~J~.~.~.~..~-~J(~L.T.J4~1~-.~`~'~.`~....~.~C4D~J.~`~:~.M/~ ............................. Owner Or O ners Of Property Subdivision [/N~),J.~..~.~---T~g~..~.J~ ................/ ~Lot No...~...J ...... Block No ............. House No ............. 4gO · Permit No...~...~'..~..~.:.'....~:?'Date Of Permit ~ .......... Apphcan, ..L~..~.~ ...................................... Health Dept. Approval ..... .......................... Labor Dept. Approval ......... ~.z .................................... Underwriters Approval J~..fl~ .......................... Planning Board Approval .....~..~..~..~.. ......................... Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ ....,~..... ........................... Construction on above described building an~d perr~t meets oil applic~o~b, le c~9.g~t~ and regulations. Sworn to~efore~f~ me~ t~ ~ / ' (stomp or s~r~~ ........ ...... Notary Public ..... ~ ~... County ~ BUREAU OF ELECTRIcrr'~ > 85 JOHN STREET. NEW YORK. NEW YORK 10038 THIS CE~IFIES THAT was examined on and found to be in compliance with the requirements of this Board. ~T. r.W. ~ClAL EEC'PT COOKING DECKS OVENS DISH WASHERS AMT. K, W, I AMT. K.W. kMT. K.W. I TIMECLOCKS [ Bm JUNITHEATERS MULTI-OUTLET NO. OF FEET SERVICE DISCONNECT [ NO. OF [ S METER IOTHER APPARATUS~ R V ,I C E Lot EXHAUST FANS DIMMERS 1550 G..J.r~ ~Ld. il'teOli:L¢ R L. T. 11 r' C~y. FOR BUILDIK D~A~MENT. THIS COPY OF CERTIFICATE ~UST NOT BE ALTERED~ AI~Y h~ MANNER. ~; THE NEW YORK BOARD OF FIRE UNDERWRITERS f aw BUREAU OF ELECTRICITY I'~ 85 JOHN STREET, NEW YORK, NEW, yORK 10038 Date ~U'[~UB~ ~ J ~-~7)J ApplicationNo. onfile ~- ~ ' ' N 175543 THIS CERTIFIES THAT in the following location; [] Basement [] 1st FL .~.e,~.in.ao, August 5, 1972 ~.,mK~ FURNACE MOTORS FUTURE AI'f%IANCE FEEDER~ -~' L K~ W. OiL H.P. GAS H.P* AMT, NO, A.W.O. [] 2nd FL outside Section Block and found to be in compliance ~vith the requirements of this Board. SERVICE DISCONNECT NO. Of: S OF CC. COND. A.W.G. NO. OF HI-LEG A.W.G. PER ~' OF CC. COND, OF HI-LEG Lot EXHAUST FANS AMT. H.P. DJMMERS E NO. OF NEUTRALS ~ W, G. OF' NEUTRAL Jacob Haupert 2803 Wilson Ave. Bellmo~e,L.I. 11710 11 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.