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Home My WebLink About8492-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's O~iee Southold, N. Y. Certificate Of Occupancy No. Z Date ............................ THIS CERTIFIES that the building located au ............................ ~tree~ Map No. ~ & Block No. -'~ conforms substantially to the Application for Building Permit heretofore filed in this office dated ~c ~ ~& 19 ....pursuant to which Building Permit ...................... , No.~ dated ~ t~, ~ A .............. 19 .... , was issued, ~d conforms to all of the require- ments of the applicable provisions of the law. The oceup~ey ~or which this certificate is The certificate is issued to (owne , of the aforesaid building. Suffolk County Department of Health pprova~ .................................... UNDERWRITERS CERTIFICATE No. ~ HOUSE NUMBER ~ Street Building Inspector FOB~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8492 Z Date ................ Apr~.l.....1.3 .................. , 19..~E~. Permission is hereby granted to: .............. ~¥~r~o~..~e .......... N~zor.v./lle ..... to ~-%1,d..~; e~;..~-,t-va-t,e...oz~e ...~.am ~ t.y.. &wet.]:~g ................................................................... at premises located at ..~et,..-~9-~.-...Ne~s~..P.t~..~.rop ....................................................................... ................................................ Ol~,..~e~a~e~..ad .......... ~teheg~te ............................................. pursuant to application dated ......................A~.:~:I:.'I. ........ ~.~ .......... , 19...c/~, and approved by the Building Inspector. Fee $.1 g.~,2,0 ......... 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 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 end 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: I. 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 S ap.t, emb,em.,....1.?..,.J 9 FJ 6 New B~lilding ......,,~ ....... Addition ................ Old or Pre-existing Building ................ Vacont Lond .............. S/ side 01d }V~enhaden Road. 350 ft 3/ n~ wm~,~+ .- - Location Of Property ......... ~r ...... : ........ ~..-....,.v......~....~...~* ............................ m.....~....~.~...~¢e~.~zz.~w.~..A~ao l~assau ~ozn~, ou~onogue,N.y. Owner Or ~ners Of Property ..... Q~..~...~.~.e.~.~..~.~S ......................................................... Subdivision ......................................................... ~o&~ Sec'~,~. No. ~2 Block No. House No ~75 ~3Nassau Lot ..................................... Permit No..~.~ .......... Date Of Permit .~.~J.~Z.~..Applicant ..~.~.9. fi~.~..~ ~.~.fl~.~...O.~.~.q.~ ~uild er Health Dept. Approval 6-S0-54 9/10/76 Labor ~pt. Approval N/A Inc. 3033 9/ 3/76 Underwriters Approval .............................................. Planning B~rd Approval ........................................ Request For Tempora~ Ce~ificate ........................................ Fin~ Certificate ....... ~ ........................ u 5,00 Fee S bmitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. Applicant · . ................. Sworn tO before me this ................ da~ (stamp or seal) Notary Public THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY B5 JOHN STREET, NEW YORK, NEW YORK 10038 ~ly the electric'al ~quipmen~ as described below ~r~d introduced by the applicant named on the above app~icatlon number in thepremi~es of Mr. Spiers, s/s Old Menhaden ~oad 361' w/o Wunneweta ~oad, Cutchogu~ L.I. ~hefolh,,cingloc,,tion; ~ Basement ~ ~stFt. ~ ~,,d Ft. outside s~o~o, mo~ ~t 392 FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS 18 APPARATUS: t or / s GFI : 1-1/2hp R V I E T A w G. m Ho OF HI-LEG OF CC COND 2/O Britelite Elec. . ~ A · TOWN CLERK'S OFFICE /h ~ ~ ;. ~::~,5 ~ LD, N.Y. -'~'' .... _ .... - ~ ,, ~ oz - '~~ ~ o~ ~ ~ ~" ....... t'"~ ...... . .................... r~~'i;;~"~"~""~ ~ ~ APPLICATION FOR BUILDING PE~IT I NSTRU~IONS o. T~is applicatio~ must be completely fill~ in by ~pewriter o~ in i~ ~nd s~mi~ed in triplicate to the Building~ Inspector, with 3 ~ts of plans, accurate pl~ plan ~ ~ale. F~ acco~ing to sch~ule. Qre~s, ~ giving a det~il~ ~escription of layout ofpr~e~ must ~e ~r~ o~ t~e ~io~r~m which is ~ of t~is appfic~tiom~ ~. ~e wor~ cov~r~ ~y t~i~ ~licQtio~ m~y ~ot ~e co~e~e~ ~e~ore i~s~Q~c~ of ~uil~J~ Permit. ~. ~po~ ~pprov~l of t~is application, t~e ~il~i~g inspector will issue ~ ~il~i~ Permit to the ~ppliG~t. S~ch per~i~ ~1~ be ~ept o~ the premises available for insp~tio~ throughout the work. '. e. ~o b~il~in~ s~all be ~cupi~ or u~d in w~ole or i~ p~ ~or ~ny pu~ose wh~er until a Ce~ificate ~11 ~ave bee~ gra~ted by the ~ildi~g Inspector. ~PP~IC~TIO~ IS fiE~E~Y ~ to t~e Building Dep~rtment for t~e issuance of ~ ~uilding Permit Building ~o~e Ordinance of t~e Town of ~ut~old, Suffolk County, ~e~ York, a~ ot~er applicable ~aws, Ordinances ~e~lotions, for the co~str~ion of buildings, ~ditions or offerations, or ~or removal or demolition, as he,in ~escribed. · ~e ~pplic~nt a~rees to comply wit~ ~ll ~pplica~le I~ws, ordinance, ~uil~i~g c~e, ~o~sing ~e, and regulations, and to o~mit out~orize~ i~pectors ~ premJse~ and i~ buildings ~r n~e~ i~tions. (Sign~tur~ of ~ppli~t, ~r ~m~, if ~ ~mtlon) · ...... (Addro*~ of opplicont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, Plumber or builder. ~,\~ c',- ' N~me of owner of pr~mi~e~ ..... ~ ................................ k .................. ,~ ............................ : .................................................... If ~plic~nt i$ ~ ~otgte ~ign~tut~ of duly ~uthoriz~ ~ffi~r. .... ....................................... (Nome and title of co,orate officer) Builder's Licm~ No. ~ ~'~' Plum~r's License No. ~ ~ Electrician's License No. ~ ~ ............................................ /~co- //~-- 7- ~{ ~her Trode's License No ............................................... l. L~otion of I~ on which proposed work will be done. Mop No.: ....... ~.~ ....................Lot No....~..: ....... Uunici~li~ 2. State existing use and ~cu~ncy of premises and intended use and ~cuponcy o~ propped construction: o. ~isiting use o~ ~cuponcy ...................................~.~ ........................................................................... b. Intended use and ~cup,ncy ~0~~ ~.~k~,~C~ 3. Nature of work (check which applicable): New Building ......L~... ......... Addition .................. ~tel/~loh Repair .................. Removal .................. Demolition .................... Other Work ................. L[;.~.;.:..'..' / '~ ........... c-~? ~ ,n :; J~scription) ' ,. timat ..................... ......... ................... (to be paid on filing this a~lication) 5. If dwelling, number of ~elling units ......... ~ ................. Number of dwelling units ~ each flor ............................ If garage, numar of ~m. ~ ~Z~: ...... .~......~.~.~.~..: ..........~....~..~ ............................ 6. If business, commercial or mix~ ~cupancy, speci~ nature and extent of ~ch ~e of u~ ............................ 7. Di~nsions of existing structure, if any: Front ~- Rear ................................ ~pth .................... Height - Nu~er of Stori~ ........... ~.....'.~ ............................................................................................. Dimensions of same structure wi~ alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire n~ constru~ion: Front ............... ~ .............Rear ....... ~.~ ............ D~th ......~.~.; .......... Height ...~ ......... Number of Stories ....................................... .......................... : ........................ ~ ............... 9. Size of lot: Front ................~.~.:.~.~.., ................... Rear ................. ~.~.~ ................. Depth ~..~.~..; ...... 10, Dote of Purchase ......~>h.~.....~..V...~.~..., ............ Nome of Fo~er ~ner ............... ~.~.,.~ .................... 11. Zone or use district in which premises are situated ............... ~ .................................................................... 12. Does pr~osed construction violate any zoning law, ordinance or regulation: ............. .~.~....~ ..................... 13. Will lot be regraded, .....~.~..~ ........... Will exce~ fill be remov~ fr~ promises: ( ) Y~ (~ No 14. Na~ of ~ner of premises ~.E...L..~...~.~Y.~,.~}A~re~ ~w ~ · ~.~-..~:~: ~ No..~.~.~.~,~.~ Nome of Archit~t .............................................................. A~re~ .......................... ~... Ph~ No. ~ ~o~ ~ ' ..................... Name of Contractor ~c~ ~L~ A~ress ~~ ~ Pho~ No. '~.~.~.~.~. PLOT DIAG~M L~ate clearly and distinctly all buildings, whether existing or proposed, a~ indicate all ~t~k dime~io~ from prope~ lines. Give street ~nd bilk number or description according to d~, end show street n~mes ~nd indicate whether interior or corner lot STATE OF N~ YO~,/~ ~ IS S ~o,,~ o~ ....~~ - .......................... :: ..................................................................... being duly swam, d~oses a~d says that he is the (Name o{ i~ividual si~i~ obove H~ is the ................................................................................................................................................................................. (Contractor, agent, co~orate officer, etc.) of said owner or owners, and Js duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set fo~h Jn the application filed therewith. Swam to b~for~me this ........... ~~ o~ .............. ~.~ ......... , ~...2~ ~ ~ ~. Publ~c~[~~~.. ....... ............................................ (Signature of applicant) JUDITH T. BOKEN 52-0344953 Suffdk Coun~ 2.7 ~o. P~TCiVO6;UE~ IV. ~ : /! 77Z' .I liti~s for this )b' J.u have been N REAR FRONT ELEVA-~ION £L~.V,~TIO~, LE~T 51DE [LEVA-TIO~ II II I I I I L'iF- ~]J L J L J ,- 1 BASF_ hl E N-t' LEVEL, SCALE L g k J FOLI NP/k,'~ ION, F'L AN, ScaLE ~= I/~'' L',,J - - LiJ -- '~,.~DECK pO.~T F-ko- L .q I I I 55cT{0~ -F%l~u F~o~-V ~-~ s~tt.