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Home My WebLink About7217-zTOWN OF $OUTHOLD BU~I~INC, DEPARTM~,NT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~,~ ...... Date .............. ~.1:... ~.8 .... , 19.7.~. THIS CERTIFIES that the building located at . Peconic..Bsa,. l~lvd ........ Street Map No~mms ....... Block No ...........Lot No. [ ...... ~attit~ek. [. l~ur~J..l)l~t conforms substantially to the Application for Building Permit heretofore filed in thi.~ office dated ...........l~xy...1 .... , 19 ~.tt. pursuant to which Building Permit No. ?2rTZ.. dated .........h:a~.... ~ ...... , 19.~.1+., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which thJ, certificate is issued is ...gri.v~ate..one. l~am~I~..dwe&ll~ng. ~£th. &a~ga .&ctdno ............... The certificate is issued to . .~.~,~ ~L~m...J.~..~$1'4~ ...... 0.~/r~el' ......................... (owner, lessee or tenant) of the aforesaid bailding. Suffolk County Department of Health Approval ...1~ .ti., ............................ UNDERWRITERS CERTIFICATE No. ~[Z.22/?~...by..~,. l~,ul~clCL ................. HOUSE NUMBER ...... 900~ ... Street ....P~con~c .Be~..B2L~rl .................. FOB3J NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N,. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7217 Z Date .................. ...~....../. ....................... , Permission is hereby granted to: ~.....,.z//..-.~~ ......................... .... i~.~,::, ~~-- ,=~,,..,~ '~ ....... .X.~.~..:~.~...:....~..=~....~. ....... ......./f tO ........................................................................... ;..~. .................................................. .(.) .................... .~..~..~....,~...~..~-.~...~)...~.~a...~/./--~ ' . ............... ........... ~ ~- -~ ~, ~7' ................. '7' .............................. .'"' ~::' .................... at premises located at ...... ..~....~...~....~.......(..~..,'~..~.~/..:'~......~..~.,~.~...,,~..~....~...~..*~t ....... .../...~.~....,,.,.z..~......-.. ................................................................................................................... - --" ........ ....... ...... pursuant to application dated ....... .q~..../.../. .................................. , I~...~...., and approved by the Building Inspector. B u dll;gng Inspector TOWN OF BUILDING TOWN CLERK'S OFFICE $OUTHOLD, N. Y. r-~,-~ . ~r h---~ ~,~r.~ 19.~.....~. ~ Application No...~......~....t'...,~.. ......... Examined ........................ , . 7' ~/ '7 -~ /_*_~o~,~ H "K - ,o,,~S ~'~ Approved ........................................ " ' ]2 ........ " Perm,t,No..~..~ .........' /. ................ Disapproved a/c ............... ~ ............. ~ ............................................ ---~ ---~;,~ --- - --*,' -i§~j' -i~i~-~rl ~spector)TM APPLICATION FOR "UILDING PERMIT Date ........ ...... /.. ........... / INSTRUCTIONS a. This application must be completely filled in by typewriter o~. in ink and submitted in triplicate to the Building~,~ Inspector, with 3 sate of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing Lo~cation of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving o detailed description of layout ofproparty 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 ~vailable 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 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 applic~)f, or~ame, ifa corporation) ............................ ........... .............. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .....~../.'../.././.'.~...~.. ....... ~7..~...,~..~'........~.../:.~.....~ ................................................................................... If applicant is a corporate, signature of duly authorized officer. : ,.,~ay (Name and title of corporate officer) ~" Builder's Licemse No ..................................................... > Plumber's License No ................................................. Electrician's License No. ../../..~.. ....... ~ .. Other Trade's License No ............................................... 1. Location of land on which~ ~, /-~ ~_3//pr°p°sed-~°rk will. be done. Map, No.: .....~'..../. .............................. Lot No....~...' ................... Street and Number .~..O...X'...~?....7......~..~....~.?...~...C.~....~...~./...~'..~...' ................................................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................ b. Intended use and occupancy ..... ~.......~'...~..../'......2..~....~'...~'.~....~... ............................................................................. 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ~......: ...... Repair .................. Removal .................. Demolition .................... Other Work ......................................... ~-.d ...... ~)~ o'o - ~"- ~,,,,~l (Description) 4. Est mated Cost .~.~0~ Fee ..'~...~... .... (to be ~id on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on ~ch flor ............................ If garage, number of ~rs ...... ~ ......................................................................................................... 6. If business, commercial or mix~ ~cu~ncy, sp~i~ature and e~ent of ~ach ~pe of use ............... ~ .......... 7. Dimensions p~isting structures, if any Front Z~ . . R~r .... ~ Denth ~ ' .~,~,..../~.:..~. ......... ,u~ro,~,or,, ....... ~ ....................... .......~'.~L~i~EL..-;.E."..;"""'"'" ....... Dimension~of ~me structure with alterat o~ or add t one' Front ~.~/ '/-------- ------ '""" ""~ Rear ~ ~' ~,~ ...... ~. ................ .e,o~, ...... /~....[[~-~;~;~;,~ ..... ~ ................. , ................ ~ ...... 8. Dimensions of entire n~ construct on Fro"t . ..~.~.~. Reo~ '[~[~'[~D~t h .~.~..~ .......... .e,~, ...~...~ ....... .~m~o~ S,o..s ...... 4~ ............................... ~ ........................................... : ......... ~ ........ ~. Si~e o~ ~o~: ~ont ...... ZZ~ ......... ~ ............................. .e~....~&~... ~e~th &~X ~ ,0. ~at~ o, ,u~,e ..~..~...~.4~. .................... ,~e 0, ~o~r ~; 11. Zone or use district in which premises are situated 12. D~s pr~osed construction violate ~ny zoning law, ordinance or ragu arian .~ ']~"~-'~'s'"~.. 13. Will lot be regrad~ ..... ~ ............ Will excess fill be removed from premises: (V) Yes ( ) Nb 14. Name of ~ner of pram see ~.~..~..~ ......... A~ re~ .~:.~ ~.~/.~ , 0~ . .~ ~ ~~ Name of Architect .............................................................. A~ress ................................ Ph~e N0 ....................... Name of Contractor ............................................................ Address ................................Phone No ....................... PLOT DIAG~M L~ate clearly ~nd distinctly all buildings whether ex ~t ng or pr~osed, and indicate all set-~ck dimensions from prope~ lines. Give street and b ~k number or description according to de~, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, tcc COUNTY OF ................................ ~ '"'"' ................................................................................................. being duly sworn, deposes and says that he is the applicant (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 and to make and file this application; that all statements contained 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. Sworn to before me this ........................ o, ............................................ ........ _ (Signature o~ ............... TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, ~1. 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 oil buildings, property lines, streets, and unusuai 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-ex'st'ng 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 ...~..~.../~..~..~ .~......~.....~.?....~. Mew Building ................ Addition ................ Old or Pre-existing Building ................ Vocant lond .............. Location Of Property .~...~....~....~......~...~.....~..~...~..~..~'C:... ~.../~...~........~.,.L...¥...~..:.~...~...?...¥./~....~y...,,~.j~. Owner Or ~ners Of Property .................................. ~ .............................................. Subdivision .~'.~.f...~¢5 ........................... Lot No....~... Block No..~.L.... House No...2~CO Permit No. Z.~.~.. Date Of Permit ~.~(J.~Applicant .................................................................. Health Dept. Approval ...... ~.:..~ ....................... Labor Dept. Approval ~' Underwriters Approval ..~.~..Z~.~...~.~.: ........ Planning Board Approval. ~'1~ Request For Tempora~lCertificate ........................................ Final Certificate ...~ ........................... Fee Submitted $~. ............................... Construction on above described building and pe,,~c,m/~,? all,,.a. Loplica~,,,~,9~es an~, regulations. Applica nt .....~...... ~/~..~_ _.~.~.....~-.....~:?~......~..~ ......................... Sworn to before me this ....... of Notary Pubhc ~~--~". County (stamp or THE NEW YORK BOARD OF FIRE ~UNDERWRITERS :~T' BUREAU OF ELECTRICITY ~-- 85 JOHN STREET, NEW YORK, NEW YORK 10038 1974 71579 N 155166 THIS CEEIFIES THAT ~y t~ ~t~ ~U~nt ~ ~c~ b~ ~ int~ by t~ ~t a~ on t~ o~ ~pl~ ~m~r in t~ p~m~s oJ in the foliowing location; ~ Basement ,~as~mi~o~ April 13, 1974 DRYERS FURNACE MOTORS RJTURE APPUANCE FEEDBES [] lstFI. [] 2nd FI. outside Section Block and found to be in compliance with the requirements of thi~ Board. RANGES COOKtNG BECKS OVENS [NSH WASHERS AMT. K.W. At, T. K.W. k.~T. K.W. SPECI/d, REC'PlsT. AMP. TIMICLO~KS/A/~T A~] TEANS BELL ~UNITHEATERS MULTI'OUTLETN~S.Y~TF~T 150 Ct NO. OF S METER C Lot EXHAUST FANS DIMMERS A. W.G. NO. Of HI-LEG A, W.G. NO. Of I~UTRAL$ OF CC. COND, OF HI-LEG OF NEUTRAL 1/0 1 1/0 Robert A. Ooodale, 525 Orchard St., ~;ew Suffolk, L.I. 11956 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT B! ALTERED IN ANY MANNER,~ ,