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Home My WebLink About8730-z· OB.~ NO. 4 TOWN OF $OUTHOLD BU~.~ING DEPARTMENT Town ~erk's Oltice $outhold, N. Y. Certificate Of Occupancy ~ THIS CEBTIFIES that the bui]d~ng located at . .01d..Shtpyar¢~ ~a ........ Street Est. · Map No..F.o..t~..d.e.r.s... Block No ........... Lot No. J..00 ..... .S.o.u.t..h.o.l.d....N.,.Y., ....... conforms substantially to the Application for Building Permit heretofore fried in t_hls office dated ..............,I.u. 1..y..1.~., 19..7.6. pursuant to which Building Permit No.. dated ..........J'..tO-. Y....1.1~...., 197.6.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to . .R.o.b.e.l~..&..I~t.u~.~ .~40~.rSZ ..... 0¥nel~.s .................. (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval N..,.R.o ................................ UNDERWRITERS CERTIFICATE No...N~2.0.gQ ..... &I~E.. ~...1976 ................ HOUSE NUMBER ..... ~.2.~. ..... Street ...0.3,d...Sh~,pya~.cl. L& ....... $OU,thold .... Building Inspector ~ UNTIL FULL NOT~I ~ee~ ~u~derw~ltera eertl~iea~e Fee to get FORM NO. 6 TOWN OF SOUTHOLD , Building Department 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 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: I. 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 New Bqilding ................ Addition ........... ..... Old or Pre-~e,xisting Building ......... ~.... V'bcant Land~7. .......... .,, Location Of Property ...... .,~..~./.~.;~,..~.Zt....i~,.~'/~.,~~ ....... ~'-(-'~ Owner Or Owners Of Property .L%~.~...'..~...~~¥.....~~.. ....................... Subdivision'~~~ ' ~ ~-~,~C~ ..... Lot No../EZO.,.,.. Block No ............. House No ............. .... i""T'"; ............................. ........... Permit No....~.i.~..,2.U..ZDate Of Permit .~.~./2Jm...Applicant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .................~..~'. ......................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FinaJ Certificate .......,,J~_.... ....................... Fee Submitted $ .5.. ............................ Construction on above described building _on~ ~t~,.zey ~plic~ ~e2s~ ~on~ regulotions. Applicant ~..~..:..~;......~....7.~ ............................... Sworn to,.~,..before me/~..~ / c~ ?this 6 Notary Public ...,,.~¢~.~::'/~'//~ ~' County THE O, te August 5, THIS CERTII~IES THAT NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 J976 ~pplieationNo...Ji,e 870472 N 297090 only the electrical equipment as described below and introduced by the applicant named on the above appl~catLon r~umber ia the p~mises qf Robert Morris, 425 01d Shipyard Lane, Southold, L.l. ..~, .~.,,,i,,~ o. August 2, 976 a~dfou~o~elncompl~ancewithther~q~ireme~tsof~hi~Board. OUTLETSFIXTURE SWITCHES FIXTURES RANGES OVENS DISH WASHERS FANS DRYERS FURNACE MOTORS OIL I SERVICE DISCONNECT S E OTHER APPARATUS: TIME CLOCKI UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO, OF FEET A. WG OF NEUTRAL GFI Swimming Pool) This certificate covers compliance at the-date of nspection only. Because of unusual environments it is advisable to have frequent test and/or-repairs made by a qualified person. Spuds Elec. Svce. lnc. Box 166 St. James, L.l. 11780 This certificate must not be altered in FORM NO. J. TOWN OF SOUTHOLD , BUILDING DEPARTMENT TOWN CLERK'S OFFICE Examined ............. 19Z..~.. Approved ................................ ~.~-..i 1~.~-.~.... Permit h~o. -~-"Z..('~'"?'"i"~'"'"'"~"'- Disapproved o/c.~;~ ................... (l~uilding Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No .............. ~.2. .............. a. This application must be completely filled in by typewriter o¢ in ink and submitted in triplicate to the Building 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 mast be drawn On the diagi'om which is part of this application. c. 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. 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 Laws, Ordinances or Ragu at OhS 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, build_j~g~cod~, hous)~Fode, and regulations, and to admit authorized inspectors on premises and in buildings for necessary_(rnsp~tio~s. (~ __ (Signature of applicant, or name, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................. ~.~....~..~...~..'. ................................................................................................................. Nome of owner of premises ...'