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Home My WebLink About8455-zFORM NO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. Z?.~.~2 ..... Date ....... Dlee~l~el,..17, ....... , 19. THIS CERTIFIES that the building located at ~/~ ~~~. AVe, ....... Street Map No.. ~ ........ Block No. ~ ~ .... Lot No, . .~ ........................... conforms substantially to the Application for Building Permit heretofore ffl~ in ~is office dated Ra~h 29~ . , 19~.. p~suant to whi~ B~dMg Pemit No.. dated ~eh..~ .......... , 19~., was issued, ~d confoms ~ ~ of the req~ ments of the applicable provisio~ of the law. The occup~w for which t~ certificate is issued is ~g ~ .8~.!$~ .~. ~ri~e. ~. ~l~;d~llin~ ......... The certificate is i~sued to . ~. ~,. ~Y. ................................. (owner, ~) of the a~oresaid budding. S~olk County Department og He~th Approval ~ ......................... UNDERWRITERS CERTIFICATE No.. ~Q3~ ................................... HOUSE NUMBER ~ ...... Street . ~Y~. A~ ~ ........................ B~lding Inspector FORI~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING PERMIT (TILIIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CO)VtPLETiON OF THE WORK AUTHORIZED) N? 8455 Z Permission is hereby granted to: ~e~.~...~l.e~v .................................................. ~:- ' at pmmis~ l~a'ted at ...JJJ....~O.~..Yie~..AYS ........................................................................... and approved by the - ~ ."-..: ................... ......... ~y ........ , ,~..,~.~., Building ,ns~ector j Co FORM NO. ~ TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This apphcation must be filled m typewriter OR ~nk, and submitted in DUPLICATE to the Building Inspector with the following; for new buddings or new use: 1. Final survey of property w~th 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 similar buildings and installations, a certificate of Code comphance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te plan requirements where applicable. 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 hnes, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condmon of buildings. 3. Date of any housing code or safety inspechon of buildings or premises, or other pertinent Jrt- formation required to prepare a certificate 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 $!.00 Dote ..... .... New B~ilding ................ Addition ...~ ..... Old or Pre-existing Building ................ Vacant Land .............. · ocat,on Of Propert ..... Owner Or Owners Of Property ...I.~..J~..J~.~..T.. .........~..~...1~. ...... ~ ............................................................ Subdiv,sion ...~..1.}¢~.; .............................................. Lot No ............Block N~ ......~,. House No ............ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For l'emporary Certificate ........................................ Final Certificate ..N~... .................................. Fee Submitted $ ....c~...~..~. .................... Construction on above described budding and perm'~r~s~all applicable codes and j~egulations. Sworn ,o before me this ~,,~.~4~/..f~ ?.~.0 ................ day of ............................................ (stamp or seal) C,O,~=it' Z 7' "// ~j._ ~ Notary Public .................................... Coun'cy ~ z.~/,7/7~, ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS ]'Ir BUREAU OF ELECTRICITY 8.5 JOHN STREET, NEW YORK, NEW YORK 10038 ^ugust s, 976 pp,.ca,lo.,o.o.s,. ao24s N 297038 the el~tricul equlpmen~ ~ ~scribed ~low and introduc~ by t~ appllcan& na~,d on the above application =umber ~: the premlses of ~r. R. Bayley, 1/4 mi. w/Kenny's Rd., Southold, L.I. mc Sollowi.s loco.o.; [] B~., [] ~.,t rE. [] ~.d r~. outside August 2, 1976 and found to be m comphance u',th the reqttirernents of th~,~ Board. OUTLETS ECEPTACLES SWITCHES INCAND ENT FLUORESCENT 2 t ~Sl i OTHER APPARATUS MULTI-OUTLET SYSTEMS NO OF FEET Lot EXHAUST FAN' DIMMERS E NO OF NEUTRALS A W G OF NEUTRAJ Gene Heacock Cedar Beach Rd. Southold, L.I. 11971 Lic. 943]3 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be idenhfled by the,r credent,als ........................................ , 19 ........ rmit No ..................................... Disapproved a/c .................................................... ~ APPLICATION FOR BUILDING PERMIT ate ................... , ..... INSTRUCTIONS a. This application must be completely filled in by typewriter or' in ink and submitted in triplicate to the Building J~7 Inspector, with 3 set= of plarm, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining~remises or public streets of ~: areas, and giving a detailed description of layout 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 ~. shall halve 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 re~me~,al or demolition, as herei.n described.