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HomeMy WebLinkAbout8674-zTOWN OF SOUTHOLD BuILnING DEPARTMI~T Town Clerk'~ Off, ice Southold, N. Y. Certificate Of Occupancy No.Z~.aSi ....... Date ............. C,o'~ · · ~. ....... ,19..~, THIS CERTIFIES that the building located at . ~[mmec~tt. th- ............ Street Map No. Xenne¢ et~ .l~lock No ........... Lot No, .~ .... /~outhvlcl ............... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ June...22., 19..76 pursuant to which Building Permit No. 8~?bZ. · dated ............. Jun~..2.~, 19..?/~ was issued, and conforms to all of the requir~ merits of the applicable provisions of the law. The occupancy for which this certificate is issued is .P. ri:late. ~wimm~g. pc~ol, w.i. th .f. ence .&. &oees.so~ys ................... The certificate is issued to . .Bicha4,d · &. ~Jaro.Z.$n- Ehl~nger ..... u~mer ............. (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval . I* .1.~o .............................. UNDERWRITERS CERTIFICATE No.l~a.91+06© ...... J.u2,y. · .2~ ·..1'97~ .............. HOUSE NUMBER ... aO1 ~ ...... Street . .Xem~eeet.t..gr .......................... ........ ...: ......... Building Tnspectoz~ FO'P-M NO. ~ 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? 867 Z Permission is hereby granted to: ........................ ~.~.~.L~Mk .... ~ ~' · .................... to ...b....~...]~...~%~:4 g.~:;LT.&.~t alC~.~.~.~.M~,g..z~ogl..~.~h..f, en~e..A..ae~e,,sa~ ..................... at promises I~at~ a~...~.....~ ......... ~.~.~..~ ............................................................ ........................................ ~g~%~...D~L~ ......... ~a~&....H.~. ......................................... pumuant to application dat~ ....................... ~.....~ ............. , 1~...., a~ approv~ by the Building In~tor. I~l IO~l ~0~ eO~~ ~0 ~ ~ 1 ~.00 Fee $ ........................ TOWN OF SOUTHOLD , Building Deportment 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 disposol--(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: I. Accurate survey.of property showing all property lines, streets, buildings end 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 o 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 Date .............. ~'~ .-~.~/. ~' New Building ................ Addi,~ion ................ Old_or Pre-existifCl Building ................ Vacan~ Land .............. o o,,on ..... - ' ......................... ................................................................~~~Lot No .............------~ No .......... Subdivision Permit No.' .................... Date~ .................... Applicant Health Dept. Approval ~~ .......... ~ ....... Labor ~pt. Approval ~.~ .......................... _ Underwriters Approval~....~~Planning B~rd Approval ..... Request For Tempora~ Ce~ificat;~::'.~~ ......... Fin~, Certificate .... ................................................. . // 4 -- NOTARY PUBLIC, STATE OF ..... , QUALIFIED IN BR~'COUNTY~,~ Notaw Public .~'.?:Z:~.~.fx4~ ........... Coun~ Comm. ~xpire, M.'rch ~' ' I ~ ']THE' NEW YORK BOARD OF FIRE UNDERWRITERS ~', .. ~i - :L ; ~ ; BUREAU OF ELECTR C TY "?'- ~, ]i ~:r-- !!i{;;I ~ '~[u~j!t :,, '85 JOHN STREET, NEW YORK NEW YORK 10038 HIS CERTIFIES ~HAT~: ~ ~:' ' ',, :' ' ' ' ' ~y t~ ethnical eq~tp~nt ~ ~r~ ~Jow a~d zntr~ced by the applicant ~ reed on the ebove application ~u tuber ~ the pre~tses of ,. Richa~d~:Ehl~nger, Yennecott Drive, Tuthull Rd., Southold, L. . ," '~"" "::~ ~ ' ' outside w~ami~don~ ~ 'Jul'y :15,. 1976, , ~ndfou~tobelncomotlaneew[ththerequirementsqthlsBoard, ~ FIXTURES , "~. RANGES OVENS EXHAUST FANS DRYERS d,~ ~,'FURNACE ~MOTOES R ¸ V (Swlmm~ng Poo'l?;?Th~s certlf, tcafe.covers compliant? a; the date of inspection 'only~i:~Bec'ause 'of' unusual environments ~t ~s~advisable " to have frequen~',~,test and/ow repairs made by a qualified person, Mattituck, L.}. 11952 . 'r Lic.1227 O~;~t~Na~;;~ ~D ~1_ _ This ced[ficote must nor he o~ered in any monnerr return to the office of the B~~tials, ~Cg L/5,. Approved ........................................ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~UTHOLD, N. Y. No ....... Disapproved a/c ............. ;.:~,;;;:~.,~,~.~.:._.:.::,7.::,:x~,.~,~...;~t.,TZ.:::.~.~,/k~__ ......................... ,..: ................................................ ............................ ......... / (Building Inspector) / APPLICATION FOR BUILDING PERMIT Date ..............v~!.~,/.(.';./.~,:.....::.:~'. ......... , 19....~./..