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Home My WebLink About8595-zFOILM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No... Z~)19.~ .... Date .... .A.u./p~.. ~.. THIS CERTIFIES that the building located at . .8. ~.0..~ .u.~..$.e.~..DF.~.v..e ....... Street Map No .... 5.023. .... Block No ........... Lot No ..... 5.0. .......................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... M~M....1.9 ....... , 1976.. pursuant to which Building Permit No .... .8.5.9.5. Z dated ..... ~.a.y.....~.9. ........, 19.7.~.., 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 ....... P.~.ivate. 0r~e .Faro~ly. I~allin~; ................................ The certificate is issued to . R.D. Houston & Sons ( owner, of the aforesaid building. Suffolk County Department of Health Approval ...... 6.-S.Q-.94 ...................... UNDERWRITERS CERTIFICATE No ......... .N3.8.8.77J ............................ HOUSE NUMBER .... .83Q ...... Street ..... .S.u~q~J:..D.~:~¥.e. ...................... ......................................... M~.t.t~t~.c.t~,. N,e.w .¥p~k .............. ....... : ,. : - ........ Bmlding Inspecto~{' FOEM NO. :3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. N°. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8595 Z he by g anted'fo .... ~'~" -"' Permission is re r :' ..... ~":"~"~">.jl~'. : ......... ~..**.~,~:'":'":'i?:''~'''''~ ........ ~I~ ~ew o~ f~mil~' dwell~g . ' at premises located ~t .' ~" TOWN OF SOUTHOLD , Building Department Town Clerks Office 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 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 disposol--(S*9 form or equal). 3. Approval af 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: J. Accurate survey.of property shewing 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 9. 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 ...6.~'..~..~.E.'.~....~).?.., ...... J~.'/~,~./..~...cc/~.jk'.; ................................................................... Owner Or C~ners Of Property ..~:.[~.;....J..~>?.?..~..~.~A)......~...~.~.?.~....~.C~-..; ............................................. Subdivision ,.~.M~...~..r:,L~...../.~..,~.~?.//.~......~..~...~...,~Z~....Lot No..~.~'::'..~.,.. Block No ............. House No..~.,~.~.. Permit No. ~.-~...~.,5.,~. Dote Of Permit :~'./.~.~./.2.~..Applicant ./~.l~g;J~.~..b...,..H..~..~..JT.~?~ ................ Health Dept. Approval .....~......(.i.....~JLLi(~...::L..~.,J./Labor D~pt. Approval ................................................ Underwriters Approval ...... ~:.;I.i.~.k..,!"~./.'7/..'- '~ ~' ........... ii. Planning Beard Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ....~ ................................. Fee Submitted $ ............. ...,.~/. ............... Construction on above described building and permit meets~.ell c~Dlicabl~ and regulations. Applicant ......................................................................................................... Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, N. Y. 11971 TEL. 765-1802 I ! THE NEW YORK BOARD OF FIRE UNDERWRITERS ____pm BUREAU OF ELECTRICITY ES JOHN STREET, NEW YORK, NEW YORK 10038 ,~,~ Jun. ~. ~7~ ~,,,~,,~,.,o.~o.o,..,,.~ N38~771 THIS CE~IFIES THAT Nat ~tuok~ L.I. DRYERS I FURNACE ~,~OTORS ~JTURE AIq~IANCE ~RVI~ ~N~T IO.~ I s E X 100 CB 1-Smoke I COO~INO ~acs I OVENS IDISH WAS,I'IERS AMT. K.W. WT. K.W. V , I C E OF CC. CCt4D. 3 NO. OF HI-~EG EXHAUST FANS ~ERS John AugusCitus Box 293 East 8etauket, L.I. 11733 Li0.1032 ~ Th,Per, ~ 's ceOificate must not ~ aher~ in any manner, return to the office of the ~ard if incorr~t In--rs ma be identified b t~ir c~d~tials , .............................. TOWN OF SOUTHOLD TOWN CLERK'S ~UTH~D, N. ~pr~ ........................................ , ..........re~r ~ ................................. ~i~pp~ .lc .......................... ~ .......................~ .................... ...................... a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, 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 o~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building 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, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, hoqsing code, and regulations, and to admit authorized inspectors on premises and in buildings for nec~l~ ir~pec~-- , · ~l~ignature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 'Name' ....... of owner"'"'"'"'"'"'"'"'""'"'"""'of premises ~"'"'""'"'"~'~'~/~'"' ........ ~' ........ ~"~"'"'"'"'"'" ~ ....... ~' '""'"'"'"'"'"'"'"'""'" ................ '"'"'"'""'" If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's, License No ................. ~-.~,.7.~,~, ........... Plumbers,License No ..... /~./~..~...:'./....~...~r~,~pT~ .... Electricians License No. ~/.~?'-...~....~~' Other Trade's License No ............................................... Location of land on which proposed work,will ~ doi;i~.. Nta~l~.: ........................................ Lot No ......................... , . Street and Number .................................................................. ~ ............................................... r .............................. State existing use and occupancy of premises~and intended use and ~%gil~pancy of proposed construction: c,e,V;' a. Exislting use and occupancy .............................................................................................................................. b. Intended use and occupancy ................................................................................................................................ Building~' / 3. Nature of work (check which applicable): New .. ................. Addition .................. Alteration .............. Repair .................. Removal .................. Demolitior ..................... Other Work .................................................... 4. Estimated Cost .............. ..~...~?....'.~.. ......................... Fee 7~Z~ ~ (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 ........ ~ ................... Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ 5¢:~N'l'~b~r of Stories ......... ~,~,~.;~ .......... 8. Dimensions of er)tire new construction: Front ........ ...,.~ ..................... Redr ...... ...'~..~ ............... Depth ........................ Height ......~.....~.. ........ Number of Sto~ries ............ ../.....'~.~.. ............................... ., ............................................................ Size of lot: Front .............. ~../_.~...~.~.....,, ..................... Rear ........ /....~.?.......~.. ................. Depth ./.~./~...~....~... ........... Date of Purchase .................. :/.... .............................. Name of ormer Owner ........................................................ Zone or use district in which premises are situated ................................................... ~'~ll~ ........................................ Does proposed construction violat~ any zoning law, ordinance or regulation: ..... K.:....T .......................................... Will lot be regraded . ........ ./..].L~. ...... Wi,~ll~exces, s~ fill ~be r.e~oved;~/~j~rj~--~ ~""~ -- j)) Yes Name of Owner of premises ......~.../..~..'~...~....~..?.....~..~...~..~.". Address ........ ~ ........... Phone No~~'/'~ O---,'i ............ 10. I4. Name 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 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 YORK, COUNTY OF ...... ~lj.~'..~o],,k ......... ............................. · q4J~Jl~,~'~..J'~l.~t4~ ............................... being duly sworn, deposes and soys that he is the applicam (Name of individual signing contract) above named. He is the ............................................ OT~I~[ ............................................................................................................... (Contractor, agent, corporate lofficer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application ore true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set fo~th in the applica~on filed th~ewith. SWorn to before me this /J' ( ~"-~ ............... of ........................... ......... , / Notar Public,. ................................... ~' (Signature of applicant) The water supply and sewage disposal systems · for thzs reozdence will conform to the standards Health~ces~°f the Suffo~ ~ounty~Department of .7, bot. 51 ko t ~t,~ ~q.ft. ARC" 20, UBDIVI$1ON~IAPF/L~OINTH~.~RC£ ..i UNAUTHORIZED ALTERATION OR ADDITION TO Il(iS SURVEY iS A VIOLATION OF SECTION 7209 OF THE NEW YORK $¥A~E EDUCATION COPIES OF THIS ~URV~Y MAP~OT OEABING TH[ LAND SURV£YOR'S tNK~O SEAL OR EMBOSSED S£~L SHALL NOT fie CONSIDERED TO BE A VALID TRUE COPY z~o00STRAHD~R AVENUE,' RIVERH ~T MA TTI TUCK: §1 Lot ,¢ ~,re0 , .Ev,s,o.s YOUNG &'YOUN ~C.~'~¢~_°F~ LAND ~URVEYOR; N Y S 'L ~ NO~ 1~84S : I N.Y.~ ~ ~, 4~ 3 -'I