The URL can be used to link to this page

Home My WebLink About8419-zFO~tM NO. 4 TOWN OF SOUTHOLI) BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy Map No... ~ ....... ~loc~ ~o...~, .... ~,ot ~o...k ...... ~ ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ ~.~.. ~1 .~?, 19.~.~. pursuit to which B~ding Permit No. ~l ff. ~ dated ..... .~.( ~.., 19~., was issued, ~d conforms to ~1 of the req~ merits of the applicable pro~sions of the law. The oecup~cy for which this certificate is (o~er, lessee or ten,t) of the afores~d building. S~olk Cowry Dep~tment of Health Approval . ~.'.~ ........................ ~DERWRITERS CERTIFICATE l~o. /.~ ~. w.z .~., .......... ./ ................... HOUSE NUMBER ~~. Street...~. ~..~.q.q~..~ Building Inspector FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT M~ US~T BE KEI~T ON THE PREMISES UNTIL FULL COMPLETI(~N OF THE WORK AUTHORIZED) N? 8419 Z Permission is hereby granted to: FORM NO. 6 TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcation must be filled in typewriter OR Ink, and subm~~the Buildmg 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 F,re Underwriters. 4. Commercial buildings, Industrial buildmgs, Mulhple Residences and s~milar buildings and installations, a cerhficate of Code comphance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildmgs (pnor to Apnl 1957), Non-conformmg uses, or buddings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildmgs 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 dwelhng or land use $5.00 3. Copy of certificate of occupancy $1.00 _/ / mte .... .............. New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..~.~/.ff..~.....~....~..~....0 ............ ...~....~..~.../~...~...~.~.~.~.~..~......~... ................ Owner Or Owners Of Property ..~./.~-~/..~...~...~. ....... ~ ..... .~?..8...~..~'.~...~...O.~.~....~... ....................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............ Permit No ..~..~.ff.~...~.... Date Of Permit ..~.~'..//...~./4?.....Applicant [~-(-~..~....~...,.....~..../~,.~.A./...~..~..~,...,~... ....... Health Dept. Approval ............................................ Labor Dept Approval ............................................... Underwriters Approval ....~...?....~...~..~....~. ...................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fincd Certificate .... ~ ............................... Fee Submitted $ ..~.....~ .................... Construction on above described building anal per~it mee~s oil applic, a~nd ~gu, lations. Sworn to before me this ....... . day of ............ THE, NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~'I ~ I ' 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~a,~.ay 26,"1976, L. ~ppl,.a,io. No. onZ, te 85753.6 N 285499 THIS CERTIFIES THAT ordy th~ electrical equipment ~ ~scrib~ ~low and intr~uced by rhe applicant nam~ on the able application number in the premises o~ Rich~d W. Orathwohl, Main Rd., Moores Lane &Alv~ Lane, Cutchogue,L.I. ~..~.~,,~a o. ~ay 2 h, ~ 1976 /.. , and found to be i. comphance with the requ,rement, of ti, is Board. ~IURE ~ COOKING DECKS DISH WASHERS EXHAUST FANS 1 1 ~'1, DRYERS FURNACE MOTORS SERVICE DISCONNECT APPLIANCE FEEDERS TIME CLOCKS MULTI-OUTLET DIMMERS SYSTEMS NO OF FEE1' S E R V I C E NO OF CC COND A W G [ NO OF HIL£G A W G [NO OFNEUTRAL$ A W G P~E Z OF CC COHO OF HM. EG OF NEUTRAl QTHEII AI~ARATUS.~ ' ' I, , (Su±rr~ing ?oo_~)'This cert±£icate covez~s compliance &t the date of inspection only.' ~ec~use o£ unusual e~v[ronme~s it ~_h~v~_.~e~u~nt ~e.~.. an~/oz' z-epa±rs m~e by a gua3.ifie~ pez, son, FREE ESTIMATES R. C. ELECTRIC ROY CHALMERS COM~ACK. N Y 11725 Lfc. 1610E GENERAl Per D ~fhcc of the Board il~ incorrect. Inspectors may be idenhfmd by TOWN OF soUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFI¢:E SOUTHOLD, N. Y, Disapproved o/c .~....~.~.---~,~ ME$$1NA BUILDING PERMITS RONKONKOMA, L.I. N,Y. 11779 TEL. JU 8-1243 Application No /' ~ INSTRUCTIONS '~- a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving o detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may nat be commenced before issuance of Building Perrnit. 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 progress of 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 So~thold Suffolk County, New York, and other applicable Laws, Ordinances or 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. ..... "u" ................ (signature cf applicant, or name, if a corporation) .................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Oco ,~u~ C~ Narne of owner of premises ~ C..IJRP--~ ~,,..>. ,(~:'.~I~N If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) 1. Location of land on which proposed work will be done Map No.: ........... .~Sc.l~t~'~.. ......................... f>~.oO~'~oJ/No.: ........................ Street and Number ~x~ ~.. j tJ (<-D, Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy /~..~ · b. Intended use and occupant,~ ........... .~...~....!....,~......~?.....(....~......~.. ~ ...~... ~ ................... 3. Nature of woik (check which applicable): New Building ~ ................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...~...~...9.....o~....-..~ ................................ Fee ...../.~'~....~....~ ............................................................ (to be paid on fi!ing 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 ....'..'7..o..~ ................ Rear ........ ..'~.~ ................. Depth ...~..~ ............. Height ....... /. ............... Number of Stories ............./. ................................................................................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ..... 8. D'mens,o.s of entire new construct,on: Front ....... ...................... Rear..::JJ J :J:JJJ::'Depth ...... ............ ~.e?~'., ,~'u,,, ..-..-~.~.. ..... Number of Stories ...................................................................................................................... 9. Size of lot: Front ....J..'7..~. ' .................. Rear ...... ./.~.2.;g.~ .............. Depth .....~...~'./.:..~..0..~. ......... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in ~hich premises are situated . ...~. ~. ~ .'. ......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ...... ~ .0. ................................. 13. Name of Owner of premises .~l.¢~H~,~,,,~.~-/~.T.t/./~f3.~..~Address ...~/).IAL/>...~.'...G...~.T.~.~..¢~....~,. Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ....~.~a~.~-.R~.~.....~q~.~ ............ Address .~e.~.f~!~.~.o.~.p.~..; ......... Phone No.q~..~.1~'..~.o. ..... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fram property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or c'~,"~, int STATE OF NEW,~ORI~,~ / ~' ~ $.S ........... tl.~Z.J,4P..:.., ./~.. .......................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. 'H~ is the .............................................. ~ ............................... ~ ....................................................... (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 all statements 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 fil~d therewith. __ -- - Sworn to befor9 me this ~ ,// ///~ , / xg(~ ~-/~ / ,/ · ................... ........ ...... c.~. ~ ~yF.~ c~ ~ ~u~ ~ ~EL. JU 8-124~ J LE" O0 .-.. VIIV L L