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Home My WebLink About7166-zFORM NO. 4 TOWN OF SOUTHOLD BUII,IHNG DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupency No.~6.1.07 ....... Date ............. 5.e~.t} ..... 13..., 19. ?.1+. THIS CERTIFIES that the building located at . ][~.S · ~1S.].1. Cr. eek. D~'lve... Street Map No. xxx ......... Block No.. ~ ..... Lot No. x~CX... 3.o.~th.o.],4...N.;Y.; ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ~,px, il.... 8, 19.71~. pursuant to which Building Permit No..7.1667.. dated .......... April ... lQ, 19.7~'., 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 .. Px-i. vatt .(accessory) · a~ia~ing..pool .with .fenc.e .&. aqulp~eni;... The certificate is issued to . .Thomas. & .Lorr&t_~e..¢assid~. ..... Q~mera ............ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Ii. ,2: ................................ UNDERWRITERS CERTIFICATE No. ~l163Da2.. June...~.. ].9.7~ .................. HOUSE NUMBER .... 2~.~0 ..... Street .. l~tll. ~-~eek J]ri.va .................... [ ..... 1~o~ NO. ~t TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN ~J.ERK'S OFFICE Sou'rl.tOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7166 Z Permission is hereby granted to: at premises located at ...Jly/l~..fllel~...J/d;]r~..JJ,4,®ejj..l~z.~,ft ............................................................. pursuant ,o application dated ...... : ........... ~ ....... e ................ ,/~...., and approved by the Building Inspector. · r · NO. I ° TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E om,ned ........... ....... .................. ....... ...... . ,,..z./. ........ Di~ppraved a/c ........ ~. ,-..~....-..... ............................. - .................................. INSTRUCT'IONS ^pplicotion No. a. This application must be completely filled in by typewriter o~' in ink and submitted in triplicate to the BuildingS' Inspector, with 3 sets 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 adjoining premises or public streets o~ 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 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 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 ~j Regulations, for the construction of buildings, additions or aJterations, or for removal or demolition, as herein described./V The apphcant agrees to comply w~th all applicable laws, ordinances, bu'ld'ng code, hous'ng code, and regulat'ons, and td admit authorized inspectors on premises and ir~ buildings for necessary inspections. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .......... .'~Aq~L~...~.~I.~.:J.~.9~v. ........................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...............~..28QCI~].0CIQ(J ............. Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ............. 2..-qJ;l~..~JJ~,],J,~,$ ................................................................................... 3.,.~,latdre of work (check which appJicable): New Building .................. Addition Alteration. ),....~-...-..'.%r. ~, Repair .................. Removal .................. Demolition .................... Other Work ..... IM~JJlI~ ..IqllJJ, ................ .- ~" (Description) 4. Estimated Cost Fee (to bJe pa~d on filing this application) ............... $ 5~ ............................................................... 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 use ............................ 7. Dimensions of existing structures, if any: Front .........~,~ ............... Rear ........ ~,~ .................... Depth ....... :~2 ......... Height ................. : ...... Number of Stories ............................... S"~II~/ .................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ....... JJ ......................... Rear ...... &il .................. Depth ....... 35 ............. Height .................... Number of Stories ........................... Jli,~.~ll~.41je~ ............................................................. 9. Size of lot: Front ......................... ~,00 ......................... Rear .............. !l_~_~ ..................... Depth ..... !.~ ..................... 10. Date of Purchase ........................................................ 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: ............... I~ ..................................... 13. Will lot be regraded . ........................... Will excess fill be removed from premises: (~1) Yes ( ) No 14. Name of Owner of premises .....'Jllml~m..~m~l~ ................... Address ..~.l~JJ..4Jll~lJ~.~l' Phone No..J&$..3:JJ8 ..... Name of Architect ....... ,,~---JlleJ"* ............................. Address ..Jj~-;Jl~l~,,l~... Phone No..g~..~..;J;J~JJ... Name of Contractor ..... C~l~..Jl~..lle~J, iI ......................... Address J~.._0:.__.,~., ,~.iJl~' Phone No..B/14J..&,~lO0 ..... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names end indicate whether interior or corner lot. ,,, 153 FT' T',. STATE OF NEW YORK, I c ¢ COUNTY OF ................................ f~'~ .......................... ~.~.....~l..l~..~. .......................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contracf) above named. He is the ....... ~ .................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements conto:ined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. before this ..l~...J.....~..... Sworn to me of , , . ....... ........ : .............. .............................. ./ ~ARE? SU~D~U/~J$~-~ ~' (Signature of applicon/) Cert. ~'iled in Na~sa~ County THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~i ~- ak 85 JOHN STRBET, NEW YORK, NEW YORK loose ".,..,une N 163022 THIS CERTIFIES THAT ozdy th~ el~ctr~a~ equipment as described b~o~ and introdut~d by tff~e appelant Mns~d on t~e obo~e appl~ation ~lSmb~r in the pr~mises of Tom Cassidy, W. Mill Creek Rd., w/o Richmond Drive· Southold, L.I. inthefollotvingloeation; ~ Basement [] lstFI. [] 2nd Ft. outside Section Block Lo~ ~vaz examined on ~4~y~ ~ · 19 7 4 and found w be i~ complla~e ~ith the r~uirements of th~ fl~rd. DRYERS FURNACE MOTORS FUTURE APPUANCE FEEDERS AMT. K.W. OIL H.p. GAS H.P. A,'SAT. NO. A.W.( RANGES K.W. COOKING DECKS OVENS DISH WASHERS ,~,~T. K. W~ I ~,,~T. K.W. MT. K.W. TIMECLOCKs BELL uNITHEATEKS MULTI-OUTLET SERVICE DISCONNECT NO. Of: S OTHER APPARATUS: R V I C E NO. OF CC. COND. PER ~ EXHAUST FAN! DIMMERS OF CC. COND. OF HI-lEG OF NEUTRAL 1 G,F.I. (Swimming Pool) This certificate covers compliance at the date of inspection only. Because of unusual environments it is advisable to have frequent test and/or repairs made by a qualified person. COPY ,F~ BUILDING DEPARTMENT. ~NNER; FORM NO. 6 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. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 19§7), Non-conforming uses, or buildings and "pre-existing" land uses: I. 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 · Date ....... ~... ~..~..(..cl....!...~ New Building ............ diti .~.. Old or Pre-existing Building ................ Vacant Land .............. Locot,on of Proper ........ Owner Or Owners Of Property ..~....~.....~........?.......~....~..~..r..~.:'.?..~.....~...:......~..~/ Subdivision ...................................................... ~ ......... Lot No ............. Block No .......... House No ............. Permit No...~../~...~.. ~ Date Of Perm t .............. .~...~/....'~.. App cant ...~ ./.~....~J~.z ............................................... ~' .~..~ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .~....~./.~........C~...~.~ ....... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ ...:~...~ .................... Notary Public ...~'.~..~....~..: ......... County ~O~.~T ~~"~'~ Construction on above described building and p~mit meets al~licable cod~s and r~gulations. Sworn to before me this / ,~,~7 ~//~7 -' TH OMAS