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HomeMy WebLinkAbout8413-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. z7699 ....... Date ....... O'dhe ~, .......... ' 1977' ' THIS CERTIFIES that the building located at . Sound..Road .............. Street Greenport, N. Y. Map No..XX ...... Block No.~ ..... Lot No .... XX ...................... conforms substantially to the Application for Building Permit heretofore filed in this office dated Ma~n~h 4, ..... , 19.76. pursuant to which Building Permit No.84].31.. dated l~arch 8 ...... , 19 '76" 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 . .~nqroun~ swimming .pool with. f6n~e. 6nclo~ul~e ................. The certificate is issued to John. & I~clwina- S~ezec .......................... of the aforesaid building. Suffolk County Department of Health Approval . It/l{ .................. UNDERWRITERS CERTIFICATE No. ~27870~ ............................... HOUSE NUMBER . 71'0 ... Street. 'Sound ROa'd/'G~'~f~;' N.' 'Y: ....... 1~'0~.~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~' - .... ,; BUILDING PERA~IT ~? ~ .~ . S PE T MUST BE KEPT ON T,k't EMISES UNTIL FULL ~.: ~. ~ COMPLETION OF THE WORK~.~THbRIZED) ~' N°. 8~I13 Z:, Date .......................... ~..~. ....... ! ......... 19..~.,~... Perr~ission is hereby gront~ to: ~.~. ~~. ~..~a~.~.l~_..~. ~: .:~..~.3~ ~~~ ~, : f~. ~-.~- .~ - ....... . ~ ~. ~.~ ..... .~ ......· ............; .................... : .......................... ~:~-:? - ~, ~ ~t~ ~t ;8~. ~ ................................................................................................. ~iic~.~Oiod ............... ~:.~.....~.., ............... :.-.~ ]~.., ond opproved by the FO~ NO. 6 TOWN OF $OUTHOLD , Building Department Town Clerk~ 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 and installations, a cerhficate 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 ..'....~,~..~ ,... ~.../. · .~..Z.~. New B~ilding ................ Addition ..q ............ Old or Pre-existing Building ....... ~ ......Vacant Land .............. Location Of Property .....~....~.~......._~...~c~....~../) ..... ~"'~'""'~'-';'"'7'''~' ?'~'~r~''''''''~'~,~ .-- ~t /~ ...... "~'~'"~'" ......... Owner Or Owners Of Property ..... ,~.~ ....... ~ ....... .~.~.'~-?~"::.:'~....~.~..~.~ ........... Subdivision ................................................................ Lot No ............. Block No., .......... .~ House Ne../ .......... Permit No...~...~../...~.....~..... Date Of Permit ..~.~....~..../'..7..~...Applicant ~/~'/F~.~~ Health Dept. Approval ............................................ Labor Dept. Approval ........... :~ ................................... ~ ~ ~'~ 7~ ? Plannin~ Approval ~ Underwriters Approval ............................................. ~ Board ........................................ Request For Temporary Certificate ........................................ FinoJ Certificate ~ F. $ ................... Applicant ~.~ ~ . [ ~iii~ii iiireO~e this ............... Couni (stamp or seal)~ '~l~ u/ THE NEW YORK BOARD OF FIRE UNDERWRITERS d I BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK. NI~W YORK 1003e o, te April 14, 1976 .4pl, licatlonNo, onfile 850201 N 27.8709 THIS CERTIFIES THAT only the electrical equipment ~s d~scrlbed below and introduced by the applicant named on the abov~ application number ~n the premlse~ of John C. Skrezec, 28 Sound Road, Greenport, k.I. inthefol[owmglocat~on, ~ B~,.ent ~ i.,trt ~ S,d Ft. garage,outs ide Section Block wan examtnod on Apri] 12, 1976 andfottndtobetncotttpltancewiththeretltttrementsofthtslloard. FIXTURE OUTLETS ~ECEPTACLEStl SWITCHES] -- INCANDESCENTi F~U~ ESC~FIXTURES j RANGES ICOOKINO DECKS t OVENS J DISH WASHERS EXHAUST FANS ' -- I .... SYSTEMS SERVICE DISCONNECT I I S E R V I C E OTHER APPARATUS (Swimming Pool) This certificate coversCompliance at the date of inspection only, Because of unusual environments it is advisable to have frequent test and/or repairs made by a qualified person. DIMMERS AWG OF NEUTRAL Spuds Elec. Svce. Box 166 I St. James, L.I. ll780 LIC# 192E Th~s cerhf~cote must not be altered in any manner, return to the ofhce of the I~oard ~f incorrect Inspectors may be ident~fied by./the~r credentials a. This application must be completely filled in by typewriter or. in ink and submitted in triplicate te the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plat Plan showing location of lot and of buildings on premises, relationship to adjoining, premises or public str. eets o~ areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram which is part of this appl~otlan. