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Home My WebLink About9015-zIN)iai]lO, ,I TOWN OF SOUTHOLD BUHDING DEPARTMI~'T Town Cl~k's Ofiee Southold, N. Y. Certificate Of Occupancy Map No ......8.59 .... Block No ...........Lot No .......... 6 ....................... conforms substantially to the Application for Building Permit heretofore ~ed in thi~ office dated .. December... 23 ....., 19.76. pursuant to which Building Pm-mit No .... 90-1/5Z dated . .Deoembe~,..2.~ ......, 1976.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which Sht~ certificate is issued is ...... P. rl.v.e,-~..One. Fam/.:LT. Dwelllr~ .wLth .Add. it:ion .&,. Al'cere.'l:.%ona The certificate is issued to ......... We.~.~.en. Hufe., .J'7:... .............. .~ ............. of the aforesaid building. Suffolk County Department of Health Approval ............... N/R ................. UNDERWRITERS CERTIFICATE No ................ ~!.~.2.2.~69 ..... /. ............... / HOUSE NUMBER .... ~475 ......Street ....... ~/el~.s.A.v.a ...... l.- .'? ............. ............................................. Sou.thold,~ .New..Y~rk ............. County Tsx Msp Number 2000-70-~-6 FOII~ NO. ~' TChVN 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) No. 9015 Z Permission is hereby granted to: ee,lltml,ttl~. JI .A..~,... Jh~.. ~. llllte ........ pursuant to application dated ........................ ~1~......~ .................. , 19~1~l.., and approved by the Building Inspector. Fee ,....'.~.'.~ ......... ............ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK tOO3B THIS CERTIFIES THAT O~y the e~tr~ed equipment ~ ~cd~ ~ ~ ;nt~ ~ t~ ~t ~ ~ t~ ~ ~ ~m~ in t~ ~m~s of ~exami~don ¢ObrU~V ~ ' and found to be in ~mpllance ~ith the r~ui~ments of F XTURE LECEPTACU~Sl SWITCHES I I~XTUIIES RANGES COO~ING DECKS OVENS DISH WASHERS EXHAUST FANS DRYERS I FURNACE MOTORS I FuTUrE APPUAHcI F~EDERS ~I~CI&LRECPT TIMECLOC I BEKL ~ MUs~sT~AS SER~CEDI V I : ITHER APPARATUS: t-~,.r~KH Hot w~er heater To~n Harbor Lane Southold~N,¥. Ilq?l Per ;, This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentialS. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall 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 Inspec- tor 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. Commemial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, 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 peoperty 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 informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ...... ~./~..~ ........... New Building ............. Old or Pre-existing Building .... ~ ...... Vacant Land ............. Location of ProperW ........... : .~..C~..I.~ ,~ ~/~-- ...... .~.q ~.Jr~ 0.1~;~. ~ J~.~ .~, ././. ?.7. ! ....... House No, Street Hamlet Owner or Owners of Property .... .~..6~ F'.Fi~ ~..~.:. ~.~. ~ J.~.-...qT...~-:. ! .¥.~..[4~ .~..'~ .......... County Tax'Map No. 10~.~;ction .... ,~,~ ...... Block ..../¥ ......... Lot ,~, ............ Subdivision . .~ ........ ~ ........... MapNo .... ~.,~-~ .c~ .... Lot ,o....~ .......... Permit No..¢~) X~. ~' Date of Permit ...... ...... Health Dept. Approval .......... --//.~/../~..../.U..Labor Dept. Approval ..... ~./~. ........... Underwriters Approval ,~, ~Z~.4~.~...7 ....... Planning Board Approval...~,~,/~, ............ Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $, .~.~...0, ,~. ................... Construction on above described building and permit meets all applicable codes and regulations. BUIM)IHG DEPARTMENT ~L~./~ ~ ~ ~RK'S ~FI~ -~/~ ~ -- -- ........... _.) ~ ~ ~ ~ ~-~ .................. ~ .,- ~ 57~ . yO'/C~ '~ . .~.. ~'" ~ _ ~ ~ ~t* ........................... Z~:.~.: ......... 19..~....~ __- ,,,.,,. ..... .__ a. This a~lication m~t be completely fill~ in by ~pewr ter oe in ink a~ s~ml~ in tripl cate ~ t~ Bui~i"~ Ink,tar, with 3 ~ of pl~s, accurate pl~ plan ~ ~le. F~ ~co~in~ t~ ~h~ule. . b. Plot plan showing I~ation of lot and of buildings on premiss, relationship to ~joining premiss 9r public stree~ or ar~s, and givi~ a detail~ description of I~out ofpr~e~ must be drawn on the diagram which is ~ of this a~licati~.