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HomeMy WebLinkAbout8562-zFOEM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office SouthoM, N. Y. Certificnte Of Occupnncy No..Z.'~.~.~I. Date .............. .~.k.~'..~. (~., 19'~,.... THIS CERTIFIES that the building located at .~.0. O..$.? ~ ~.~ Z .... ~ ~ Street Map No.. 5. ~ ~.~.. Block No .... ~:...Lot No.. ~ 5 ................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... ~ h X...~, 197.~ pursuant to which Building Pemit No. ~.~ dated ~ ~'( ~ ~ ..................... ~, 19.~.., was issued, and conforms to ~1 of the requffe- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .~..~WhT~...~H!...~ ~ L~'J....~ .~.~ ~.~.~.~ ................... The certificate is issued to .. ~.~ ~ TE [~ kl ( owner, of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No. ~ ~ ~ ~ ~ ~ O HOUSE NUMBER ..... 2.0~ .... Street .....~?.~.?.~.~ ....~ ~ ~ ............. ....... ................... ...... Building Inspector FOF, M NO. 2 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) 8562 Z Permission is hereby granted to: · .,;.~yaSg..~e~:~..,Li~. ............................................ ....... ~....'~r~c~;..l,~n~ ......... LU, a~cs.v.~,$],e ...... to ..~:4.~ ~:...~aa~,t..~...~:~..~ £~;..~'~ 2 ~.~.~g .................................................................................... at premises located at .3,o~...~..~.....~u~set,..~,r~]..]_.s ........................................................................ ................................................. ~se.~..~:.i.~e ......... ~.',a.tt&tuf-l~ .................................................. pursuant to application dated .......................... ~-. ...... ..b, ............. , 19..~., and approved by the Building Inspector. Fee $...~).L'.,.~J~ ......... / ~.,~:~.:.~..~. ........ ~...:~,~...::,,~., ........... ............ I ....... Building Inspec~-~i ~ FO~,~ N'O~ 6 TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION F01~ CERTIFIC~,TE 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, ar other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $§.00 2. Certificate of occupancy on pre-existing dwelling or land use $.5.00 3. Copy of certificate of occupancy $1.00 New Building ......... C~'~,' Ac~iti~n ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .......................... .~ ......................................................... ..CT.. ........ ' .......... Owner Or Owners Of Property .......~.....~..~.'Z~ ........ ~.7-.~...~.~.~... ........ ~~ ...................................... ,-~__ __ /, Subdivision ~')~),¢/~'(Z7 /VO S' Lot No .~.,/~ck No House No Health Dept. Approvol .......... pt. Apprava, ................................................ Underwriters Approvo' ......... Plann,ng Approva' .......... Request Far Temparary Certificate ........................................ Fee Submitted ~ ....... ,~. ........................ Construction on above described building an?~?~..~n.r it/~o~ ~ o~ble~ .el ~.n~d~ulations. ........ .. ........................ Applicant / Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County 7 THE NEW YORK BOARD OF FIRE .UNDERWRITERS BUREAU OF ELECTRICITY ~__j 1 8[5 JOHN STREET, NEW YORK. NEW YORK 10038 ,,,,,. October 29,-1976 ,~,,,d,~,.,,o.~,'..o-.r,~ 86244?N 309760 Nicklas Bruisick, Sunset La., Stanley Rd. & Ruth Rd., Mattituck, L.I, ,..,,.~.~,.,,~.,.do,, October 25, 1976 F~TURES ~ 32 18 17 17 , DRYERS FURNACE MOTORS [] 2nd ~1, Section Block Lot artd fottnd ~o be ia compliance wi~h the reqt~ire,nents qf this Board, FANS F SERVICE DISCONNECT MULTI-OUTLET FEEDERS SYSTEMS C E NO. OF N~EUTRAL5 OF NEU~RAJ OTHER APPARATUS: V S E R I t-G .F .I · Walter Finger ~n~ P.O. Box 991 Lic.#iS~SE Mattituck, N.Y. 11~52 D Per--~ '[his certificate must not be ~e~ed i~ any moaner; return to the office of the Board if incorrect. Inspectors may be identified by Examined ........... ...~.., 19..,~,..,~-/. ·· ~ ...~...?. ................... ................................... .F..., ,9..7.#,,rmit ....... Disapproved a/c j ............ APPLICATION FOR BUILDIHG pER~IT Date .............. ~~....~......., 1 ~__.~......: INS I RUCTIONS a. This application must be completely filled in by typewriter or in ird~ and sul>mitted i~ triplicate to the Building ~ Inspector, with 3 set~ of plans, acc,~r~e 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 oz ~ areas, and giving a detail~cl description of layout ofproplrty must be drown on the diagram which is part of this al~llcation. ' c. The work covered by this application may not be commenced before issuance of Building Permit. ~-~ d. Upon approval of this applicotion, 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 APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bufldi~a Permit mutant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other ~le I.~-~es or Regulations, for the construction of buildings, additions or.alterations, or for removal or demolition, a~ herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing cnde, and rngulaflam, and to admit authorized inspectors on premises and in buildings for necessary Inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, er~gineer, general contractor, electrician, plumber or builder. Nome of owner of pmmi.