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HomeMy WebLinkAbout8925-zNO. 4 TOWN OF SOUTHOLD BU'fl',FJlNG DEPARTMI~NT Town Clerk's Office Southold, N, Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . Deep. ~ole. J)ri~a ........Street Map No... XX ....... Block No..xx .......Lot No. ~x.. ](s. ttiJ:~ck.. Jl,~, .......... conforms substantially to the Application for Building Permit heretofore filed in th~ office dated ............0c.~.. 20.., 19.76. pursuant to which Building Permit No..892.~Z. dated ............Oc.~.. 20..., 19.76, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is. PrJ,~rate..one..f~i~l~.. d~.lllng...with .aqld~t~on ..................... The certificate is issued to .J~t~. fi,,..Dart. .... C~Wl' ............................. (owner, lessee or tenant )~ of the aforesaid building. Suffolk County Department of Health Approval .~[,i~o. .............................. UNDERWRITERS CERTIFICATE No... Iq~621+~,~. .... No~...1.. · 19~-~. .............. HOUSE ~ER ..... 2~$~0 .... Street .. Dnep. Hale. D~ive ...... ~att-~-tuo]~ .... Building Inspoctor ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8925 Z Permission is hereby granted to: Sidne Deebe A/C Rev. James Darr ... Cutcho.~.u.e ................................ _. S/S Deep Hole Ck Drive at premises located u, ..................... ~ ...................................................................................................... M~ttituck pursuant to application dated ..... : ....................... ~.q.t~ .......... :~)......, 19..~..~.., and approved by the Building In~:}octor. Building Inspector \ typewriter sortie. Fee ~ccording~o schedule. . , - · ildi on ~br~ Sas, relotionshil~ to odjoini ,n~. p. re. mises, or..p,u~, lic st, r.e~_t~,s_o~, · ~. I., Plot alert sbe~vlng:Jocation of lot o.n,d of .bu. rigs __ pr.._, ~..~,..-,,~,. on the diaaram wmcn IS pan m tnls app,lcoTio~, r ar~s, and g~ving a detailed description o? tayom oTpropeny mu=, v c. work covered this application may not b~. commenc.,e~, .before ,s~s..u..~a~c.e~ o~f,,B~uliT~ongthPeer~ cant. Such permit~ The . .by. ,. L. ~._ a..fl.~=.,,~ In,,~m-tor WlIJ issue o =u.u,,,~l ...... Tr d. Upon approval aT mis appllCmlOn; ,n.~ ,,~_-~.i,.~ th.~:.hout the work. y~ shall be kept on the premises available Tar inspe~ on ,~*~ e. No build ng sba be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupant shall have been granted by the Build ng nspector. . ' rtment for the issuance of o Building Permit pursuant to the B MADE to the Building Depa licable Laws, Ordinances or APPLICATION !S HERE Y ' ' Ik Coun , New York, and?ther ppp . _ _ . B-,,~d,ng Zon? Or.~,no=: o~.the Town.o.~. _S~_~o~:.~_!~! -,~*t~s or for ~mava, o, demol,t~.. 0. he..,.. ~.cr .~ed. '.~ (Signature of applicant, or name, if a corporation) l ~,~' ~ ........... ~ ................... '-'"'"~'"'-" ...... .... ~' ................. i~'~i~ess o~ applicant) I -~ ~'~ ~ State whether applicant is owner, lessee, agent, a~chitect, engineer, general contractor, electrician, plumber or builder. ....... i ..... ~.~.. ~-.~. ~ ................................. '~' ...... ~ ...................................................................................... ' ~ -~;~ 1~....'~.. .............. · ,~E ...~..~ .......................................................... Name at owner o~ pr~mises ......................~.' .......... I~ applicant is a corporate, signature o~ duly outberized officer. (Name and title o~ corporate officer) Builder's License No. ( ............ PlumbeF's License No. ~ ...... ~""~"~'*'~' ........... · .?..~.~.~.~ ........ Electricians License I',lo. ~..~.,~ Other Tmde's License No ............................................... Map No.: .............. .-~..... '~-'- ........... Lot No. ~. ................... 1. I.~:otion o~ land an which proposed work will be done. ..T~.....J~.. .... ~ ....................... Street and Number .......... ~'~J~"~ ..........'~"~"~'"'~' ......... '~'""~" '"; ..... Municipality 2. State existing use and occupancy a~ premises and intended use grid occupancy o~ pr~ construction: ...F~ ~ ~.~ ~.!.~..~.-. .................................. a. Exisiting use and occupancy ................. .I ......................................... ~.~ ....... .~ ......................... b. Intonded use and occupancy ................... 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................ . timoted .................... D crlptlon (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 ~.~ch type of use ......................... 7. Dimensions of existing structures, if any: Front ............ .~.¥. ....... Rear ................. .~. ............ Depth .~ ........... · - Height I ..........Number of Stories .............................................................................................................. Dimensions of same structure with alterations or additions: Front ............ J..~....