The URL can be used to link to this page

Home My WebLink About7281-zTOWN OF SOUTHOLD BI.m'.~ING DEPAR~ Town Clerk's Office Somhold, N. Y. Certificate Of Occupancy No..Z. 7.22.~. ..... Date ................0q..t...6. ...... , 19. ~.6. THIS CERTIFIES that the building located at . .~/S. Pmquaah .Ava ........ Street Map No... xx ....... Block No ....xz ....Lot No,. ~x... Cutchoiaae ............... conforms substantially to the Application for Building Permit heretofore ~ed in this office dated .............l/a~.. 2~., 19.~. pursuant to which Building Permit No. dated .............liar.. 2.9., 19. ?~', was issued, and conforms to all of the require- / ments of the applicable provisions of' the law. The occupancy for which thi.~ certificate is '~-~u~ is .. P~.lw.t.e .o~e,..fe~-~!.v.~d~,,~.el] in~. ~ith. ~n. ~cldition ................. ~T~e certificate is issued to . .~ohn .J o. ,Iesaup... L/wner ............................ (owl~er, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval .... ~.,ii, ........................... UNDERWRITERS CERTIFICATE No. 'N239'23 % ..... Aug' ~.' ~97~ ................. HOUSE NUMBER ..... ~.9~0 ....Street... P~qua~t.. A.ve ........................ .... ....... ~OR~ ~0. 2 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) 7281 Z Permission is hereby granted to: ,T~m~..~.,...,/.e~ .............................................. .......... $~38.....~l~p..~m .................................. ......... .~.z.~..~.q~..,. .................................. ~o ~ulld an addition on existing dwelling _ at premises located at ..W/.~...~.~.~.I~,II~..AT.t ...................................................................................... ............................................... ..c.~.o..~... ....... .~..~.; ........................................................................... pursuant to application dated ........................... ~. .......... ~ ....... , 197..¥...., and approved by the Building Inspector. Fee $.1~.~(~ ........... APPLICATION FOR BUILDIN6 PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter o¢ in ink and submitted in triplicate te I~m Building Inspector, with 3 seee of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan shO~ing~ location of lot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giving ~teiled description of layout ofpreperty 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 ofr this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspectio~ throughout the work. e. No building shall be occupied or used in whole or in pa rt 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 Zon,e Ordinance of the Town of Southold, Suffolk County, New York, and other appli.c, oble Laws, Ordinances or Regulations, tar the construction of buildings, additions or alterations, or for removal or demohtion, as heroin 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. ...... of ¢ StateJv~hether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises .... ~ ..... . ... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No. '"" Electrician's License No ............................................. Other Trode's License No ............................................... Location of land on which~.~ be done. Mop Np.: .................... ~ ............ LOtNo ..... ~ ............. Street and Number ..... ~ .... ~...~...~../~...~ ........... ~.. State existing use and occupancy of premises 9~:t intended use and occupan~ of proposed con,traction: a Exstn useondoccu an . .~ -- ~?.~ ~ .... · g p cy ............................. · .. .j~. .............. b. Intended use and occupancy .................~'~.,.......'...~,.....~.,~./.,~..,,,.,~, ..... I0. 11 12. - 13. 14, 3. Nature of work (check which applicable): New Building .................. Addition ...~ Alteration ................. Repair ................. .~,R~ emoval .................. Demolition .......... ./ ...... Other Work .................................................. (~v~ ~' (Description) 4. Estimated Cost ....... 5.~...~..?...~.. ............................... Fee .~...~..~~ ............................................................ (to be paid on filing this application) / 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 tvoe of use ...... ~ ............... 7. Dimensions of existing structures, if any: Front ...... ..--~.....~..... ..... Rear ..... ..~.,..?/~....~ Depth Height .....~...~.. .......... Number of Stories ........~ ...................... ~ .......................................................... Dimensions of same ~,~ucture with alterations or additions: Front ......... ..'~.....~ ..... Rear .....~..'.~."~.. Depth ....