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Home My WebLink About8438-zFOI~ NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's O~[ice Southold, N. Y. Cerlificnte Of Occupnncy No.Z?~. 7 ....... Date .......... ~a.r,..~. ....... , 19..7.7. THIS CERTIFIES that the building located at . ...C.u.s.t. ev. Av.e. ............ Street Map No. F.air, v.i.e.w..P.%lock No ........ Lot No, . ~.....20~thQld ................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... Ms r ..19 , 19.~.6, pursuant to which Building Pemit No.. dated . j..~l.a? . 2.1~..., 19. ?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 ..P?%.v.a..~e..q.n.e.f.a..m.~.~,v..d.v,e.~.tir~.g..w.~.~..h .a.d.~.f.t.iq.n .................... The certificate is!issued to .t~.. & .I4~..s .~:..D.a.n.~..e~. ~tnte. r-.s....o.u~..e.r..s ............... ~ (owner, lessee or tenant) of the aforesaid l~uilding. Suffolk County D~partment of Health Approval lq.R. ~. ..................... UNDERWRITER~ CERTIFICATE No..N..278.2.6.1. .... A..p?...1..2.. J.~.?.6. .............. HOUSE NUMBER' .. ~.0~. .... Street ....~.u.s..t.e.r..A.v.e ........ S.o..u.~.h.o.~,~l .......... ......... (. 'aing hspector ~o~a ~o. 2 TOWN OF SOUTHOLD BUILDINt~ DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT O1'4 THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8t38 Z Date .................................. jjjj~....~J~, 19.-76 ~:-~: :-: ~' I~erm?ssion is hereby granted to: ,-~ .... ; - -.~ .., .:.~,~..~..~eS,/. .~e.....~.. ~,~ ~..~- ~o~ ~,~u~..~.~*.. · ....................... . ;~f~jie~i~ated at : ....... ~'~ ......................................................................... ,~ ,.,~ ............................... ~ie~ AVe ....~1~ ........................................................ aata ..~Li~LJ~t~.~ ...... ~....tj ...... , 19.~., and app~ov~ by ........ ~ ' Building Inspector . j FORM NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office $outhold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructlons 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: I. Final survey of property with accurate location of all buildings, property lines, streets, aha 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 s~mitar 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: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os 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 Date ..../. ,.7. ,...~. ,(./...-..~...'~.. ................... t New B~ilding ................ Addition ................ O~d or Pre-existing ~uildmg ................ Yacan Land .............. Location Of ap --7 ....... ; ............... : ...... :'..-~.~ ................................ '-.-..~,-/.:< .~'.~ ............................ Owner Or Owners Of Property ..../.'/./..,4;~::~. ~.//,./.,/.~.~.....~..~/..~./..~.~.~/.~.,~....~..~. ..................................................... Subdivision ...<~....~../r.".~.~..~./.~.....~.'~..'..,%~.. ............. Lot No....~..~..... Block No ............. House No ............ Permit No -~..r~-.~'~''~.~. Date Of Permit ~.~.7.~,..~...'.~.~,Applicant ..,,~.~.-~.~//./~.,. ~'.,, ............. Health Dept. Approval ............... .~..~.c..~...~..~..< .............. Labor Dept. Approval ...~.'../.~..."~./.¢..?. ............................. Underwriters Approval .............................................. Planning Board Approval .~.~./.C.~./..%~ ......................... Request For Temporary Certificate ........................................ Final Certificate ..... ,../~.,.~. ............................ · Fee Submitted $ ..~....¢~.~ ..................... Construction on above descr,bed building af~d permit meets all ~.~pj~z~lilicable codes end regulations. Sworn ,o before me this Memorandum from .... BUILDING INSPECTOR'S OFFICE TOWN OF $OUTHOLD Town H^LL, Sou~rHOLD, N. Y. 1197t 765-1802 March 5,1986 Up--dated C.O. was done Original in B.P. file 1726Z Permits involved Winters Winters Winters 1726z 3686Z 8438Z dsm / / THE Uate April 12, THIS CERTIFIES THAT NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 135JOHN STREET, NEW YORK, NEW YORK 10038 1976 Ap.l,*a,,onNo. onS,'e 846q43 N 278261 only the electrical equipment o~ described below and ,ntroduced by th~ applicant named on the above application number in the premises of Ha~o:~d Do ~$nters, 505 0uste~ ~venue, in thefollowing location; ~ Buzement ~ 1st FI. ~ 2nd Fl. 0~ Section Bilk Lot ~..~.,.~,,~,~o,, April 8, 1976 andfoundtobe~ncotnpltancewitl, tberequtretnentsofthisBoard. F XTURE F XTURE$ RANGE$ COOK NG DECKS I OVENS DISH WASHERS I EXHAUST FANS OUTLETS ~EPTACLES SWITCHES INCAN~SCENT[ F[UORE~eNT ~Y I ~T K W ~T K W ~T K W ~T K W ~T H P ---~YERS FURNACE MOTORS FUTURE A~LIANCE FEEDERS ~PECIAL EEC'PTi TIMECLOCKS ~Ett ]UNIT HEATERS MUL~z~U[LET ] DIMMERS SERVICE DISCONNECT I NO OF I S E R V I C E OTHER APPARATUS. W. B. Ruland, Mattituck, L.I. Lic. 242E GENEtAt~NASER ~l This cert,f,cate must not be altered in an). manner, return fo the offsce of the Board ,f ,ncorrect. Inspectors .0¥ be ~y thg/r ;reden~hals~ ~ I~~ ~~.. ' mi TOWN OF SOUTHOLD ~ '. ~ BUILDING. DEPARTMENT-~ /~ ~ ~ ,~./.