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Home My WebLink About8484-zNO. & TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerlificale Of Occupancy Sunset Drive THIS CERTIFIES that the building located at ~ ............... Street Map No. S.u~..~.~..t. . .1~.°. ]S~l~ck No .... .I.I. .... Lot No, .~.1 ....... .FLa..t.t.i.t..ug.k.... N.:Y.: ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. April. ~[9.76. pursuant to which Building Permit No..~+~+z. dated ............ &p.r.i~, .... 8, 1976.., 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?.~:v.a.t.e..°.n.e..ff.a.m~.~.l:..d?.l.! .~.n~ ....................................... The certificate is issued to .l~.!.c.h.~.r..d..D.:..Hg.B51;.ola..~...S.ol~S..lr~o ..... .0~r .......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Juns 9 1977 by R. ¥Slla UNDERWRITERS CERTIFICATE No. N. 3.2.8.61.? ...... F.'~. r..!!.. !9.77 ................ HOUSE NUMBER ...8..un~.e~..D.r. Street . .~...~).Q ................................... ........ -./.,~. (:,,. ¥ .... .?.).. ?..~.~ ...... Building Inspector / FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEP~RT~EUT TOWN CLERK'S OFFICE. SOUTHOLD, ~ Y. BUILDING prERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL F~JLL COMPLETION OF THE WORK AUTHORIZED) ; N? 8~8~ Z Permission is hereby granted to: at: premises at ..... !~ated Jicotion dated · '0~ NO, $ TOWN OF SOUTHOLD , Building Depo~tment 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 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 Iond use $5.00 3. Copy of certificate of occupancy $1.00 Date ......................................... New Building ................ Addition ................ Old or Pre-existing Building ................ ¥ocont Lond .............. Location Of Property ....~..'.~./z.~..~..'~...,~..?..: ...... ~..~.,~.Z./.~7~CZ'.~. ......................................................................... Owner Or Owners Of Property ~,',.~/.~.:../Z./.~.~..~'..P.r-...~/.....~..>~...~./~.'.....~/~...~..: ................................................... .~....; ...... Lot No..?..~.. ..... Block No ............. House No...~..Z. ..... Permit No..~...~....~..~.?-x. Date Of Permit ............. ~....Applicont ...~..'...~..:...../,,~,~..~..?.:.~.~ ............................ Health Dept. Approval ~.....7..~.'.../~..'..~...~.. .......... Labor Dept. Approval ........ ..~'..../:~...CTT~... ......................... Underwriters Approval ...".~.....~.....~.?../.?......./.J.~..f~.././..?2..Planning Board Approval ........................................ Fee Submitted $ .27...,. ........................... Construction on above described building and permit meets oil applicable codes ond regulotions. App,,oan, ................. , ....................... · ......... Notary Public ....... ~~ County THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK, NEW YORK 10038 ,),,,e Z ?7 N 328817 THIS CERTIFIES THAT only the elect~cal equipment ~ described below and introdaced by the applicant named on t~ above application number in the premises of R~cha~d Hoas~0n w/s Sunse~ 250~s/ S~an~ey, was examined on Ma= ch7,1977 and flound to be in compliance witlt the requiren~ettts of this tloard. FtXTURE i OUTLETS ~RECEPTACLES SWITCHES .13 DRYERS FIXTURES RANGES ICOOKING DECKS I OVENS NO, 0¢ CC COND, I 1 3 OTHER APPARATUS: 1 smoke detector, 1 GFCI IDISH WASHERS EXHAUST FANS W G jNO. OF NEUTRALS ^.W g HI.LEG OF NEUTRAL [ 5 John Augustitus Box 293 Eo Setauket, L.I.11733 lic ~/1032 E This certificate must nor be altered in any manner; return to the office of the Board if incorrect. Inspectors may be their TOWN OF SOUTHOLD ~r/Z//?~ ._~_~r ~ ~ ~..k?/0/C' --~ BUILDING DEPARTMENT "/~.?/~//, ~ ~ ~-~~ TOWN CLERK'S OFFICE~/~/. ~ 4~/~,~ ~" ~ ~"~- SOUTHOLD, N. Y.~o/_,.o ~ ,,~-- - Examined .... ~..~ .......... , ]97,,. ..... ~,jO.~,~.j ~ _Apphc~ti~o~'JN~. ..... ,~..~-~.~..., .............. Approved .......................... v .............. , 19~....~... Permit No. C~....]...:~'.r..'..I ....... :~'""~C v~ ~b~c~ '~ ' Disapproved a/c "'~'""~'"'~~~'~- ~r~~, 5 0 l~-,~'C_O. ........................................................................................................ .................. ...... INSTRUCTIONS a. This application must be completely filled in by typawriter or' in ink and submitted in triplicate to the Buildingm Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. PI0t plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets 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 permi shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used Jn 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, housing,code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary in~pections.