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Home My WebLink About8953-zTOWN OF SOUTHOLD Bu~.r~ING DEPARTM~,NT Town Clerk's Office $outhold, N. Y. Certificete Of Occupency conforms substantially ~'~e App~ca~on for B~d~g P~it h~Wfo~ ~ ~ ~ offi~ dated ..........~. ~.., 19~. p~u~t W whi~ B~g P~t No. ~. ~ ~ ~t~ ........... ~. ~..., 19~., was hsu~, ~d ~om ~ ~ of ~e ~ men~ of ~e app~cable pro,om of ~e law. ~e oc~p~ for wM~ th!g ~ h '. ?~0 ~" ¥~ .... ~'z-'-~..~ .......... ~e ce~lca~ ~ ~u~ to~...~ .... ~ ........... ( / ~ (o~, 1~ or ~n~t) of ~e ~ores~d b~ld~g.~ S~o~Co~ty Dep~ment of Hed~ Approv~ ~' ~' ~ER~ITERS CERT~ICA~ No. ~J~ ~ ~ [~ ~ ~] Building T--pecto~' TOWN OF SOUTHOLD BUll. DING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. BUll. DING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8953 Z Permission is hereby grant~(~, j~. ,~-. I ~ ~ ................ ............................... · ....... : .............. .~.***=~.~.~..;: ............................... f'% , .................................................................................................. i~ .......... ,...~ .............. , ........ :..1.. Building Inspector. BUIM~N~ DEfAItTMINT TOWN ~Jff, K'S SOUTHOLD~ FL ¥o Examined ..... ~...~.....,: 19~ - ..... ........................................ ~ ~ ........ ~ ~. Disapproved a/c L ..... ~- . _~ . ., NSTRUCTIONS a. This application must be completely filled in by typewriter o~, in ink and subrni~ed in triplicate to the Buildingt Inspector, with 3 sate of pkms, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets m areas, and giving a detailed description of layout' ofpraperty must be drawn on the diagram which is part of this application. c. The work covered by this application may nat be c~mmenced before issuance of Buildi,ng Permit. d. Upon alaproval of this application; the'Building Inspector will issue o:Building ~permit tO the applicant. Such permit-~ shall ibe kept ' -on the promises available for impection throughout the work. e. No building shall be occupiec~ or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Bull~lng Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit PUrsuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additJa~s or alterations, or for removal or demolition, as heroin described. The applicant agrees to comply with all aaplicable',lavm, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ~ (Signature of ~Oticont, or name, if a corporation) ........... ......... ....... (Address of aPPhcant) State 'whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician; plUmber or builder. ............................ ............ : ....... .......................................................................... Name of owner 'of premises ....: .............. ..?..¢?...~..~-;~. ......... ~ .:..(~..~....*~.....~...q.~ ................................................................... 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 Tmde's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........ .~J...-[..~...-.,~,b¢~.... Lot No ...... ,.¢~.....~... ....... Street and Number ...............~..~.~...~. ...... J3.¢~.¥.~c. ...... ~,,d.~. ....................................... ~"~~p~Ji~~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ......... .~., .~.. 4~.t~1:1. l ~. ;L/. ....... ~..L~..'~.[.I.L J~ ........................................................ b. Intended use and occupancy ...... ;... ;~"3m~;~ .......... .~,~.......I; .................... , ................................ 3. Nature of work (check which applicable): New Building'. ......... : ....... Addition ....~.... Altergtion: .......... Repair .................. Removal DemolitJor. .................... Other Work f.~..~.~ /~4~_.~-- (De~cri~fion) ................... ~ ................................ Fee .......................................................................................... 4. Estimated Cost , O O o - (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... I ................. Number of dwelling units on each floor .: .......................... If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify na, ture and extent of each type of use ................. 7 ......... 7. Dimensions of existing structures, ff any:-Front .: ....... ~-.~. ............ Rear .....~r~.~. .................... Depth .....~..~,~ ....... Height ...... (..Z,..~ .......... Number of Stories ...........( ..................................................................................................... Dimensions of same structure with alterations or additions: Front ............ ..~....~. ................. Rear ........ .Z'...~'...x. ........... Depth ......~..~.. .................... Height ......... ~/...~. ............ Number of Stories ............. f. ................. 8. Dimensions of entire new construction: Front ............. .