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Butld!ng Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspachan 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 Building Permit pursuant to the,~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Law~, Ordinances 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, I~tilding code, ~l~using code, and regulatlar4, and to admit authorized inspectors on premises and in bulldingl for necessd~ns~ic~ ~ , ~ ......... ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... ......................................... ....................................................................... i ..................................................... Name of owner of premises ......'~.Q~H...~....~.:...-~.~.~..~...?n.~..~.~ .......................................................................................... If applicant is a corporate, signature of duly authorized officer. ~ (Name and title of corporate officer) Builder's License No ........... ~..~.~.....H....'~.. ....................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ...............................................~..~.~.~ R.i ~J~ p~ ep~lz,~r~ 1. Location of land on which proposed work will be done. Map No.: ............................. ..'~r..ot No ......................... Street and Number ...'~..~.....~..Q.~..~...~....[i~..?~.:. ......................................................... ~m.l~....~....~...~.'Z-. .................. h~nicll~llty 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 .......... ~......~....!....~?..!2~1./...~......~......~.....~.....~.. .................................................................. 3. J~tt~r~.worJL(check wh-~h applicable): New Building........~... ....... Addition .................. Alteration ................ R~o~-.~..,..~__ --__l~m°~al .................. Demolition .................... Other Work ................................................ . .... , ~,~ ~....~._ (Description) 4. Estimated Cost ......./~q :~.....~...~.~.':Z..~... .......................... 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 c~rs ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ....... .'=J.'~ .............. Rear ...~...?. ..................... Depth ...~:.....~.. .......... Height ...../...2~.. ............ Number of Stories / Dimensions of some structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .......... /.~.. ..................... Rear ....... ../...~'.. .............. Depth Number of Stories 9, Size of lot: Front ....... ..'?..~. .......................................... Rear ........ ..T...~.. ................. ......... Depth ..../...~...Z:.. 3 / 10. Date of Purchase ........................................................ Name of Former Owner ........................................ ............... 11. Zone or use district in which premises are situated ............. ..~::~.....~..'. ............................................... ; .......... '. ............ · ...... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....4~...~. ............................................. 13. Will lot be regraded ......,~...O. .............. Will excess fill be removed from premises: (X) Yes ( ) No A ' 're ...... 14. Name of Owner of premises ..~TI:7.H..~......~...:.~..~.....~...~....~....~'.. .......... c~ ss X-~.~.~,C..V..L%~. .......... Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor .~..~..(~...~..~.~.S. ................................... Address &.~.....~..~.T.~..~......~.....~ ~a Phone No..~..~...~..~.~. PLOT DIAGRAM Locate clearly and distinctly oll buildings, whether existing or proposed, and indicate all setJo~ck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ~ M. TTO/~ STATE OF NEW YORK, ~ ¢ c COUNTY Of ................................ ~' '~"~ ............................... .~.~..~...~....~:.....~.~..5.../...~....~. .................. being duly sworn, deposes and says tbet he is the opplicam (Name of individual signing contract~ above named. He is the /9 ~- ~E /k/T~ (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 oil statements contained in this application ore true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the oppliceti, Rn filed therewi~. Sworn i;~7 me this ~..~... ~ 9 ,~. ~ //~ ~/ ................ doy , .z .. g ' Notary Public, .. ..~x...'~..~ ................ County ~. ........... .'~..: ...~=......~...~......'~...:~ ..... ..... ~;';~;[' ;A~"''¥"''';"t'' ............................ i~i~';~¥t~re ;~";;;l~li;;n~'i ............................ NOTARY FUBLIC S~ate o! New york Nn 52,4358565 Suffotk CountY MES$1NA BUILDING PERMITS '¥~rm Expires Mfl~ch 30, ],9~L P, ~ · 13 ~ ~ 3 la ~' ~ONKONKO~^, L.I.N.Y. 1177~ TEL. JU 8-1243 0 ~ ~. /~ .. .. ~j~ --- t/SE'F- ,,_,, J..