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Home My WebLink About8791-zFOF,,~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z77~+.1 ....... Date ............ June. · 27 ...... , lg. '7'7 THIS CERTIFIES that the building located at . S/S. Gooze ~Crc.,ek..Lane.. · Street Map No. xx ....... Block No..xx ...... Lot No, . xx .~outhold. · .~; ,Y.. ........ confoms substantially to the Application for Building Permit heretofore filed in this office ~8791 z dated .. . Aug. 12. , 19 76. pursuant to which Building Permit No. 99t-.- dated .. .i, ug. 12..., 19.76., was issued, and conforms to ~1] of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . Pri~ate..swlr,~ming..~nool..~,~'ith. fence. & .:kece~sory~ ................. The certificate is issued to .Rode~ .&. l~/%e. · .~rau.tmalq... O.wners ................... (owner, lessee or tenant) of the aforesaid building. [ Suffolk County Department of Health Approval I~.]~ ........................ UNDERWRITERS CERTIFICATE No..1~$~(~9~+ . .Dee.. '27- [.1976 ................ HOUSE NUMBER .... 80.~. ..... Street .. ~oo se. C~ · La ..... P v-% · R~ltt .? ........... ' ~ Building Inspector [ FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8791 Z Permission is hereby granted to: ~.~ ~-~.....~...&~ ~.5....~...~ ~ ..vT ~.~ ~/ ~OdTl-lo~b , pursuont to opplication d~ted ........................... .~.....~.~ ...... (...~...., 19 ....... ,ond opproved by the Building Inspector. 15 oo Fee $ ........................ Building Inspector ~FO~.W; NO. 6 TOWN OF SOUTHOLD ~ Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcation must be filled ~n typewriter OR ink, and submitted ~n. DUPLICATE to the Budding Inspector with the follow,ng; for 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 disp~ol--(S-9 form or equal). 3. Approval of electrical installation from Board of F~re Underwriters. 4. Commercial buildings, Industrial buildings, Mulhple Res,dances and similar buildings and installations, a certificate of Code comphance from the Arch,tect 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 buddings and "pre-ex,sting" land uses: 1. Accurate survey.of property showing all property hnes, streets, buddings 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 Swimmtz~ Pool I New B~ilding ................ ~ddition ................ Old Pre-existing Build,ng ................ Vacant Land .............. ~05 Private Rd. ~ ~ Subdivision ................................................................ Lot No ............. Block No ............. House No ........... Health Dept. Approval ............................................ Labor ~pt Approval ............................................... U~de~riters Approval A¢¢aoh~ Planning B~rd pproyal ........................................ Request For Temparaw Ce~ificate ........................................ Fin~ Cerhficate ..... ~ ............................... Fee Submitted $ ..... .~ ..................... I Construction on above described budding and permit meets all applicable ~es and regulations. Sworn to before me this , ~~/ FRBDERIC P. RICH m ~ ~. t~0~0 Nota~ Public ........ SA~~..p. Coun~ Notary Pubhc, State of New York ~ Quahflcd m SbffeK¢ Coun~ [ Term Exp~re~ ~rch 30, ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS ak BUREAU OF ELECTRICITY ~--- , 85 ;JOHN STREET, NEW YORK, NEW YORK 100~B' D. ie Deeembes 27, 1~76 ,~m,l,c.,,,,.~o.o.~',,e 8771~7 , N 318094 THI'S CERTIFIES TRAT, r ~ only the electrical equipment as described below and introduced by the apphcant named on the above application number ~n the premises of R. ~Trautman, Goose Creak Lane, Southold, L.I. in thefollotving locatzon; ,,, ~ Basement [] ~t ri. [] ~nd rt. 0utside ' Section Block Lot wasexam~aedon December 23, 1976 andf°undt°betnc°°zPltaneewlththere~lutretnents°fthisB°ard' FIXTURE ECEPTACLESI SWI'CHES I FIXTURES RANGES OUTLETS I I T INCANDESCENT FLUORESCENT ~v~,~Y AM! ~,W S .... E ' R OTHER APPARATUS' EXHAUST FANS DIMMERS TIME CLOCKS BELL I UNIT HEATERS MULTI-OUTLET ~.V,T AMp7 TRANS.' AMI, B P I SYSTEMS NO OF FEET xw ~00FUtLEO[ J AWO OF CC COND OF HI L~G 1tO OF CC COND NO, OF NEUTRALS A W O PER ~' OF NEUTRAL (Swimming Pool) This~certificate covers compliance at ~he date of inspection only. Because of unusual environments it is advisable to have frequent test and/or repairs made by a qualified person. Peter Bo~ovi'c Main Road Southold, L.I. (/ ~ Per This certificate must not be altered in any manner; return to thee ~)ffice of the Board if incorrect. Inspectprs may be identified by their credenhaJs, 0" t4 ' I'V~AP or LAN TOWN OF SOUTHO~D, · ER 'S omc, ~UTHOLD, ,. Y. ~ ~ ~~%~ ~prov~ ..................