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Home My WebLink About8891-z FO~'~ ~1'0. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK;S ~OFFICE SOUTH'OLD, N,. Y. ~- N°. 8891 Z ~· .... 4" Per~nission is hereby granted to~:~" BUILDING PERi, IT ~ ('rillS PERMIT MUST BE KEPT ON THEP~EMISES UNTIL FULL COMPL~ION OF THE WORK AUTHORIZED) · ORM NO. 6 TOWN OF SOUTHOLD , B#ilding Deportment 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 disposal--(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. 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 $1.00~ . ? I . .......... New B~ilding ................ Addition .. or -existing Building ................ Vacant Land .............. Location Of Property ...... ~.'./....~........~....~...~....~..../. ...... ~..../~.~..~..~..~..~.....~. ................................. Or Ow.e .......... ..... ........................................... Subdivision ................................................................ Lot No ....... L..~.. Block ~ ...... House No ....... Permit No .... Date Of Permit ...... Applicant ~, ......................................................... Health I~pt. Approval ......... ~:L.~....~.~ ............. Labor Dept. Approval ......... ~ ............................. Underwriters Approval ..~~ ............ Planning Board Approval ...... .~ ............................ ........... ..... .................. ...... ~ ...... dayof ..~.~..... ~../....~....~.. .......... JUDITH (stamp or seal) Notary Public ..... ~ C°unt~otary Pul:lc S'~ell~l~' '-- C' THE NEW YORK BOARD OF FIRE UNDERWRITERS ak BUREAU OF ELECTRICITY ~- 85 JOHN STREET, NEW YORK, NEW YORK 10038 /,,,,,.January 3, 1977 A,,p',~-"o-,"o.o-Y,'"884400 N 319017 THIS CERTIFIES THAT only the ele~ trical ~qtz~ent as descrtbed b~low a~d ~atroduced by tl~e appllca.t named on the a~ove ap~ca~on numbcr ln the pre~cs of Manuel Siegel, Vanston Rd., 300' s/o Carrington Rd., Cutchogue, L.I. .,,, .,...,.,g ,,. December 30, 1975 a,~d found to t, elnco,,tpllance~tlththerequ~ret~tent~ofth~sRoard. FIXTURE ' I FIXTURES ~ RANGES I~OOKING DECKS J OVENS [DISH WASHERS EXHAUST FANS DRYERS ~ FURNACE MOTORS ~ FUTURE APPLIANCE FEEDERS ;PECIALREC'PT. TIMECLOCKS ~ BELL ~UNITHEATERS MULTt-OUTLE DIMMERS TRAN SYSTEMS ~ - - 5EKV,CE DISCCNNECT IO OF )'~ ~ -- ~ --' L .. S E t "' V' - ~ I 'C - E ....... ~ ~-- OTHE~ APPARAIU$ I G.F.C.I, (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. Glenn R. Bradley Horton Avenue Mattituck, L.I. 11952 Th~s certificate must not be altered tn any manner, return to the off,ce of the Board ff ;ncorrect Inspectors may be identified b~ ,io. 12 7 GE""'V"A"' FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. INSTRUCTIONS a Th~s apphcat~on must be completely fdled tn by typewriter or in ~nk and submitted in tr~phcate to the Budding Inspector, w 3 sets of plans, accurate plot plan to scale. Fee accordmg to schedule. b. Plot plan showing location of lot and of buddings on premises, relatmnshlp to adlolnmg premises or pubhc streets or areas, . gwmg a detailed description of layout of property must be drawn on d~agram whmh ~s part of th~s apphcatton. c. The w~rk covered by th~s application may not be commenced before ~ssuance of Budding Permit. d. Upon approval of this apphcat~on, the Budding Inspector wdl ~ssue a Building Permit to the apphcant Such permit,shall be kept the premises available for ~nspect~on throughout the work e. No budding shall be occupmd or used m whole or m part for any purpose whatever untd a Certificate of Occupancy shall have b granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the Iss[zance of a Budding Permit pursuant to the Budding Ordinance of the Town of Southold. Suffolk County. New York. and other apphcable Laws. Ordmaj~ees-or Regulations. fDr the constructlo~ buildings, additions or alterations, or for removal or demohtlon, as herein described The apph~ agrexes to compl~n all..a~hcable la ordinances, b~JiJdlng code. housing code. and regulations, and to admit authorized inspectors on p~mlses a~ in bulldl,n~(for~ece~/,Yry inspectlo (S~gna.ture of applicant, or name, ~f a corpora ~on) ...... ... {Address of app!