HomeMy WebLinkAbout8131-zNO. 4
TO~lrN OF $OUTHOLD
BUI[.r}INC DEPARTMENT
Town Clerk'~ Office
Southold, N. Y.
Certificate Of Occupancy
............ .~...~ ~ ~o 77
No. ~)C/ ~ Date ........................... , ......
Map No. )[ Block No. )~ .Lot No, ~
confo~ substan~ally ~ the Applica~for B~ld~g P~t here~fore ~ ~ th~ o~ce
dated ....... ~. ~ ..... , 19 ~ ~. ~su~t to w~ B~ P~it N ~ ~ ~
-- ~ _ dated ...... ~ ....... , 19?.~,s~su~,~dco~o~of~e~
.... ~n~ of the ~plicable pro~sio~ of ~e law. ~e ~cup~ fo~ w~ ~ ce~ca~ ~
........
~e ce~ics~ is ~sued to ...................
(o~er, les~ or ~t )
of ~e ~ores~d b~lding.
S~o~ Co~ty Dep~tment of He~ Approv~ .. ~ ~.~' ...... ~ ..................
u~wR~s C~RT~ZCA~ ~o..~?~. ~ ~ ~ ~ ~ //~ ...
~o~ ~...~?. ~.. ~,~,..~.~...~: ..... ~ .....
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SGUTHOLD, N.. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
8131 Z
Dote ........................... ,&ting ......... .~. ......... , 19...~.5
Permission is hereby granted to:
· P.~,~;~...~.:m~.~h..~..'.~t£e ..............................
................ ~.a.~....&~.~. .............. ~...~...~. ...............
Build n®w accesso..rl(' (storage) building
at'premises located at ...... 2235.....~ray..J~.e ....................................................................................
............................................................................ ~.~.e~.....l~.~.~ ........................................................
pursuant to appllcation dated .......................... AUg.....~. ............... , 19..~.~., and approved by the
Building Inspector.
Building Inspector
lcd.
~o~
BUILDING DIPA~,TMINT
rov, ................ .............. .7'.. ,,2ff ,o. ...........................
Al~lication No. J~.Z...~...L ..............
APFUCATION FOR BUILDING PERMIT
.............. .......... ,,,z,....-...
INSTRUCTIONS
a. This application must be completely filled in by typewriter o~. in ink and submitted in triplicate to the Building
Inspector, with 3 sete of pkms, aocurate plat plan to scale. Fee aoco~ding to schedule.
b. Plot plan showing location of lot and of buildings on premises, relat~onsh}p t.o. adjoining premises or. ..1~. lic st. reets oF
areas, and giving o detailed description of layout ofpreparty must be drawn on the amgram which is part aT mis al~lication.
c. The work covered by this application may nat be commenced before issuance of Building Permit.
d. Upon approval of this application, Se 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 applicable La~.., O. rdi,nanc.,es or
Regulations, for the construction of buildings, additions or alterations, or tar remova,' or aemolJtlon, as hereto aescr,~ea.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing cade, and regulatioas, and to i~
admit authorized inspectors on premises and in buildings for necessary inspections.
(Signature of app(i~;~;i:";;-";~;;;,';,"i('~';:'~;~'~i~ ........ 4
..........................
(Address of applicant) I I~J~
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
................................................................
PAUL A-~ . I~1~/,/ TI-t-
Name of owner of premises ................... .~., ............. ~...~'~.~..~.....~......~! ......... ~ ...................................................................
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'~ License No .............................................
Other Tn3de's License No ...............
I. Location of land on which proposed work will be done. Map Ho.: ........................................ Lot No ....................
Street and Number ....... ,~.~,,.~'....~J~,,N:'.,~F'J~.....~.....~,,LR/~.[.e..e:,.,(r. ..............................................................................
N~mlcipali~/
2. State existing use and occupancy of premises and intended use and occupancy of propased construction:
a. Exisiting use and occupancy ............... .¢..?:..~.s.~.~.. ....... ..............................................................................
b. Intended use and occupancy ............... ................................
3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ...............
Repair .................. Removal .................. Demolitior. .................... Other Work ~...~ .~,...O......~..~ ..... , ....
~ ~ ~ ofN.6, ~lW,~/cl~/~ ~ (Description)
4. Estimated Cost ............ ~.. ......................................... Fee
(to be paid on filing this application)
5. If dwelling, number of dwelling units ...............~ ......... Number of dwelling units on each floor ............. ~ ...........
of cars .............................................. : ............................................. * ................................................
If garage, number
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............. '~. .............
7. Dimensions of existing structures, if any: Front ............ L..2-..~ ......... Rear .......... /.~. ................. Depth ................
Height ......... ..~...~ ......... Number of Stories ........... J. ....................................................................................................
/ ' ....... /..~ ..............
Dimensions of same structure with alterations or additions: Front ................ ..~ ................. Rear
o°'! ~ '! ......... .~../. ............. Number of Stories .............. /.. ...............
