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Home My WebLink About8774-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z 75 73 Date K[0~/ f'7 19.7.~ THIS CERTIFIES that the building located at ~ 9 ~ /~ k ~ 0 DK~ ~ e- Street Map No ............. Block No ........... Lot No ........................ .......... conforms substantially to the Application for Building Permit heretofore ffl~ in this office dated ............ ~.. ~., 197. G. p~suant to which Bulldog Pe~it No. dated ............. &.~..~., 1~/b .... , was issued, ~d conforms to merits of the applicable provisions of the law. The occup~cy for which ~is ee~ificate is issued is..~.. 9~...~ ?.l.%.~...P~.e.~l. ~ ............................. The certificate is issued to .~ ~ ~.g .$.. ~'..~. ~ ~ .... ~. ~ ~. ~. ~.~. .............. (owner, ~) of ~he aforesaid building. Suffolk County Departmen~ of Health Approval ~ff lb~ Iq7 ~ U~W~]~S C~]~CA~ ~o ............................................. HOUSE NUMBER .............. Street .......................................... B~lding Inspector FOEM NO. ~ TO~N OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTH*OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION C~F THE WORK AUTHORIZED) N? 8774 Z Date ............................ A~....2 ............. , 19..2~.. Permission is hereby granted to: ............. _: ..... ~.~.~..o.~.~. ............. i ......................... .................... ; ............... ~, ~. · ·......., ....... ~ ................... .. ........ ~:_- ............................ ~,.,..~ ............ :..-_ .................. : ..... ,~, at emises located at .......................................................................................... ~,~ ~pumuant to opphcah~ dated ...... 4:;; ...... ; ........ ~g .....~ .............. ,. 19~...; and op~mv~ by the r ....:~: Budding In~ector ,,, ~ _ __ ' I~ORM NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 AFPLIGATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcahon must be filled in typewriter OR ,nk, and submitted in, DUPLICATE to the Building Inspector w~th the following; far new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, aha unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage d~sposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, hAultiple Residences and similar buildings and installations, a certificate of Code comphance 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 hnes, 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 New Building ..~.. ....... Addition ................ Old or Pre-existing Building ......I .......... Vacant Land .............. Location Of Property /cJZ,/~.0.:.J~ .................................................................................................................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............ Health Dept. Approval ............................................ Labor Dept. Approval J ............................................... Underwriters Approval ............................................. Planning Board Approval ....................................... Request For Temporary Certificate ........................................ Fincd Cerhfic~te ......................................... Fee Submitted $ .................................... Ca,nstruction on above described budding and pe/r~it meets all a~ppl~,/c~le icc)des and regulations. Applicant ....... ~.~?...-~:~'.....~. .......... ~:..'~... ............................................... Sworn to before me this '[/~7./76, ................ day of ............................................ (stor~p or seal)/~ /c~ I .~ _~ Notary Public County ~o~ ~ '7 _~ 7_.~ THE NEW YORK BOARD OF FIRE UNDERWRITERS E~UREAU OF ELECTRICITY r--J i 85 JOHN STREET, NEW YORK. NEW YORK 10038 o.,. November ~, Z~Z~ '"""""' ..... '"""~'" S~9~00 N 314343 THIS CERTIFIES THAT Thomas Qualey, Albo Dr., Intersection of Albo & Wells Rd,,Ma~ti~uck,~ L.I. ~-~-~ ~-- ~ - ~ ..... t ~ ~ .~,t ,. SYSTEMS ~ SERVICE 0t~QNNECT( NO OF ~ S E R V I C E ........ ~ METER ~- -- NO~-- ~ , - - ~ ..-- -- , ~ OTHER A~PARATUS Motors: 1-3/4hp. Gustav Bartra 227 E. Dreakwater Rd. Mattituck, H.Y. 11952 o~,r-. ~omin~ ......... ~.....~ ...... , 19(~.. ~plicoti~ ~.~.~ ........................................ , I~ ....................... ............................... o. ~i* ~lie~tion mu~t be compl~l~ fill~ b.