~cant) State whether applicant is owner, lessee, agent, architect, engin electrici n, plumber or build If applicant is a corporate, signature of duly authorized officer. tName and t~tle of corpo~t,~offlce.~) Budders L,cense No .......... .~..~.~.:....Q:. .............. Plumber's License No ......................................................... Electricmn's License No ................... ~/~ ......................... Other Trade's License No ................. ~.~..-.~. 1. Location of land on which proposed work wjl~ be done. I~'p 'No....~.~.~f~.~....~.'..!. .......... Lot No ........................ Street ,,nd Number ..... U./~Z~-~..,~.*~.~. ......... [~..~..~. ..................... ~.~.~~ ......................................... Municipality 2. State existing use and occupancy of premises and ~ntended use and occupancy of proposed construction: a. Existing use and occupancy ............... ~i ....................................... ., .......................... ~ ...... , .................................... b. Imended use and occupancy ......... : .~ ..................... ~. .......................... 3. Nature of work (check which applicable): New Building ....................... Addition ..................... AI/l~-,~_tion~,...,~.~,,.. Repair Removal Demolition .......... :. ............ Other Work .... ~.',~. ~...~ -~ ~ .~ ~ (Descr~pt~on~ ....... 4. Estimated Co~tQ.~...~. '.~ .......... Fee .... ..~....../.,,~. ............................................................................ (to be paid on flhng th~s apphcat~on) 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 ...... : ......... 'i .................... 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 ............................ Depth ................................ Height ................................................. Number of Stories ........................................................................................ 9. Size of lot: Front ...................................... Rear .......................................... Depth ................................................ 10. Date of Purchase ..................................... Name of Form~O~w~:~r ........................................................................... 11. Zone or use district in which premises are situated ....... ~:~L.~.~J~... .............................................................................. 12. Does proposed construction ,vjo. lat_e, any zoning law, ordinance or regulation: .......................................................... 13. Will lot be regraded .......... ~s (]~,..V. ............ _...;.. Will excess filJsbe re~v, ed fr(~n premises: [ ] Yes , ~ No 14. Name of Owner of premises ......... ..(~.~...~,~;~..f~....~ .................. :.~..~...'.~.......¢ .~..~..~... - (Apess) (Phone No.) Name of Architect ............................................................................................................................................... ~._~j]~ ~ /~~ ~9~ I~ ~ ]/~ ddress) ~.~p..~(Phone No, I ' 0~ (Address) (Phone PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro~ property lines. Give street and block number or description according to deed, and show street names and indicate whet~ er interior or corner lot. COUNTY OF .......... ~d ~ F' t~''~,Ft~.-~ bern dui swor~ de oses and sa stha, he ,, thee hcan, above name. ..................................................... ..... ) ....................................................................................... (~ agent, corporate officer, etc.) of sa~d owner or owners, and is duly authorized to ~rform or have performed the sa~d w~ to make and %le th~s apphcat~on; that statements contained ~n th~s apphcat~on are true to the best of h~s knowledge and behef,~d that the work wdl b~performed ~n the mare set forth,n theappl,cat,on f,ledtherew,th , CE~K~UPS~ '~ ~ ~ / ~ ~ (St~ature of applicant) fla~ma,~ GEOP, G~ AJ-IL~R5 ;i PosiNg, n:' Pr~J~id,~n~,' , ',