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Home My WebLink About7154-zFO~M NO. · TOWN OF $OUTHOLD BUII.BING DEPARTM~.NT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z~27~ ....... Date ............. J.a~.. 3 ....... ,19~.~. THIS CERTIFIES that the building located at 1~.S. Ho~toa Jba~e .......... Street Map No..xz ........ Block No. ~1~ ....... Lot No. m... ~a~!~mld.. ]~,~., ........ conforms substantially to the Application for Building Permit heretofore ~ed in this office dated .......... &pFC1, .~. ·., 19.. ?~ pursuant to which Budding Permit No..71 dated ........ A~I ...... .~.., 19.7~., was issued, and coMorms to all of the require. ments of the applicable provisions of the law. The occupauey for which this certificate is issued is .Pr~&te..me~g. ~ooX .with. fanee. & .&eaesaor3~e ................. The certificate is issued to .Tha~, .&. C4~,t~ne. ~nvay. .... 0~l~er~ .............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .N. ~J~: .............................. UNDERWRITERS CERTIFICATE No..111~ ..... J~l~e. · .13.. ~.~ ............. HOUSE NUMBER ...~69.~ ...... Street ... llor~--~. I~a® ......................... ..... ..... ~N~,! TOWN ~LIRK'S ~ ~IS' ,PERMIT MUST BE KEPT ON TIlE P~EMISF..S UNTIL FULL .~ION Of: THE WORK AUTHORIZED) 7154 Z ~outhol5 .N. Y. purmam t~ a~,l~cat~on datml .................... A~rll ...... .% .............. , ]~.%....., and approved. ~ the Bu~ing: Imi~mr. N0~15~ Need mnderwrite~ certificat~ em elee for C/O Bulling Insf~ctor FORM NO. 6 TOWN OF SOUTHOLD 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 all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Hearth 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: 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 $$.00 3. Copy of certificate of occupancy $1.00 Dete ....... ....................... New Building ................ Addition ......... ~).... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ............... t ...."~ ..................................................... Owner Or Owners Of Property ....~...0..r~,,S........~q~........~r;'..i.~..."~.ii,~., ...... .~,.D.~ .................................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No ..~ (~...~..... Date Of Permit .~.:.~..:?....~....Applicant ..-~..~..~'~..~......~..~/'~..¥ .......................... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval ..~... ......................................... Planning Board Approval ........................................ Temporary~C~rtificate ........................................ Final Certificate ............ .../~.. ....................... Request For Fee Submitted $ .~.....................--""-'--~. ............ Construction on above described building and permit meets all a~olicaJ::~j:odes and regulations. ...................... ) s,.m ........... y .... Y ........... ~....~ .............. ( p or seal) ~ Z ~? · THE NEW YORK BOARD OF FIRE UNDERWRITERS ~:1C BUREAU OF ELECTRICITM [~ aB JOHN STREET, NEW YORK, NEW YORK 10038 ,,.,e ',:',7,, 7320 3 N 164848 THIS CERTIFIES THAT only the electrical equipment as described below a~d introduced by the applicant naG on ~he ~e .Ijplic4ltion number i~ the premises of ]fho~a.~ A. Conwa),~ W/s l!or~ons ~ane, ooutho~o, ~. ~. in the following location; was examined on [~Basement [] ~strl. [] Znd ri. Outside s~tion nlo~, June ] 0 ~ 19 7 4 and found to be in compliance with the requirements of this Board. RANGES ,MT. K.W. ;PECIAL REC'PT COOKING DECKS OVENS DiSH WASHERS TIMECLOCKS BELL [UNITHEATERSUNITHEATERS MULTI-OUTLET NO. OF FEET SERVICE DISCONNECT I NO. OF S R V I C E ('Swimming Pool) ~l~ts certificate covers comphanc? at the, .dat?.of inspection only. Because of unusu.al environments xt ?. a, awsa!:~e to have frequent test and/or repaxrs made bM a qualiIxea person. Lot EXHAUST FANS DIMMERS OF NEUTRAL Thor',a~ A. Corway / t!ortons I,ane r TM~~ Southold, L.I. 11971 Pe COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. TOWN CLERK'S OFFICE' · N. ,'. tNoproveQ ........................................ , .................................................... , ~ . ..__ ............... .............. ~N~RU~IONS a. This application m~f be completely filled in by ~pewriter or in ink a~ s~i~ in triplicate to ~e BuiJdi~ Insp~tor, with 3 ~t~ of plan? acCurate pl~ plan ~ ~ale. F~ acco~i~ to ~h~ule. b. Plot plan shying I~ahon df lot a~d~f buildings on premises, relationship to adjoining premiss or public struts areas, and givinga d~ai~ ~sc~iption ef layout ofpr~e~ must be drawn on the diagram which is N~ of this application. c. ~.