--. /~ ~ '~- TOWN CLERK'S OFFICE ~ :;1~...%,/~ SOUTHOLD, N.Y. ~/ J_- ~, ~ . ~.~ ~/~/-/~ ~/~ ~; ........... ~.~ ) ~~ ~~ ..................... ..................................... ~ ................ ~. ............... ~...... ~.~..~.....~ o. Thi~ opplic~tion mu~t bo completely fill~ in b~ ~writer o~ in i~k ~ *~mi~ in ~ripli~t~ b. Clot plan ~howin~ I~tion of lot ond o{ buildin~ ~ premi~e~ relotion*hip to ~loinin~ premi~ or public oreos, ~nd oivin~ ~ detail~ d~crlption o{ I~out o{pr~ mu~t b* drown on th* di*orom which i~ ~ o{ thi~ opplicotion. c. lb* work c~md b~ thi~ o~licotion m~y n~ ~ commenc~ b~fore i*~uonce o{ Buildin~ ~ermil. d. Hpon opprov~l o{ thi~ opplic~tion, ~ Buildinfl Ink,tot will i~su~ o Buildino ~*rmlt to th~ opplic~nt. Such p~rmlt shall be kopt on th~ pr~mise~ owil~bl~ {or in~p~tion throu~h~t th~ work. e. ~o buildin~ ~h~ll b~ ~cupi~ or u~d in whol* or in po~ {or ony pu~ose whoever until ~ sholl h~w ~n ~mnt~d by th~ Bufldino In~p~tor. A~klCATIO~ IS HER[BY ~fi to th* Buildino Dopodm~nt for th* is~u*nce o{ o Buildino ~rmit pumu~nt to tho~, Buildino Z~ Ordin~oc* o{ th~ Town o{ ~uthold, Suffolk Count~, ~ew York, ~nd oth*r ~pplicobl~ R~ulatlon~, {or th~ con~tru~ion o{ buildino~, nddition~ or oltemtion~, or {or removal or d~molitlon, lhe opplicont ~r~*~ to comply with ~11 ~pplicoble law~, ordinances, buildin0 c~, hou~i~ c~, admit outhorized ink,tom on pmmise~ ~nd i~ buildln~ {or n~e~ ............... ........ ~ C~ ~ ~ ~ (Signature of app leant, or ~me, it a comomti~) /~ ~ ~ ~ ~ ~ (Address of applicont) ..... :~.~.A~..../~///..,..~.~.' .................. ~ ~ c//(Name, and title of ~o~te~ //L~ ~°fficer). /, ? Electrician's License No ..................!. ................... '. ..... Other Trade's License No ............................................... '~ "7~f~</ /~' c-'- 1. Location of land on which pr_A~sed work will he done. AArp No.: ...~..~-~........~, ......... ....~.../~.. Let No....~... ................ Street ond ~um~r ....... .(~-~.~..~....' ......... ~.~. ................................................. .., ............................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exis,tinguseond occuponcy .............. ~...~....~.~.:.~.~.~..~. .................................. b. Intended use and occupancy ................................................................................................................ 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................ Repair .................. ~emoval .................. Demolition .................... Other Work ................................................. '.. ~' , , ? (Description) ' 4. Estimated Cost ......... ~ ~ ~., 6 ~ Fee /~-- ' 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, ifany: Front ....... .'~..~.... ........ ........ ............. Height ...../~.~. ........... Number of Stories ................................................................................................................. ! Dimensions of same structure with alterations or additions: Front ........... ..~.'..~..~ .............. Rear ...~...~.. ................. Depth .......... .~...~.....~. ......... He,ght ....... ~..~. ............ Number of Stones; ............................... 8. Dimensions of entire new construction: Front ......... /.~...?'.~ ............... Rear ...... ./~....x/.~...~.... Depth ....~...,~ ..... Heig~ht ..... /~.../. ...... Number of Stories ............/.. ...................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ....................... ~ ................................ 11. Zone or use district in which premises are situated ............... .~..~..¢...~,~'~../.~. ........................................................... 12. Does proposed construct~io/~ violate any zoning law, ordinance or regulation: ..... . .~......~....~ ............... ~ .......... 13. Will lot be regraded ..~...~...; ............Will excess fill be removed from premises: ( ) Yes (~"~'No 14. Name of Owner of premises ~.~.~.~ ~..~,/~..~.~,.B ..~./..4~.~Address ..~.~.~Z'.~-~...¢'.; ...... Phone No...~./~.T~.~..~ ~ame of Architect ....~ ............................................... Address :;:;~~;:: Phone No ....................... Name.of contractor ....... ~.4Z.~42....~._~.~A~.. Address Phone No..~....~.~...~..~....'~..? PLOT DIAGRAM ' Locate clearly and distinctly oil 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. STATE OF NE-W,~R_J~7~i/,~ I¢$ /~ ............... ~~.E( ....... ~%~ .................. being duly sworn, deposes and soys that he is the applicon, ~Nam~vidual signfng con~ac¢ above nam~. / 3 ~ (Contractor, ~gent, corporate officer,, etC.) of soid owner or owners, and is duly out~rized to perform or hove performed the s~id work and to m6ke ~nd/file this application; that ~ll statements contained in this opplicetion are t~e to. the best of his knowled~¢and belief;/ond that the work will be performed in the manner set fo~h in the application filed therewith. / / Swam to before me this ~ / / ........................ Co.n .......... .......... -- ~ / // (Signature of ~pl~t)