The URL can be used to link to this page

Home My WebLink About7081-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPA_~TMENT Town Clerk's Ot~ice $outhold, N. Y. Certificnte Of Occupnncy No..ZT.~.~, ..... Date ..... Pobru~l~y. lot ........ , lg.~. THIS CERTIFIES that the building located at ~/~. Sound..Road,..Gl-eollpo~JS[reet Map No... ~X ....... Block No. Xx ........ Lot No. X~ .............................. conforms substantially to the Application for Building Pemit heretofore filed in this office dated . Pebl'tlal~y. 1.1~.r ...... , 19711,.. pursuant to which Building Pemit No. dated . Feb,,laity. 1.1~.~ ....... , 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.~.iv&.te. on~ .fairly. dvel~.tng..v~.th .&dd~Lt~,on .a~d. The certificate is issued to . .. ~llleent .A,..Roete;L ................................. of the aforesaid building. Suffolk County Department of Health Approval (owner, UNDERWRITERS CERTIFICATE No. Ifil.¶ ~ .................................... HOUSE NUMBER .%~ ......... Street .... So,and .Road .......................... .......................................... G~e~npo~.t,. N,..][o./ ................. Building Inspector FOI~M 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) No. 7081 z Date ...................... ,.e~ ....... .1.Lk .............. , 19.~.~... Permission is hereby granted to: V ~,~,~ .~,.~...~,~sJ....~.. :,.~,~'.~ ................................... ........ · .3 9.9 .....¢ a.~w~ ~r~ ..;'~.v.e ............................ ............... ~.lo=~..~.~..~r ....... t.lCO.1 ................... to ....~.l.~..~...&~.~;Lt~;~g~...o~,..~zl~.tj.~g.. ct~e:..lln~..~.~,). .............................................. at premises located at ...~.gU,O,~..~LO~,d ................................................................................................ ................. i .......................... .q~:~.e~.~ ~'.~ ......... ~..,~.,. ........................................................................... pursuont to opplication dated .................. ~ ......... 4-~. ............... , 19..~k., ond opproved by the Building Inspector. Fee $..15..,,0~ .......... l~Ol~I NO. $ TOWN OF $OIJTHOLD Building Deportment Town Clerks Office Sou~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 ~zunusual natural or topographic features. 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), Nomconforming uses, or buildings and "pre-existing" land uses: ]. 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 occupabcy $1.00 Date :~......~ .............. J"~'"7~ ./ New Building ................ Addition .....~.... ...... Old or Pre-existing Building ......~ ....... Vacant Land .......... Location of Property ................... .4.....9. .......... ....... ......... Owner Or Owners Of Property ....~/..!.~...(~.~...~.....~... ........... .,~...:....~...~).Z/~.~..j ........................................ Subdvson ~'-~' /~. ~O .-~J ~ LotNo BlockNo H ,z:. ........................................ r'"'v ................................... oase ~o~ / L~ ~ Permit No....L..O....~J../~Date Of Permit'~j.!~],.-I. ~..Applioant .~L~...C..~.~..T.........~...:.......~...¢...H....~../. ..... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ v Sworn to before me this ~/'~ ................ dayof ............................................ (stamp or seal) /2[~ Notary Pub c County ,//.x,~Zl~ .. ................................... THE NEW YORK BOARD OF FIRE UNDERWRITERS '~, ~ SUREAU OF ELECTRICITY --~ 85 JOHN STREET, NEW YORK. NEW YORK ~003~ ~,~ July 30. 1975 ~.~.,..,,..,~,....~.,~52626 N THIS CERTIFIES THAT . _ ,~ inthefollowjn~l~ation: ~ B~ement ~ IstFI. ~ 2nd FI. outside .~tion was ~amlned on J~y 28, 1975 ar~l found fo be in compllance with the requiremen~ of th~ ~a~. FIXTURE ~ ,~ ~ ~ RXTURES ~ RANGES [C~KING D~S i O~NS I DISH WASHERS EXHAUST. ~FANS OUT.TS ~ECE.ACLES~ SWITCHES *NCANDE~E~ FL~E~,NT ~[~' ~t KW ~T K.W. DRYERS [ FURNACE MOTORS J mTURE A~UANCE FEEDERS ]SP~IALR~'~J TIME~KS I BELL IUNITHEATERS MULT~T~ DIMMERS / SERVICE DISCONNECT NO OF I S E R V I AWG. NOOF Hi-LEG 1 i 100 CB OTHER APPARATUS: 2 Furnaces, Oil: 1-1/8, 1-1/12bp. 1- Post light. Robert A~ Goodale' - R.R. 1 Box 15a Main Rd. Mattituck, L.I. 11952 GENERAL MANAGER This certificate must not be altered in any manner; return to the office of the Board if incorrect, i,,spectors may be identified by t~eJr ~credentials. in in ink and submitted in tripl' .~ te the B~iidJng ~ In~, ~ 3 ~ ~,p~, ~ ~ pl~ ~ i~ ~ ~le. ~. b. 'P~pla~ sh~ing'l~ti~ Of lot and of buildi~ ~ premix, relationship to ~joini~ p~:,~:~ m ar~s,.ond.givi~.a.~aU~ d~ripti~of I~ o~ mu~ ~.d~n ~ the dl~mm ~h is ~ ~~ ~ c. ~~r¢~er~ ~ ~ a~li~ti~ ~y ~ ~ comme~ ~fore i~nce of'Buildi~ pe~ff. ~ 'd. U~' ~Oi of ~is ~licati~, ~e Bui~l~ I~r will is~ o Buildi~ ~it to ~e ~1~, ~h ~ff ~: shall ~ ~ ~ ~ ~m~ ~ilable ~r i~i~ ~t ~ ~. ~, e. No ~ldi~ ~11 ~ ~c~i~ m ~ in ~ole 0r in ~ ~r any pu~e whir until a ~ffffJc~ ~ ~c~ ~ shall h~e ~n g~ ~the Bulldi~ I~r. .' .A,P,.PLI ~CATIO~N .!S Id.EREB. Y.MA_DE to the Building Department for the issuance of a Building Permit i~ar~uant to the ~ou.alr~.' x. or? u?. mance at ,the T_.own of Suuthold, Suffolk .Cou.n. ty, New .York, and other applleable ~ ~ or ~egu atl..om, mr me construct~.on of bu!ldlag~.: .ac~d_~itlom or ~!terations, or ~or removal or demolition, m ~ ~rlbed. in.e ..appll. c. an.t o~..r?s to.comply with?l apph.cable law~, o.rclinanees, building' code, hotalng code, and regu~, and to aam~t aumonzea inspectors on premises and in buildings Tot nec~ inlj3ectJol'~. ~ ........ ' ' '~;~ of ;~,~;;;F' "")7~';'; ..... State whether applicant is.owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ame f n r · ~// ~'~ ~ ~A/'~ , N o ow , ofpremses..:~...~.~..../~.../~.....~...: . .. ~..( ....... ~ ..Z.~.~ ~ ~' ................................... ..... If applica~ture of duly authorized officer. (Name and title of corporate officer) Bu Iders Lmeme No ................. ;;;;; ............................... ,,, , ........ ~¢ / ;~.~., ~ r,umoer s L~cense No .......................... Other Tmde's Mcen.~ No ............................................... 2. aStateExstneXisting use and occU ancUSe and occupancy of~ ~-.~.~ .premises and intended use~/A4~rand occupancsocf_~_propo~ construction: g p y ~....~..T....: ~ /.. ~ ~. ............................... · .............. · ' - ................... =: ................. '-: ......... ;" - ":,~' ...... ;': .:~ 'z'z::' b ntended use and occupanc ,~, ,, ,,~,, ,.,,~=,, ,~, .... ,,~-,,/,,~ ~,., ,,,~,,~,,, ~ ~ ~-- ,,~,,~ ~' ~-' Nature of work (check which applicable): New Building .................. Aziclition .................. Alteration .~. .......... . ...... Repair .................. Removal .................. Demolition ....... i.~ .......... Other Work ................. ..................................... (Description) Estimated Cost ~ ~..