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Home My WebLink About8452-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No, .Z72.2.~. .... Date ............ 1~. p.~;....8...., 19..7.~. THIS CERTIFIES that the building located at ...BI~ .l~szr3~bn. 1)~ ........ Street ~¢ap No..S..~.t.~. 9.1~..S~ock No .......... Lot No, .9... 0~een~Q~t.. 1~.~.. .......... conforms substanti~]!y to the Application for Building Permit heretofore filed in this office dated ............ F~a~. ~2~, 19.?~5. pursuant to which Building Permit No..~. ~P-~. dated ..... Ai~L~,..~[19. ~,~, 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 . PR.~y$.t.e.. qla0. J~l$.l.~. fl.~.~.l~'lg ..................................... The certificate is issued to . .D.t*;. ~I.~.~.l~..e.1 . .I~. ~.b~...&..~.~f.e. .... .0M!I...e.r.~' ............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....S.~.~.t...8...~ 9.7.6....b~...R.,. ?.~..l~.a... UNDERWRITERS CERTIFICATE No...~.~9.~.~..~.6 .... .~.I~...] .2...]. ~.~. ............... HOUSE NUMBER .. 8~ ..... Street .. l]l~. l~Ia~'~ .I)~. ...................... FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8452 Z Permission is hereby granted to: Gl~n~-- F. ~.. ~le~-d.~aa~a.. &. ~o~ ...I ne...~'.C...N.. ~esbah ....... J~. F,.... ~ame~p~:r ~, .................................. -: to ~u.~l~ ..~w...mue.. Sa~%y.. ~well~ ............................................................ . .......................... premises located at ....... ,.., ................... ::.,.~,.~ .......... ~ ............. ., ,~ ................................................ Jtu~.-~tari.~-. D~. ......... G;~eeg~po~t ..... {~t~!~'-a,~,D-,-). ......................... ; .................. ~ .................... ;.;----y-;~,---::: .......................... ~W~!~1-~.v~.-~%;;2;-~,.;:~;;-~-:7,--t.~:,-~,~_ pursuant to qpplication dat~ 19 ~ an~ a rov~ b 'th ~ Building Inspector. Fee $,,1.t3~ ........ ,! i: / / / FOKM NO. $ TOWN OF $OUTHOLD , Building Deportment 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 all buildings, property lines, streets, and 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 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. g. 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 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 Bra ....... New Bu. ilding .... ..~.. ........ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..~.l.~.~,.....[~....~.~,,?~,~.~.t~....~...e..~..~..~,,,~ ......................................................................... Owner Or Owners Of Property ....~.,.....~..:....~...~...~..~.~....~. ................................................................. Subdivision ..C'~s~.'~..~O.~::~...~..~.~.J~,.~..-~ ..... Lot No.....C( ...... Block No ............. House No ............ Permit No ..................... Date Of Permit .................... Applicant .................................................................. Health Dept. Approval ................................ Labor Dept. Approval ............................................... Unde riters Approva, Plannin, , rd Approval Request For Temporary Certificate ........................................ Find Certificate .......................................... Fee Submitted $ .... ~......~...u.. ................... Construction on above described building anc~ermit meets all applicable codes and regulations. Sworn to before me this ............. ...... ............................ (stamp or Notary Public ................... ~County THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 o.t. AuEust 12, 1976 Zpp,~.tio.~o.o.f,~e 850228 N 298186 THIS CERTIFIES THAT only the elvctrical equipment az dezcribed below and introduced by the applicant named on the above application number in the premizes of Dr. & Mrs. Mesbah, Blue Marlin Drive Albacore, Southold, L.I. in the~followlng location; ~] Basement [~ 1st .,~. ~2nd Fl. outside sectlo. Bloat, rot wa. examinedon August 9, 1976 andfoundtobeincornpUaneewiththerequirementsofthisBoard. SERVICE DISCONNECT I NO OF [ S E METER NO OF CC COND ~ 200 SW x 1 OTHER APPARATUS Panelboard/s: I GFI RANGES COOKING DECKS OVENS DISH WASHERS ~PECIAL REC'PTTIMEC,OCKS BE UNIT HEATERS MUL11~UT~ , , , ITRAN ~ , SYSTEMS i 50 R V I C OF CC COND OF HI ~G EXHAUST FANS DIMMERS ~, [ WATrS AWG OE NEUTRAl 2/0 2/0 1-16cir.125amp, 1-1cir.125amp Robert~ A Goodale RE1, Box 15A Main Rd. Mattituck, L.I. 11952 Th,s cerhficate must not be altered ,n any manner; return to the office of the Board ,f incorrect Inspectors may be tdentsfied by t~ ~%..