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HomeMy WebLinkAbout8384-zTOWN OF $OUTHOLD BUH.I)ING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupancy No. Z. 7.2.6.0. ...... Date .... .S.ep.~.e. ~?.~.e.r.. ?.9. ......... , 19..7.5. THIS CERTIFIES that the building located at 1~/$. PZ~r,. lsla~.cl .I~, ..... Street Orient By the Sea Orient, N. ~v. Map No.. ~k4~ ...... Block No...X ....... Lot No...98 ............................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .. F.®b. 2b~ ............ , 19. ?h pursuant to which Building Permit No. dated .. F. eb. 2bt ............. , 19.9.6., 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 Private..0z~e..fs.~.i~.. dw.e. ll~lng .................... ~ .................... The certificate is issued to .l~r~e. ~ .F.I'aD.~$. L~,bxtrt. ............................ (owner, ~) of the aforesaid building. Suffolk County Department of Health Approval . .3.e~.t.:. 2.9. ~. ~. ~.7.6...( .R.o.b.? .rt. .¥.~.1.1.~. ). UNDERWRITERS CERTIFICATE No...N.2.9.7.0..9.~. .................................. HOUSE NUMBER .2.~. 3.0 ......... Street .P.Z..u~...I.s.l.a..n.d...L~..n.c. ...................... ............................... ............................... Building Inspector ~'01~1~ 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) r? "- 8384 Z .L~-~~ ~ ~ at' pr~emises !ocbted at BiJilding Inspector FORM NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office $outhold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcotion must be filled in typewriter OR ink, and submitted ~n 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, aha 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 exishng buildings (prior to April 1957), Non-conforming uses, or buddings 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 os to use, occupancy and cond~hon 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 Rte ..... ..... New Bqdding ../:~...). .... Addit,on ................ Old or Pre-existing Building ................ Vacant Land .............. Locohon Of Property ....~..~....~...~....,~.~....~.~.'.../~.Z~'~..-).......~..~.Z~..~. ................................................................. Owner Or Owners Of Property ..../~....~..~.~.~/~....~...../~.../'~..../~....~....~....~-.,~......~.../...~.~./..~.~.... ................................... Subdivision ...~./~.../:.~-.X~....'~..,.~.../....~.../'~...~...~..'~...../~.. .......... Lot No..Z .~..... Block No ............. House No ............ Permit No..~.>.~. ..... ~..... Date Of Permit .~.~./~j~..~..Applicant . .~.~.,..~...~.~....../~....~..~....../~../,../?. ....... Health Dept. Approval 7/.~..~;~/.~....~..~/~..Labor Dept. Approval ....... ~. ................................ Underwriters Approval~..f~..7..~....~...~.... ................ Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FinQI Certificate ........................................ Fee Submitted $ .................................... Construction on above described building and p~.,mit meet~s.~all applicable codes and regulations. ,~ Applicant ...... ~...~....../...C~ ....................................... Sworn to before me this // ................ day of ............................................ (stamp or seal) DLx/~ ~ Notary Public .................................... County THE NEW YORK BOARD OF FIRE UNDERWRITERS d I BUREAU OF ELECTRICITY I 85 JOHN STREET. NEW YORK, NEW YORK 10038 vo,e August 6, 1976 ~ppa.atlonr¢o.o..fil~ 852337 N 297095 THIS CERTIFIES THAT only the electrical equlprnent as de~crlbed below and introduced by the applicant ~amed on the above application number in the prernlses of Mr. Liburt, 2130 Plum Island Lane, Orient Point, k.I. i. rae/alt,,,~,i.g~o, at,o.; ~ Ba,~,.ent [~ r, tr~. [] ~nd ~. outsideSection Bloc~ rob wa. ex.,,,,a~d a. August 2, 1976 and fo~nd to be ~n con~pliance with the requirernents of thi. Board, FIXTURE t I FIXTURES , ~.cu,v OUTLETS 1ECEPTACLES SWITCHES INCANOESCENT FtUORESCENT w~o~ 16 21 I0 16 O.VERS t FU~-^C~ M0~gRS, I FUTURE.~ APPL,A.¢E FEE°ERS SERVICE DISCONNECT I I O0 I CB OTHER APPARATUS. RANGES SPECIAL REC'P/ S E R NO OF METER NO OF CC CONO ~IMECLOCKS ' ~lL UNIT' HEATERS - DIMMERS V C E I GFI D.P. Elec. lnc. 349 W. 13 St. Deer Park, L.I. 11729 L i c 46 I GENEE~~ Th~s cerhf~cate mast not be altered ~n any manner, return to the ofhce of the Board ~f ~ncorrect Inspectors may be ~denfif~ed by ~enhals. 0 I¢' l-¢ ,J.,' ;_ ,'~', h~ I~) ~_ -'- Z tN'~UI%/kN¢I:; trqHicate to the ,Butidir~ INSTRUCTIONS a. This application must be completely filled in by typewriter or.in ink and submitted in . Inspector, with 3 set~ of plans, accurate plot plan to ~ale. Fee accord,ng to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areca. S, and giving a detailed description of layout ofpraperty must be drawn on the diagram which is part of this application. 