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Home My WebLink About8877-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .Nf~/.C,R..2? ............... Street Map No..xx ........ Block No. xx ...... Lot No.. xx.. So~ztholc~.. l~, [, .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... .Sep/; ~019..7.~/~pursuant to which Building Permit No.. dated ....... Se. pt. 20.., 19.'?~, was issued, and conforms to ~11 of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .P.v~.v.a~;~..s.~$~;t,r~g. p.o.q~. ~.2/;h .fcr~c.~,ng..~..ac.c.e~o:~ff~ .............. The certificate is issued to .Jo.h .n..bl.o ff~.t..&...J.o, h2 .C~l~q~ ......................... (owner, lessee or tenant) o£ the aforesaid building. Suffolk County Department of Health Approval ~;.,R, ......................... UNDERWRITERS CERTIFICATE No .... 1q~05.~8 .... Oct..~ ~ 9~/~ ................. HOUSE NUMBER . ...~.8~. ~.~.... Street .... .C.R?.~' ..... S..o.u.t.h. 9.1.d' .................. Building InspectOr FOI~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N~ Y. BUILDING PERMIT ~ (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~ N°. 8877 Z Date ....................... ?..?.?. ,.~. ....... .~...0. ............ 10.~..6... Permission is hereby granted to: John W. Moll.at ..................... .a..~.~ ..... ~.o...u.~ko.~..a' ......................... ~tJ~ Build hem ~,rivate swimming p, ool with fencing & Ace~.sory. s ~:~ -, to ................................................................................................................................................ '~'~ ~ - ~ Southold r- · ............ ~ ................................................ ; ........... : .....~ ............. Z' ....................... ~h~Ud~{ t~ O~][eOtiO~ dot~ "7 ................................................... ' ~V'~'"' ~ono opprov~ by the Ihs~'~to[: FOKM NO. $ 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 Health Dept. of water supply and sewerage disposel--(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: 1. Accurate survey, of property showing all property lines, streets, buildings and unusual natural or topographic features. 9. Sworn statement of owner or previous owner os 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-exist[og Building ................ ¥o~ant Land .............. Location of pr erty ............ ........... ............................................................. Owner Or Owners Of Property ......~...~.-.~L,~.,.....~....:....~.~ ........ ~ ........... .~. ........ , ..... .;'~.~ .......... Subdivision ................................................................ Lot No ............. Block No ............. House No ............ Permit No. ~..~...~..~... ,~... Date Of Permit .~./;.~./..'~..,Applicant .... ..~..~..'~..~.......,..~.~ ...... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Ur~derwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Finctl Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicable cod~s find regulations. Applicant ............ ~..,,~..! ....... ,~...'~Z~.....~ ...:.....i ..................... Sworn to before me this (stamp or seal) Notlary Public .................................... County THE NEW'I~/ORK BOARD OF FIRE UNDERWRITERS ''' ' ~ BUREAU OF ELECTRICITY F . ak 8.5 JOHN STREET, NEW YORK, NEW YORK 10038. october 1 76 A...c..onNa. o./i,. 88080 N 306398 THIS CERTIFIES THAT only the electrical equ~pmcn~ ~ deacribed belo~ end introduced by the applicant named on the above applicotlo~ number in t~ premlzes of John Moffat, n/side North Road, ~ Boisseau Hd., Southold, L.I. ~ t~ywto.,i~g ~o~.~o~ ~ ~,~t ~ ~ ~'~. ~ s~ rt. out side ~ao~ m~ wa~ examined on Se pt e~ e ~ ~0 ~ ~9 7 6 and found to be in compliance w,th the requirements of this Board. FIXIURE J H FIXTURES RANGES Jc0~KiHG D~CKS j OVENS [DISH WASHERS EXHAUST FANS -~RS J ' ' FUngiCide?ORS, ~, j FUTU~ AP~IANCE FEEDERS~ SPEcIALREC'PT._' ' ' , TIME CLOCKS [ . '., T aAN'BEt[ JUNII 8tAT~S , , MULII.OUsysTEMSLET __ DIMMERS., OTHER APPARATUS' ?anelboard/s: 1-1air., lOOamps. 1GFCI "' (Swimming Pool) This certificate covers compliance at the date of inspection only. Because of unusual environments it is advisable to have frequent test and/or repairs made by a qualified person. Paul Burns Town Harbor Lane GENERAL MANAGER This certificate must not be altered ,n any manner, return to the office of the Board d incorrect. Inspectors may be identJied als , - .~,Z~.~~- ~ ~ . / ro>vE NO. i P�L(77 > TOWN OF SOUTHOLD G � BUILDING DEPARTMENT !� TOWN CLERK'S OFFICE - SOUTHOLD, N. Y. cc��O� l ) Examined ......... ..... ............d`...., 19. 6 l�Ap licat'/ No. ... ...... .. ... 4 �7 Approved ............................. ... 19 .... Permit No. ... , .�.G.. .... �` 0 f�/ o — i r Disapproved a/c ................... ............... ................. v r ......................... ....................................... ,.. 0 ...................... .... ...... ......... ......................... r (Bu In r) APPLICATION FOR BUILDING PERMIT Dote ..........� ...:�...................... 19.7�P...... V INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildings Inspector, with 3 sets of plans, accurate plot plan to wale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. A 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. P 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 thew 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, as herein described.gf The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to O admit authorized inspectors on premises and in buildings for necessary inspections. J ......... . ........ ..... .......... (Si1W' ;ture of cpplicant, or name, if a corporation) ........... �.1A...................... ' (Address applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.ic .............................�......(7.l..V��.. ............................... ............................................................... .......................... Name of owner of premises ........;x.(l.:?1... .....0 r, Q ...... �.... :...0 ?!?.��............................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. .............. ................. 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,�J ......................\ Street and Number ....................�V!^COM,-(.J. &A.-A-7........ ................................... ?ti.......d............................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .........:�R—.n/.1 :.......................................................... ...... ....... . . ..... b. Intended use and occupancy ...................��R..k ti-� ll� ��Z � `�"" .. ..... ... . ............v�.. 111 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition.........,.......:.. Other Worka�R�c .�1tU.!! (Description) 4. Estimated Cost ..... a �..................:...............:.....Fee ...:............................................. ............................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................Number of dwelling units on each floor ............................ Ifgarage, number of cars ............................................................................................................................................. b. 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 some 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 ........................................................ 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. ...................... Nameof 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 and block number or description according to deed, and show street names and indicate whether interior or corner lot. J o0 STATE OF NEW YORK, t S S COUNTY OF ................. f ................................................................................................being duly sworn, deposes and says that he is the applicant (Name of individual signing contract above named. Heis 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 thar the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........................ day of .......................................: ... 19........ NotaryPublic. .................................................... County ................... 1..... . ..:.Y Y .............. (Signature of applicant)