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Home My WebLink About8896-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Ottice Southold, N. Y. Certificate O[ Occupancy No..g?..~.~. Date ............. ~ ..... 12 .... , 19..76 THIS CERTIFIES that the building located at . .Pvt. Ito~tl..(..E~w~ds. La) Street ~or Sub Map No. ~ ........ Block No...~ .... Lot No, ~ .... 0~e~t.. N.,~, ........... conforms substantially ~o the Application for Building Permit heretofore filed in this office dated .......... Oct...~ .... , 19.76. p~suant to which Building Permit No..~8~6Z. dated ............ 0c~...~ .... , 1~76.., was issued, and conforms to all of the req~e- ments of the applicable provisions of the law. The occup~cy for which this certificate is issued is .PF~6~..Qn~. ~2~ .~i~.~.],~ ~ ....................................... The certificate is issued to . .~-$.~b~h .Vga. ~2 ...... ~ ................... (owner, lessee or ten~t) of the aforesaid building. Suffolk County Department of Health Approval . UNDERWRITERS CERTIFICATE No. ~16~0 ...... De~....1 ~...~7~ .............. HOUSE NUMBER .... 69 [ ....... Street ..... gd,mr~ ~. ~ .. (~. ~O,W, .) ........ ~0~..~t~e. bath. &. ~O~Ch .re- ~. f~-shed- ~y- o~e~ ..................... · ~,J~,~ ~(...~c~,h ............. Building Inspector FOI~M NO. 6 TOWN OF SOUTHOLD , Building Depar~ment Town Clerks Office Southold, N. ¥. 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 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 Bqilding ..... ~x ........ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .... .~.~ ~.~..w...~.?..~.S..~.an.e. .............................. Owner Or Owners Of Property ......... ~.[~...~..e.~.~...~.on Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No...~.~.~.~...~.... Date Of Permit ..(~g..~..~.z...7,~plicant ~[~le~. Cotn_~l;z'ucl;~.o~ Coz' Health Dept. Approval .... ~..2..-..~,~..-..~.~. ..................... Labor Dept. Approval ................................................ Underwriters Approval ...... ~;~..-.~,~m~...~ ..................... Planning Bcard Approval .... : ................................... Request For Temporary Certificate ........................................ FinQJ Certificate ......... ~ .............................. te 00 Fee Subm t d $ .~.~. ........................... Construction on above described building and~p~rr~it m~e,et~all opl~licgble codes and reguJ~ions. ........... ......... .... · ~.. day of ..~.~..~.....~.~ (stamp or ,eel,~ /~-- ~ta~ Public ........ ~.k~/g... Coun~ ~ , Term Ex~ires ~arch 30. ~ ~ , t ~ ,~ ' ~ Approved ....................... /.. .............. , 1~...~... Perm,t No....~..0.../..-: ................ ~Z './~/~ ~/~,~ Disapproved a/c ......... .?~,..~T~.:.'% ................... ~Y"~t' .......... ~-'-( ~ '/e/<-p~ ~" - ~-~ ............................ .................... ,- ...... ~' ............ ~L':Z~' ............................. (Building Inspect9 . Date .....DD~.~,...[.l. 3..~.6. ................ , ]9 ............ INSTRUCTIONS o This application must be complete ¥ filled in by typewriter o~ in ink end submitted in triplicate to the Buildlng~ Insl~ector, with 3 set~ of plnns, ~ccumte plot plan to ~:~lo. Fee accordmo to schedule.~ b Plot plan showing location of lot and Cf buildings on premises, relationship to adioining premises or public streets o~.~ areas, and giving a detailed deseriptio ,n of layout ofproperW must be drown on the diagri~m which is port of this opp icatian/~ c. The work covered by this application may not be commenced before issuance of Buildin§ Permit. d. Upon approval of this opplicotlon, the Building Inspector will issue o Buildin§ Permit to the applicant. Such permit~ shah be kept on the promises ovai}~ble for inspection throughout the work. e. No building shell be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancyr~'~ shall have been oranted by tho Building Inspector. APPL CAT ON IS H£RI:BY MADE to the Building Department for the issuance of a Building Permit pursuant to the Bu ding Zone Ordinance of the Town of Southo[d, Suffolk County, New York, and other applicable Laws, Ordinances or Re0ulotiOns, for the construction of buildings, odditlons or alterations, or for removal or demolition, os herein described. The applicant ~grees to gomply with all applicable lows, ordinances, buildin0 code,~housin§ code, and mgulotlons, and to admit ~uthorlzed inspectors on premises ~nd ir~ buildings for necessa? inspectlons. (Signature or applicant, or nome, ~* o corporotionJ . It.,~:_. 1.1.~.~ ...0rt.~n'l;~ .. I~.:Z., ...1.1.¢.5.7. ............................ (Address of applicant) State whether applicant is owner, lessee, a~ent, architect, en~ineer~ ~enerol contractor, electrician, plumber or builder. BUILDER N~me of owner of premises ........ ~.~.~,~.a...~.e.~k...~.Ol3..~[l~.~lltl~l ........................................................................................... If a~plic~, is a corporate, ,~gn~ture of duly authorized officer. (Name and title of corpor~e officer) Builder's License No ..................................................... Plumber's License No ..... .3:..