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Home My WebLink About8426-zFOF,~I NO. & TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . l~gr~.h...~.~.¥~.ey...R.o.a.d. .... Street Map No..L..e.e.~.ar.d..~.ttBlock No ........... Lot No, . .~.0. .... .8..o~..~.~.o.l.d....~.,.Y.: ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... S..e~4~2.' .~.~7.6., 19.7.~. pursuant to which Buiiding Permit No...~..~..~.Z.. dated .......... ]~bI'...I~..., 197~6., was issued, and conforms to al1 of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to ~.oy..C..,. ~.o..~.sg.~.....O~rne.~ .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health ApprovaJ Allg..26.. J.9.7..6...b~r. R,..V.i.1.]:~. ..... =DERWRITERS CERTIfiCAtE ..... ............. HOUSE NUMBER .... 7.~.80. ....Street ....N.O.I'..t;~ .B.a...y~..~.¥..R.o.~? ................. Building Inspector ~OR~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF TIlE WORK AUTHORIZED) N? 8 26 Z Permission is hereby gronted to: ..... It~r "¢~'"~ellml~ ......................................... ............... 61.....~ea,~..~e&4.; ....... ~ to ~t~a. ~w...on~.. £am,l,}r. :~i~;~n~ ..................................................................................... at premises located at .,]~0:1;...1~)....~l~I~'~l'~..~'~ ....................................................................... pursuant to application dated ................... ~Z'......~6 ................... , 19.~.., and opproved by the Building Inspector. FOBM NO. $ 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 oil buildings, property lines, streets, end 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 existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: l. 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 dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 D te ............................. New Building ...~, ...... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...~[2.80...~T.....~g.v.£e.~z..D. cl. ..... ~.O. tL~Dlf[.s...~,,~Z ................................................... Owner Or Owners Of Property .......... ~.o.~....~.;...~..o.~.~.~..o..z.z. .......................................................................... Subdivision ..~.~.f~.f~X'..~...~.a.T..(~.~ ............................... Lot No....1..0.. ..... Block No ............. House N o, .?, ~ .8. .0, . Permit No. ~426~. ........ Date Of Permit ..~/.J.~./.?.'~..Applicant .~Q~....~.,...~.D.[3ZZ~.D;C ............................... Dept. Approval ..... .X(..~. ............................... Labor Dept. Approval ....... ~ ..................................... Health Underwriters Approval ..... .~...r,? .................................. Planning Board Approval ....~. .................................. Request For Temporary Certificate ....... ~Tp ............................. Find Certificate ..Y...e..s. .................................. Fee Submitted $ ............. .~ .................... Construction on above described building and Rermit meets all applicable codes and regulations. ....... ............. ............... Sworn to before me this ' .......................... .... .................... Notary Public .... ~ ....... County, , ~," ,,THE NEW~'YORK BOARD OF FIRE UNDERWRITERS rt'1 , ' ' I~ ", ' ' ' BUREAU OF ELECTRICITY = / J~ ~, ~;,, 'Jt.,;l[[~)~;,,fl!.? ~,i ..,~ 85 JOHN STREET NEW,,YORK NEW yORK 10038 ' ,~ ~ , ' only the cintra] equipment ~ ~scribed be~ ~ intr~'c~ by ¢~ applicant named ?n t~e a~ app~cat~o~ n~mber m the prem~es . Roy ~C.. Johnson, w/s North"Bayview.Road'Ja~ob's 'LaneaTopsail Lane,".