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Home My WebLink About7360-zFORM NO. 4 TOWN OF SOUTHOLD BUW.BING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificete Of Occupancy No. 2~6.~.Q{~ ...... Date ............ Sept... ~3 ..... , 19.7t~. THIS CERTIFIES that the building located at .l~gb.ar$. Ro.~d .............. Street Map No..F.o...u~l..e.r.s...E~ock No ......... : .Lot No.l~. & .~1.~ ..... 8O:,lthold.. ~.,Y,.. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ Jibe.. 2~, 19. ~ pursuant to which Building Permit No. ?~6~.. dated ......... J.~..2.~ ...... , 19 ~., 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.~.v~.t.e., o~.e..fekeAly. ~ell~ng .dYellin~ .~it.k .an. &ddl~;i~m ....... The certificate is issued to p.a.u~...~. ~Tl.e2 .C~.~ .... O~r~ers ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . N..R, .............................. UNDERWRITERS CERTIFICATE No. p.e.~d.~.g .................................... HOUSE NUMBER .¶.~. ........ Street. J~b&r.~ .Road ........................... FOEI~I 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) N? 7360 Z Date ......................... J'.g~...~) .............. , 19.~)4,.. Permission is hereby granted to: ........... ~.Qw~h~ld~ ................................................. ~o ~.~.% .d....~...~.a...c!.~..t. L~:~...o~....~z;;L~.t,~:c~...<h¢~:.l Jm,~ ................................................................. at premises located at ....~...q~...~...~...]~.~...~?.~.....?..g.'0Xk~,(~Z'.~..~.~8,.~. ........................................... .................................... ~bs~..H~cl ......... ~ou~t~ .................................................................... pursuant to application dated ....................... J'~1:~..~6 ................ , 1~...., and approved by the Building Inspector. 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: 1, Final survey of property with accurate location of ail 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. 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, street:F, buildings and unusual natural or topographic features. 2,Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3, Dote 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 Dote ........ s. .............. New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property East side Hobart Road, Southold Owner Or Owners Of Property ............................ ~.~1~1 A~ C,~mlnltl[....~....~ ............. ~ Shlrle~/.[ .................... Camznz[....i..t..~l .......................... 15 ~ Subdivision ................................................................ Lot No. ½...%4~.. Block No ............. House No..%~35.. Permit No. 7360 Date Of Permit ..~..~..~.....2:.6..'..?AJpplicant Edward Williams Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate X Fee Submitted $ ...5......0..0. .......................... ,~ Construction on above described building and permi~ n~eets oil gpffJi~oble code~nd regulations.~ pp ........ ~'" '~? ........... · ..~¢=¢4~~.... -~._?~ ~ ..................... Swar ,to before ..... ~..,~..... day of ..~.,.~/i.!.~..~7 h/ (stamp or seal) Notary PgbJJ~ ~'~.. County ~ ........... ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS aW BUREAU OF EI.ECTFUCITN~'~ ~ . [~ SS JOHN STREET, NEW YORK, NEW~*Y ~C~RK:'10C)38' ,~,,,, s,~,~ ~,~ ~,,.,,.~o.o.~,~ ~r~.-'. N 184258 THIS CE~IFIES THAT in the~oll~ing ~at~n; ~ B~ement ~ Ist FI. ~ 2~ Fl. OU~B~d~t~n B~k w~ examt~ ~eptembe~ ~9~7~ a~ou~tobeln~mplia~ewiththe~q~irementso~th~B~rd. DRYERS FURNACE MOTORS FUTURE AFPUANCE FEEDERS SERVICE DISCONNECT [ NO. OI S RANGES SPECIAL REC'P'I R [COOKING DECKS [ OVENS [DISH WASHERS AMT, K.W. i AMT. K,W, ~T. K.W. TIM',CU~CK$ri ,BELL UNIT HEATER$ MU,%.~T-OUEMTSLET EXHAUST FANS DIMMERS Room }{eaters: P-1. Okw, 2-. 75~ Paul Burns Town ~arbor I,a. Southold~L.I. 1! COPY FOR BUI~IHG DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTER~ IN ANY MANNER. b°~ ~G I~0 TM: ~ ~ -- MONUMENT ~0 SUBDIVISION MX~P FILED IN TII£ O~'h-ICE OF, ~ TI4K CLERK OF SUFFOLK GOUNTY ON IdAY t()~ 193Y P~ M~ P NO. ~. ~ t~EVIS IONS YOUNG ~ YOUNG 400 OSTRA'NDRR ALDEN ~' YOUNG PRO~E$SION~I ENGIN£'ER L~NO SU~VEYOR~N SURVEY FOR RIVERHEAD, N.Y. HOWARD VZ YOUNG £ANO SURVEYOR HYS. .LIe. NO. 4559.~ PAUL A. CAM/N/TI B SHIRLEY C~bIINITI HALF OF LOT 14 6~ LO T 15, "FOUNDERS E'$ r,4 TES" ~0~ NO. ! D sopproved o/c ......... ............... Appli¢otion No...7,,,.~,.,.....C~,, ................ ~ APPLICATION FOR BUILDING PERMIT Dote ~ ~ ........................... , INSTRUCTIONS o. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plat plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to Odjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the 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 o 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 been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building 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 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 .....,~...~...~....~. .............. ..~..'.~.~.(..~,.../i.t)..f....~.'. ........................................................................................... If applicant is o corporate, signature of duly authorized officer. (Nome and title of corporate officer) Builder's License No ..................................................... Plumber's License No ....... ~.~ ......................... Electrician's License No .... ~J..~.~ ..................... Other Trade's License No ........ ~..~ .................. 1. Location of land on which proposed work w~ill 1~ done. Map No.: ..... .~,.~ ...................... Lot No./.,.~..:.~...~...i.~...!,~. Street and Number ..... .,~.~..o...~..~...l~...Z........~ ......................................................................................................... Municipality 2. State exJsHng use and occupancy of premi?s and in~,ended use and occupancy of proposed construction: 3. Nature of work (check which applicable): New Building. ................. Addition..,.,,............'"~ Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................. /...C ~ (Description) 4. Estimated Cost ............................................................ Fee ............................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Numbcr 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 use ............................ 7. Dimensions of existing structures, if any: Front .......... : ................. Rear ................................Depth ...... , .............. Height ........................ Number of Stories ....... .......................................................................................................... Dimensions of same structure with alterations or odditions: Front .......... ; ......................... Reor ............................ Depth ................................Height .... M'..;'. ................. Number of Stories ' 8. Dimensions of entire new construction: Front .................... . ............... Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9, Size of lot: Front ........................................................ Rear .......................................... Depth ..... ". .......................... 10. Dote of Purchase ........................................................Name of Former Owner ................ ~ ...................... 11. Zone or use district in which premises are situated .............................................................. .~ ..................................... 12, Does proposed construction violate any zoning Iclw, ordinance or regulation: ........................................................ 13. Will lot be regroded ..,...;...: ................. Will excess fill be removed from premises: (() Yes (~) No 14. Name of OWner of premises .................................................... Address .,' .............................. Phone No ....................... Name of Architect .............................................................. Address ................................Phone No ....................... Nome of Contractor ............................................................ Address ................................Phone No ....................... PLOT DIAGRAM Locote clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frara property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, I¢ c COUNTY OF ................................ f~'~ .............................. ' ........ ~. ............................... :.~. ....................... being duly sworn, deposes and soys that he is the applicam (Name of individual signing contract) 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 ond to make and file this application; that all statements contained in this application ore true to the best of his knowledge and belief; and thor the work will be perforr~ed in the manner set forth in the application filed therewith. Sworn to before me this ............. : .......... day of ............................................ , 19 ........ Notary Public, . ................................................... County (Signature of applicant)