~.~..3...-.?. ............................. lectrician' icense No. ................................ Other Trade's License No ............................................... ].,J~ . ~ Location of land on which proposed work will be done, Map No.: ...................................... ./..,.~.~,: Lot No ......................... Street and Number ..... ..~..~.~.h..~,...P..ff....W...~.~'..'.....Q~.-~'.~.~.~'...,~-[~,. ................................................................................ Municipality State existing use and occupancy of premises a/~d intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..~..0..~..9. .................................................................................................................... b. Intended use and occupancy ..g.~.l:.,e.....~..~'...~..~...~.~,...~..~..9.,~..1..~.~J~ ................................................................................ 3. Nature of work (check which applicable): New Buifdmg. ,.....X ......... Addition .................. Alteration ............... Repair .................. Removal .................. Demolitior~ .................... Other Work .................... i~'~'~'~i~ii~'i ............ 4. Fstimated Cost ............. ~.0.~40.00.,.00. ...................... Fee ~ ---f ' ....... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... .Oi'~t .............. Number of dwelling units on each floor ............................ If garage, number of cars ......................... .. ................................................................................................................... 6. If business, commercial or mixed o~:upancy, 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 ................................ B. Dimensions of entire new construction: Front ....... ]~..~ ....................... Rear ..... ].?..~ ................. Depth ....... ~,~.~..'..8.~... Height .....~ ........ Number of Stories ............... .'l~/.g ................................................................................................ 9. Size of lot: Front .......... ~6~.~. ..................................... Rear ...... ~.~.~.~.~..? .................... Depth ....... 3.~.~..8..~. ......... 10. Date of Purchase ......... ~.~.~...~,.~.~....~'.~...~..~ ............... Name of Former Owner ..g.~.~...~.~..q.~.....~..@..~..]r..t.~'- .................... 11. Zone or use district in whicl~ premises are situated ....................... A ........................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................. ~.~ .................................. 13. Will lot be regraded . ........... ~.G ........... Will excess fill 'be removed from premises: ( ) Yes (X) No 14. Name of Owner of premises ..~,...~..~..~l~l.l~.~.~ .................. Addres~,l~..,~.~....g.~.~.~.~'lPhone No. ~J.~J..'.~.~.... Name of Architect ~'~..~...~.g.~.q~...~.~,.~..~.]....~..l~ ..................... Address~..l~..]r..~.~i~.~/.~..~..~..?..~.~.R Phone No. Name of Contractor ~.~n..~'~e.~a.o.~:J.~l~..-O-~r.~*Address .J~D,1L.].~.¢. ............ Phone No. ~.-....~.~.J~.0. Orient, PLOT DIAGRAM Locate clear y and distinctly ell buildings~ whether existing or proposed, and indicate all set-back dimensions frore 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_YOJ~e,, - l S S COUNTY OF ..~-~.~:~,.O~..~,i...-.,~,~'E'~/~,~ ....,ti~.,E~ Blt i'!,~/t~e/~!/...~.:~..~..~l_n...~.¢.....~...,~......?,~. ............ being duly sworn, deposes and says that he is the opplieom (l~e Of individual signing contracf) , obove named. p~. ~.e.i~er~.lL ..~.p... ~ .e~!.e.~...O..o, ~ .q.~.9..¢..$..o..n.. ~..o.~t~.~ ..................................................................................... He is the (Contractor, agent, corporate officer, etc.) of sold owner or owners, and is duly authorized to perform or have performed the said work and to make and file this opplication; 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 ~.~.._~.~....~...~......, 19..'.~-~ ....... ..... dayof ............ Note y Pubnc, c .ty ....................... x",... · ....... ...... JJ I I · P.. E A IL ' II ..5 I OE EL EV/~T/oN. P COMMUNITY 'PLANNING, ', ALBERT sAN F~A~ANDRE II I 'g P.,.ONT ELEVATION' I · P,.IGHT ,5 IDE ELEVATION' E M I:L SOUTH' FRANKLIN AVE'. PLUMBING MUST BE INSTALLED ACCORDING TO CODE PRO_VISIONS ,9 · 1~,7 FLO0/~ ' .'5 E op~Oo~' (.o_) "4" ,* ,4-" ~7:o~ 37-'c · C ELLAP. PLAKI. CHECK & VERIFY ~,LL, HEIGHTG:.IFROM~ SECTIONS P.:ZFORE EXCAVATION AND INSTALLAT~O;N OF FOOTINGS, 1,7.'.7' 15 '- O" o (0 , CONTRACTOR TO CHECK ANDYERi'- ~r' ALL CONDITIONS AND DIMEN. SIONS AT SITE AND TO REPORT AN V DISCREPANCIES TO THE ARCHi T~CT, 'ATTIC PLAN' · ~OOFED 5'..~." ¸4' . I<.1 TC Fi E Iq- 4' 4'~ . ANDE R§ E N"WI N [:)O\V' ,5 C H E D L,J J~E": Electrical Contractor to verify number and Ic~ofion df all outlets so as to PI lkST ~- )vl~4~ P. oo M. .B7 ~.~) F L 001~, PLAN.