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Home My WebLink About8427-zFO~M lqO. 4 TOWI~ OF SOUTHOLD BUH~ING DEPARTMENT Town Clerk's Office Southold, l~l. Y. Certificate Of Occupancy No. 1~.7~.~.8. ..... Date .......... ~..O~....lt. .........., THIS CERTIFIES that the building located at Hilt. l~oa(l. ~ast; ........... Street Map No. gaiL~e s. ~t:. Block No .......... Lot No, . .~ ...... Bout~old ............... conforms substantially to the Application for Building Permit hereto£ore filed in this office dated ....... I~I'..1 (} 19.. 7~ pursuant to which Building Permit l~lo. dated ....... .P~..~...1.6..., 19..7.6., 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 . Pl':l,'~at~..ol~a l~.a~iLy .cl,~tlLilrig ................................. The certificate is issued to .l~:lis&be.t,h Yalaboill'gal~i~ ........ ~na~. ............ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .,~I0.~. .~ .19.76 .b. lr. I~.,..V.~.l~,a .... UNDERWRITERS CERTIFICATE No. I11308.~.90 ..... 0el;...~0 · . .976 ................ HOUSE NUMBER 87~ .... Street . ltl3.1, lclo~d. ~re~t; ....................... FOi/~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, Ft. Y. BUILDING PERMIT ' "';(~rl~tlS *PER~i~- .MUST BE ,I~E'PT ON THE PREMISES UNTIL FULL (JOMPLETI~0~ ~OF THE ~V~RK AUTHORIZED) . to apphcatmn, ddfe~ ............................. ..-~.~.; .........,......., 1,9.: ..., and approved by the THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 Oa,e October 20, 1976 ~,,pl,ca,lo. No.o. yUe 850227 N 308590 THIS CERTIFIES THAT only the electrwal equipment as described below and introduced by the applicant named on the abo~e appllcxat~ort r~umber in~ t~he pr~erni~e,s of Elizabeth~VanBourgandien, 875 Hill Rd., (South Side), Southo±a, ,... in the following location; [] Basement [] 1st FI. w,,,~xa,.~nedo. October 18, 1976 FIXTURE OUTLETS IECEPTACLES SWITCHES INCANO~$CE FIXTURES FLUORESCENT w,~ DRYERS I FURNACE MOTORS FUTURE APPLIANCE FEEDERS er ~ w ~L3 "FE OAS "" 1 2 12 SERVICE DISCONNECT J NO OF J - S 1 200 CB J x fillER APPARATUS: ~ 2nd Fl. Outside Section Block and found to be in compliance with the req.~rements of this Board. RANGES COOKING DECKS OVENS DISH WASHERS ~,T KW J AMT KW AMT KW AMT J [ W J ll.t 1 ~.6 1 1.5 1 ,PE~ALREC'PT. TIMECLOCKS J BELL J UNIT HEATERS I M~L~LET ~T ~ ~Z ~PS TRANS. ~T H P NO OF FEET 1 30 1 R V I · C A w G , NO O~ HILEG OF CC CONe Lot EXHAUST FANS DIMMERS AWG OF NEUTRAL 4/0 1-G.F.C.I. Robert A. Goodale R.R. 1 Box 15a Main Rd. Mattituck, N.Y. 11952 Lic .#783E D P~ trent[als ' This certificate must not be altered ,n any manner, return to the office of the Board sf incorrect. Inspectors may be ~dentifled by BUILDING DEPARTMENT,,,/ TOWN CLERIC'S OFFICE SOU~OLD, N. Y. ~ om,n ..... D~sapproved..] ...................... a/c~_ ................ . ...................................................... ~ APPLICATION FOR BUILDING PERMIT Date ............. ; .......... ~X jJ..(~ .......... , ~......~....,. ~ , INSTRUCTIONS a. This application must 'be completely filled in by .typ~_writer o~ in ink and submiffod in triplicate to the Building Inspector, with~ 3 set~ 6f pla~, aCcurate pl~ plan to i~ Fee according to schedule. b. Plot plan showing, location of lot and of buildings on premises, relationship to adjoining premises or public streets of areas, and giving a detoded description of layout ofpraperty must be drawn on the diagram 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 Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ,~ , ,'~ (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber o[ builder. Name of owner of premises .....~'.....L..)..~...~..~:~..~...-~....~.. .................................................................................. If applicant is a corporate, signature~f ~l~ly authorized o~fice~r~ ,,/ (Name and tiff& o corpora · o icer) Builder's License No ..................................................... Plumber's License No ...... ....~l.....~.~...T.,..~3q......~..LUka,,.../o.."~9· Electrician's License No. (~ o o~a-}~-.~-~.L..~.