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Home My WebLink About7617-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupancy No. Z6.br,.%2 ...... Date ............. April .... 29.., 19. ?5. THIS CERTIFIES that the building located at .Pee.on~.e..l~ay. Blvd ........ Street Map No.. ~;x ........ Block No... xX ..... Lot No, .XX .... La~l~.e~-...t~,y., ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. OCt...7.., 197q. pursuant to which Building Permit No. dated ....... ~Nov ....L~ ......., 19 .~.~., was issued, and' conforms to all of the require- ments of the applicable provisions of the law. T e occupancy for which thru certificate issued is . P.~:lYa.te. one. ~amlly..clwe~.liug .wi.th. an..addi.tic~n .................. The certificate is issued to Ed.w.i/~. F~hler~ ...... 0w~e.~ ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .N.~.R.: ............................. UNDERWRITERS CERTIFICATE No. ]q2~62~ .... &P. EJ[~. ~ .19F~. ................. HOUSE NUMBER ...... 3 ~.0 .....Street . .~,..P.~¢ .o~kJ, q..B~qy...~[.V.d ................ TOWN OF 5OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N', Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 7617 Z Permission is hereby gronted to: ..J~o~..~. ....... J~t~~'t .................................... fo J~ ~,~,~..a~.. a~.J, ~.~.gp~ ..~ ..~,~.~ ~;~.p.g...d~O~x~$ ................................................................ at premises located at ..~,.~9~11~C..~a-~-..~7~ ................................................................................... ....................................................... l,a~e~....~.i., ............................................................................ pursuant to application dated .........................QC.~ ....... .~. ............ i., 19.~J~..., and approved by the Building Inspector, Fee $.,t~5a .QO ........... FOF,~ ~0. $ TOWN OF $OUTHOLD , Building Deportment 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 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. S. Submit Planning Board approva~ 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 cede or safety inspection of buildings or premises, or other perHnent formation required to prepare a certificate. C. Fees: I. Certificate of occupancy $,5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of cerfificafe of occupancy $1.00 New Building ................ Addition ..... ~.... Old or Pre-existing Building ................ ¥ooant Land .............. Location Of Property ..~..~..~'~,.....~.~...~,J~..~...: ....... ~...~.....~...*..~. ..... Owner Or Owners Of rope y ..... .'~:~.~,~ ......... .~-,~..~.~.~,~ ................................................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No ..................... Date Of Permit .................... Applicant .................................................................. Al/-/ Health Dept. Approval ..... /..~... ................................. Labor Dept. Approval ..............(..~.,~...~, ...................... Underwriters Approval ~..~.J.~..~..~... ......... ~..2~....Planning Board Approval ........ .~.......~., .................. Request For Temporary Certificate ........................................ Fino. I Certificate ~ Fee Submitted $ ~ , , . Construction on above described building and permit meets all applicable cod, es and regulations. .... day of ........ .......... J- (stamp or THE NEW YORK BOARD OF FIRE UNDERWRITERS ta~ BUREAU OF ELECTRICITY ~- 8$ JOHN STREET, NEW YORK, NEW YORK 10038 m,., April 2, 1975 ,~p.~..o.~o.o./,. 776846 N 216626 THIS CERTIFIES THAT only the e~ctr~cal equlp.tent as ~scrlbed beJo~ and lntr~uced by t~ applicant ~med on the ab~ appl~catlon nu m~r in t~ ~re~es of Edwla A. Eh~e~s, Pecon~c Bay B~vd., w/o Laurel L~e, 3amespo~t,~.~. wasexaminedon March 27,1975 andfoundtobe~ncoo~pJlance~i~hthereqHire,nentsofthlsBoard. OUTLETS ~EC'PTACLES SWITCHES INCANDESCENT FLUORESCENT ~ ~T. KW. j ~t KW. ~T. K.W. ~T. K.W. ~t. H.P. ~DRYERS I FURNACE MOTORS J FUTURE APPLIANCE FEEDERS iPEClA~REC'P TIMECLOCKS J BELL ~ MULTI-OU~ET DIMMERS -- SERVICE DISCONNECT Electric Room Heaters: 1-2.SKW 1-1.25KW RR1 Box 1SA Main Rd. GENEEAI. MANAGEE Hattituck, L.I.11952 Per !?_ O'L his certificate must not be altered in any manner; return to the office of the Board if idcor(ed, lnspector~ may be ~dentified by lheir credentials, · a. Th,s .?pi. lc _ot~.must b~eomB~te.~ fll.led in ~ ~nter ~ ~n ~ o~ s~ in ~pl~ ~ ~ BuiMi~ . ~ ~ ~ I~ion of I~ a~ of ~ildi~s ~ premiss, mlati~ship to ~joini~ pr~im ~ ~1~ str~ o~ ~ areas, a~ g~ a ~ ~ription of I~ ~ must ~ d~ ~ t~ di~mm ~ b ~ ~ this ~licati~.~ c. ~ ~ ~ ~ ~is a~l~at~ ~ ~ ~ com~ ~fo~ i~nce of ~ Pe~. ~ .~.,, ~.