~: .~..~...._ Height ......... ./'...~'7/~.."umber of Stories ........ ~ ....... 8. Dimensions~of e~t~ren/'' ewconstructlon: Front ....... : ............................ Reor..../...x~/..~.. ...... Depth...~..;~... Height .,Z/~ Number of Stories, ..~ ............................... Size of Iot:-I~ront ............. ~,...~...~v~ ...... i ........... Rear .... Dote of Purchase ...... ~/~./../.~./..~..~)...'~... ..................... Name of Zone or use district in which premises ore situated ................... >.~ ................................................. Does proposed construction violate any zoning law, ordinance or regulation: ....... ~ ......................... Will lot ~,regraded ..... ~-.- ~_sLf_ill~be removed from premises: ('~e~ (.) Name of Owner of premis~ .~..~..i Address//,~..~.~~.~Phone No. ~..:~....-....~../..?O Name of Architect ......... .~.....~...~...~... ........... ~ ...... Addr~:....~..'.~hone- ~z~- J~,~ ~,,-9'. N~. .......: .............. Name of Contractor ..............~ ........................................... Address ................................ Phone N° ....................... PLOT DIAGRAM Locate clearly and distinct y al buildings, whether exictinn or nmnosed and indicate all set-b~ck dimensions from property hnes. G~ve street and block number or descriDtlon according to deed, and shrew street names and indicate whether interior or corner lot. 0 .................. ~~;, ................. ~ing duly sworn, deposes and says that J~e i~ the applicant ~mT~e.- o~ -~J~]Ji~u~lng con~ract~ ' above nart'~L/ He is t~ ............. ~..~~ ............................................................................................................................ (Controctor,-agent, co~orate ~icer, etc.) of said ~ner or owners, and is duly authorized to perform or have performed the said work ~d to ~ke and file this application; that all statements contained in thls application are true to the best of his knowledge and belief; and tha~ the work will ~ performed in the manner set fo~h in the application filed therewith. Swam to ~fore me this __ . . ~ ............... ~ ............ ~ ............................. , 1~.. ot** ......... ................... ................................. N~ ~C,'State ot ~ew Yo~ ' FORM 1~0. 6 TOWH Of SOUTHOLD Building Department Town Clerks Office but*hold, 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 Cede 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 I~ildings. 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 ................ Vacant Land .............. Location Of Property ..................................................................................................................................... Owner Or Owners Of Property ....................................................................................................................... Subdivision ........................... .~... ................................. Lot No ............. Block No. House No ............ Permit No.7Z~IZ~.................... DoteOf Permit ~(..=.~.Applicont ..Lr,¢~ _/ Health Dept. Approval .............. ..k~..~..~.. .................... Lobar Dept. Approval ~x[_~, Underwriters Approval .............................................. Planning Board Approval .......................... ~ ............. Request For Temporary Certificate ........................................ Final Certificate ~ Fee Submitted $ ......... ..~..~ ............... Construction on above described building and permit meets all applicable codes and regulations. Applicant Sworn to before me this ................ day of ..... ~... ....................... (stamp or seal) Notary Public ........~...~ .......... County THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY i~Z' 85 JOHN NEW YORK, NEW YORK tOO3B STREET, THIS CE~IWIES THAT only t~e e~t~al ~u~nt ~ ~sc~ ~ ~ int~ by t~ ~pl~t ~ on t~ a~ ~pl~ numar in t~ p~m~ of ~ F. Jona~h~,~[lock ~. & So~d Ave. ,~t~uck,~.Y. in the following location; [] Basement [] 1st Fl. [] 2nd Fl. Section Block Lot ~...~.,.i,~d on OcZober 5, 1979 and found to be in compliance with the requirements of th~s Board. PECIAt EEC'PT TIME CLOCKS BEss UNIT HEATERS MULTI-OUTLET SYSTEMS EXHAUST FANS DIMMERS SERVICE DISCONNECT NO. OF S R I C OTHE APPARATUS ~'An inspection has been made of the exposed electrical equipment in OF NEUTRAL the premises ~ndicated. No obvious unsatisfactory condition vas found." BNau~[ F. Jonathan Eye Dr. Glen Cove,N.Y. 11560 I~te must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. [] COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTII~ICAT! MUST NOT BI ALTERED IN ANY MANNER.