~.~ ~ ............................... : ........ .~ignature of applicant, or name, if a corporation) ...... ................................................................... II 'r ' (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................................................ ....................................................................... Name of owner of premises .......... /./.L.,C.L/~,~.: ,.In~,,.....'~'[.,,'....././.,'T...~'~..,~...:.....~ ................ ' ........................................................... If applicant is a corporate; signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ............ ~.~...~.~..~..~..~. ........ Electrician's License No ....... ~ ...... /Ooo-lOC- ~- 3~ Other Trode's License No ................................................. '.P'~/'~V~ .~C./~9 _. , 1. Location of land on which I~)~/:)osed work will be done. Map No.: ~.~ ...... Lot No .....~..~ ........... · ]~ ~/~ . Street and Number ...... ~.~ ......... ~..~..~,... ........ ~/~.~f .............................................. ~~ ~ Municipali~ 2. State existing use and occu~ncy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ....... ; ........................................................................................................................ b. Intended use andoccupancy ...... ~../.../.~../.-"..~......~...~..~..~.~... ............................................................................. 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolitior ..................... Other Work ................................................ . .... . . ~ ~"'~' (Description) 4. Estimated Cost ............................................................ Fee '7 ~ - (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, specifyon, ature and extent of each type of use 7. Dimens OhS of exzst ng structures, f any: Front ...~..C:....'. ............ Rear ................................ Depth .................... Height ........................ Number of Stories Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................. 8. Dimensions of entire new construction: Front ........ .~..l~. ..................... Rear ................. Depth~..~....'~'.. ............. Number of Stories ..................................................................................................................... 1 1. Zone or use district in which premises are situated ......................... :....;7.; ................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... ,~...~. ......................................... 13. Will lot be regraded . ...... Y,~.$ ........... WJllexcessfJl, be r~emoved from premises: ( )Yes (l~No Name of Architect .................... >, ....................................... Address ................................ Phone No ....................... Nome 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 NEWYJDRKx , ~ ~cc COUNTY O~ ..~..~.~.:/~.~ · ......... above named. sw~d says that he is the applicam He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duty authorized to perform or have per[armed the said work and to make and file 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 applicati°n filed ther_~ith. Sworn to before me this /" ~ \ , ......... ..... of .......... ....... ./.i ............ , [ / ' .' ,, · ' .... - / x ~ -' ~ ,~.~Z ; h~ ~~ - ~ota~ ~um~c, ...... ?.,....~'. ........ ;.~ ............. , ........ ~un~ ....... '~.,~. ~ ~.~..~, ~.~ ...................................... (Signature of/applicant) JUDITH T. BOKEN Notary Public, Slate of New York No. 52-0344963 Suffolk Co~ Commission Expires March 80~ Dot NOTRE: ~ SU~D/VI$(ON MA£FILED tNTHE O?FIC£ OF~'HE CLER~ OF SUFFOLK COUNTrYON APR 9~ 19 ~'0 AS FIL~ NO 5448. 7209 OF THE NEW YORK STATE EDUCATION LAW COPI[$ OF THIS SURVEY MAP NOT ~EARINS AGENCY AND L£NOING ~NSTITUTION blSTED RE'VISIONS YOUNG & YOUNG// 400 OSTRANDER AVENUE, RIVERHEA~, SURVEY FOR: } ~o~ 5/; " ~UW~E~ ~OLZ~, q '~ 5895 AY : GUARAt~?IE£D 'TO: L-P t / / 4~00STRANDE~R AVENUE,~ RIVJERHEAD, NEW ~ORK SURVEY FOR~ ~ ' ~ A A HOUSTO~ ~:SbN& ~NC SO, tHOLe, , . / · / .~40: I ~ .MAr~lgZ5 I 2,8 0