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Home My WebLink About8820-zlrO~M NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Ot~ice Sou~hold, N. Y. Certificate Of Occupnncy No. ZSO~.~ ..... Date ........... l~o.v.. 2.~ ......... ,197.7.. THIS CERTIFIES that the building located atN/S. Skunk. Lane ............ Street Map No. I,~as~,. Fm.s · Block No ....... Lot No. 2 .... Cu.to~og~e ·. · ~ .Y. ......... conforms substantially ~o the Application for B~lding Permit heretofore filed ~ ~is office dated ........... A~ .. 2~., 19.76. p~suant to which Bufld~g Permit No..8820Z. dat~ . ) ...A~g.. 2~ .... , 197~.., was issue, ~d confoms to ~ of the req-~r~ ments of the applicable provisio~ of the law. The oceup~cy for wM~ ~ ce~ificate is issued ~ Rri~ate. one. family, dwe~.ling .w~h. al,tera~ion, & .A4d,i.~io~ ....... The certificate is issued to ~ic~rd ~..Hila. ry. Je.rse~~ ....... ~ers .............. (owner, lessee or ten~t) of the ~oresaid building. Suffolk Cowry Department of He~th Approval .N .R ............................ ~ER~ITERS CERT~ICATE No. ~3~9~Q ..... ~pr. 2~.. ].~77 ................. HOUSE NU~ER .... 8~6~.. Street . Sk~. ~n~ ..... ~u~heg~ ............. B~ldMg ~speetor TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CC~PLETION OF THE WORK AUTHORIZED) N9 8820 Z Permission is hereby granted to: .~l~,~;l,..~q~.e.~ ....... ............... hoz..2~.~....Ctl$~h~l~lll ..................... to .$-~l~d.. ~r* · ~lld £t i~n..~. ~;r~ ~t ~i.. ~w~!q,~.~ ............................................. .......................................................................................... ::'~ ............................................ v-.~: ................. al' premises located at ~-.~..~...[ ......... ~f~,$~a~..~.,~ t,t~ ................................................... ~...] ................. ....................................................... ~....~ ....... C.u~o~__~ ....... ~.z, ...... , ............... [J .................................................................................. ~,..., ........ pursuant to application doted ......... Building Inspector. FOltM NO. a TOWN OF SOUTHOLD , Building Department Town Clerks attica Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Inmtructio. s 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: ]. Final survey of property with accurate location of oil buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage dJsposol--(S-0 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buddings, Industrial buildings, Multiple Residences <:nd similar buildings and installations, (3 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-existing" 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 premises, or other pertinent in- formation required to prepare o 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 occul~3ncy $].00 .......... ./.,.. ..... .............. Date // New B~tilding ................ Addition ...... ../........ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...~..Z~/...~....5~.. ....... ~.'K~'~'n(~..~.~'L.~.~'~.-.~.:~-~.'~'~.N~~;~ ..... ..~.....~.~ ............ /------'--;--3 Owners Of Property ..J~..I.~.~.~..~.I..'.~..~-'.H..~...~....~- ........ ~.~...~....~.-~.. .................................. Owner Or ...../ ............ ,o,,o .... .... .... Hou,, Permit No. ~..~...~.0...~,... Date Of Perm,t .~.O.~..~'-~./Z~.Apphcant ..... ./..~//...~...~....~.~../--'....../~.~.../~...zZ..q. ............. Health Dept. Approval ........... /..~....~. ...................... Lobor Dept. Approval ................ ...~..,../~.. ...................... Underwriters Approval .~...~.:.~..~..~...~..0. ...................... Planning Board Approval ....... ./...~.../~... ....................... Request For Temporary Certificate ........................................ FinaJ Certificate ........... ~ ........................ Fee Submitted $ ...... ...~...~ ................... Construction on above described building~c~E~~s all Ol~cable codes and regulations. Applicant Sworn to before me this .... ~'-~"~~(.~_ ...... · ,.~,.!.,.. doy of,~-~ /Z ///,~'"~""~ ....... Z...Z. ........ (stomp or seal,,~rh ,,~~- ~' Nota~ Public .... ~... Cmn~ THE ,NEW YORK BOARD OF FIRE UNDERWRITERS ' al( BUREAU OF ELECTRICITY ~-- ; 85 JOHN STREET, NEW YORK, NEW YORK ~O03B Va,~ ApZ'±:L 28, Z977 .~,p,,c,,,ion,,'o.o,,.ri,~ 90:I..038 N334990 THiS CERTIFIES THAT only the electrical equipment as described bolow and introduced by the applicant ,iamed on the above application number rn the l~remtses of Richard Jersey, n/side Skunk Lane, 200' e/o Pine Tree Road, Cutchogu~, L.I. ,,, a,~/,,uo,cmg t,,,aao,~ L-~.~.,~n~ [~Z~t ~t, [] .*,,art. outside FIXTURE FIXTURES i RANGES JCOOK NG DECKS OVENS D SH WASH£RS~T EXHAUST OUTLETS ,ECEPTACLES SWITCHES,NCANOESCENT ~LUORESCE~ 7~~=M~"I} ~ I ~ ~ ~ ~ W ~t ~ ~ ~ --~--C~ DRYERS j FURNACE MOTORS j FUTURE APPLIANCE FEEDERS ;SPECIALREC'PTJ TIMECLOCKS j BELL JUNITHEATERSIMULTI'OUTLETJ DIMMERS ........ ' .... SYSTEMS ~.... j ..... ~ ' ~ T ~ ~ i ' i~ _~ ........... it G.F.C.I. Ruland E].ec.Co., P.O.Box " ............ '"" T "1 "- oh 2J~ G, ENERAL MANAGI:R This certificate must not be abated in any manner, return to the off,ce of the Board ,f incorrect Inspectors may be ,denhfled by IrOB]( NO. 1 TOWN OF SOUTHOLD BUI~ING DEPARTMENT TOWN CLERK'S OFFICE~ ~UTHOLD, N. Y.~ ........ Dimppraved ~/~ .................. ~ .............. ~......~ ........................ ....... APPLICAT'~ '0" 'UILDIN' PE~ 'ht~'~. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plat plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing.~4x~and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of opplicont, or ~me, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ........... !..~...~..?'...~.~..~.......~.....~...~....~.~.....~...~..G....~T..~.. ......................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...................... !..~...~. ....................... Plumber's License No...~...*'....!~.~......~......~....¥.~T....?...~.~..'?.. Electrician's License No ............................................. Other Trade's License No ............................................... l l'l ff Location of land on which proposed wor~ will be donel /V~p No.: ....... ~ ............................... LotNOl *[[e~ ................ Street and Number .......................... ..~..I..C:.~....~...~..~.....~....~.....~....~...?....'~ ............. ..~....~...~.~.!..-~....¢.%.~...~..-~. ..................... Munici~li~ State existing use and ~cuponcy of premises and intended use and ~cupancy of proposed construction: a. Exisiting u~ a~ ~cupancy ......................... .~.~ .............. ~ ......... ~....~ .......................................................... ~CU onc' . ~' ~~ b. Intended use ond p y ..................................... .7.....u~.;=. ....... .~ ..................................................... 3. Nature of work (check which applicable): New Building,. ................. Addition .................. f Alteration Repair .................. Removal .................. Demolitior ..................... Other Work ................................ ~. .................. (Description) ......................................... .~ ................. Fee .......................................................................................... 4. Estimated Cost I k) ~ (to be paid on filing this application) I 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 .......... "q. ................. 7. Dimensions of existing structures, if any: Front ...... ...-~....?. ............ Rear .....~..T...~. .............. Depth Height ..1'..~...."~...~ ......... Number of Stories ............... ! ................................................................................................. Dimensions of same structure with alterations or additions: Front ....... ...'~...~..T...1. .............. Rear ..... ~4-..?...~.~.. .......... Depth .........'~.....'...~. .............. Height .......... !..%.....?..T......Number of Stories ............. ! .................. 8. Dimensions of entire new construction: Front .................................... Kear ............................ Depth ........................ Height ..!..~....'~.....~...~ Number of Stories ................ .~ ................................................................................................... 9. Size of lot: Front ........ La...~L.a. .................................... Rear t~,.-J~, De th t/~%, 10. Date of Purchase I ''~(- ~' Name ........................................................ of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ................. ..~)...~ ................................. 13. Will lot be regraded . ........~.~ ................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Nome of Owner of premises il..C.).f..~..~....f~....~..../~:..~....~...~.-~.~:.~,~,ddress ...~....~-.~...~..!.¢...-.J~... ...... Phone No. Name Architect Address Phone No ............ ~ ' "' " '~' ........................................ x-/ ~ ....................... '~ ...... ....................... Name of Contractor .~..!~ c, t4~ u~- '~-~,,4 ~_-~ Address~.....~...'~....%.t~..~.~..J4..'Z.~. Phone No. -1%,4 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 show street names and indicate whether interior or corner lot. STATE OF NEW Y(~°,K, ~ S S COUNTY OF ....... ~..~. ~.~..~?.~ !.%w. ...... ................................................................................................. oemg duly sworn, deposes and says that he is the applicant (Name of individual signing contract') above named. He is the ..... ..~....T..!.~...~.~..~;."T. ............... (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 ore 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 / ........ day of .............. , ;;b,ic.. ............. ..... Cou, ...... ........ ................................. - # /J '~ (Signature of applicant) &~LAIA TSONTAKI$ NOTARef ,t~,'BLIC, Stat~ of New York ~ , No. ~2-9317934 , Commission E~ires ,March 30 192..~... :g Lt,i 0 BAY AVE.,~ ,; U' E MAP OF PP,,.OPEP, T~ ~VF..Y~, '~01~ APPRO~VED AS NOTED DATE: ~ ¢~ 7~ FEE',/~''~O B~ ~'J '- NOTIFY BUILDING DEPARTMaNT AT 765-2660 9AM TO 4PM FO~, REQUIK- J TION OR START FRAMING