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.