~.~.(S.~.~.~h.../~.~..~...~'~4.~. ....................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of cgr, porate officer) Builder's License No ................... Plumber's License No ................................................. Electrician's License No .......................................... Other Trode's License No ............................................... Location of land on which proposed work will be done. Map No.: .~..~.~..~..~.~....~.~Z~. Lot No ...... /.'..0.....0. .......... Street and Number ..... .4J.:.~..~.....~X~....S...H../..~.,?/~.~....~-~.~..-~......; ........................................ .~..o.,~.4,.~...~..g.:~.~ ........ Municipality State existing use and occupancy of premises and in*,ended use and occupancy of proposed construction: a. Exisiting use and occupancy .............. /~.~..D. 4.~...~.-..~..~..~. ................................................................................. b. Intended use and occupancy ............... .~....uq..../....~?.-..~3./...~...~......~-.-.°7g......~'.. ................................................................. 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ................ P, epair .................. Removal .................. Demolitio~ .................... Other Work .....i..~.~..~.~......~.....~....../~:.. .............. (Description) 4. Estimated Cost .........¥-....'R~....c~...: ............................... 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 cars ............................................................................................................................................ 6, If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ..... ~.~.. ................ Rear .......... ~...O.. ................ Depth .....~.9 ........... 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 ......... /'~.J~ ............. Depth ...~.(m. .............. ~ ..... ~..'.~. ....... Number of Stories ..................................................................................................................... 9. Size of lot: Front ............. ?...~..'~, .................................... Rear .......... .,7.,,~,. ........................ Depth ..... .'.~r../'..~.:..g'..,~,. .......... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ............ .../~....~..~....: .......................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... .~....O..: ........................................... I3. Will lot be regraded . ........ ,.~....~.. ........... Will excess fill be removed from premises: ~') Yes ( ) No '- ]4. Name of Owner of premises ....~...~.~.~....~..?.....~...?.,.~..~.I.,S ........... Address ..¥.'.~.~.~..~¢/1~.~.~...~. Phone No....~.~..,~.~.....¢.~" Name of Architect ......... ~¢~..~.~..~. ..................................... Address ................................ Phone No ....................... I4~9~gz.~:~..~,l'.,.~./~/f.~one No...$'3(.~.;:$.~.~..~'... Name of Contractor .....~..~/...,,..~.~....~. ............................ Address '~ PLOT DIAGRAM L.ocote clearly and distinctJy all buildings, whether existing or proposed, and indicate all set-back dimensions froro property lines. Give street and bJock number or description according to deed, and show street names and indicate whether interior or corner lot. D $'FA'I'E OF NEW YORK, I c c COUNTY OF ................................ ~'~'~ ........................ E....~.~..~...~......f~...~.,.~..~./.~..~.. ............................. being duly sworn, deposes and says that he is the applicam (Name of individual signing contract) above named. He is the ......................................................... ~.,.r.=...~...,~,..~. ................................................................................................... (Contractor, agent, corporate officer, etc.) 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 a~l statements contained in this application~re tru,e~to the best of his knowledge and belief; and tk. aT the work will be performed in the manner set forth in the app/lica~on/filed there,~th. Sworn to before me this ~ ] I ~ /il ........ ............ . Notary Public, ......~...~..,,~C...~ounty ..... (~,..,.L.,-,~......~':~,.....~.~.:..' ........ ~. ...................... ///J ~/ ~ (Signature of applicant) ~ ~ KIt~ PLNN /