~ S~uthold~ "' outside ~ , .3 , was examined oq ' Auras t 2 3'~, 3 q 76 , 'and found to be m com~li.nce ~ith, the requ~rtm¢.ts of this Bo.rd ...... RX~URE FIXTURES , ~ EANGE$ DISH WASHERS EXHAUST FANS OUYLET5 $WITCHE$ DRYERS n .1' ,,FURNACE MOTORS FUTURE APPLIANCE' FEEDERS TIME CLOCKS: UNIT HEATERS MULTI-OUTLET , DIMMERS SYSTEMS NO OF FEET SERVICE DISCONNECT L, ,h ~ 1112 INs , t A W G NO OF HI LEG d Cr-.~NWll ,~Ge. NO OF NEUTRALS ~CCCOND , , , ," ,, .%-.,.~v, , ~ .... ,.,,~ ,,;j,, ,, -'" ,, ',,,j , ".,." '~,,.':{,,'",,i'", ~,,,., ,3. :- ,, - ,; · I = "~" ~'3 ;~/;'----_ ,,, 1t : ~¢ ,: h -. ,,! , ~ ,, ~l m ,d ' ,I, ' GENERAL MANAGER of the Board if incorrecl nspect0rs~may be identfed by ~helr'l TOWN O~ SOUTHOLD ~ ~ .~ *ttLl~ffi ~ IUILDIHG PEblT IN~U~I~S b. Plot plan ~ing I~ofio~ of I~ and 0f buildi~ ~ premiss, r~l~flog~ip ~o ~ini~. pr~ or~s, and givi~ o ~toil~ d~ripti~ of I~ ofpr~ must ~ drown ~ t~ di~mm ~ch is ~ of ~is ~lic~i~. c. ~e ~A c~r~ by ~is o~licoti~ ~ m ~ com~ ~fore i~uonce of Buildi~ Pe~it. d. U~ O~QI of ~is o~lic~ion, ~e Buildi~ I~tor will iss~ o Building Pe~if to the ~licont. Such ~it shall ~ k~t ~ ~ pr~i~s available for in~im ~t ~ ~rk. e. No buildi~ shall ~ ~cupi~ or u~ in ~ole or in ~ for any pu~se ~er until a Ce~ifico~ of shall h~e ~en gmnt~ ~ tho Buildi~ In--tar. ' APPLICATION IS HEREBY ~DE to the Buildi~ ~nt for ~e i~uonce of o Buildi~ Pe~it pulnt Buildi~ Zme Ordinance of t~ T~ of ~old, ~lk Count, New York, and other opplic~l~ Regulations, for the c~m~i~ of buildings, oddities or olter~i~s, or for m~al or ~lit~, ~e applicant ogres to c~ply with all o~licable I~, ordinal, buildiq c~, h~si~ c~e, a~ ~ulati~, (S'gn~u~ o~ ~liconf, or m~, if (A~ of ~licant) State whe~er applicant is ~ner, les~e, agent, o~hif~t, engineer, general c~tmctor, el~tricion, plum~r or buff Nome of owner 0f remus ~g~ ~ ~o~80: If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No..~ ............ Electrician's License No. ~.~z...~.. ......... Other Tmde's License No ............................................... Location of land on which proposed work will be done. Map No.: ........ .5..5..~.9. ....................... Lot No. 10 Street and Number ,~..,0,?,.,~.,~,...~. 3'..v~ew Rd. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy .~.o...a~....t....~...a~...~.... b. Intended use and occupancy ..... (~,.{~...~.{~1~.~1,~..~.~.]~.~ ....................................................................................... 3. Nature of work (check which applicable): New Building, .~,.~. ....... Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior, .................... Other Work ..................................................... (Description) 4. Estimated Cost ....~.!..~.~.0...0..9..*..0..0. ................................ Fee ...:~..~.l..p..0...O. ......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... .Q~.e. .............. Number of dwelling units on each floor ....Q~. ................. 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 ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ............ : ................... ................................... Rear ....... ~...0. ................ Depth 28 8. Dimensions of entire new construction: Front 50~ , Height ......1..4..t. ........ Number of Stories ....... .~..~..~. ....................................................................................................... 9. Size of lot: Front ....... .~.0.0.~ ........................................ Rear ...... .1.~.Q.~. ........................... Depth ...~0.0. n.4.~.~ ............. 10. Date of Purchase ....... .~...e.g..~..*.....1..!.L...1...~.~.~ ............... Name of Former n,----"T'eewa~'d' 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ord~nce or regulation: ....... .~.o. ............................................ 