~ c. The work cover~ by this a~lication may n~ ~ commenced before issuance of Building Permit. d. Upon approval of ~is a~lication, ~e Building Insp~tor will issue a Building Permit to the applicant. Such permit~ shall be kept on the premises available ~r in~ti~ th~gh~t t~ work. e. No building shall be ~cupi~ or u~d in whole or in ~ for any pu~ose wh~er until a Ce~ificate of ~cupancy shall have been granted ~ the Building In--tar. APPLICATION IS HEREBY ~DE to the Build ng Depa~ment for the issuance of a Building Permit pu~uant to the~ ~uild~ng Z~ Ordinance of the Town of ~thold, Suffolk County, New York, and ~er applicable ~s O~i~nc~ or ~egumtions, tar the constm~ion of buildings, a~iti~s or alterati~s or for mm~al' or demol t ~ -~ ~:- The apphcant agrees to comply with all applicable I~s, ordnances, building c~, h~si~ c~e, a~ ~ulati~s and admit authoriz~ in~o~ on premiss ~d in buildings ~r n~essa~ i~tions. ~ ' ~X. ~- ~~ ~ ., (~ign~tu~ of ~ppli~m, ~ ~m~, ff ~ ~tl~n) ~,~ ~ ~ ' ~. ~.~ ~ /,. ~. ~ .~ ........ ~.~..~..~..~.~ ........................................ ~ ~ ~ ~. ~ ~ ~ c .= . (A~ress of applicant) State whether applicant is ~ner, les~e, agent, a~hit~t, engineer, general c~tractor, electrician, plumber or builder. .... ........ .................................................................................................... If applicant is a co~orate, signature of duly authoriz~ officer. ........ ...... Build*r's kic~ ~o ........................... ~ ......... Plumber's Licen~ No. .............. ;.., ...... ;~ .............. El~trician's Licen~ No. ~' ~ : ZD ~-~ ~. L~=tion of I~ on which p~osed work will be done. ~=p No~: -- ~ - Lnt N~ ' .um .r / ~ ~ ~ ~unlci~li~ 2. Stere existing use ~nd ~cu~ncy of premises end intended use end ~cu~ncy of p~ed C~stmction: Exisiting use o~ ~cup=ncy ...... Intend~ use Qnd ~cu~ncy .............. ~.~....~~.~ .................................................................. b. 3. Nature of work (check which applicable): New~l/{il,din~' · ................. Addition ...... Alteration ............. Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... (Description) (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 each type of use ............................ 7. Dimensions of existing structures, if any: Front ..........~..,Z-..~. ........ Rear ....... ~'..7~..; ............... Depth .~..~....;. ........ Height ...... /.~...l. .......... Number of Stories ....... ./.. ....................................................................................................... Dimensions of same structure with alterations or additions: Front ............. ~..~....~ .............. Rear .....~,....z:~...~ .............. Depth .......... ~'-'-'-~...~ ........... Height .......... /.. ............... Number of Stories ~. ............................. 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ..................... Height .................... Number of Stories ................................................................................................................. 9. Size of lot: Front ...............~..~?T~ ................................. Rear .............. /~¢?~. ................... Depth .....~..~....l. ......... .~.. 10. Date of Purchase ..~4'.~'~ ............ /.~'~'~?. ................ Nome of Former Owner ............................................... .~ 11. Zone or use district in which premises are situated ....4~.~'~'., ........................................................................ t~.j~_~~ .... 12. Does proposed construction violate any zoning law, ordinance or regulation: ~.~. .................................. .~..~ ..... 13. Will lot be regraded ..... x~. ................. Will excess fill be removed from premises: ( ) Yes ]4. Name of Owner of premises ..~.~..~././~i'-- ............................. Address ...~....~.ZT.?....~, .~.. ..... Phone No~ Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor . .~..~..&~...~...~./..../~'~......~...~.. ................. Address~'~.'r./.J'Z'4C~..~,,F,~.. ........ Phone No. ~.a?...'..Z..~...?..~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ~ C-t~ ~ ~-~P- ~-~.?1,~. - STATE OF NEW YORK, COUNTY OF ...... J~uf fnlk ........f ""~ , .... ~...J:..~..~....~.~.. ....... .~....~...~....Z~.....~.....~....../.~..~. .......................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contra~ above name. . He is the ~' (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contain~ in this application are t~e to the best of his knowledge and belief; and that the work will b. performed in the manner set fo~h in the application filed therewith. Swam to before me this ..... ~.~.~ ......... day of ...~.~ ..................... , 19....~.6 .......................... ~ . / ~ ~_ ~_ ~/, // (Signature of applicant) ~ARY 'AVENU E ~OC'~F¥ ~DOC~ N