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Home My WebLink About8775-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupancy No ............ Date .......................... , .... THIS CERTIFIES that the building located at ......................... Street ~f77o ~7 Map No ............. Block No ........... Lot No conform3 substantially to the Application for Building Permit heretofore filed in this office dated /~ {/~' F, 197£ pursuant to which Building Permit No.~77- f4 v ~ 3 197/,_ dated ................. , .... , was issued, and conforms to all of t~he require- ments of the applicable provisions of the law. The occupancy for which this certificate is fssued is .............................................. ; .................... The ce~ficate is ~sued ~ ........................... : ..................... (o~er, l~t) of the ~oresaid buil~g. S~olk Co~%y Department of He~th Approval ............................ HOUSE N~ER B~ilding ~spee~or '1~O~, N ~F SOUTHOLD BUILDING DEPARTMENT '"TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT N? 8775:' PHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL.FULL COMPLE~IQN OF THE]~V~RKAOTHORIZED) ~ ~Jie ....... Z. AUgust 3 ., '-:~ .......................................... 19 76 ~; Pe~rmission is hereby granted to: W ' indsway Building Corp ... Southold Build new one fami~.Z dwe~l~.ng ............. p m s ~ated, at ................ ~ ...... ~ield Pa~k ~, ~ ~ ~ . ........... ~. ..... TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions ^. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Budding 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 (5-9 farm or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buddings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre~ex~sting" 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 pr~mises, or other pertinent in- formation required to prepare a certificate. C. Fees: I. 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 Bqilding ....../..~,... .... Addition ................ Old or Pre-existing Building ..... 'i' .......... Vacant Land .............. Location Of Property ...... ..L..?..'~.. ..... !..~.. .......... ~...~..;..~../.~,......~.~..~....~,...L~ .j~.....~.,:.(~.-~.....~..J.L~ ,' Owner Or Owners Of Property ..... .~.../.~..~..~..~./,~:~r...~£./..'/9.~......~v;~..~.~ ............................................... Subd,v,s,on ....................... ~ ............ .~....~...~....Lo No ........... ack No ............. House No ........... 1 Health Dept. Approval ........ .~...~. -~...~.?..{~...~. ............ Labor Dept. Approval Underwriters Approval ....... ..,~...,~.../...~./...,~....~.. ............. Planning Board Appr¢ Request For Temporary Certificate ....................................... FinoJ Cerfific¢ Fee Submitted $ Construction on above described building and permit meets all applicableIcode~,.,-and regulations. ~ ~' Applicant ....i~ ::" :~e~C~"'~'"' I ...... , Sworn to before me this /" / ~ (stamp ................ day of ............................................ Notary Public .................................... County or seal) W THIS CERTIFIES THAT THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 10038 ~ [~'~{~5 JOHN STREET. NEW YORK, NEW YOrK rml~ the electrical equipment as described belo~c and tntroduct,d by the applicant named on the al,ore applicatlort number ~r~ the premises tn the.follcnt t.g location: FIXTURE OUTLETS RECEPTACLES SWITCHES NCANDESCE~,tT FLUORESCENT ~ Basement [] let Fl ~ 2nd Fl Sectton Block Lot ~nd fourtd lo be ~n co~pltat~{ o ~t~lh the requ~rement~ of llt~ Board FIXTURES RANGES COOKING DECKS, I OVENS DISH WASHERS ~ EXHAUST FURNACE MOTORS J FUTURE APPLIANCE FEEDERS SPECIALREC'PT[ TIMECLOCKS BELL ~UNITHEATERS IMULTI.OUTLETI DIMMERS ~ I SYSTEMS ~ -- ~ I DRYERS SERVICE DISCONNECT I NO OF I S E R V METER I C E NO OF HI[~G J' 06~ W G~Jl'~O OFNEUTRA,$J A W 0 / AMOUNT PLEAEE REMIT BY CHECK OR MONEY ORDER TO THE ORDER OF THE NE~, YORK BOARD OF FIRE UNDERWRITERS ~AS CASH SENT BY MAIL WILL BE AT ~IRISK OF SENDBR PeK THIS IS YObtR BILl. FOR SERVICE RENDERED AND I$ NOT A CERTIFICATE OF COMPLIANCE THIS BILL PAYABLE AT THE NEW YORK OFFICE 85 JOHN STREET NEW YORK, N Y 1003P BUI~IHQ DEfARTMENT ~, O~ -- ~ ~ CLERK'S ~FI~ ~ ~ ~ ~ ~UTHOLD, N.Y. ~ ~ ~ ........................ a. lhi~ ~lic~tion mu~t b~ completely {ill~ in by ~p~writor o~ in ink ~nd ~ubmi~ in ~ripli~t~ to ~h~ Buildin~ b Pot plan showin~ I~otion o{ lot ond o{ buildings on premi*~s, r~otionship to od~oinin~ premi~e~ or public oreos, ~nd oivino ~ d~t~il~ d~cription o{ ~o~ o{pr~ mu~t be drown on th~ dio~rom which i~ ~ o{ this oppllc~tion. c. Th~ work cowr~d by thi~ o~lic~tion may n~ b~ commenced b~fore i~suonc~ o{ Buildin~ ~ermi/. d. Hpon oppmwl o{ thi* ~pplic~tion, th~ Buildinfl Insp~tor will i~sue ~ Buildin~ Permit to th~ opplic~nt. Such shall be kopt on th~ pr~mi~s avail~bl~ {or insp~tion thr~hout th~ work. e. ~o buildin~ ~h~ll b~ ~cupi~ or u~ in whol~ or in pa~ {or ony pu~o*~ whoever until ~ C~i{ic~t~ o{ ~cupancy sh~ll h~w b~n Omnted ~ ~ Buildino In~p~tor. APPkIC~TIO~ IS HfiR[BY ~DE to the Buildino Dop~ment for th~ is~u~nc~ of ~ BuildinO ~rmit pumuont ~uildino Zone Ordin~nc~ o{ the Town o{ ~uthold, Suffolk Count~, ~ew York, ~nd other opplicobl* Lo~, Ordin~nc~ Regulations, {or th~ con~tru~ion o{ buildin0~, oddition~ or olteratlon~, or {or r~m~l or d*molition, a~ h~r~in d~rib~d. The opplicont ~rees to comply with oll apalicob~ l~w~, ordinances, buildln~ c~, hou~i~ c~, and odmit ~uthori2ed inspocto~ on pr~mi*** ~nd i~ buildin~ {or n~e~so~ .................... ............. ....... ............ .......................... ~Xddr~s* o{ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................................... O.~.~.m~..~. J~..~.~.~...~u.....~ .................... ~ ...................................................................... Name of owner of premises ...... ..~..,~J~J..10.~.....~.J~f ........ ~..0..{.~.}0.~..'JT}~.....~/i~-~ ............................................................ / / / If applica~'~a corporate, signs~'ure o~dul~authorized .... ~.. ..... Bi~e and' ti~"-"¥~' o~ c-'"'-o';~'~';~'~ of~]"'"'"~'~r) ........ Builder's License No ..................................................... Electrician's License No......~...~..~.....~........~..~.jt4t'~-'' Other Trade's License No ...............: ............................... ('% , . ~ ~(~ ,~ * _ 1. ~Teaet~O~nOdf ~undm:~rWhich p~.~.~k~k~ ?~b.~. do~...M.~,.~p No.: .~.~..'.'.~.~.~..*...~..~..~.....~..{~..~.~:~!....:;::.:: .... .......................... M;];ii~ii~/ ..... 2. State existing use and occupancy of premises and intended use ond occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................ b. Intended and ........ ~l~........~. h\~,~ .............. use occupancy ..~.......-.~. ............................................................... 3. Nature of work (check which applicable): New Building' ........I,~... ..... Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work ........................................... ; ......... ~./~, 7 ~---- (Description) 4. Estimated Cost ..........~.O~..~-~ ..................... 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 ............. 0..~..~ ................................................................................................................... 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.... ........... t~ ~'. ............ Depth .....~..O. ............ Height ...... .~..~.! ...... Number__,°f _Stories ......... ~ ................................................................................................. 9. Size of lot: Front .............. l..J'..~.~ ................................ Rear ......... 1.3..~... ..................... Depth ...l~.,....~ .............. 10. Date of Purchase ...... ...~1~.~.~......~..I~..~.~O'- '~ ............... Name of Former Owner .~..~r~.l~..~.~...~.~/.,(~/7,~.-- ................. 1 1. 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 ......~.~"~ ........ WiJl excess fill be removed from premises: ( ) Yes / , 3- 14. Name of Owner of premises ...~.jr'~J.j~.~...~ZJ.~..~..~.~,~Addres~ ..;~;...J~J.~..J~.4 ...... Phonei~o ....................... Name of Architect .................. 4/. ............. ,~. ........... ~..~.......! Address ..~ .............. Phone No ....................... Name of Contractor .............I~ ..................... /,/. ............. }../.... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fram property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. / STATE OF NEW YORK, ..................... ................... du y sworn, d ases and soys he ,s the opp,com (Name'' of individual signing contract0 above named. He is the ..................................................... ¢O~J;~'n¢.'~oz'. ................................................................................................... (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 , ............ :~..~.... day of ....................... .A..~.~t....~.~ ....... , ]9..7..~.. Notary Public, . .......... :~ ........... ~.S_CI.~'~Q3,,~ ...... County ~..; ........... ;;.: ...................... ...~..:=.~-..::.-.~.-.'.--. .................. · , [3ignature of applicant) NOTARY PUBL C ~iat No. 52-8125850, Suffolk CountV.~ Term ExDi~'es March 30. The water supllly & sewage dlsposat terns fo~ this residence will conform to the standards of the Suffolk County/D~part- meflt of lieaith Services. Unauthorized a~eatlon or addition to this survey I* a vio~alJon of mct/~ 7209 of the New Yoek State Education Law Copies of th~s survey map not beanng Ihe Jand surveyor's *nked sea~ or embossed seal shaJl nat be considered to be a vafid copy. Guorantees or cert*hcahons ~ndmated hereon d~aJl mn only to person ~or whom i'he survey ~s prepared, and on hi*, behalf 1o hfle company, governmental agency and Ionc4ng ir~shtutson herea., ond to lbo a~s~gnee, of the lending insfltutio~. o~' ceHtflcahons am not transferable to odd~tional im, t.tu~ms or subs, ea uent owners SUFFOLK COUNTY DEPARTMENT OF REALTE SERVICES FOR APPROVAL OF CONSTRUCTION ONLY APPROVED /$ 2! TEST BORING O' TOPSOIL 1.5',, 2.5' LOAM SAND WITH TRACE OF GRAVEL II' GR, WATER SURVEY FOR WIIVD$ WAY ~UIL DING COI:?P AT SOUT'HOLD TOWN OF SOUTHOLD SUFFOLK COUNTY~ N.Y. SCALE: 1"= 40~ SEPT, I,$, 1972 JUt-Y ;27, 1976 N.Y,S. LIC. NO. 287~5 RIVERHEAD~ The water supply & sewage disposal sys- tems fo~ this Temdence w,II conform to the standards M the Suffolk CuuflLY Depart- UI~I~OLK COUNTY DEPARTMENT OF HEALTH ~ERVICES FOR APPROVAL ON CONSTRUCTION ONLY DA~E HS ~F. NO. ~PRO~ /$ ~0O, Unaut~z~d a~mtlon or addition to Ihk ,urvey T, a vldation of ~ecflo~, 7209 of the New Yoek State Educat,on Law. Cople~ of this ~urvey map not bearing the land surveyor's inked ~ea! ar embossed ,eal shall not be considered m be a vat,d copy Guarai~fees or cerhhcat,ons mChcated hereon shall mn only to the persoc for whom the survey m prepared, and on his behal~ to the ttlle o~mpony, govemmental agency and laud,rig Inshlutio~ IJlled hereon~ a.d to the ass~grmes of the lending inshluhon. Guarantees or ce~hf~cations are not transferable to add/.onal ,m~itulions or ~ubsequent owners. SURVEY FOR WINDS W~Y BUlL DING CORP. AT 50UTHOLD TOWN OF SOUTHOLO SUI=FOLK COUNTY~ N.Y. SCALE: I": 40' SEPT. 13, 1972 JULY 27~ 1976 TEST BORING O' TOPSOIL LOAM S.4ND WITh TRACE OF ~R.4VEL ' ! GR. WA TER REFERENCE: IW/O 3MI THFI E~ EQUIT'[ A~[STR~C. \ ~ IRIVERHEAD~ N.Y. 76o**S - 74 500 Unauthorized cdterat~o, or od&ho, to th.s survey is a v,olcmon of section 7209 of the New York Slate Educohon Low Copies of fh~s su~ey map not ~eoung fho ~znd su~eyo~s m~ed Gu~rz, n~e~s or cerhhcahons md,ceded h~o~ ~hall run ~nly to pe~¢on for whom the su~ey ~s prepar:d, ~J on hm b=holf to htlo compcny, governmental ogon~ and landing instdution Jllte¢~O~t~¢~ ¢0~ th~8 ~ocst. tot~ hgve bee~ hereon, and to the ass~gn~ of the lending mshlutJon. ~arante~apeOCe~ ~T ibis dcpartme~ ~ %o~nR ~lef of general Engineertn~ /,5 All distances to wells and cesspools am by Iocahon from house owners and field observahons, since most wells and cess- pools are not ws~bie these &mens~ans r'rmnot be cerhfied TEST BORING TOP$OIL LOAN SAND WITH TRACE OF GRAVEL I1' . GR. WA TER SURVEY FOR MI£DRED A. B ONFIELD AT SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. SCALE ~ I"= 40' SEPT. 13, 1972 qULY 27, 1976 NOV. 24, 1976 REFERENCE = M/O SMITHFIELD PA RK FIL ED DEC. T LV_^ 'T E' L E VA I, ,] - P; C.. T §0~114~ ~CELLA~ -4" P,C. F 0 U ki I)/~ TI i) /xi - ?t_ A lX, I 4.R LL.~ S I'DE E L,E \t: A T'