~$ ..................................................................................................... If applicant is a co,~omte, signature of. duly authorized officer. .................. ......... Builder's. Lic~ No ..................................................... Plum~rs' Licen~ No .... ~...~ ........ ........................................... ~~ b ~her Trade's Licen~ No ............................................... ~~~,//'4 ~-- ~ ~r '.~ ". ,~.~.b~ .~ ~"1 ~ ~ . Dp~o~ w w .~e p .. Street and Numar ' ~/'~.~:..~.....~'~..~ ............................................. Sfote existing use end ~cu~ncy of premises ond inten~d use ond ~cu~ncy of a. ~isiting u~ a~ ~cuponcy..L...~.~..~ .............................. ,~ ............ ; ................................................. b. Intend~ use a~ ~cu~ncy ............. ~..~.~ 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work .................................................... (D cr,p.o.) 4. Estimated Cost ............................................................ 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 ~rs ............................................................................................................................................. 6. If business, commercial or mixed occupancy, sped~ nature and extent of ~ch ~pe of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................Depth .................... Height ........................ Nu~er of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... R~r ............................ Depth ................................Height ........................~...~umber of Stories ................................ ~; 8. Dimensiops. Of entire new construction: Front ~ ................................... Rear ............................ Depth ........................ Height .................... Numar,of Stories ................................. ./.....,..,..-..~ ................................... ./.~)':/ ....... , .................. ,,~t. 1(. / ',I. 1~ ~'~' ~ ............................... ,,,, ................................ ........ ......... Date of PurcNase ........................................................Name of Former ~ner ................................. ; ...................... Zone or use district in which premises are situated .................................................... :.~.: .......................................... Does proposed constructi~ violate any zoning law, ordinance or regulation: ........................................................ Will lot be regraded.../..... , ~ excess fill be removed from pmmise~: ( ) Yes (,), N~/ Name of ~ner of pram sas .................. : ................................. Addre~ ................................ P~e No~..t]~...~ .... Name of Architect .............................................................. Addre~ ................................ Pho~ No ....................... Name of Contractor ............................................................ A~re~ ................................ Ph~e No ....................... PLOT DIAG~M Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ~11 set~ck dimensions from prope~ lines. Give street and bilk number or description according to deed, and show street names and indicate whether interior or corner lot. 12. 13. 14. STATE OF NEW. YQRK. ,, ~ ¢ S .,COUNTY OF ..~.Z~.O.....~.. ............. ............... .~....O~....~...~....~..~.....~..~.~ ........................................ being duly sworn, deposes and says that he is the applicant (Name of individual signing contracf) above named. He is the ..................... O~¢1~!~. ................................................................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed 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 that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........ ........ Notary PubliC,. ............................. ...J~.. · .~..~. · ..~.. ..... Count/ .d. ~..~... ;. · ~....~-.~,,~'~ .................................... ~, , /-x ,-,..-, ' ~'~_/ ~' ~" (Signature of'applicant) NOTARY PUSUC. State of New Ymk No. 52-8125~50, S~ffoik ~oun~ L.Ot sUBDIViSION ~AP FILED INTHE OFFICE OF THE CLERK SOFFOLK 'COUN~'Y ON/tP~. 9~ 1970 AS FILE NO. 5448, WATER SUF~PLY~-PRIVATE WATER COMPANY OF SURVEY FC? ROYAL TERN', INC. LOT 55 "SUNSET ',,KNOLLS, SECTION TWO" USLIFE TITLE INSURANCE COMPANY OF NEW YORK MAT~I TUCK I'' r6WN O~ : SOOT.HOLD SUFFOLK C'¢UNTY, N Y YOU~N6 & YOUNG, LAND SURVEYORS MAR.31 ~:,~,n:cT of Ceue~al Engineerin~ SerVices , APPLICANT '~L O~ STAKE OFFICE OF THE CLERK OF :ILE NO, 5448. .-R ~,OMPANY ~3UARANTEED TO USLIFE TITLE INSURANCE COMPANY OF NEW YORK S U ~01~ ~OUNTY( N ¥, "~oON!G a YOL~NG,, LAND SURVEYORS ', ~OO OSXRANDER AVENUE MAR~,~ i~91~6 t. ~ i''=~0' / 76-194 ? © APPILQVED AS NOTED ',,~. NOTIFY BUILDING DEPARTMENT 76S.2660 9~TO 4~ FOR REQUI~ ED INSPECTIONS: .1. B~RE BACKFILLING FOUNDA ~TION OR ~ART FRAM NG '2. BEFORE COVERING PIPELINE ' . ~,*,,~3. FINAL WHEN JOB COMPLETED ~T ~S~NSIBLE'~R DESIGN OR CON