~9rk cover~ b~.~is ~li~n ~ay n~ be comme~ ~f~e i~c~, of Building Permit~ d. upon apparel'Of th~ appll~ati~ ~e~uilding Insp~tor will issue a Building Permit to the applicant. Suc~ permit, shall be kept on the premises available for insp~tion through~t the work. e. No building shall be ~cupi~ or u~d in whole or in pa~ for any pu~ose whmever until a Ce~ificote of ~cupancy~ ' shall have ~en granted by the Building Inspector. APPLICATION~_~R~Y ~DE to the Building D~pa~menJ~ the i~uance of a Building Pe~it pu~uant to the Building Zone O~inance o~ the Town of ~uth~, Suffo~.Co~,'NeW Yo~, a~d o~r a~, ~an~s or Regulations, for the construmion of buildings, a~tims or alterations, or for mm~al or demoliti~, as he,in ~e applimnt agrees to comply with all a~licabl~ la~, o~i~nces, building c~, h~si~ c~e, a~ ~ulatims, and to admit authorized insp~to~ ~ premise~ a~ in ~ildings ~r n~e~a~ i~tions. (S,ignat'.m~iof~ or nartfe/if a ~Srpbmtior~J. (Address of applicant) applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,, plumber or builder. t State whether ............................ .................. ....... ........ .............................. ......................... Name of owner of premises ..... /....,~..i~/.~..7~.~.....; If applicant is a corporate, signature of duly authorized officer. ,~ (Name and title of corporate officer) Builder's License No ..................................................... Plumber's Lice~'e No ................................................. Electrician'~ License No ............................................. Other Tmde's License No ............................................... StreetL°cati°nand°f land on which._~.~,,~[?o~s~._2 ,o r k w~- .ciTe. Map No.~ .~ ~..~ ........... Lot No......~. ................ Number ..... ~..e.~,~...~....~.....~.. ............... .~. · .~.~..~. ~......~. ................................................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...... ~..~1. ........................................................................................... 3: Nature of work (check which applicable): New Building :~ ................ Addition Alteration Repair .................. Removal .................. Demolition ........... ~ ........ Other Work (Deecription) 4. Estimated Cost ............... .~..~......'~.......~ .............. 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 type of use .~..~. 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ......... ; .................. Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .............................. ~.. Depth., ,,,~ ~ ................... 10. Date of Purchase ...... ~......~...~...~.. ...... ~..~.~ .......... Name of Former Owner ,~.~.,~..~..,~.......~..~.%Z,~.e~'.F~....~.. ....... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction.violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded .........~l/.~...O.. ........... Will excess fill be removed from premises: ( 14)/Yes ( ) No 14. Nome of Owner of premises .................................................... Address ............................. ;.. Phone No. ...................... Name of Architect ..~ ..................................................... Address ~jj~:~.~ Phone No ....................... Name of Contractor~..~.~.....~.~./~.~Z..~.~.. .................. Address '~'0',~/'/~O~9~ Phone No. ~.~./...~....~...~.. 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 shaw street names and indicate whether interior or comer lot. ,,/ ! STATE OF NEW,,~'.R~,/,e/~'-~¢c '~ COUNTY OF ~...fo.o ............................. .~ .................................................................. being duly sworn, d~es and says t~t he is the applicant (Name of i~ividual signing contrac~ ab~e name. He is the ....................................................... ; ......................................................................................................................... (~ntractor, ag~t, co,rate officer, etc.) of said owner or owners, and is duly authorized to pe~orm or have perfo~ed the said work and to ~ke and file this application; that all statements cantoned in this application are tree 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. Swom t~ me this ~ .~ / ............. ........ , 4 . -- ........... ............ ................................... ,JUDITH T. I~OKEN Notary Public, State of New York No, 52-0344963 Suffolk Caunt~ Cemml.i~n Exl~ms ~ 30, 19..(.~