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Home My WebLink About8596-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPART~.NT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. Z73~.2 ...... Date ..............N..oy.... 3 ...... , 19 THIS CERTIFIES that the building located at ... Little. ~Ieek ~oai ..... Street Map No. Xx. Block No.. ~; ..... Lot No, .X~.. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. ~Y...i9, 19...7.6pursuant to which Building Permit No...8~.6.Z.. dated ..........lflaY....~) ..... , 19.?.6.., was issued, and conforms to an of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is..~.~..iy.a.t.~...o.n.~., f.~.l.y..d~..~.1..~ ...................................... The certificate is issued to . J.e.~f. &. ~er~ .~{~l~,~e .... (~e~ers ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .09.t..2.6..1.~7.6., .BAr..R.: .V..~.l.l.a. ....... UNDERWRITERS CERTIFICATE No...N.~ .0~...~.....l..ug...2.~....~ ~.7.~. ............... HOUSE NUMBER ...... ~2~ .~ ... Street .... L:l..ttl®. l~eek, ltoad ................... 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) N? 8596 Z Date ~a~ 19 ' 19..~..6... Permission is hereby granted to: Ee, s~ind....I'~m~s,.Iz~..&/C..,J~...&..t,,a, ren Hulse ............................. ~o.u.~hold ................................ at premises located at ....Zd,~;.~e.~.Nmek..~.aad ................................................................................. .................................................... ~.q~..e..h..qg.u..e. ...... ~,.~..~.,. .............................. ~ ....................................... pursuant to application- Building Inspector. dated ...~....r.......,....~,,%Y.,.:...1.~. ....... :....~,~,, 19,:.?.,~.,; and approved by the Fee $~.6 ,~.0 ............ I, ' - DUllOlng Inspector ~ TOWN OF SOUTHOLD , Building Depaffment 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 disp0sal--(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), Nomconforming 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 Date ...Z~. ,. -~.-~.../. ,.,~. ii ,,~,. ,~... ............. B I ///~ ' I t uld t New ~ti ding ................ Addition ................ 0 d or Pre-exis lng B i lng ................ Vocan Land .............. .............. ...... ? ...................................... ......................................................... Subdivision ............... ..~..~....~..'.~Z...~........./ ' ............. Lot No......~. ...... Block No..? ....... House No.....~. ....... Permit No ~/'7~ ~' Date Of Permit ~,'?..,.~....~..~..~..Applicant ~.,~.'.~,..'..~....~....~......~..~...~....~.~.~....~. ,.../'~..., ...... Health Dept. Approval ....................... ,~. .......... ~.~/,,.,.Labor Dept, Approval ................................................ / Underwriters Approval ..................Z.L/~.~,~,,,~,~'~,~,~..o. Planning Board Approval ,.~,.7¢;~ Request For Temporary Certificate ........... ~'"ii.. ............. FinoJ Certificate/f,~, .............. Fee Submitted $ ........ ~,...~..~..,.~.. .......... Construction on above described building and permit meets all applicable codes and regulations. ......... ~.. day of ..... ~...Z~,~- '.~...~.~. .... (stamp or seo,) o,ory ub,,c ......... praved .............. ....... e,m,t Disapproved a/c "' "' ~ -'~ . ............ ; ............... '~~-~ w,-~' ........................ -~ ~'--~' ~'"~ ,..~.~ ..................... ....................................................... .......................... /~ ~ APPLICATION FOR 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 or areas, and giving a detailed description of layout of property 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. INSTRUCTIONS This application must be completely filled in by typewriter ac in ink and submitted in triplicate to the Building 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, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. / / ,.~' ,- ~, ..... ~D'~ ~----') / .