The URL can be used to link to this page

Home My WebLink About8478-zTOWN OF SOUTHOLD BUILD]I~ DEP~t'I'M~Tr Ta~m Cled~'s O~i~e Southa~ N. Y. Cerfi~icate C~ Occupancy Map No ............. Block No ...........Lot No .................................. conform~ substantially to the Application for Buildi~ Pernflt heretofore filed in t~i~ office dated ............... .A.P..~...~, 197. ~. pursuant to which BulJ&in~ Permit No. ?..~.'7..~..~ ~ ............... ~ .~...,s ~.7~., was is~,.a. ~ eo~or~,, to aU o~ t~ ~uive- mmt~ of the applicable provi~om c~ the law. The oeeul~mcy for TI~ eer~ieate is issu~ to. f]O.e. .............................................. (owner, of the afores~ build!nS. Suffolk County Department of Health Approval ....~. ~..~.' ........................... UND~RWP. ITERS CERTIFICATE No ~ ~0~ ~ HO~SS NU~B~ ........ ~.~. ?..0 Street ...~..q .~..~ ¢~*~.~ ~.~...~ ~: ~ ....... ~/~.~ ~. ...... BUt]di.g Inspector FOI~M NO. 2 TOWN OF SOiJTHOLD 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? 8478 Z Date ........................ AJ:J~.:J.1....6 ............ , 19...~.6. Permission is hereby granted to: I,~J,.s..$4eGeue~..&...ge~eth.~..Neaae~ ........... ............... · .ee....i~a.~,...~cl, ......... kaa~.e;l, ...... to .huild..a~.~itio~..o~..exi~tln&..dw~L l~n~ .............................................................. '. at premises located at ..... ,.q/.q..P. eco~ c..~...cql~'cl., .................................................................... ............................................................... Laux. el .................................................................................. pursuant to application dated .......................A[9~,.~..~ ........ ~' ........... , 19.76.., and approved by the BuJlding Inspector. Fee $..~.,~..I~.Q .......... TOWN OF $OUTHOLD , 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 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 oil 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 New BHilding ................ Addition .....!../........ Old or Pre-existing Bu Id n~l ..... Vacant Land P Y ...................... z ......... //' ........................ .~. ~. :.~-.: ............... z.., Z'/.. ;.~,~ ........................ Owner Or O ners Of Property Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No. Dote Of Permit/..z...-r./..x....,:. Applicant ..... ~¢,~...~..~4-....~~.~F/. ..... Health Dept. Approval ............................................ Lobar Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval .................r ...................... Request For Temporary Certificate ........................................ Final Certificate ~' Fee Submitted $ .................................... Construction on above described building and p, er~/~,t meets,all, applical~le codes and regulations. Applicant ....... .(.~......~.?~.~.. ~~ .-~.....~.. '~. ...................... Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stomp or seal) ..... THE NEW YORK BOARD OF FIRE UNDERWRITER5 ak ~- '?:~ ~ 85 JoHN STREET. NEW YORK, NEW YORK 1003,8 a.,~ August 13, 1976 ~Pmllc°'i°"N°-°"fl* 860248 ' Lois McOowan-Meaney~ sfs~de Peconic Bay Blvd., Laurel, FIXTURE FtXTURE$' , , RANGES OVENS DISHWASHERS FANS 4 ; 21 12 "i4 '::~ ' ~RYERS MOTORS FUTURE APPtlANCE EEEDERS SERVICE DISCONNECT S E R V I C E I Smoke Detector Fred Salonla,. 137 Village Ave., Elmont, L.I. 11003. This certificate must nor be altered in any manner;, return to the office of the Board if inc&rrect, In¢~ectgrs ~ay b~ identified by ~ FOKM NO. 1 ' ~ / TOWN CLERK'S OFFIGE ~/~o~ ~UTHOLD, N. Y~- Disapproved o/c ..... :~ ......... ~ .............. ~~~~ .......................... ................. ; ................ ............ / .//:.~' ~ z, / ~~ ...................... ,,~ ............ ,~--' / / ' INSTRUCTIONS o. This application must be completely filled in by ~pewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 sets of plons, accurate plot plan to ~ole. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relotionsMp to adjoining premises or public streets ore~s, and giving o detailed description of layout ofpr~er~ must be drown on the dlogrom wMcN c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon opprovol of this application, t~e Building Inspector will issue o Building Permit to t~e applicant. Such permit s~oll be kept on t~e premises available for inspection throughout t~e work. e. No building s~oll be occupied or used in w~ole or in port ~or any pu~ose w~ever until shall hove been granted by the Building Inspector. APPLICATION IS HEREB~ MADE to the Building Deportment for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, Ne~ York, ond other applicable Lows, Ordinonces or Regulations, for t~e constru~ion of buildings, additions or alterations, or for removal 0r demolition, The applicant agrees to comply with' oll applicable lows, ordinances, building c~e, housing code, and regulations, admit authorized inspectors on premises' and i~ buildings for n~esso~ in~ections. .......... .....