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HomeMy WebLinkAbout8437-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.. Z7.~03 .... Date .......... Feb .. 2 ....... , 19.77. THIS CERTIFIES that the building located at l~uU. D~O~I.. & .~liul.~yar~.. I,~treet Map No. ~ ........ Block No... ~X .... Lot No..~. -ga.s~ · ~,io~. · .~.~.~ ..... conforms substantially to the Application for Bulling Permit heretofore filed ~ this office dated ............ ~ .~ , 19..7~ p~suant to which Bffil~g Pemit No. dated ......... ~ar. 2~.., 19..7~ was issued, ~d conforms to ~1 of ~e req~ ments of the applicable provisions of ~e law. ~e occup~cy for w~ch this ce~ificate is issued is . ~~. oho. S~ly..~wS~g .................................... The certificate is issued to ~om~l .& ~ .~a~oe~ .... ~ ............ (owner, lessee or ten~t) of the ~oresaid b~lding. S~olk Co~ty Dep~tment of He~ Approval ]or · '3.. ~97~ · .by. R, .Villa... UNDERWRITERS CERTIFICATE No. ~32R~96 .... ~-2.7 .~9~ ................. HOUSE ~MBER .. ~80 .... Street ..... ~. Roa~.. ~,. ~Nto~ ............ 7~ Shipyard ~ne .... ......... Bffilding Inspe~or~ FOEM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT -TOWN CLERK'S OFFICE ~ SOUTHOLD, N. Y. BUILDING PERMIT (THIS PE~v~IT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8437 Z FORlli NO. 6 TOWN OF $OUTHOLD , Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcotion must be filled in typewnter OR ink, and submitted m 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, 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 Underwnters. 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 s~te plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conform~ng uses, or buddings and "pre-ex,sting" land uses: 1. Accurate survey of property showing all property lines, streets, build,ngs 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 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 I~te ~'el~ruar~ 1~ ~977 New B~ilding .....X. .......... Addition ................ Old or Pre-e×istin9 Buitdin9 ................ Vacant [a~d .............. South East corner of Yaiu Ro~d ~. Shipyard L~ne, East l,!arion Location Of Property ............................................................................. ; ............ .,, .......................................... Owner Or Owners Of Proper~y ...T).!.o..?,_%.s.....a...kL%~i.,~D.._S..~.n..~_e..~.o_.q.e. ....................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............ ~/24/76 C. ~f. Powe!l Permit No .8...4.,~...7...~. ..... Date Of Permit .................... Applicant .................................................................. Health Dept. Approval ..!]7../..~./.~.~. ......................... Labor Dept. Approval .............................................. 1/. 27/.77 ~9259~ Plannin Underwriters Approval ...... ~ .................. :. ..... .~...: ...... g Boord Approvol ........................................ Request For Temporory Certificate ........................................ Fin~ Certificote ...... ~.X..~ .......................... Fee S bm tted ....................... Construction on above described building and permit meets ..all applicable codes and regulations. ..... ................................... Sworn to before me this Pub,,c ......... (stomp or seal) THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY =tab 85 JOHN STREET, NEW YORK, NEW YORK 10038 v,,t,. January 27, 1977 .~,,.,i.,t,o.,~',,,,,,y,i. 877180 N 322596 THIS CERTIFIES THAT only the electrical equipment ~ described below and introduced by the applicant named on the above appllcatim~ Thomas Santac~oce~ ~in Rd., Bet. Shipyard Ia. & ~ 2.a n. Outside and found to be ~,~ complmnce with thc requirements of th~s Board RANGES CO0~INO OaCKS ~ OVENS DISH WASHERS EXHAUST FANS FIXTURES RECEPTACLES SWITCHJ[S 54 33 21 FURNACE MOTORS FUTURE APPLIANCE FEEDERS DRYERS TIME CLOCKS UNIT HEATERS '4ULTI-OUTLET SYSTEMS NO OF FEET DIMMERS SERVICE DISCONNECT S E R V I E OTHER APPARATUS. NO OF CC CONe C A W G NO OF HItEO A W G lNG OF NEUi'RAL$ OF CC COND OF HI LEG 1/0 tJ I AWG OF NEUTRA( 1/o Mike Sili~:is Main Rd. East Marion, N,Y. GENERAL 10939 Lie. 6L7g O · · lt,s c~,t,hcale must not be altered in any manner, return lo the office of the Board ~f ~ncorrect Inspectors may be ~denhfled by thru TOWN OP SOUTNO BUILDING DEPARTMENT ...... ..... Disapproved a/c .......................