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 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. B .A,P..PLI _CATIO~N .!S HEREB. Y.MA_DE to ,thee B.uilding Department for the issuance of a Building 'Permit pursuant to the u.mng Lone vramance at the ~own at :~mold, Suffolk Counb/, New York, and other applicable Laws, Ordinences or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as heroin described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulaticm, and to admit authorized inspectors on premises and in buildings for necessary i~-~octions. (Signature of applicant, aflame, if a corporation) ...............................' ............................. State wh~ether applicant is owner, ,e~_~ agent, architect, engineer, general C~, electrician, plumber or builder. ..... ...... .......... : ................................. :.,:Z,:!:::,,i .................................................. Name of owner of premises ....~...~.....~..~.....~~ ........................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title o~/~orporate officer) Builder's License No ..................................................... Plumber's License No. ~ ~'/-'/~ ~'~ Electricians L~cense No ............ ~./. ............................ / Other Trade's License No ............................................... 1. Location of land an which proposed work will be done. Mgp No.: .....-~...~./...~'.~.. ...................... Lot No....~...~.... Street and Number ,....~..~...~......~....~..0.~. ............................................. ~.~i. , Municipalitl~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed ~l~truction: a. Exisiting use and occupancy ..................................... . ............................................................................................ b. Intended use and occupancy ...... F~..~ .............................~ ...................................................................... 10. 11. 12. 13. 14. Nature of work (check h applicable): New Building....~ ..... Addition .................. Alteration ................ Repair .................. Removal .................. Demolition ......... ~lf......~t h~,,~k .................... i~'~il~i~'~ ........' .... Estimated Cost ............................................................ Fee ...... ~ .................................................................................... (to be paid on filing this application) If dwelling, number of dwelling units ......... J. ................. Number of dwelling units on each floor ............................ If garage, number of cars ..................... J. ...................................................................................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth ....... ............. Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of~Stories ................................ Dimensions of entire new construction: Front ........ ..'~..~.../. ................... Rear ......."~...~.-/.. ............. Depth ~/~ / ~ I Height ...... ./.?. .......... Number of S~ories .................................................... : ................................................................. Size of lot: Front ..... /~.:...2....~.. ................................ Rear ...(...~'..~..~.~ ............. .......~h ..... ~ ....................... Date of Purchase ........................... .J....~.~.. ................. Name of Former Owner .!~//'~'~'~ ~ ......................... Zone or use district' in which premises are situated ..................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation: ........ ..~..2 ......................................... Will lot be regraded .....~....~.~..?.~ ........... Will excess fill be removed from premises: ( ) Yes ( .~ No Name of Owner of premises ....~..~...~~ ....... Address ................................ Phone No ....................... Nome of Architect ...?~.~--' '~ ~/) ......... Address ..~ Phone~' '"'- ' No. Name of Contractor ..~.....~-..~....~. Address .../..~:./...~.~Phona~) ' ~'~" No..?...~..?..~...~.?..~.~ P~OT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indica/te all set-back dimensions from property lines. (~ive street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ~ ¢ ~ COUNTY, OF ..~; ........................... [~',~,, ................................................................................................. oemg duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. .............................................. ('~c;,t r;3ctor;"~gent, c c;;~; ;; ;;; ' ;~'~i~:'~'j ';~'~;.'i ............................................................... of said owner or owners, and is duly authorized to perform or have 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 be~o[e me this - ~- 'F --' ~ ....... ~ ................ Y ..................................... ~'0'1' ,'~:J'~J~ .... ~'/ ~'/~ ~. // Notary Public, . ...... i....': ....................................... County ,~...~/..6~:( . ~//-4..~..:. .:.,~..: ........ ,~ ~~,~ ,~, .~'~-~ ~/'(S'~Fmture of/~Splicant) NOTARY PU~L'TC, Sf~te ~f i~ew Yor~ No. 52-~S22026 - Suffo~;: County Commission Explre~ March 30~ I~.,m~l ~' i i -YJJ tL., 0 0 0 5S'•o' ? 7Z2 = m 0 o°vf 'n Ln t aTO Y r U f� o LOT �� 96 47S.mj2' 0. 740 i29' 30' V - 145 . 44.' 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