Depth ................................ Height
8. Dimensions of entire new construction: Front .............. ~..~, ................ Rear ........... /.~-.[ ....... Depth ..... ~.. ..............
, !
Height .......... .~. ....... Number of S~ories ........................................... :....-.~: ...................................... .:...-.~ ..................
9. Size of lot: Front ........................ .~.. ............................ Rear .......... tJ~,~... ....................... Depth ...Z~. ....................
10. Date of Purchase ........ ~..C..T.....~.TJ..~.~J ..................... Name of Former Owner ..~,~J,~.....~..:..J~.~..~.~. .......
11. Zone or use district in which premises are situated .........................~L~...U..~....~..L. ............................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ........... .~....O.. .....................................
13. Will lot be regraded . .............. .~...0. ....... Will excess fill be removed from premises: ( ) Yes ( 0 No
· pAULI'.+,I-d P. e~....A:..l~.+A ress,J~.:~l,~.~i.~..~.~..&~oneNo.
14. Name of Owner of premises ...................... I~ ....... ~. .......... dd ......................
Name of Architect ................................................................. ~ ....... i?~,,ZT...N:~ip:... Phone No .......................
Name of Contractor ............................................................ Address ................................ Phone No .......................
. PLOT DIAGRAM
Locate clearly and~ distinctl~ oil buil~s, ~ether existing or proposed, and indicate all setJoack dimensions from
~eet aha moCK numaer dr descnp~an~ccording to deed, and show street names and indicate
property lines. Give st,,r lot. /
whether interior or con
N/ . ~"--
STATE OF NEW YORK, ~ S S
COUNTY OF ..~...:f.:....;.;..t%~',~:
.... ,,Li 'T.. be.,-,
duly
deposes
and
that
he
is
the
appJicanl
........................... ..~....,?., ..,~p ......... :..... ...... :, ............. ~ sworn, says
(Name of individual s~gnmg 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 all statements contained in this application are true to the best of his knowledge and belief; and
thor the work will be performed in the manner set forth in the application filed therewith.
Sworu, to before me this ~ ~ ~-, · -
~-_ ~-~ _. !
· /. / ,-F.
Notq~ Pub,c, ................................. C......~t~"'~nty ...~ ........... : .......... ;:::......: ........ ;. .... :....., ..
" '~' ,' ~gnarure or app,canT/
·
APPLICATION FOR CERTIFICATE OF OCCUPANCY
FOEM NO. G
TOWN OF $OUTHOLD
, Building Deportment
Town Clerks Office
Southold, N. Y. 11971
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:
i. 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.
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 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:
t. 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 ....... ,a.':.y..:.'/..!;. .......................
New Building ................ Addition ...... :.~... ...... Old or Pre-existing Building ................ Vacant Land ..............
Location Of Property .~.aB.~- f3iPA.~. /~d~, kAU~'.C
Owner Or Owners Of Property ..p./.~.L....~.:..../~.~..L)..,j-~../~.~....~. ...... ~f~..~./~l.g'..~n~.~..{.~. ............................................
~7.....~.'... Lot N --
bdi
Su vision ..................................................... o ............. Block No ............. House No. .
Permit No. 7.5~./.:~/.:~Date Of permil~,-~..~..~:..!.?.~J(pplicant (~ t/~et~:' L~/'//~¢q~
..... r~---~_~' ' '0 iiYe0'i~' ~' ............................
Health Dept. Approval .............. '. ............................. Labor Dept. Approval .......... ..~.. .................................
Un_.d~,y_wf,,_~te~rs_Appfo,,j?,~l~j ...................................... Planning Board Approval ...... '"'7 ...........................
Request For Temporary Certificate ........................................ Final Certificate ..........................................
Fee Submitted $ ....................................
Construction on above described building and permit gW.~ts all ,gpplicable/c~ocles and reg}dations.
Aoo,,ca.t ........
Sworn to before me this / /~'O / ~
................ day of ..~ ......................... (stamp o~eal)
Nota~ Public ........ ),~.~ ......... CounW ~5)c-~ /&~ ~-3
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
~,C]l 85 JOHN STREET, NEW YORK, NEW ~YORK
10038
,,.~eju~y ~5, 197~ A,,,,,c.,,o...~o.o..j,,e 807704 N 235489
THIS CERTIFIES THAT
Bernat ~ ·
paul h Bray Ave. Alho Dr - Wells Rd., Mattituck, L.I.
inthefotlotvinglocatlo,t; ~ Base ..... t ~ lst[7. ~ 2~d'FL outside S~tlo,,
FIXTURE
OUTLETS
5
2O 10
FIXTURES RANGES OVENS
E R -V C
NO OF CC CONO
pER ,~
A. WG
OF CC COND,
AWG
OF NEUTRAL
OTHER APPARATUS:
Motor/s: 1-1/2hp
~N-'
I,~ ThJs certificate must not be altered in any manner; return 1o the off ce of the Board f ncorrect. Inspectors may be identified by their crede als.