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HomeMy WebLinkAbout8692-zFOItM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificete Of Occupnncy z 7ass No ............. Date ............................... THIS CERTIFIES that the building located at ..................... ~ t~ 0 '~ ~ ~ L ~ ~ . ~o ...... a ~ Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ., 19 .... pursuant to which Building Permit ~o, ~ ........ G ~ ~ ~L. dated ~JO ~t b~ ?~ o 19 -~ .b, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ........................................................................ The certificate is issued to ........................................................ (owner, ~t ) of the aforesaid building. Suffolk County Department of Health Approval OC ~ 7~ t ~ ~ b ~ & - So - ~ ~ 7 UNDERWRITERS CERTIFICATE No ............................................. HOUSE NUMBER Street .......................................... Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDI~4G DEi~ART~£~T TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8692 Z Permission is hereby granted to: F:t ~.c~.. J~a ~O.a;z~.Q ......... ~/g...,~.t ~u~...&...,T~,~'~ Fuch~ ....... 12~......S:,~z- ~ .. L~k~...g.~.~.v.~ .......... P. ate.h~e to .. ]-.~ ~ .]. ~... 2. ~t.. ~.~ '~.~Z~ .t~...~n.~.. f. amf. ~. ¥.. &u.e :[! t~g ................................................................. at premises located at .~f~...~..~.....~e~.~.~..[~2~.~.$ ........................................................................... ............................................ J~m~t ~!e~r...R~a~t ........ .~o~tbo;~,....N..~-. ............................................ pursuant to application dated ............................ .~.ti~.....~J~ ........, 1~-6...., and approved by the Building Inspector. Building I n~pe~C0 r FOlh~J[ NO. 6 TOWN OF $OUTHOLD , Building Depmtment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY in*tructions 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, o 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 land use $5.00 3. Copy of certificate of occupancy $1.00 Date .................../0 /./~ ...... /. ................. New Building ...... /..~.~... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Loca,,on of Property ........ Owner Or Owners Of Property h~ < ~1 I)/C ¢ ©~.}~,l ~ Subd~ws~on .................................................. '1 ............ Lot No ........ ~ ' .... Block No ..... .~ ....... House No.......,.....' ' ' Permit No...~,!~..~)..~.. ..... Date Of Permit-12, 2.(~ ...... Applicant ..~..k. gJ.~.t..~.~..t.!?.?...., ::.~ Health Dept. Approval .~,.T..~..g..~..~.]...~. .................. Labor Dept. Approval ................................................ Underwriters Approval ........ .~..:.~..~q.~**o. ...................... Plonn ng Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ......... .~../..... ........................ Fee Submitted $ ....~ ............................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ...... J: ~.~, .l~ J~. ~J.[~.9~... J~. ~-..~..' ..., ,~,, .: .................................................... Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) ,~C d~d-~ THE NEW YORK BOARD OF FIRE UNDERWRITERS ak BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~ate October 6, ~.976 Applic..o,,No.o. Sile 8?4243 N 306600 THIS CERTIFIES THAT only $he electrical equipmen~ ~ dezc~bed bel~ and ~ntroduced by t~ appJlcant ~med on the abo~ applicatlo~ numar in the premises of Arthur Puchs, n/side R~r Rd., 260' e/o Main,Bayview Rd. Southold ~Bayview ~. I. ~ ta~/o.o~g ~o¢~t~;~ ~.~,~e.t ~ r~. ~ ~d r~. outside Section Block ~t ~..~..~do. September 30, 1976 and found to b~ in compliance with the requirements of ~his Board. FIXTURE ; SWITCHES FIXTURES RANGES OVENS DISH WASHERS OUTLETS DRYERS OTHER APPARATUS: *Special receptacles: Motor/s: 1-1/2bp 1 G.F.C.I. i Smoke Detector !-30amps., 1-50amps. 1 5 Sapanaro & Mineo Inc., 1 102 Oak Avenue, . GENERAL MANAG~ ~1 Shirley, L.I. !1967 Lic. B3~E _~/~ ~i T~is certifi¢c~te m~st no~ be altered ~n any monner; return to t~e office of ~e ~oor~ if incorrect, inspectors moy be dentifi~d by ~ credentials. ~ TOWN OF $OUTHOLD ,~/ /~ ~ , ~ ~UILDING DEPARTMEN¥ ~/~ TOWN CLERK'S OFFICE~/~/~ - ~~~~ ~ ................... .......................... ............. INSTRUCTIONS ~ a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Buildin~ Inspector, with 3 set~ of plans, accurate plot plan to ~ale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets oJ ~reas, and giving a detailed description of layout ofproper~ must be drawn on the diagram which is part of this application. c. The work cowred by this application may not be commenced before issuance of Building PermiL d. Upon approval of this appljcation, the Building Inspector will issue a Building Permit to the applicant. Such permit ~hall 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 Ce~ificate of ~cupancy ~hall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building P~rmit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances oF 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 inspection,r~x9,. (Signature of applicant/J/or name, if a ~cfo~poration) ....... ....... (Address of applicant) applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber ~'~ilde~. State whether Name of owner of premises ~..