~ ~10~ ~16n ~howin~ I~tion of lot ond or~*~, *nd ~ivi~ o d~tnil~ d~rlption c. Th~ ~ork c~r~d by ~hi~ ~lic~tion m~y n~ be comm~nc~ be{ore i~u~nc* o{ Buildin~ d. Hpon oppr~l o{ thi~ opplicofion, ~h~ll be kopt ~ tbe pr~mi~ ~ail~bl~ {or in~p~ti~ ~rou~h~t th~ ~rk. e. ~o buildin~ ~h~ll be ~cupi~ or ~h*ll hav~ ~on omnt~d ~ ~h* Buildino I~or. APPLICATIO~ IS HfiR[BY ~D[ to th~ Buildino Dop~m~nt 8u d n~ Zon~ Ordinanc* o{ tbe Town R~ou ot one, {or th~ con~tru~ion o{ bud Tbe opplicont ~r~*~ to comply with ~11 odmit outhori~d in~pacto~ on premix, ~nd .......... ................. ~:~ss ~f applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................... ................................................................................................................................................ Name of owner of premises ...... ~/.~:~..,..~,ff:,:,~/~..~....'z~.~..,......~..~...~...~.~.~....~......~.~l......~..&~..~J~.d~.~..~..y. ....... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Electricians License rio.....~-.. .................................. Other Trade's License No ............................................... ~ o..~....' Location of land on which proposed work will be done. /V~ap No.: ......... : .............................. Lot N ......................... Street and Number r~..'~.r~.~:....:..w..:.'..:.......'w~..:....:.T....~w.: .............................................................................................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ................................................................................................................................. b. Intended use and occupancy ....... ~.~....~...~.~,~.~/.~...~r~ .................................................................................. 3. Nature of work (check which applicable): New Building' .....~ ......... Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior ..................... Other Work ..................................................... (Description) (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 ....... 7.. ......................... Rear ....... ~../.. .............. Depth .~.....~.. ............. Height .~.~...~ ........Number of Stories .............~.. ................................. -; .................................................................. 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: ........................................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No Phone Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ 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 end block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ~ S S COUNTY OF ....Suf:Eolk ........... f ' ............................ 1~'~.Ed~14;./~..~/~I]Z~.~.2Al~O. ......................... being duly sworn, deposes and soys that he is the appliconl (Name of individual signing contract0 above named. He is the ..................................... ~.~;G.,-3..~..fn~...CD~..~.~¢.~QZ' ........................................................................................... (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 thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .......... 2r~l ...... day of .............. AU. g3J,~.~. ............... , 19~..0..... Notary Public, . ................................ Sg.~;~311¢ County ELIZAB[Tf~ ANN NEWLLE NOTAEy PUBLI~, State of New York No. 52-8125850, Suffolk Term Expires March 30. Court (Signature of applicant) o (¢ 5"o Co)[' AT ONAUTHORIZED ALTEEATION OR ADDITION EDUCATION LAW /V/A T 7'"1TUC k~ H. S. ReT. NO ' APPROV£D: SUFF. CO. DEPT. OF HEALTH 8ERVICEB FOR APPROVAL, OF ¢.~:)NSf~UC'fiON ONLy O/~ '¢,',~ ......... t'O-b ..... DI~SPOSAL, IBY~TEMII FOR THIS R~I- ~ WI~ C~F~M ~ ~AND~ OF ~UFFO~ CO. OF H~L~. OWNER: ..... ,,co. ¢~)U~Iy [~E~L2H DEPAR~F.N~ SUF'F. CO. DIrJml'. OF' HIE. ALTH ,I~VI~IEI IT&TI[MIIQ~q' OF INT~N'r &" I~OR APPROVAL. OF CON~I~UCTiON ONLY {L~-~r'~fl- Z' THE WA?ER IUI~Ly AND IA'WA(Ii DATE: DIIIK)~AL DI'NC~ WILL CONF'O'RM TO THE ~ ~:~.j H.B. I~EF. NO,: ' OF Hr~A/TH. i *~ I,?. AP,'L~,Km' APPROVED AS NOTED NOTIFY BUILDING D~PARTMENT ~t S~lon ?~5.2660 9~ TO ~P~ FOR RESUlt- N, y. ~fa~ Education LaW, ~g iNS~CTIONS: Office Of I Gordon K. Ablers, ?. Ei I S~ton 72~, Su~l~ ~ )tti¢~ Ot Gordon K. Abl~, P. ~ I. I ' ~Offie~- O~L' Gordon K. Ahlers, P. E. · 'Alteration of this Oocument except by a Licensed Ik~al Engineer, ts Illegal", ~m:llon 7209, Subdivision N. Y, State Educotlon Law, JI