~...~. ............... Rear ............. ~..~...~... th ..... .~...~..../. ........ Height ...... !..7<..~ ..... Number of Stories ....... I ............................................................................................................. 9. Size of lot: Front .......... ...~...~....~ ................................. Rear ............. ~..~..~ .................. Depth .~3..o...t....-...../..~..~...~. 10'. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ............... ~..~.G.[.~.'~:~.~ ................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ........... ~..~>. ................................... 13. Will lot be regraded ....... .~.~..~ ........... Will excess fill be removed from premises: C,,")~Yes ( ) No 14. Name of Owner of premises ..~.~.~..%~...~..r.l~n,..~.~...~'..~c.. ..... Address .~:~.~.~Jl.g.V.%...~ Phone .No..~ .................... Name of Architect .............................................................. Address ................................ Phone No ............... ~ ....... Name of Contractor ..~....'S'.~...J'~'......~:~'-~.,~'.'-'~rx,.~..w',~..~.~..~Address .~.~I..~.~. ............. Phone No.~.~TT...'t/....Z-..~ PLOT DIAGP,~,M Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate oil s~t-bo~:k dimensions from property lines. Give street and block number or description eccording to deed, and show street names and indicate whether interior or corner lot. .................. ; ............................................................... t ............. ~eing duly sworn, deposes ond says thor he is the applican! (Name of individbal signing contrac0 [ .,~ _~ above nam~. ~ He is the ................................................................................................................................................................................. (Contractor, ag~t, co,orate officer, etc.) of said owner or owners, and is duly authprized to perform or have performed the said work and to ~ke and file this application; that all statements ¢~tained Jn this application ore t~e to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed ther~ith. Swam to ~re me this m ~ ~ n '. .. · " ,,~THE'NEW YORK BOARD OF FIRE UNDERWRITERS . ~' BUREAU OF ELECTRICITY ~ ' 85 0 ' ' [[~' ' ~ J HN STREET, NEW YORK, NEW YORK !0038 ' .977 Appt,ca.o. No.o./,ie 897937 kl qqO A 90 THIS CERTIFIES THATrt ,~ , only the el~trical equipment ~ ~s~ribed bel~ and in~roduc~ by the applicant ~med on the able application number in the premises o~ , .; ~Joye~ 0 ConnoF,~3895 Ke~n Blvd., Box 667, Oreenpo~t, in *he~ollow~nglocatmn. ~ ~-B~ement, ~ l~t FI ~ 2nd Fl' ' O]~qq~ S~tlon Bilk Lot ~ 0 und ~ound to be in compliance with the requlre~nents of thlz Hoard. R I I APPUANCE FEEDERS TIME CtOC~S BELL UNIT HEATERS MU[TI~UTLET DIMMERS ~UIP. 1~2W 1~3W 3~3W 3~4W NO'O[E~C~C~D- ~ HI-LEG 150 ' '.C: .x 1 1 1 Elec.room heaters: 2-1,25kw, 5-1.0kw,'l~.75kw, 2-.5~ I G.F.I. I Smoke Detector ~ Paul R. Burns, Town Harbor Hd., Southold, L.I. 11971 Lic.28ZE Per This certi,fi~cate.must not be altered n any manner; return ,o the office of the Boare if incorrect. Inspectors may oe identified by the~.c~'edenti~s~, FOI~ NO. $ TOWN OF SOUTHOLD , Building Department Town Cle~s Office Southold, N. Y. 11971 APPLIGATION FOR CERTIFIC:ATI: OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLIC,~TE 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 /s~p..~. Z //, /?7 ~ DQte New Bqilding ................ Addition ...~.. .......... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ~/~..~.~i Ze ~-<, ~c/ ~ ~/'~- ?~' r 7' Owner Or Owners Of Property ...~..9..~...~....~.. ........ ~....~.o....~....~...o..~ ................................................................. Subdivision ................................................................ Lot No..?...~.. ..... Block No ............. House No ............. Permit No. ~.,.P~..~.Z~.... Date Of Permit .,(//..~z./.~.~...Applicant ..~...V...~......~..~,.~..5.~...~....t.~.:~.~..[~..7. .............. Health Dept. Approval ...... .~....!.~.. ............................ Labor D~pt. Approval ................................................ ~.' ' Underwriters Approval .~...~. ..................................... Planmng Board Approval ........................................ Request For Temporary Certificate ........................................ Finctl Certificate ...... ~.. ................................. Fee Submitted $ ...~... ............................. Construction on above described building and permit meets all a~licable~ codes and regulations. Applica .......................................... ................ day of ...... /.../. ~...../...~,.. ,/../.... TERRY (stamp/°r ~1) ........ .~ .~x_ , JUDITH T. ~f New York Notary Public .~uanty Notary public. State _ ~.~, ~_~ fllmiSsion £x0ires I > 0