~L.,...:....'. ...... , 19..,Ll, Permit No....~:/..~f..~-~ Di~pprov~ o/c ............................................................................................ ................................................................ ~,..'. .............. ~ ................................ ,'/ ///' , ................... .,, ................. ? (Buil~i~ ~s~tor) APPLI~TIOH FOR BUILDING PE~IT o. lhi~ ~lic~tion mu~ b~ compl~l~ fill~ in b~ ~p~writer o~ in ink o~ ~mi~ in b. ~lot plan ~howin~ I~tion of lot ~nd o{ buildin~ on premise*, relationship to odloinin~ premise~ or public oreos, ond ~ivi~ ~ d~toil~ d~ription of lo, ut ofpr~ must be drown on th~ dioorom which i~ ~ o{ thi~ ~ppllc~tion. c. Th~ work c~r~d by thi* o~lie~tion m~y n~ b~ comm~ncnd b~for~ is~uonc~ o{ Buildin~ ~rmit. d. ~pon ~ppmv~l o~ thi* ~pplic~tion, th* Buildin~ In,p~ctor will i~su~ o Buildin~ ~rmit 1o th~ opplieant. Such p~rmi~ sh~ll be kopt on th~ premise, awil~bl~ {or in~p~tion throughout th~ work. e. ~o buildin~ ~holl b~ ~cupi~ or u~d in whol~ or in p~ {or any pu~ose whoever until ~ ~h~ll h~v~ b~n ~mnt~d by th~ Buildin~ AP~kIC~IIO~ I~ ~[R~BY ~D~ to th~ Buildino Dopartm~nt {or the i~su~nc~ o{ o 8uildinfl P*rmit Buildino Zon~ Ordin~nc~ o{ th~ T~n o{ ~uthold, Suffolk County, ~w York, ~nd other opplicobl~ Re~ulotions, {or th~ con~tru~ion o{ buildinO~, ~ddition~ or ~lt~mtion~, or {or mmowl or d~molifion, The opplicont ~r~e~ to comply with ~11 applicob~ la~, ordinances, butldin~ c~, hou~i~ ~, odmit ~uthoH~ed in~p~tom on pr~mise~ ~d i~ build~nO~ ~r n~e~o~ i~tlon~. (Signature of applicant, or ~me, if a co~omti~) (Address of applicant) State whether ~pplicant is ~ner, lessee, agent, amhitect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ...... .~...~....~...h.'...~.. ............. ~.~ ...... ..-~....~...~...~....-~......~.....~...!~.~ ............................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No..~ ........ L....~. ................................... Plumber's License No ................................................. Electrician's License No ......................................... ;... Other Trade's License No ............................................... 1. Location of land on which proposed work will be_ done. Map No.: - Lot No ......................... Street and Number Munici'pality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ' b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................ Repair .................. Removal ' Demolition .................... Other Work ..................................................... z/ (Description) 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 ............ z.....,. ........... 7'*;' ~'egr ............................ Depth ........................ Height .................... Number of Stories ................................................ : ................................................. >.?.?.-? ......... / '~1 ( ~'/ 9. Size of lot: Front .................... : ................................... Rear Depth ................................ 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 14. Name of Owner of premises .................. ~ .................... ; ..... ; Address ................................ Phone NO... ....... ;...././.;..~. Name of Architect .............................................................. Address ................................ Phone No ............ Nome of Contractor .!.L~ ........................... ............ L.:..:~ ....... Addre~ ............ ~ ........ ' ........... Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate alt set-back dimensions from 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~ ~ S S COUNTY OF ............. ~ .................. f ' being duly sworn, deposes and says that he is the applicom (Name of individual signing contract) above named. He is the ................................................................................................................................................................................. (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 tk, a~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this - ........................ day of ...................................... ~....., !9 ........ Notary Public, . ............................................ , ....... County ~ARY PUBL ~ State ot New York NO ~ a~2585~ Suffolk ~un~ (Signature of applicant)