~.. ............. Rear .....~....D. .................. Depth ............. ..t~...7. ........... Height ....: ....... I. .............. Number of Stories ................................ 8. Dimensions of. entire new construction: Front ............... [..,.~. .............. Rear ............ ~...~.. ......... Depth ...... "~'"7" ........ Height ......... I.~... ..... Number of Stories ............... ! ................. : .................................................. ~ ......................... 9. Size of Idt: Front ~.O '~- ... Rear ...g~,,,. ............... Depth 10L Date of Purchase .~... ................................................... Name of Former Owner ,.-~., .................................................... 11. Zone or use district in which premises are situated ........................ .~.....~'...~...I....~....E....~/,.?../....~.....L.. ................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ............... ..l~....O. .................................. 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) ~es~ ..._(l~_No m ........ ~ Ad~m~~ c~13 ,~.,- 14. Nome of Owner of prem,ses ...~ .......................... ~....~........~. .............................. ~.~. ~h?l~ ~ _...~.~,.~/..~..~ b~ property lines. Give street and block number or whether interior or corner lot. Nome of Architect .............................................................. Address ................................ .Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from according to deed, and show street names and indicate ....................... ...'~.JJ ....................... ~...: ............. ~ ....................... being ~cl~ly sworn, deposes and says that he is the opplican~ (Nar/(~f-'in~vidual sigj~i~g c~trac~ ~ above name. I~ // ~ / ~ ~ ~ He is the .~~ ............. ~ ........................................................... / (Contractor, agent, co~Orate officer, etc.) of ~i~ owner or ~ners, and is duly aut~rized to peFf~r~ or h~e performed the said work and to ~ke and file this application; t~t all statements contaJn~ Jn this aD~hcation are true to the best of his knowledge and belief; and that the work will ~ performed in the manner set fo~h in the application filed ther~ith. Sworn to ~fo[~ me this ~ ~ ~ ........ · ............................. FORM NO. $ TOWH OF SOUTHOLD , Building Department Town CIc~.s Office Southold, iq. 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 cor~JitJon 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-existing Building ................ Vacant Land .............. Location Of Property ~[~p~.h..~.~"e.~D...~.~..z..Y.e.~.'~..~.?:~`~.~.~.u.~.k.~.~..:~:~:~f~: .............................................. Owner Or Owners Of Property ....R..e...v........~...a.~.e..~...~.~..? ............................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. ................... 10/ 0/76 · Sidney ..B. eebe A/C Rev. Bar~' Permit ldo. 892 ~.Z Date Of Permit ........; ........... Apphcant ............~' .................................................... Health Dept. Approval ..... ..~....[~ .......................... Labor Dept. Approval ................................................ Underwriters Approval ....~....j:~.~.~.~.g.A~.. ............... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FinaJ Certificate ............ ~ .............. Fee Submitted $ .~... ............................. Construction on above described building and permit meets all applicable codes and regulations. Applicant ,,, .S. ~ ..d..n..e..~..,, .~. ,e. ~..b..e. .......................................................................... Sworn to before me this ....... /..~,... day o ............................... ,.. ..... Notary Public ...,,~/,~!:.... County (stamp or seal~'/~,~7 ~- THE NEW YORK BOARD OF FIRE UNDERWRITERS __ hlq BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK. NEW YORK 10038 ,.,?vember z, :~977 ,,p,~lic.tlo.,¥o.o. Si,e 9~-6537 N 362~G5 THIS CERTIFIES THAT only the electrical equtpment ~s described below and introduced by the applicant named o~ the above application ~un~ber i~ the premises of ~. Gildersleeve, 25~0 ~eep Hole Dr., Ma~i~uck,L.L ..... s examined on 0 ct ob er 2 7,19 7 7 and found to t,e in compliance with the rcq,,,rernents oy this Iloard. FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS FIXTURE I OUTLETS ~ECEPTACLES SWITCHES iNCANDESCENT FLUO~ESC~N~ ~[~Y ~T. K.W. ~T. K W, AMT. K.W. ~T. K.W DRYERS I FURNACE MOTORS FUTURE APPLANCE FEEDERS SPECIALREC'PT~ TtMECLOCKS BELL ~UNITHEATERS MULTI-OUTLET EXHAUST FANS AMT H P. 1 F DIMMERS WATTS SERVICE DISCONNECT NO. OI i lO0 .CB . THER APPARATUS: 1,smoke detector i G.F;C.I. NO. OF NE UTRAkS A.W. O OF NEUTRAL 1 5 Ruland Elec. Co. P. O. Bo x 14 3 OENERAt mA~l?Ota ~j Mattituck,L. I. 11952 LiC.282E ~is certificate must not be altered in any mannm; return to the office of the Board if incorrect. Inspectors may be ~fi~ ~their credentials.