~ Other Trade's License No ............................................... ~t JO / 1. Location of land on which proposed work will be done. M~p No.: .~..../~... ...... ~ ..... Lot No......~.~ ................. ...W.,..q. ....... Street and Number .............................................................................................................................. , ........ Municipality 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 ........ .~...~... ...................... ~ ............................ 5 ................................. 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................. Other Work ..................................................... ~',.~ I~ / °~ ~ ~ ~ (Description) 4. Estimated Cost .................. .;...~...°......C~..,~...(~e ............ Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... .Q..~...~..'~......Number of dwelling units on each floor ............................ If garage, number of cars ..... ...~-...~......O. ........................................................................................................................ 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 ............................... 8. Dimensions of entire new construction: Front ...... ...... ~J. ........... Rear .. .~. . .. :. ................. Depth .....~....~. ............ Height ......~.~./..~ ....... Number of Stories ........ I.././...~ .............................................................................................. 9. Size. of lot: Front ....... I..O...O.. ....................................... Rear ......... .~.../:.l.b ..................... Depth ...J...~...~..: ................ 10~ ~l~ate of Purchase, iii ....... '[..~..~....~. ................................ Name of Former Owner .....~...~...Q..~...f~...~. .......... : ....................... 11. Zone or use district in which premises are situated ......................................................... 12. Does proposed construction violate any zoning 13. Will lot be regraded ......~.~.~.. .......... Will excess fill b,e removed from premises: ( ) Yes, ( 1~o 14. Name of Owner of pram sas .E.~...i.~-~.~.~..~...~...~. ~...~... A~re~ ..... }~i~.t..~....t~..:...~.~.~.... Phon~ No.D.....B....~..~...~....~.~..°. ~ome o{ Ar,bit,ct ......... A~r~ ..~.~T~S.~.~ '~hm* ~o ....................... Name of Contractor ~)...~ ......................................... A~res~ ................................ Phone No.Z .................... PLOT DIAG~M L~ate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~k dimensions from prope~ lines. Give street and block number or description according to de~, and show street names and indicate whether interior or corner lot. STATE OF NEW Y/DRK, ~ [¢ S COUNTY ....................... --.....J~.~..~...:..../~.....l~...~....O.j~..~../. .............. being duly sworn, deposes and says that he is the oppliconl (Name of individual signing contracf) above named. He is the ......................................... .~.l'~..:...0..~.~..~.' 'q~'"...T..~~ ................ ' .................................................. (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 cqntained in,this application a~e.true to the best of his knowledge and belief; and that the work will be perfdrmed Ir~ the manner set forth in the' applic~tior~ filed therewith. Sworn to before me this /~..~(~doy of .......................... ~~ , 19 ........ ~/ Notary Pub"c, .........~-'~.~ ..... Cou ty .... ../....~~ ......................... ~ .......... NOTARY PUBLIC, Btate o~fNew Y~k No. 52-4522026 - Suffolk Commi*slon 'J~xp. ires March 30 If.,~.-~ t41LI' Oq I "-----k K~ 67' _J y. ¢ R(IOVE ELEVA-F lO "1 APPROVED AS NOTED DATE: MOTIFY BUILDING DEPARTMENT A~ 765-2660 9AM TO 4PM FOP-. P, EQUIli.', LL) INSPECTIONS: 'i BLFORE t~^CKFILLING ,t ~FVLLED . ~ EiL L A R, FLOOR, 'lOP 'F LLED c"'"l 2. ~L OCK, 2..' L 0 ~,,,] E 1%. ,....r'£,.J i___l .8'gE& ~,V,'.' LI~LLy¢oL.' _ .Z" ,' 1 ~" FIE U Idle P, ~LL .2,-"~'J- c'~" FIR '70iS'TS I ' .3' 1. · CL. I Iv, KtlCIAEN ~. CL, t 3V6" ~ A LL~ ~" L~V, AREA I f -'1 [ C OND FLO 0 ~,- PLAN o OVER ~RA~ I I I !. % 4" FILL - R CHT CLE\/AT ON ,, PLUMblklQ ~, f