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Home My WebLink About8301-zNO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, No Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at ...Rogo~.s. Bo. ad ............ Street Map No. 5e;[x~or. .Esl~lock No...? ....... Lot No, 9. .... S.QuthoJ. d.. I~.,Y, .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. ~o~ .. ~ 7', 19.7~. pursuant to which Building Permit No..&]0] ~.. dated ............ ~o~,..]7-.., 1~/~.., was issued, ~d conforms to ~1 of the requff~ ments of the applicable provisions of the law. The occup~cy for which this certificate is issued is .. P~.J,V~..~e..$~r~i]~t'. dw.e. lli~. ~ith. ~ddi~on ..................... The certificate is issued to . .]]d~m.~. ~ahm ..... 0~mer ............................. (owner, lessee or ten,t) of the aforesaid building. Suffolk County Department of Health Approval . .~, R... ............................. UNDERWRITERS CERTIFICATE No..~37~0~ ..... ~. 2~...].~76 ................ HOUSE NUMBER .... 69~ ....... Street .. Ro.~srs. ~lva~ ......... 8ou~held. ........ Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 8301 Z Permission is hereby granted to: Robt i[ya~t l~e ~/C ~dV ~z'aha 3ol~thold at premises located at ...~.~...~. ................ ,.~.,,e~.. ................ _,J~_~...~..~...d~...~.. ................................................ ........................................................ ~.q~e.r.~...~. .......... ~.~ ................................................. pursuant to application dated .......................~[~. ....... ].~. ............. , 19..~.~.., and approved by the Building Inspector. Fee $..1~.., ..~ .......... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~- nr : 85 JOHN STREET, NEW YORK, NEW YORK 10038 ,~.t~ Maz;e:;,. 23'.~.~'76 .,ppl,cat,o.~¥o.o.~,le ~3727~N 275051 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of Edward Graham, e/s Rogers Rd. 200's/o Hippadrome Rd., Southold,L.I. in the fallozving location; [] Basement [] ' 1st FI. [] 2nd ri. 0 ut $ide Section moc~ Lot was examined o~ March 18, 19 7 $ and found to be in compliat~ce with therequiren~ents of this Board, RXTURE ~ FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES SYSTEMS S. NO. OF FEET OTHER APPARATUS: E R V I C 1 GFCI Ele ct titian . GENERAt Mattituck, L.I. Lic. 2q2E Per D This cerhficate must not be a~tered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their c~ TOWN OF SOUTHOLD , Building Department 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. 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: 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 New Bqilding ................ Addition ..~ ..... Old or Pre-existing Building .>~.~ .......... Vacant ~.ond .............. Location Of Property ........ ...~....~... *.~.......-':~.. ........ &..~...?.h..~ .............. ?~~.~....~... ..................... . Owner Or Owners Of Property ...... ~.-~ ,~....,~., ......... ~.~~ ................................................. ' .... Subdivision .... ~-~,~.r.~~ ................... Lot No. ,..,(~,. ..... Block No, ,Z ...... House No.,,~...~.~'~- Permit No. ~.~...~.~....~... Date Of Permit .ff./~.../~/./,,,~,pplican, ......... ~..Z.~ ,/,-.~..~.~ ............... Health Dept. Approval ...."--..~,,./;,.~... ............................ Lobor Dept. Approval ,.,. ,.~....v- ,f,.~..------ ................................ Underwriters Approval ~...~..Z..~..~...~/.. ........ ?~.?..~.~...~....Pionning Board Approval ..... ...~...../~.. ........................ Request For Temporary Certificate ........................................ Final Certificate ........... ~ ......................... Fee Submitted $ .................................... Construction on above described building orr~ermit meets all applicable codes.oDd regulations. Sworn to before me this ~-~J ~ 7,.~,~,'_.~ Notary Public .......~,~, County e Disapproved a/c ....................................................... Date November 17 19...~.~. ~ II~iKUCTIONS ~ a. This application must be completely filled in by ~lgpe,,~,ter or in ink. and ~bmitted in tril)iiaaee b. Plot plan ~ng location of lot and of buildings an premises, relationship to adjoining premMs or puldic j~mets areas, and giving o detailed description of layo~ oflX'Ope~/mus~ be drawn on the diagram which is pa~ of this application. c. The work covered by this application may nat be comrnenc..ed, before issuance of Building PMmit. d. Upon approval of this application, the Building tmpector will issl~ a Building Permit to the applicant. Such permit ~,, shall be kept on the premises availaMe for Irmpectlan ~ ,~' ~ e. No building d~all be occupied or ueed in whole c~ in part for any pu~x~ee whatever until a Cmtlflcat~ of shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of a Building PMmtt I~mugnt to the Building Zane Ordinance of the Tc~m of Southold, Suffolk County, New York, and ather applicc~le Lau~ O~inmlCeS or, . Regulations, for the construction of buildingl, cx:ldflJo~ or altera~/iam, ar for removal' or demdlfle~, ca ~ deecn~becl~ The ..applicant agrees to comply with all ,~icable la~, ordtmmcm, b~lcling ca~, hauling cads, and regulal~m, and to . -~ admit authorized inspectors on premises and in buik~ for necessmy inq:)ections. ~ Robt L. Hyatt Inc (Signature of applicant, or name, if o ca~ G~.dclress of al~licaM) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................................ ........................................................................................................................ Name of owner' of premises ...~.~W..a:.r...~.....G.?.~ ................................................................................................................... If applicant is a corporate, signature of duly authonlzed officer. (Name and title of corporate officer) Builder's License No .... ..~.~.. ........................................... Plumber's License No ................................................. ~ Electrician's License No ............................................. Other Trade's License No ............................................... ~ ~( 7 ~ 7 1. Location of Iand on which proppsed work will be clone. Map No.: ...?..e.~.e...~.o.~ ................ : Lot No ......................... Street and Number ...... 1~n~.c~...]?u:~. ......... ~OGt, h~].&....3T,.~ ........................................... ,~i~~ ........ 2. State existing use and occupancy of premises and intended use and occuppncy of proposed camtmction: dwelli.n.~ ....... a. Exisiting use'and occupancy ........................................................................................................................ same with an addition b. Intended use and acculxmcy ..................................................................................................... ? ......................... 3. Nature of work (check which applicable): N~ew Building. ................. Addition ......xx~ .... Alteration ................ Repair .................. Removal .................. Demolltior. .................... Other Work .................................................... (DeecriptJon) 4. Estimated Cost ......................... ~.~.~.~.(~..~. ............... Fee ..~.~.Q.0. ............................................................................ (to be paid on filing this application) 5. If dwelling, number of thralling units ........ .o...~..e. ............. Number of dwelling units on each floor ............................ If garage, number of cc rs ............................................................................................................................................. 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 ............................ [~Nepth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ............. :L~. .................. Rear ........... .1~ ............ Depth ...... 1.6. ............ Height .................... Nurriber of Stories .......~;~D. ....................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ....................................................... ! 1. Zone or use district in which premises are situated ...... ~A.~!..~.~-s.~ ............................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ ~ .......................................... 13. Will lot be regraded ...~,Q .................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ...1~-(~:..~1~1:~L1~ ........................ Address ......~D.~l,~1~Q,~1, ...... ~ NG ..................... Name of Architect .............................................................. Adaress ................................ PhOne No. ...................... Name of Contractor ....1~ ~L~L~'~,.~.t..~I:~ ........................ Address ........... ~.g.~.~,. Plane No. ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all setJaa~k dimensions from property Ii'rms. Give street and block number or description according to deed, and sh~5~v street names 6nd indicatw whether interior or corner lot. /F' STATE OF NEW _YORK, I S S COUNTY OF ........... · ..................... ,~O]~;I;;..]~:l;.t .................................................. being duly sworn, d~ and says t~t he is the opplicon~ (N~ of i~ivid~l~ signing c~t~a~ a~e na~. He is the ............................. ~ .................................................................................................................................. (Contractor, agent, co,rate officer, ~c.) of ~id owner or ~rmrs, and is duly aut~rized to peHorm or have perfo~ed the said work and to ~ke and file this a~licatJon; that all st~emen~ contai~ in this application are tree to the ~st of his ~ledge and belief; and thor the wo~ will ~ perfor~ in t~ ~nrmr ~t fo~h in the opplicati~ f~ ~i~. .S....w~..T....t~.[%.f~.~ d~t~ .................... ~D~h~...., 19....~~ ~~ Nota~ Pu~ic, . .................... ~.~ ............. C~n~ ..~ ............................................ // ......................................... N~A~'~B~. ~ ~ ~ ~