~,. INSTRUCTIONS This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Building Oo Inspector, with 3 sets 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 adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application, c~ c. The work covered by this application may not be commenced before issuance of Building Permit. C~ d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit 4 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 '~u~ce~f a Building Permit pursuant to the ~'~ Building Zone Ordinance of the Town of Southold, Suffolk County, New/fork, an/] other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, o7' for ren, g~'val or deg~olition, as herein described. ~ The applicant agrees to comply with all applicable laws, ordinances, b~lding c~e, housingZg~Je, a.od regulations, and to . admitouthorized inspectors on premises and in buildings for necessa(y ins.,/~::ns. ~,~/// ~ ~ .............................. ......... ........................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................................................. ................................................................................................ Name of owner of premises .................. .~2,,'.~e:.L:~,?./...kT...? ....... ./.~.L(..,~:~ .............. ~:.~...Z.~..z.'::,.,q..C...>.. ................................................ If applicant is a corporate, signature of duly authorized officer. . (Name and title of corporate office~r)/) Builder's License kb, Plumber's License No .................... : ............................ Electrician's License No ............................................. Other Zrode's License No ............................................... // ~ C~, ~)/ '~ , 1. Location of land on which proposed work will be done. Mop N .: ....~.~ ............. ~w...~k~,NoA...:7 ................. Street and Number .......................... ~':~ ~-'~' <~./~ ........ Z~ff,E~.~ ...... ~:~&:~ ......... Municipali~ 2. State existing use and oCcupancy of premises and intended use and occupancy of proposed construction: ~<~ a, Exisiting use and occupancy ....................... ~...~ ..............~ ........................ p ....................................................... b. Intended use and occupancy .................... =...~,.~....~....W-~-= ........... ~ ............. ~ ...................................... 3. Nature of work (check which applicable): New Building.~ ................. Addition ............. .~:~ A)teration ............... P, epai r .................. Removal .................. Demolitio~ .................... Other Work ................................................... ~' / -~ d"O ~Description) c>oo ...................................................................... 4. Estimated Cost ............ ~.. ............................................. ree (to be pai~ on tiling this application) 5. ff dwelling, number af 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~mens~ons of existing structures, ff any: Front ............................ 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 .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 1D. Dote of Purchase ...........~ ............................................ Name of Former Owner ......................................................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed constructlon ~i~late~z~ any zonings[law, ordinance or regulation: ........................................................ ~. w,~ bt b~ ~egr~ded ........... ~ ......... ~.fi, b~ removed f~om premi~e~.:,¢ ~ V~ ¢ ~ ~o Name of Architect .............................................................. Ad~ress ................................ Ph6ne No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... ~ PLOT DIAGRAM Locate dearly and distinctly a]~ buildings, whXbther existing or proposed, and indicate all set-back dimensions from property lines. Give street and black number Or descriptio~ according to deed, and show street n~mes a~d J~dicate ~vhether interior or corner lot. STATE OF NEW YORK, COUNTY OF '"'~l~'.~ll~ ........... .................................. being duly sworn, deposes and soys that he is the applicam obove nome& the ............................................... ............................................................... of s~id owner or owners, and is duly authorized to perform or have performed the said work and to make and file 'this application; that all stotements 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 flied therewith. Sworn to before me this '~1; .............day of ....................... ~,,.~. .......... ,~9....,~.~. /'~,,~,, _ (") .... ..~.~...,~.., Nota,¥ Public, ................................ ~1~ '~'" Cou ty C))' "~'"~'P""~ ...... ~:¥~,:'" "7: ............................ -"--~- ' ," - (~3ignoture OT opplicon~) -- ,/~ I:LIZA~ETH ANN NFVILL~: NOTARY PUBLIC, State of New York NO. 52-8125850, SuffelkCo Term Expires March 30, 19