13. Will lot be regraded ....... ~.9. ................ Will excess fill be removed from premises: (][) Yes ( ) No 14. Name of Owner of premises]~3,%....0.,...qT..D~q~'~.{3~ .................. Address ,l~,.Y.~,.~.~,~.f....~..~°hone No. ~..~.c~..-..2.~.~..8.... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGP~M Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back 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. < 70'- ISg' STATE OF NEW YORK. ~ c c COUNTY OF ..... ......... ................... ~Q~..~.,...~Q]3~'3~.QZ3. ........................................... being, duly swgrn, deposes and says that he is the applicanl (Name of i~ividual signing contrac~ ~ above name. He is the .................................... O.~e~. ................................................................................................................................ (Contractor, agent, corporate ~ffic~r, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contain~ in this ap~ication~are tree to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Swam to ~fore me this ....... ~.~ dayof ~.~ ....... ............ ..... .......................... , 19...7.~~~ ~ ~ ~~ ~'C Nota~ Public,. ~OZ~ ..................... C~n~ ~ ......... ............................. ~. 52-812~, SUTr01~ ~Ou~. DISTANCE TO NEAREST WATER MAIN- 22 MILES SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW - COPIES O~ THiS SURVEY MAP NOT BEARING THE L/~ND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO SE A VALID TRUE COPY -- OUARANTEES INDICATED HEREON SHALL RUN ONLY ~3 THE PERSON FOR WHOM THE SURVEY IS PREPAREO~ AND ON HIS BEHALF TO THE TITLE COMPANY, BOVERNMENTAL AGENCY AND LENDING INSTITUTION USTED HEREON~ AND TO THEASSIGNEES OF THE LENDING INSTITUTION GUARANTEES ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD O~SERVATIONS AND/OR FROM DATA OBTAINED FROM OTHERS THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT OF HEALTH S~RVlCES ~ APPLICANT __J~y C__ __~'~Z~,'___ ADDRESS_&L ~$~¢__ff~ /?/~,e~e._~¥...~'~.i' __//gat __ TEL. _~6 ? - ,~..~.,c~__ _ ~ DATE APPROVED SUFFOLK COUNTY DEPARi'MENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY .s REF..0. ::- v NOTES m= MONUMENT O = STAKE ELEVATIONS SHOWN THUS,. 35 0 SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON JUNE 4, 1971 AS FILE NO. 5599 SURVEY FOR ROY C JOHNSON I~ SHERRY A JOHNSON LOT IO "LEEWARD ACRES AT BAYVIEW" AT BAYVIEW TOWN O~ SOUTHOLD SUFFOLK COUNTY, N. Y GUARANTEED TO THE TITL ~ ENGINEER~ NYS LIC ~ HOWARD W Y01 NYS LIC NO 45895 /EYOR YOUNG 8~ YOUNG, LAND SURVEYORS 400 OSTRANDER AVENUE RIVERHEAD, NEW YORK DATE : SCALE NO. FEB, 3, 1976 1"=60' 76-70 AUG P-5~ 1976 / ~/0~~~ - , ~ ~ , DISTANCE TO ~E~EST wATER MAIN- 2~ MILES THE ~OCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD O~SERVATIONS AND/OR FROM DATA OBTAINED FROM OTHERS THEWATER SUPFtY AND SEWAGE DI~AL SYSTEMS FOR THIS RESIDENC~ WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT O~ HEALTH APPLICANT ADDRESS TEL. NOTES SURVEY FOR ROY C JOHNSON 8~ SHERRY A JOHNSON LOT I0 "LEEWARD ACRES AT BAYVIEW" AT BAYVIEW 'row. o~ SOUTHOLD' SUFFOLK COUNTY, N. Y ·: MONUMENT 0 = STAKE ELEVATIONS SHOWN THUS'. 3S 0 SUBDIVISION MAp FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY Q~N..,~..[ 4, 1971 ALDEN W YOUNG, PROFESSIONAL ENGINEER AND LAND ~RVEYOR N Y~LIC NO 12845 HOWARD W. YOUN~ LAND ~RVEYOR NYS. LIC NO 45895 YOUNG & YOUNG, LAND SURVEYORS 400 OSTRANDER AVENUE RIVERHEAD, NEW YORK DAT E- FEB. 3, 1976 SCALE 1"=60' NO. 76 - 70 A. PPROVED AS NOTED ;," i · · 3//~/7~ , :'' '. ' ' 1. B?ORE- ~6KFIL~ING FOUNDA r ~ : ' ,' ' ~, FINAL ~HEN JOB¢O~LETEB ' ," , ' , ,,, :. .' ,: ~ :~ h Id .1 BE,~RO0~ I O' 5 L _£J , ~, ..... ~ ....... iCJ