-~.~......~......~:~.~ ............ (Signature of applicant, or nome, if a corporation) / ~ ~ 6 , (~dress or,applicant) . , / State whether applicant is owner, lessee, agent, architect, engineer, general contractor .electrician, plumber or b" uilder. .......... ::.~:~...~ ................................................................................. Name of owner of premises ....~.~....~....~.....~~:~.~.: If applicant is a corpo/at~, signature of duly authorized officer. .................. ......... Bu der s k c~se ~o ~ ~.~....~.:...: .... ~ [~t~'~ u~o ~o ..... ~..~.~ ...................... Other Trode's License No ............................................... Location of land on which proposed work will be done. Map No.: ..................... .~ ................ ~ot No....:-..-:...._.~ ...... Street o.d Number ...................... '~ ---- '~ ---- ----~'~' ' ~...~...~'~"..~.~.~:~Z..~.~~..~. ~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .~..~.r... .~,c~-r~-~ .~..~~ ............................ ....... /' 6' ,, / ' ,, ,,~.. ~./"~ b. Intended use and occupancy ......................................................................... : ..................... ~.~.~-'~.~./.~.~ .......... 3. Nature of work (check which applicable): New Building'. ................. Addition........'/// ....... ... Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work ..................................................... ~ (Description) 4. Estimated Cost .............. ..~J..~..:.~..~. ...................... Fee ..t.~Z.....'~.. .......................................................................... (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. D mensions of existing structures, if any: Front ...... ¢~,~.'..~ .......... Rear .....~..~....~ ............... Depth ..~ .......... Height ....~.~.(. ........Number of Stories ................... ~ .......... Z...~ .........~ .................................................... Dimensions of same structure with alterations or additions: Front ............ ~ ............... ~ ..... Rear ~ ~ Depth ......... ~..~ ............. Height ...... ~.~ ............. Number of,Stories ............Z.~ ....... ' /~ R~ /~ ~ 8. Dimensions of entire new construction: Front ........... ~ ............................................... Dept~ /~ Height ...~ .............. ____ --Number of S~ories ..................................................................................................................... 9. Size of lot: Front ..~,..~.~.:.~.~. ................................ Rear ......... ~.....~.¢.Q...'. ......... Depth ...... ~.Z.~.- ............. ,~ ~ ~/~ c ~,~..~-- ..,f'~;~., ,~./.~),'T ' 10. Date of Purchase ...:;~...~..e,....Z.Z..~.Z. ............. ~e of ~ . ' 12. Does proposed construction violate any zonlngll~~rr~l~on: .......... ~. ..................................... 13. Will lot be regraded ........ ~ ............ Will ex~l ~---- -s~ove~qom~r~se~L~Yes ( ) 14. Name of Owner of premisesL.~.c~..~.~.~.~.~ ~~¢~.. Photo No. Name of Architect ......... ~ .............................. Address Photo No .......... ....... Name of Contractor ..~{~f~.~..~.f:~f.C~ .................. Address ..~¢P.K~L~,~. Pho~ No. Locote clearly and distinctly all buildings, whet~OTDiAGRAM ~~,.0t~ ~ lines. Give street and b~ock number or~ ~r existing or propose~'~ indicate all set-~ ¢ dimensions from ?cription acco~dLng to de~d, and show street ~mes and indicate ~ether interior or corner lot. ~ ~'(~ ~ ~ :~- I~.° ~ -~" OF NEW YORI~/z [~ ~ COUNTY OF .......................:L... ............. ................................ ....... ............................ (Name of individu~ ~i~ contract) ~0~ above named. ~ ~ Z~ ~- ~r t~h~'¢tg~ tHt~ 'f/17 ~ He is the ................................ ..~ ~.,...-..~.Z.[~..~Z ....... ...~ ~... .................................................................................... ,[ (Contractor, agent, ~1 ~te officer, etc.) of said owner or owners, antis c fy ¢,.'th~i~ }~ p~~ve performed the said work and to make and file this application; that all statemen~ contained in this applic~(io~ are true to the best of his knowledge and belief; and tha~ the work will be performed in fha manner set fo~h in th~ ~pplication filed therewith. Sworn to. before me this 0 _ ~ ...... ............ o, ...................... ~o~e~ ~h~,/.'.~ ...................... ~:.S.~.~ ..... Co~ ............. ;~ ................... . ...... ~..,...,.~. .............................. Qualified m F~:~s~ali Caun~ 0 0 0