~-~ ~--:~ , ~ ' /? -- (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................... Name of owner of pr. mists appticant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Electrician's License No ..... ..~.~... .............................. Other Trade's License No ................................................ Location of land on which proposed work will b,e done~. /~p ~::.'~.:.~.~~.<~.~-~L'}o,~, N,p ......................... /Municipality State existing use and occupancy of premi}Fes and intende/d use and occupancy of proposed construction: & Nature of work (check which applicable): New BuilrJmg~· ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior, .................... ~her Work ................................................... Z (to be paid on filing this application/) 5. If dwelling, number of dwelling units ....................... Number of dwelling units on each floor ....~ ..................... ]f 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 some structure with all, rations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ................... .,~.~. .......... Rear. ........ ~.?] .......... Depth ..,,.,,~,,-,~ ......... 11. Zone or use district in which premises ore situated ..... L'..-/././.~/.Ld.~Z~/.~..¢'~....' ..................... .~ ...................................... 12. Does proposed construction, violate any zoning Iow, ordinance or ~'egulotion: .......... .~/.~.¢~.:.~...~. .............................. 13. Will lot be regraded .....~.~::~_ ,,__Will ex~ess fill be remove~d-~,, -- --f[°rnpremi~es; ( ) Yes (~No Name of Architect ............: ................................................. Address ..~.¢ ........ : .................. Phone No ....................... Name of Contractor ... : ..... Addres one No.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex/sting 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 ¥C~RK._ .._ I S S COUNTY~-'- /?/./.. - '.~. ), ~-~ ~--~ OF ....... ~ ....... (Name of individual signing contracf) above named. He is the .................. ~:.-;:~c~g~...~ .................................................................................................. >~....~... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and ~make and f~e this application; that all stctements contained in this applicction are true to the best of his knowledge and belief; ~nd the; the work will be performed in the manner set fo~h in the application filed t~rewith. / Sworn to before me this , ) / ~..~ , ~ ~ ~ 4 ,"/ (Signature of~plicant) y pUBLI5 ~t ?'"': .THE NEW YORK BOARD'OF FIRE UNDERWRITERS " ' ak ' ,'?:';h ;' ': BUREAU OF ELECTRICITY STREET, NEW YORK~ NEW YORK 10038 ~-- , ~: $5 JOHN '~ ',~'~,;;'~,u~st' ;~';', ~..97'~' ,' ~.~.~.~,o.~.~ -8~?~ "N CERTIFIES THAT - ~, ~i , only t~ el~t~cal equipment ~ ~sc~ibed below and intr~uced by t~ applier ~ed on the a~e appl~tion ~umber in t~ p~m~e$ of , ' ', Jeff B. 'Hulse~Little Neck Road,',Eu~ene Road, Cutchogue,L-~I;'~ was examlned on , kugust-,;~9,-~:,!g?6, . and f~und ~o bein ~ompliance wlth the requlrements of rhis Board, RXTURE SWITCHES", FIXTURES RANGES , ;OOEING D~KS OVENS DISH WASHERS EXHAUST FANS ~OUTLETS FL~E~ENT DRYERS UNIT HEATERS .* pecialS receptacles:' ':'l-50amps., 1-30amps ,Motor/s: 1 1/ hp ~'~'.' , ~ ~ 1 G.F.C.I. ~ ~ ~" ,~ ~1 ~ Mike Siliris, Main Road, East Marion, L.I. 119~9 GENERA Lic .6t?E D This certificate must not be altered in any manner~ return to the office of the Board if incorrect, inspectors may be identified by ..... =, yORK STATE [jDU CA'F~ON LAW, o ?.OCT a§ 1976 The sewage dizposal and water supPl7 facilitie~ for this location bare been inspected by this department and found ' ~' ~ ~ ..... , ~EM~OSSED SEAL SHALL NOT B~ CONSIDERm ~'~ " 1~, ~ ....... ~To ~ * VAUO r~uE co.. ~TO THE ASSIGN~H~ k/d APPROVED AS NOTED DATE: v~c"~ L ct "'-~6 NOTIFY BUll-DING DEPAP, TMENT,/*F 765-2&&0 9AM TO 4PM FO& REQUIR,. ED INSPECTIONS: 1, BEFORE BAGRFILI. ING FOUNDA-, TION OR START FP, AMING 2. BEFORE COVERING PIPELINE 3, FINAL WHEN JOB COMPLETED NOT RESPONSIBLE FOR DESIGN OR CON~. STRUCTION ERRORS .LZUl/~ ??o~nl ,.~//E/I T.l-/lfj~