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter ac in ink and submitted in triplicate to the Building~~ Inspector, with 3 set~ ofcplans, accurate plot plan to scale. Fee according to schedule. b. Plot Plan shOWing location of lot and of buildings on premises, relationship to ad oining premises or public streets areas, and g vJng a deta ed descr pt on of ayout ofproperty 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,,O 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,r 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 og~,es 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 or builder. ~ilde~ Name of owner of prem ses ~....~......&,...~.~....l~.....~.?....8....~..~..i?.,,e.e. ....................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No....~... ............................................ Plumber's License No. ~.?...~?......(~.....,4~.i-?.L...i~...~... (i~ lite lSeellled Electrician's License No. d~ d~ ~er ~e's ~ice~se ~ ............................................... L~ation of la~ on which proposed work will be done. Ma~o~..~..~t No....~ ................ Street and Numar q~.~.~...~.~..~.~..~...~..~.~l...~..~l...~~ ..... Muni~ State existing use and ~cupancy of premises and intended use and ~cupancy of propped construction: a. ~isiting use a~ ~cupancy ~ ~o~ ~e ff~xt~ ~we]]zn~ ........................... b. Intend~ use and ~cupancy t ' 3. Nature of work (check which c~oplicoble): New Building ~ .......... Addition .................. Alteration .................. Repair ................... ~mev4d ..................Demolition .................... Other Work ................................................ . ..... ? o (Description) 4. Estimated Cost 'i"Ull~ ......................... ~ ............. 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~j~ll~..l~e~et~d ................................................................................................................. 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 .U.! ............................Rear ....lit. ................. Depth ...~.? ............... Height ...~dt ..........Number of Stories .....~1~ ..................................................................................................... ~ .... 9. Size of lot: Front ..... ~'~1. .......................................... Rear ..l~.~.e...~ ........................... Depth .~l~.~.:~ ........ 10. Date of Purchase ........................................................ Nome of Former Owner .~,..~1~1~0~.~!1~ ............ i ........ 11. Zone or use district in which premises are situated ~,lll~t~l.l~t~;[~,~ .......................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ...... ~ ............................................. 13. Will lot be regraded ....~ ................ Will excess fill be removed from premises: ~ Ye~' ( ) No 14. Name of Owner of premises ..~J..&.-M..Bm~e~ee® ........... Address ..~l~i~ .................... Phone No..~&~[~..~ Nome of Architect ............ ~..&.M.~a/~14~e~ ........... Address ..J~ ..................... Phone No~ Name of Contractor .......... ~e...~e...ll~l~ll~,~ ..................... Address ...~.~.e. .................... Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back,dimensions from properb/ lines. Give street and block number or description according to deed, and show street ne~es and indicate whether interior or corner lot. STATE OF N~ ;u, ~ c S COUN'I",y OF ~--%.t~l~T.~..J/~.. ........ ~' .......^"~...~.. ........ ~'e~ ..................................being duly sworn, deposes and soys ~hot he is the applicant (Name of individual signing contract0 above named. He 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 oll statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Notory Public, . ......................... County ............................................... NOTkl~f PUBLI~, St.t~-f No. 52.$t25850. Suffolk Cou~I~ Term Expires M~ch ~, f9 /~ ~.6_~477~_2_0_78___7 z~ Z r~O~.tDE '">e --~' ? 175.00 ~NrENT OWNEI:~ [ SUFFOSK COUNTY BEALTB DEPARTNEN~ DATE NOV O~ 191§ .. D. ~'. # ~ s~:~_~ The ~'~rs':o Oi~posal a~d weter supplsr f ,"t.r'.c., for this !ocotion ~ve been Z~%e~ices Z ~I~CYISA VIDLATION©F R. DHDE APPROVED AS NOTED~ DATE:__ ~ ::~. '~0 NOTIFy BUILDING DEPARTMENT ED IN~ONS: ~ ~F~E ~K~LLING ~OUNDA~ ~IO'N OR ~ART ~RAMING A. BEFORE ¢OVE~ING PIP~LIN~ 3, FINA~ WHEN JOB C~P~TED l