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Home My WebLink About8602-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. Z 10289 Date December 8 19 80 THIS CERTIFIES that the building ................................................ 6/4-725 Main Road, Southold Location of Property ............................................................... House No. Street Hamlet 2'~ County Tax Map No. 1000 Section .............. 56 .Block . ........ /~ . . ,Lot .... :'~. ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated T,~ 1976 8602 Z 1 ,, ,y 2il., pursuant to which Building Permit No ...................... dated .. ?'F. ?.z[: ................. 19 ..7.6, was issued, and conforms to all of the req{iirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ...... ,,~o. r.~..a~.~. ~;.~.~ .e. ~o. r.m.e.r..~. ¢~.t..i.o~..=..(~'-:~%9..,~ .~r.a.~. 9.h~F~. ):' .......... The certificate is issued to .... J. 9 ¢.e.9.~....C.a.r:d. ~% .a.g .d...LMm..~..C.g .~.cl.:[.a. ................... (owner, ~~ of the aforesaid building. Suffolk County Department of Health Approval .. N./~ .................................... UNDERWRITERS CERTIFICATE NO .... .Ixl.~,0. ? .7.7.~. ..................................... Building Inspector Rev 4/79 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? 8602 Z Permission is hereby grafited to: ..................... ~a..aaat ....... ~tmla ...... :... ~::~.a..a.~.s..t~.e.~.°.~.e..~.t.~.~.a.~.~.~.~..~{~.~..~.~r~)~`~:~: ........ ~::....., .................. ..... ,. ................................................. :,~.~ala~r~$:~.t:l~, .......... : ...... :..~ .......... :. .................................. pul,rant to ~pplic~tion d~t~d ........ ,.....;...:..~-...~....: ............ , 19~;., ~nd opOvov~ b9 the ~ui~d[n~ Inspoctor. FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 featu res. 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 installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit P~anning Board approval of completed site plan requirements where applicable. 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..S.e. ..t.emb. .... Addition to: New Building ............. Old or Pre-existing Building X Vacant Land Location of Property . .qo.. ~,~..~..a.i.~..~..o.a.d.~.. Sp.u.~.b.o,]..d.~ .~f~.w. ,¥p~. ....................... House No. Street Hamlet Owner or Owners of Property Joseph Ca~:d±a and Lu±sa Cardia County Tax Map No. 1000 Section .... 56 ......... Block .4 ............. Lot,.. 2,:] .......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. 8.,6.0.2. ..... Date of Permit 5../.2.~./.7..6..Applicant.. ~.o.s..~...C.e?..d~.e: ................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...... ~. ................ Fee Submitted $ 5.00 Applicant /~.t, .... ............................ Rev, 10-10-78 ! -17 MAiN F~OAD MAP OF LAND JOSEPI-t .SAEAND ~WN ~F 50orHOCD; N.Y. SCAL ~ ~'-- I" THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY Da~e ~pplJcation No. on,lie N5 in the/ollowing location; ~ Base,te,~ ~ 1st FI. ~ 2nd Fl. S~tion BIoc~ was exami,,ed o,, k~9~ Z4~ ~980 and found to be in complian,'e with the requlremen~s o~ thi~ Boa~d. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS 2 DRYERS APPARATUS: S E R NO, OF NEUTRALS1 AWG OF NEUTRAL [his certificate must not be altere ' in any manner; return to the office of the Board if i Inspectors may be identified by credentials. INSTRUCTIONS _~ a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Building f Inspector, with 3 sete 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 acljoining premises or. public streets o~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part at 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. T' 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 Buildi.ng Permit pursuant to the ~. Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances ~ 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 cnde, and regulations, and to admit authorized inspectors on premises and in buildings for necessary ir-~apections. (Signature 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. N ......f ow .... f ~ e ........................... ~, ............. , ................. : ......................................................................................... 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 Trode's License No ............................................... :~ .~ 1. Location of land on which proposed work will be c~e. AA,ap No.: ................. ~.....~.. ........ Lot ~9.^....../...% ........... Street and Number ......... I..~.'.l.~ ......... .~.. ....... ~.~.. ...... q ....................... ~, .............. .....~j~.~'~ ....... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ............ ~ ........................................................................................... b. Intended use and occupancy .................. .~.~..~ ............................................................................. 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ...~..~...~...~z~,..~,,~ ..................... [ ~ ~d~ (Description) 4. Estimated Cost -.-...'-.Z.~.~.,..... ....................................... Fee ...~. ..................................................................................... (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 ........................ ~... I f 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 ....... ~..~..i. ............... Height .,..~ .................. Number of Stories ..... .~7... ..................... 8. Dimensions of entire new construction: Front ........... J.~. ................... Rear ............................ Depth .....J.~.. ............. He ght :.~ ~ Number of Star es ~ .................................................. 9. Size of lot: Front ...L.']~....~..I......, ................................. Rear ..... ]....9~....?'.. ......................... Depth ........ /..~....~.. ............... 10. Date of Purchase .......... /.././.~/.7...~.. ........................... Name of Former Owner .~,,).D?~....~.~...('...~.(.~.,.[~.. 11. Zone or use district in whi/ch p~remises are situated , iX ~ J~ E~ ~.. .~. I 12. Does proposed construction violate any zoning law, ordinance or regulation: ...J~.O. ............................................. 13. Will lot be regraded . ~.0 Wdl excess fill be removed from rem~ses ( premises'' ...................... ' ' Address P ' :~l~tone)-.~ Ye~ No.( .~. ) No Name of Architect .............................................................. Address ............................... Phone No ....................... of Contractor .................. .~.~...~.~..~ ................... Address ..~f'~.~..~one No..~.:~.~...D....~....~.. Name PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck 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 NIE~I~II. ~ c c COUNTY OF .~.~.~ ............. ~'~ ................................................................................................ bern= duly sworn, deposes and soys that he is the applicant (Name of individual signing contract~ above named. 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 make and fife this application; that all statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ~ill~J day of , 1 II, . · ........ : ......... ....... .... ~-~ --~ ~-~ . ~ -- ' J / (Signature of applicant) I~IOT,~RY PUBLIC, State of ~. 52-8]25850. Suffo~ Co~ T~rm Expires March 30. 19~