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Home My WebLink About8231-zFORM NO. & TOW~ OF $OUTHOLD BU',DING DEPARTMRNT Town Clerk's Ol~ice $outhold, N. Y. Certificete Of Occupency THIS CERTIFIES that the building located at . ~..fy .~...~.2,....~.. ?. ~.~. .... Street ~a~ ~o..~.~.~. ~o~ ~o ........... ~o~o..~./ ....... ~~..~.. ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... · .~..... ~.., 19~.. parsuant to which Building Permit No. ~.~'...~./..~' dated ~ °~ 19 ?.~, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy fonwhich this certificate is .................. The certificate ~s issued~J .... ~ ~,~.. (_~,wn~',~lessee or tenant):~' ....... ~ ..... of the aforesaid building. Suffolk County Department of Health Approval ,..~...~.~.' ........................... ........ '~' .../..r...7.... UNDERWRITERS CERTIFICATE No .... ~..30.~..~./. .7. ~ ~ ~- ~' /-o. t.~.~.., st~t.../~,~..~...~i ~.,,.~- .......... HOUSE NUMBER.. Building Inspector FOE]~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTkfORIZED) N? 8231 Z Permission is hereby granted to: eeo~ ~..e...~.o.a~.$~.....~q...~.~..~..z.~ ........ to t~Uild new aocessor~. .............................. building. (.l?..e. 9..e.~...~ ~.t,..9~.e....~.~.~..~e'* at premises located atL° a~sall Poitq~ P~o~ ......................................................... ~/Z~...~u..~..~,~..~oa~l ....... .~'.~e ....................... pursuant to application dated ................... !~..q.~ .......... ..~. ................. , 19~..~...., and approved by the Building Inspector. Fee $..~..O..t...(~).. ............ THE NEW YORK BOARD OF FiRE UNDERWRITERS --dl BUREAU OF ELECTRICITY I 85 JOHN STREET. NEW YORK, New YORK 10038 THIS CERTII=IES THAT Cutc~ogue~ L.I. teas exa~,i~ted on Septemb eP 13 ,~ q 9 7 6 and found to be in compliance with the requirements of this Board. FIXTURE I I FIXTURES RANGES :OOKINGDECKS OVENS DISH WASHERS EXHAUST FANS i OTHER APPARATUS~ 1-4.5kw hot water heater E R V I C E Ruland Ele¢. Co. Box 143 Mattituck, L.I. 11952 Lic 242 D Thfs certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by TOWN OF $OUTHOLD ~ Building Depmtment 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 disp0sol--(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 formation required to prepare a certificate. C. Fees: i. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00Date ~i 3 ~ /'"~'7 New Building ~.t~..¥.... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Proper/y ..~'~L,~,~L~L'~!~.~:g~...J~.? ............. i..~ ........................................................... o, ......................................... Subdivision ............................................................... Lot No..~.T/.,.... Block NO ............ House No../~.~/..~.C) ................. Permit N .i~....g'.'~.../...~..... Date Of Permit/'.'~(~/~./Z~.i....Applicont ~.~..~.. ~' Heolfh Dept. Approval ...... : ..................................... Labor Dept. Appro¥ol ................................................ ! Request For Temp~ry Certificate .......... ' .............................. Finc~l Certifieote ...... ,~,.... ......................... Fee Submitted $ ....... ~..:-: ........................ ?~-FL~ day of ~Tb~ Notary Public ............ ,~c~.?J~.-~..~ .~,. ....... County ROBERT JAMES WIESEHAHN NOTARY PUBLIC, State of New No. 52 ~4612~39 QualiFied in Suffolk Cou~ Construction on above described building q, nd permit meets all 6pplicable codes and regulations. Applicant...~.. :~L~.i~ ..4~..:.~..:,....~/~...~' / ~l :L?/?~ ~, ,~¢:T..,; ,"~,, ~, .q .......................... Sworn to before me this ~Z~ ~ ~ ~ g~ (stamp or seal) FOB~ NO. ! TOWN OF ~34JTHOLD BUILDING DEPARTMENT TOWN ~LERK'S OFFICE SOUTHOLD, N. Y. Examined ......... ........ , ,e~oproved ....................... I(~.~....... ....... , 19 ?.~..'~ermit No. .................................... (~"-'"~ ''~ / A~plication No ................................ Disapproved a/c ~ ................ ..... APPLICATION ~OR gUlI. DIN~ PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or pubfic streets at 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 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 Bu Id ng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regu ations, for the construction of bu Idings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing co~. e, and regulat ons, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of 0applicant, or name, if a corporation) ~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician~' plumber or builder. ............................ .... ............................................................................................. Name of owner of premises ~...~......~..~6~.-.~....t~.....~/. ~. .......................................... 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 No ............................................. Other Trade's License No ............................................... Location of land on which proposed work wi. Il be done. Map No.: .......... , ....................... --,~ ~='" Lot No .............. - ' ........... Street and Number .............................. ,~[...~.~...~......c~....~ .......... .~...~.../;...~...~.........cl~-~...C...k~.T..~..~v~n~.c~;~..~...' State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisitinglntended use andand occupancy ............. ~ ~.~:..~..(~Z~i~ ~ -~---~-.. c~....L. "~o ~..~ .~. ,. .............. .......................... _~ To ~,..c~~..~,, ............ b. use occupancy ................................................... rL7--~ 3. Nature of work (check which applicable): New Building.....~...... ..... Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work ..................................................... ~/ ~ O ~ (Description) 4. Estimated Cost ...b~...~.. ................................................. Fee .......................................................................................... (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 ..................... i .~.:. ................................................................................................................. 6. If business, commercial or mixed ~ccupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of St6ries ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ...~ ........................ Number of Stories ...... ; ......................... new construction,: F. ront] ........... f...~, ................ Rear .......... ./..~ ........... Depth ..... ~. ................ 8. Dimensions of entiA'e ~ O Height ....... I/,L.~. ....... Number of Storie~ ,,.....x ............................................................................................................ 9. Size of lot: Front .......................................... i;;;~.,~. .... Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name~.f Former.Owner,~......... ............................................ 11. Zone or use district in which premises, are situated ............. ~)'~ "~'"/~/-'/~......~..~..~. .............. ...~ ................................................. 12. Does proposed constructio~j¥?ate an~;'zoning law, ordinance or regulation: ..... j~J...~)... ........................................ 13. Will lot be regraded . .......I~/~ ................... Will excess fill be removed from premises: ( ) Yes (~) No 14. Name of Owner of premises .V..~...~.~.....~..LC.o..~...~...1 ................... Address .~.....o.,.~..~../~.~...~...c~.....~.... Phone No./~.~..~..~.¢,~,~ Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ~.....0...~....~._~....~.........~...o.~.~F.g..~t.~ ..... Address ...~....~..'~..~'.]t~.~..t.0..~hone No.~...~..~...%~.~..~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock 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 YOR'K,~ }S.S COUNTY OF ...... ~i~;;~l ~" ......... ...................... ~. _ -~t.'~-,~.~'_'.'_' ......................................... being duly sworn, deposes and says that he is the applicant ( Nlil~lll[l~~ ning contract) above named. He is the ....................~----- -- -- -------~--, ~=---, -~-~-~-- ~--.~-. ~--,~'"l~J~J~'~'~;"';'~¢~;~;~'~'~;'~;";;;.~ ............................................................... of said owner or owners, and is duJy authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained Jn this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fodh in the application filed therewith. Sworn to before me this ................~..:'. ....... day of Nota~lic,__ ............................. ...... ............. .............. .... ~ / ' t~gnature 8~pphcant)