~.~ The applicant agrees to comply with all applicable laws, ordinances, buildir~g~'gd~, housing code, and regulat,ons, and to ,~, admit authorized inspectors on premises and ir~ buildings for necessary i~,ljle~ons. / ..~ ............ ................ ~S~zg~oture of a,ppli?.nt, or name, ~fa carp#ration) ........ ........ (Address of applicant) State whether applicant Js owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............. ...... .................................................... : ............................................................ Name of owner of premises ........ ~.l'~'~:...~. ........ ~......~....~/...~.!..~,....~/-- ...................... : ............................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No....~.~.~.~....L<..:..~.. .......... .~&~ Plumber's License No. (W..~.~). .................................. Electrician's License No..'C~L~..[~...(/J~.....~..~-I.! ...... Other Trade's License No ............................................... ,~' Location of land on which propose~l work will b~l done. Map No.: ..... ./......':: ........................... Lot No....Z..¥-...,~; ........ Street and Number ..... ................................. '..r'~..(':~/~.[~.l,.#.. ......... ~ Municlpahty'" State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ........ .~.~.~.~. ....... L .~. ................ ~ .................................................. b. Intended use and occupancy ........ .~..~....~...~.0:~1~ ....... ~...~...~.~.....~......~:...C~.~y~/ ..................................... 3. Nature of work (ch~ck which applicable): New Building.. ................. Addition .~ ......... Alteration .............. Repair .................. Removal .................. Demolition .................... Other Work .................................................... 4. Estimated Cost ...,~.....~.1..~[,~. ..................................... Fee ! G-~ (Description) (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 ....... ~..l.~J.: .......................................................................................................................... 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 ..,L.?. ............ Height .I,~.i~0.~'. ............ Number of Stories ...~ ............................................................................................................ Dimensions of same structure with alterations or additions: Front ......... ~..,~. ................... Rear ..~..~ ..................... Depth ......... J.~ .................. Height ............ (.~. ............ Number of Stories ..... I .......................... 8. Dimensions of entire new construction: Front ....1~ ............................ Rear ......... J.~ ............... Depth ..(..~. .................. Height .....J.~.~ ......... Number of Stories ........ ~ ............................................................................................................ 9. Size of lot: Front .......... ~ ........ }. ........................... Rear ..... ~ ......................... :. Demh .....~ ................ 10. Date of Purchase ..~.~..~.~. ............................ Name of Former ~ner ...~....~.~..~.[~ ...................... ] 2 c i , I .... ~.~ .......................................... 13. Will lot be regraded ......~.~. ............... Will excess fill be removed from premises: ( ) Yes ( ~o 14. Name of ~ner of premises ...~-.~..~4J~.~ ............ Addre~..~.JL{}..~[(J~Phone No..~.~.~.~. Name of Architect ..~.~.~.~.~.~.~...'.......~ ............ Addre~ ........... ~.~. .................. Phone No .......... ~ ........... Name of Contractor ..... ~...[.:..~ .............. A~re~ ..5~J.L.c[~ .......... Phone No.~.~.;.~.~. PLOT DIAG~M Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~ck dimensions from prape~y 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, ~.S.S COUNTY OF .~1,]~1; ............. .................... jJtJJ3J~..~....~ir .~Jr: .................. ;,. ................. being duly sworn, deposes and says that he is the applicom (Name of individual signing contracT) 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 oil statements contained in this application are true to the best of his knowledge on~ belief; and that the work will be performed in the manner set forth in the applicat, jerr3~ed therewith. Sworn to before me this , /, /5 ,~ // Nota~, Public ~n,Pg'~_~: r'o-n~, ,. j~j~ _~ .......... <./ " " ........................... : ......... · ..... ............... ...................... NOTARY PUBLIC, State of New Yor~ No. 52-8125850, SuffolkCoununJy/y Term Expires March 30, 19 >[ t~ ~ N~'ATION F'I.AN v~JT ~OU~D VIeW A~/E- .~LL-~'VA'TION : _: F---/H~_.A'TH INF.,1 WAL.L A~DITION TO 1~\CHA MJ~,~MKS. 1~, t~¥LEY 50L)NID VIEW AWE.. ,_~:)UTHOLD , NIF--W ~LA,N DETAIL6 ~/~/'~