~.. ~ .............. Fee · ' (to be paid on filing this application), If dwelling, number of dwelling units ..... ~...C(J.....Number of dWelling units on each floor ...~..~..~:;:~-P~ ....... If garage, numoer at cars ................................... ~ ................................................................................... If business, commercial or mixed occupancy, specify nature and ·extent of each t~pe of use . . ~ Dimensions of existing structures, if any: Front ~..7....~..--..../.m.;.'. ..... Rear .~.Z~..~...-T'.Cq...~ ....... Depth ../..~........~J.o Heiaht ........................ Number of Stones .................. ~...~.~.~.~ ...................................................... · ... ,- ................ Dimensions' of s~ame_, stndcture~ with alterations or additions: Front .~..~...~'...'~...do....~.......y.~[...' Rear ...~..? ........ '-- ./'..o. ........ Depth ..................... :[3...~?. .... Height ........................... ;Number o,,Sto es ..... 0~.j..~.~. .......... ,. 8. Dimensidns of entire new construction: Front .. ~. Z. .: . ..-:. .. ... ./..°.... .: ..... Rear ...~..7....;r..'~..~.o.....~.... Depth ..~.'..7....~'...-';../.P/,,,. Height .................... Number~ of Stories ........................ u}: ............................................................ ~'"'"~'~' 9. Size of lot: Front ....... 7..~'......~ ...................................... Rear ..... ..7....~.. .............................. ,Depth ....../~...~.....~. 10. Date of Purchase ............ ./..~..~.....~.. ............................ Name of Farrier ~Owner ..~..~.~..~....C~....~.~.~....~.....L./ 11. Zone or use district in which premises are sit,uated ......................... ~.. ............................................................... i .... 12. Does proposed construction violate any zoning law, ordinance or regulation: .......... .../~...O.. ...................................... Will lot be regraded ......... ;..(.?...O..... ...... Will ex,:ess fill be removed from pr~mises: ( )--Yes (~ No " .... 14. flame or uwner or prem,ses ...... /.,,.: ........ .I....~..~....'...;, ............. '~;,~--~.~.,~.-_~.~...~.~.~ . Nome of Architect ....... .~. ........... ~ .................. ^ddress49~y~'~J[).~..,~J/,.~io ....................... Name of Contractor Address ,~9~~~,z~.bac~ PLOT DIAGRAM Locate k dimensions from clearly and distinctly all buildings, whether existing or proposed, and indicate all property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW YORK, 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 ~ 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 tha~ the WOrk will be performed in the manner set forth in the applic~ation filed therewith. Swam t~ before me this ~~ / , o, ..... Notary Public, .................................. ..~ County APPROVED AS NOTED DATE: ~ ILl (~ ~cJ - FEE: I~BY ~ . 3. FINAL WHEN JOB COMPLETEO NOT RESPONSIBLE FOR DESIGN O~ ~N- 4'.¥~z" B Ab~mON To Oh~g ~TORy FO0 N DATI oN PLAN t BEDROOM PORCH .SouND BEDROOM z:~" 4'- LI~A KITCHEN: N , ROO~F b ,E 4q SOL'Nb -¢i~".' j Ab~r'no~ To Ot~' $"roR',.r' ~.s~O~,z~j "A-A" ¢ "B-B p~op,asE~D F~otqT FLP-VATtON ~OPOSED F_ LEVATI'O, ki, iE ....... II I i~ ZEal ~ ULLiZ-_T;J I L-I 5OL)"r'H,SIDE, E'LE'V'ATION,,_ _ F~OFOSED ELEVATION I :,===-]a=~.F = = = = ..... ====== ..... -'~ T " P~o Po ~ F___. b SOUTH 51bE.. ELEVATION i L___ -~.-_'~