~...~..~..~ ~ .~... ..~.0~.l~-.I ~...~.~.. If gpplicant ~ a corporate, signatur,¢ of duly authorized officer. ~)'~' a ean ~-' '~:~)'r~('o'r~'~'C'''~ (~ rj~o te officer) Builder's License No ..................................................... Plumber's License No. ~c,.~l~,~_~,,1.~E,r...~. E ectr c an's Ucense Other Trade's License No ............................................... 1. Location of land on whic' propo d work will be d ne M~pNoi ' bot'o "~' ..................................... Municipali~.~_,~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .~.[ ............................................................................................................ b. Intended use and occupancy ........ ~~(~Z~ ......................... 3 Nature of work (check which applicable): New Building'. ................. Addition ........... '. ...... Alteratioo ............ ,. ~ P, epai r .................. Removal .................. Demolitior, .................... Other Work .................................................. (Description) ~.~21 ~00 ~" ~ ......................................................................................... 4. [sfimated Cast ...................................................... (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. g~mensions of existing structures, if any: Fron~ ............................ Rear ................................ Depth .................... Height ........................ Number oE Stories ................................................................................................................. Dimensioas of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ........................ t...Number of Stories ..... v'"'( ....................~ ~ I , 8. Dimensions~?f entire new construction: Front .~ ............................. Rear..~.~. .................... Depth ~..~ .......... ~,~, Height ..1~. ............. Number of Stories ..... ~ ................................... , .......................................... .l.~..r.I .................. .~ 9. Size of lot: Front ..~. .............................................. N~.~f~..~er~'''= ---~, . . ...... .... Depth.........,..........,.....-. ~/~./ .....~ ,0. ~ o~ ~.rc,~ ........................................................ '""-.....-..... ............ .......-...-.............-...... ~ 11. Zone or use district in which premises are situated ..................................................................................................... 12 Dees proposed construction violate any zoning law, ordinance or regulation: ..~ ............................................. 13. Will lot be regraded ..... ~.~. ............Will excess fill be removed from premises: (~ ( ) Yes No 14. Name of Owner of premises~T~.~.~.~.~.....~..... Address ................................ Phon~ No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contr~ctor~.~.~.[~...~....~ ...................... Address~¢.~.~..~.~.~hono ~o. ~.~..~.. PLOT DIAGRAM Locote clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from propcrty lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. S I-/\'['E OF NEW~RieT-.-.-.-.-.-.-.-.~_I~.~ I S S cou N'r¥.,,~._ ~ ~ _OF ...~L~..... r" ............ ..~.~x.~.~..~.~.~ ........................ ~,,~ d.,~ ~om, ~o~ ~,~ ~ ~h~ ~ ,~ ~,~ (Nome of individual signing contracf) ~bove n~med. He is the ........................................... ~.....~ ............................................................................................................... ~(Contracto~agent, corporate officer, etc.) of s~id owner or owners, and is du y ~to perform or have performed the said work and to make end fda this application; that all statements contained in this applicction are true to the best of his knowledge and belief; IV, at the work will be performed in the manner set forth in the application filed therewith. Sworn to ~fore me this .... .~C~. do~ o~ ................... ~.~.., ~..~ ~,~ ~ ~o~ ~,~,~,. ............ =......~.~..~...~o,,~ ..~ .......... ,~...:~.....?~.~. .......................... ELIZAB~H ANN NEVILLE NOTARY:pUILIO, State of New York Term Expires March 30, ,1 AP~:~OYED AS NOTE~ · ' ' r NOTiFY;BUILDING DE~A~NT A~ I ~ 7~5.2660 9AM,~O ~M ~ REQUI~ J -~ TIGN O~ START~F~ING ' ~, BECORE COVER NG P ~EUNE , ~ 3, FINAL WHEN JOB ~P~ , STRUCTIO~ E~.O~S ' ' ¸=1 t -j