Loading...
HomeMy WebLinkAbout8446-zNO. · TOWN OF SOUTHOLD BUILIHNG DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No...Z .77.9.~. .... Date ...............~.u..1.y....2.6 .... , 19..7?. THIS CERTIFIES that the building located at ~./.~..D.e.p.o.t...L.a. ............. Street Map No. ~ .......... Block No..X? ....... Lot No....xx.....CBt..d.~.h. qg~..e .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............~e~'...~.. 19.76. pursuant to which Building Permit No.. dated ...........P...a.r...2..~ .... , 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 ....F.a.r..~...~.t..l~t.~.n.g. ~.s.t.o..r.~.~e. ). ......................................... The certificate is issued to . .J~.dr.e. .&..T.h.o..s...C.y.b..u~..s.k .~ ..... .o~n...e.r.s. ................. (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval . .1~ ~.R.o .............................. UNDERWRITERS CERTIFICATE No...N..~2.21+~ .J.u~..e.. ~..6...~..9.7.7. .......... HOUSE NUMBER .......... ~..~.0.~Street D..epp.t...L.a.n.e. ......... . .C~.t..c.h.o.g~..e .......... FORM NO. ~ TOV/I~I OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby gronted to: · Building Inspector. Fee $.t..~..~ ......... FOI~M NO. $ TOWN OF SOUTHOLD , Building Department Tow. Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, end submitted m DUPLICATE to the Budding Inspector w~th the following; for new buddings or new use: 1. 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 d~sposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buddings, 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: 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 as to use, occupancy end 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 .......~, ~-~...]..~.~. C~ ' .,1.,,2.2 ........... New Bqilding ..... ~.f~ ..... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .'vf~.S..,~e~o.t..T~z~t...C~tc~o~Ae.~...] ..... .~ ...................................................... Owner Or Owners Of Property ...... ~.~..f~...&..~.~.OZ~.S...C~r~:]:S..~'~ ...................................................... Subdivision .........,~.e.~fL, .......................................... Lot No ............. Block No ............. House No...bf~..©. ..~' Permit No ~.~.6~ ........ Date Of Permit ...... ,~/,~'/.7~pplicant ...... .Th~m~s..&..And~o...C~.bzzlstci .... Health Dept. Approval .~./~ ................................... Labor Dept Approval ..... ~/.~ .................................. Underwriters Approval .............................................. Planning Board Approval ..~/~ .............................. Request For Temporary Certificate ........................................ Final Certificate ....... ~ .............................. Fee Submitted $ .~.~.O.Q ......................... Construction on above described building and perm~it meet~ all appl~ab~9 codes a~:~gulations.~ Sworn to before me(,t~his day (stomp or seal) of Notary p~u~b~iyC.~.~ ........ County NOTARY PUBLIC, State of New York RESIDING IN SUFFOLK COUNTY No, $2-53?$900 Commf~s~on Expires M~rch 30. I~..~'..~. THE NEW YORK BOARD OF F1RE ,UNDERWRITERS '~ ' rL1 .' · ~ BUREAU OF ELECTRICITY i~;)-.?' [-~ e~ , i ~;,' ~ ~ {~ ~85 JOHN STREET, NEW YOrk, NEW YORK'10038 THIS, CERTIFIES ,THAT: ~ ~ , ~ -hi ~;~*l: o~ly the electrical equipment ~ described belo~ a~d ir~rod~ced by ~he applicant ~ed o~ ~he aboue ap~llca~io~ ~umbcr Cybulski-Brother , Depot Lane, between' 25th"~and 27th Ave., Cutchog~ ~ 1st H. ~ 2.d FI. ' , ' 'iii ill~: ,il'~ '{ ' Section Bl~A , Lot ~.~.,,,n~.o,~on June '9. '1977 '",,' ~ ~ FIXTURE ~ I FIXTURES RANGES ,KING DECKS OUTLETS I SWITCHES fLuO~$Cet4~ DRYERS FURNACE MOTORS OVENS DISH WASHERS EXHAUST FAN.; FUTURE APPLIANCE FEEDERS iPECIALREC'PT TIMECLOCKS MULTI-OUTL~f SYSTEMS NO OF FEET DIMMERS AW'G OF NEUTRAL ~SERVICE DISCONNECT .' '~ -' ' $ -" E NO OF CC COND PER ~' This cerhflcote F.B. "McCaffery 'Bridge "IBox 245 Cutchog ' LI- ,¢Lh J;' . GENERAL -1%ic'. 1145E-: musf not be mitered ,n ony mmnner; return to th~ off,ce o~ t~e Bomrd i~ incorrect In~pecfor~ tomy be lSenhCmd leir credenhoJs. TOWN OF SOUTHOLD BUILDIN~ DEPARTMENT TOWN CI.I~K'S OFFI~ ~OUTHOLD, N. Y. &opro ........................................ , APPUCATION FOR BUILDING PERMIT a. This application must be completely filled Inspector, with 3 sets of plans, accurate plat plan INSTRUCTIONS in by typewriter o~ in ink. and submitted in triplicate to the Building to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, ondgi'Hng a detailed description of layout ofproperty must be drawn on the diagram which is pair 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 pert 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 applic.able Laws, Ordinances or Regulations, for the construction of buildings, additions or alt~wations, or for removal~ or demolit,0n,- a~ heroin d~scrlbed~ 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 inspectior-~ v (S~nature of applicant, or name, ~ a corporatio~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bui~lder. 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 N~ ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ............ ..~ ........................ LOt No ...... .~... ............. "Street and Number ..~)~.~.~......~J~.~.~-.'~ -- ......................................................... {~..U..~.~...~..~.~.~..~. ................... ,. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..... Z~.~.~. ...... -- ~,~/~.'~.. ........................................................................ b. Intended use and occupancy ...... ../~',e~ ~ ......... ~.~. ~..~..~;. ....... ~..~/~ ............................................. ,/ 3. Nature of work (check which applicable): New Building......~.... ........ Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) 4. Estimated Cost ..... ----~..~..~).~. .................................. Fee ...J....~.¢...~.. ......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each flor ............................ If garage, number of ~rs ............................................................................................................................................. 6. If business, comme~ial or mixed occupancy, specJ~ nature and extent of each ~pe of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................Depth .................... Height ........................ Nu~er of Stories ................................................................................................................. Dimensions of ~me structure with alterations or additions: Front .................................... R~r ............................ Depth ................................Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ ~& ..................... Rear ..... ~. .............. Depth ,~.~ ............. Height ..~.~..~. ......... Number of Stories ......... ~.~ ......................................................................................................... 9. Size of lot: Fret ...... ;~ ,~ .. Rear .......... ~.~.~ ..................... Depth ...~.~ .................. ' 10. ~te of Purc~ ;;~.:;.."~./....~.~.~J ............. Name of Fo~er ~ner ~.~.~.~.~,~.~ ....... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...~ ............................................. 13. Will lot be r~grad~ ..... ~ ............... Will excess fill be removed fr~ p~jses: ( ) Yes ( ~No 14. Name of ~ner of premises ~.~....~.~.~ ........ Addre~ .~R.~.~.~ ....... ~e No. ~.~.. Name o~ ~..~M~e....~.~U.~J ............... Address ..~.~E.e.~[..[ ..... Ph~e No. ~7~. Name of Contractor ............................................................ Address ................................Phone No ....................... PLOT DIAGRAM 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. ! T ' I I.f' joo: j~' x ~,7' (----2o0 L4,u&- STATE OF NEWY~RK,. . ~cc (Na~e:6f indi~dual signing ~ntroc~ above name. / ' (Contractor, age,t, Co~orote officer,, 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 containS.ia-this a~ication .~e.tCu& to the best of his knowledge and belief; and that the work will ~ perform~ in the manner'se+ fodh in the applica~n ~ed therewith. Swam to before me this ~ ~ (S[~ature of applicant) MARY ANH CYBULS~(I NOTARY PUDLIC, S~ofe o~ N~w Yor~ RESIDING ~N S:JF~OLK COU~4TY Comm~sslon E~plr~s ~t~rc~ 30,