~1 of ~is ~l~f~i~ ~ ~ildl~ I~[or will i~ a Buildi~ ~it to the ~licam. S~h ~it~ e. of Occupanc~ No building shall be occupied or used in whole or,in port for any pulpose whatever until a Certificate shallhave~~bytheBulldinglnspector. ', . ': ~'-=' .A,P,.PLICATIO~_ IS HEREBY MADE to the' Building :~pei~c~ent for the issuance of a Buildirm Permit pursuant to the~ · Budding Zone Oldtna~ce of the Town of Sal~thold/S~ff~lk County, New York, and other ~ Lalm, Oedinanc~ or , .~ulatio~s, for the construction o.f buildings, additio~s or alterations, or for removal' or ,~m bin demribed~ ,e .a. ppli. c.a~ a~.rees to comply with all applicable laws, ordinances, building code, housing cede, aad re~, and te~r aam~r aumonzed Irapact~aes on .promises and in building~ for necessary inspections. (Signature of applicant, or nome, if a coq~oration) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... ................... . ' .......... ; ..................................... (' .- . Name of owner of pmm,ses ...... .~.~.~.~,~.....~..~.~.~ .................... ...~..~:..~m...~.:...?e~l~ .......... ~.. .................... ~!~nature o.f duly authorlzed off k:er. (Name and title of coq~orate officer) Builder's Lic~se No ..................................................... Electrician's License No. Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ........................................ Lot NoL ........................ ~Ykmi~ality State existing use and occupancy of premises and intended use and oc?pancy of propaeed comtmction: Nature of work (check which applicable): New Building.. ................. ,~dditiofl .................. Alteration .~.~, . Repair .................. Removal .................. Demolition .................... Other Work ..................................................... · ~ , '~ (DO ~_ ~ (Description) 4: Estimated Cost ...[~.~..(~.~.Q .................................... Fee ...../..~ .................. ~ ............................................................. (to be paid on filing this applicatiOn) 5. If dwelling, number of dwelling units ...... ~ .................... Number of dwelling units on each floor ............................ tf garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................ ~ ........... 7. "D,mens,ons of ex,s, tmg structures, if any: Front ...... ~i.....~. .............. Rear ....... .~.~ ................ Depth .....~..~ .......... Height ........ .~.~.] ....... Number of Stories ....... J ............................................................................................ L ............ Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ......~.~z:~!. ................ Nuf~nber of Stories ......... ! ...................... I Dimensions___ ,°f entire new construction: Front ........~....~.. .................... Rear ..... ~;~.~ ............. Depth .....~..~ ............. Height ...... .~..~.....' .... Number of Stories ........... ~ ....................................... ; ................................................................. Size of lot: Front ..........~....~.~ ................................. _ ~, ,~,Rear ....... ..~_...~)..¢~. ...................... Depth ......~..~..(~)..r. .............. Date of Purchase ........................ ../..~.?....x.~.....~.../...~ame of Former Owner ......................................................... · ~. one or use district in which premises are situated ......~1~.l~.~,..~,......?..~..~....!...~'..~." -- Does proposed construction violate any zoning law, ordinancet --or regulation: ............... L ........................ : ............... Will lot be regraded ..~..~ ........... ~ Will excess fill be removed from premises-. ( ) Yes (/() No 14. ~'~ -~ ~L Name of Owner pf premises ...... ~).l.~.......~-..~.~.~.~b.... Address ................................ Phone No. ~ ........... ~.~ Name of Architect ............................................................. Address ................................ Phone No. t~ Name of Contractor ..~Z~_,,~.~.I~.I~.~IX~....~....~I.t~.... Address ......~.t~...~)...~...,... Phone No ........ i..~. ........... 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 whether interior or corner lot. 9~ 11. 12. a ............................ ~~,~~eing duly ~orn, d~oses ~nd soys t~t he is the applicant ~ (No,of i~igi~l ~gnin~ ~t~ ~above name. ~ ~ ~ [.e ,s th. ..................................... .............................................................................. : ........................ ~ (Contractor, agent, co~orate offi?r, ~c.) ~of ~id owner or owners, and is duly aut~rized to perform or h~e performed the said work and to ~ke and file this application; t~t all statemen[s ~contain~ in this application are tree to the best of his ~ledge and ~lief; and thor the work will be perform~ in the manner ~t fo~h in the application filed the~i~. Swom to ~fom me this -- ~ / _ _ , , ..................... ............ ,oto, .......................... .......... .I