~edent;~ls. INSTRUCTIONS a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Building Inspector, with 3 sete of plans, accurate plat plan to scale. Fee according to schedule. b. Plat plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram which is part of this application. c. The work covered by this application may nat 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 applic.able Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolihon, as 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 ir-.,pections. (Signature of applicant, or name, if a corporation) ......... (Address of applicont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................ ................................................................................................................................................. Nome of owr,,r of pr, m ses ..... ........ .............................................................................. If appJ~:ant is a corporate~ signature pf duly authorized officer. (Name and rifle of corporate officer) Builder's License No...~:..~.~ ....... :. ............................ Plumber's License No....~.~.."~'.k-~.~..S.C,-~I~,-.....~.L Electrician's License No. ~.(~.~...{~L.~'.-,.m~.......~.~ Other Trade's Licen. No ............................................... {. Location Of land on which proposed work will be done. Map No.: ...: ........ ; ........ .~-...'~ ........... Lot N~ -..%<....~.. .......... Street and Number ~-e-~;~-~`~^~'~J~'~~;~k~J~ ......................................... ~ ~F~,, ' ~.~1 Municipality 2. State existing use and occupancy of premises and intended use~f proposed comtruction: a~ Exisiting use and accupancy ................................................................................................................................ b. I ntended use and occupancy .....~..~.L,~.g~.L.~"--~-,'- .....?.. L~s.~.L...L'....~.....~.~. .'(.~L~..~.- ................................. 3. Nature of work (check which applicable): New Building...~.. ........... Addition .................. Alteration "" Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... I. ..................... Number of dwelling units on each floor ............................ If garage, number of cars ............... I ............................................................................................................................. 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 .,....../~..e~ ...................... Rear ......~....?. ............... Depth ...~.....I ................ Height O~ ~ Number of Stories ~k 9. Size of lot: Front ......... ~L.¢~..~ ................................... Rear ................~. ....................... Depth ...~....~..'.~." ............... 10. Date of Purchase ............. ~ .......................................... l'~[me of Former Owner ........................................................ 11. Zone or use district in which premises are situated .....~.~.1~.~.}..~..~.~..-~......~...~ .................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ~ {~ ' 13. Will lot be regraded ...y....~..~.:__ -- - .~ . ,,_.Will excess fill be removed from premises: ( ) Yes ( ~No 14. Name of Owner of premises .I....~..I.~,.l~l.i...~l.I...~.].~.~.~lJt.l~,ddress ................................ Phone No. ...................... Nome of Architect t~.~.~....~...%...~..~.~.qJ~J~ Address ................................ Phone No ....................... Name of Contractor .~. ~.~.~..~.f~...~....~....~......~.~..... 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. STATE OF NEW YORK, ' ~cc COUNTY OF ................................ ~'~ ................................................................................................ being duly sworn, deposes and soys thor he is the opplicanl (Name of individual signing eontracf) 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 all statements contained in this application are true rathe best of his knowledge and belief; and thor the work will be performed in the manner set forth in the appli'cation filed therewith. Swam to before me this ........................ day of ............................................ , 19 ........ Notary Public, . ................................................... County (Signature of applicant) Builder Glenn F. Heidtmann & Son P.O. BOX E., Jamespor~, N.Y. 11947 ?gP--S~.66 HIGH COPIES iHS LAhD ~LBACO~E D~IVE ~ ~ ~s " I APPR©¥'~D ~,~ hlOTED ..... 34'-o II I 11 'Z / doo~ -' r /~ ~- ~ '-'~ ' .......... ~ ~ ~ ' "'" ' ,' I " I I I I I I I ' I ~_~ I ~L I I ~ _ d~ ~ ............................... _ j_l__,_i__, ' j .................. ~ i1