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Home My WebLink About7847-zFO~ ~0. & TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy Stevensons Road THIS CERTIFIES that the building located at .PV.t....1~l,..# ? ............. ~xx Map No ............ Block No ......... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated . A~r£1. · 2/~ ......... , 197.~. · pursuant to which Building Permit No.. 78/,7Z dated . .A.p.~il... 2.~ .......... , 19..7.5., was issued, and conforms to an of the req,~ire- ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to .... J~.hn..~...Be¥.e?.l~...L.om.a.$ ........................... (owner, of the aforesaid building. Suffolk County Department of Health Approval ......... N/P~ ................. UNDERWRITERS CERTIFICATE No ........ P~..~c~i,~g .......... !'t [". [ .5. ~'.~ '. [L.i ~.[~I?.~ HOUSE NUIVIBER ............. Street..~'~e.v.e,.n,~0r~a .l~o~.ct ~. Py.~,. 8.o.~I. #. ?. .... ........................................ Ori~n~,. N,e.w. ¥.or.l~ ..................... Building Inspector FORH NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7847 Z Permission is hereby granted to: ........... ~Z¢. ...... ~...~...~ ......... .5..~..~.~ .... at premises located at .........~?...~..7...~. ..... ~.O..~....J?. .... ].~) .................................................................... Building Inspector. /~o~ Fee $ ........................ ............. ~r...,~....~Z~~ .... Building Inspector l~OltM NO. 6 TOWN OF SOUTNOLD , Building Deparfment 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: ]. 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: 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 New Bqilding ................ Addition ....~ ........ Old or Pre-existing Building ................ Vacant L~3nd .............. Location Of Property .... ~j~'~~f~g~-~-~/~-~c(~m~i~C .............. Owner Or Owners Of Property .... ~'..<~.,~'.~T....Z~ ..... ~;.~;~e:~.e~',,~T.. ......................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............ Permit No.-~..~i?..~..~.....,~.... Date Of Permit .................... Applicant ~.~...r,Z.,...,~'~¢~.~,~.~. ..... Health Dept. Approval ........... ~.,.~, .................... Labor Dept. Approval ....... ~t%~.,..~... ............................ Underwriters Approval .............................................. Planning Board Approval .,~,~--~ ............................ Request For Temporary Certificate ........................................ Fincd Certificate .....~ ................................ Fee Submitted $ ,~.,....~... ........................ Sworn to before me this ................ day of ............................................ Notary Public .................................... County Construction on above described building and permit meet~ all applicable codes and regulations. Apph c~n~t ..,.~,~...~'~,~. ~ ~.~,~.~ ~ ....................................................... (stump or seal) ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS pm BUREAU OF ELECTRICITY [~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CE~IFIE5 THAT ~ly t~ e~t~ ~u~nt ~ ~c~ ~ ~ int~ ~ t~ ~t ~ on t~ ~ ~t~ numar ~ t~ p~m~ o~ ~mas- Johnm Private Rd. 2nd lef~ after Causeway~ arlene, L.I. w~erami~don Juno ~ !~ and found to be in complla~e with the ~quirements of th~ B~rd. SERVICE DISCONNECT I NO. Of I S E I I~0 CB m . x ~'2 OTHER A~ARATUS: 1-C.F.I. 2-omoke ~tectors RANGES sPEaAL REC'PT, R 0~: CC. COND. 1/o 1.~ TIME CLOCKS ~ UNIT HEATERS MULTI4)UTLET ~T. A~PS. TRANS!~ N~.YSc~TI~ET V I C EXHAUST FANS AMT. H.P. DIMMERS 2,/'O G~S Contr. Box 215 $outhold, L.I. 11971 Lic. ~87 This certificate must not be altered in any manner;, return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY Of CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. * ~UILDIN~ DEI~ARTM~NT ~ TOW. ca~(~ O..,C~ ?4*~r- ~ ~* ~ ~ ......................~:':" ' '""=~ 7~y~ ~.,,~..,~.o ............. Z ............... ~,~ ,,~ ~,~ ,~- ~,,,. ..................................... ....................... ~ ............. ~,. ......... Di~pprov~ a/c .............. ~........~~ .............................. {Building In~tor) ~te ................................................ ,19 ..... INSTRUCTIONS o. This application must be completely filled in by typewriter o¢ in ink and submitted in triplicate to the Building Inspector, with 3 set~ 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 public streets o~ areas, and g v ng a detailed description of layout ofproper%, 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 hove 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 removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t° admit authorized inspectors on premises and in buildings for necessary inspections. . :...:.:', ....... ..! :'.' -' (Signature of applicant, or name, if a corporation) ........... :....!...:..!....~...: .............. L...' ...................... ?. .............. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer,.:ge.;~~~ electrician, plumber or builder. Name of owner of premises ............................................................................................. ..~ .................................................... If op~/s q~r~orate, si~l~ature of dul.,~, uthorized officer. ~~.:~...,...~.~::~,:.:-.~.. V (Name ~d title of coca,re officer) Builder's Lic~se No. (~ ,., -- r ~ ~ Plum~r's Licen~ No ................................................. Electrician's License No .............. : .............................. Other Trade's License No ............................................... Location of land on which proposedl $ t, ,b, il;w°rk [will~^be: doge.i Map %'-' ~ ~ !N°': ........................................ ~,~ ;~ ~ , (~\ t. L~tlNO;,., .~.,~, ................. Street and Numar .......................................................................................................... /. ........................ ; ............... M~ici~li~ State existing use and occupancy of premises and intended use and occupancy of pr~osed construction: a.Exisiting use a~ ~cupancy ~ I' r ~ ) ~ L ' ~ ' ~ ~ I ~ ~ 4 property lines. Give street and whether interior or corner lot. 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ........... · Repair .................. Removal .................. Demolition .................... Other Work ..................... · ....... ..~.~ ................... (Description) /? (' - 4. Estimated Cost ............................ [ ............................... Fee .......................................................................................... (to be paid C~h filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 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 .................................... P, ear ............................ Depth .......... : ............. Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ............................... 10. Date of Purchase ........................................................Nome of Former (~)wne.r ........................................................ 11. Zone or use district in which premises are situated ................................................................. : ................................. /, 1:2. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ J 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes (~"~ No 14. Name of Owner of premises .................................................... Address ................................ Phor~ No ....................... Name of Architect .............................................................. Address ................................ .Phone No ........ 7~ ...... ~"!~ Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ail. set-back dimensions from block number or description according to deed, and show street names and indicate 7 and says that he is the appliconl STATE OF NEW ,Y. OI]~/~:/~ ~ ¢ S ' COUNTY OF .................. - ................................................................................................ aemg duly sworn, deposes (Name of individual signing c~trac~ above name. ~ ~, _ He is the ( ~r, agent, corporate officer, etc.) of said owner or owners, and is duly aut~rized to perform or have performed the said work and to ~ke and file this application; t~t all statements contained in this application are tree to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Swam to ~fore me this ........................ o, .................................... Nohow ,,Ui .................... ........ ...... .......... ....... y~.~ ~,~ ~ ELIZABETH A~N.NEVILLE ~OTAEY pUBliC, S,at,. of New Yo~ No. 52-812585r. Suff,d~ Cmmty Term Expffes M~l 30, Tu~VN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Al~raved , .9~...~... Permit No...Z..~....~..Z.~ ..... Disoppraved a/c .............. ~...... ............................. (Building In~l:~:tor) Application No. Y"~'"~"l ............... APPLICATION FOR BUILDING PERMIT Date 1L, 19 INSTRUCTIONS a. This application must be completely filled in by typewriter oK in ink and submitted in triplicate to the Building Inspector, with 3 sete of plons, 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 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 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 Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, 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 inspections. ~ (Signature of applicant, or name, if a corporation) .......... ....... ............. .......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer,~, electrician, plumber or builder. Name of owner of premises ......... ..~...~...~....k.! ........ ..~.......~....~...~...~'..1~..~...~. ........ ~.q..~.~ .................................................... I~~ ~ rporate/;~of d~authorized officer. Builder's License No ..............0....~;.......::.['[..~...U...C....~ ....... Plumber's License No. T, Electrician's License No ....... ?>..~...."~...?...T~......1~7¢.. ........... HZ_ Other Trade's License No ............................................... Location of land on which proposed work will be do_ne. Map No.: ........................................ Lot No Street and Number ....... .~..~...T...[.......'~...O,6..~. ........ '~1. .......... ~{(..~.!...M~....Q.~..~...,.~.,o...~....~../.....~!..~.,I~..~..' ............... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ~.,~(~C ~___~.)~..IL'( ..~..~..ELLIN'~,-.. b. Intended use and occupancy .................................... 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ..................................................... J,~ '~ 0 0 ~' . ,~ ~ (Description) 4. Estimated Cost ........................... .~ ............................... t'ee ........ /." ............................................................................... (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 ............................................................................................................................................. 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 ................... , ................ Rear ............................ Depth ........................ Height .................... Number of Stories ............................................................................... 9. Size of lot: Front ....................... L..~....0. .................... Rear .......................................... Depth ...~...~. ...................... 10. Dote of Purchase ........................................................Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated "~'~'~ I ~ [~ t~' '1' IJl~ L_ /v'0 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ ~ .............. 13. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes (~') No 14. Name of Owner of premises ..~...:.~......~..:......~...0...?....~.....~... ......... Address~)..?>..!..~...l~...'t'.. ................ Phone'~o.D..~....~...~..?,~...... Name of Architect .............................................................. Address ................................Phone No ...................... Nome of Contractor ................... .~. .................. (~-~ddress ..~ ...... Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all setJo~ck 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 YORI~,, COUNTY OF ..~~. ........ ..~....~.,,~.,...~_..~...~....:......~..:..~.~ ~ ~.~ be ng duly sworn, d~oses and says t~t he is the eppliconl (Nome of i~ividuol signing c~troc~ above nam~. He is the .............................................. ~'~g~, '~rporate officer; ;'~;~ ........................................ of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; t~t all statements contained in this application are tree to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Swam to before me this ................... ........ Term [xp~re~