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Home My WebLink About9546-zBUILDING ;PERMIT (THIS PERMIT MUST BE KEPT' ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9546 Z Permission is hereby gronted Building Inspector. NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No..Z. 9.3./~.8. ..... Date .A.u.~t..s~. ....~. .............. , 19.7.8.. THIS CERTIFIES that the building located at ...29.3.5 .Nassau. P/c, · RtL... Street Map No ..... 7~5 ..... Block No ........... Lot No ......... 12 ....................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...Novembez'...9 ...... , 19.7.7- pursuant to which Building Permit No...95/,6Z dated ...November ..... 9 ......, 19. '~7, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ..... .~?.~.ya..~.e..On..e..F?.~.~y...Dw..e.~.~:i~g ................................... The certificate is issued to ..... i~.~.s.s..O'.o.....~..n...T.a.]:.b..o~ .............................. ~onnnt (owner, ~c~_~ ) of the aforesaid building. Suffolk County Department of Health Approval ..... 7.-5.0.-?..~.8...J.B.3.y....2.7.,.. ~..9.7.8... UNDERWRITERS CERTIFICATE No ..... Pending HOUSE NUMBER ... ?.9.3.5. ...... Street ...... s..a.u..P.o..~.n.~..1~..o.a.d.: .............. Bdildifig Inspector FO~[ NO. $ TOWN OF $OUTHOLD Bulldi~g Deportment 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 triplicate to the Building Inspector with the following; for new buJldlngs or new use: 1. Final survey of property with accurate location of oil 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 o~ property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os 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 3. Copy of certificate of occupancy $1.00 $5.00 ,..,/ . Date .... ~..z../..2.~.: ......... : ...... New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ...~...~/.......Z./...O... Owner Or Owners Of Property ....~...l...~[~......d..~.~....~.,..'~/...i ..~,.~....~..~...~....~...T/. ............................................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No. of Permit .................... , d~/ ~ ~ Health Dept. Approval ............ ~..:.....t../.~..~.~... ....... Labor Dept. Approval ................................................ Underwriters Approval /..~/.' ................................... Planning Board Approval Request For Temporary Certificate ........................................ Final Certificate ~ ..................................... Fee Submitted $ ~..;..~b'7,~ ....................... Construction on above described building gpd perj~it meets al,[ appJ~coble co, es and regulations. .......... . ......................... ........................................ Sworn to before me this ~l,A/' da f ' ................ y o ............................................ ,stamp o~ Notary Public .................................... County THE NEW YORK BOARD OF FIRE UNDERWRITERS p m BUREAU OF ELECTRICITY F-- 85 JOHN NEW NEW YORK 10038 STREET, YORK, THIS CERTIFIES THAT Oll*l Jacobs, Flassnu POINT wos examined on July 31 , 1978 and.foundtobeincomplioncewitAt~requiremen~so~tA~s~o~rd~ FIXTURE LECEPTAC~I SlIT ] FIXTUI~ES ~ ICOOK~ DICKS I OVENS l DISH W,J~illl~S, EXHAUST FANS ~V~ ~ [ ~. ~ J S E I V I C l Panelboard/~tl-3clr. 12~amp. l-Smoke DEtec?or 1-200emp. Transfer Switch I-4.SKW Hot ~ater Heater Goodale £1ec, RR I, Box ISA, Main Rd ~attltuck, L.I. ltq52 This certificate must not be altered in any manner; return to the office of the Board Lic,783 E //L be identified by TITLE VAN TUYL~ ~. a. gNAUTHORIZ~D ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF $£C¥1ON 720~ OF TN~ N~W YORK STATE STAMP HOLE SUF!~. CO. DEPT, OF HEALTH Jl~¥lCIJ~ ' : ~A~EMENT OF INTENT -- ~" FOR A~PROVAL OF CONSTEU~TION n.~<y.~ THE'WATEH SUPPLY AND SEWAGE !1'-' DATE: , ::,(~tl~ I DENG~ WILL CONFORM TO THE TOW ETAMP ............ Z" FOR ~PPROVAL OF CONS~u~ON /o~,, . ~, ~E,~ WAT~ SUPPly AND EEWAGE H. $. EEF. NO.: , STA~S OF SUFFOLK CO. DE~. Disapproved a/c ............................................................................................ , APPLICATION FOR BUILDING PERMIT ~ ............................... , INSTRUCTIONS a. This application must be completely filled in by typewriter o~. in ink and submitted in triplicate to the Building Inspector, with 3 set~ of plum, accUrate plat I~ to ~cale. Fe. Fee ecc~n~ing,to,~ched~le, b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets os 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.qpplieati ,on may not be commenced be.fore issuar)qe of Building Permit. d. Upon approval of this aPPlication, fl3e Building Inspector will issue a Building Permit {o the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used ir1 whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY NL~DE to the Building Deportment for the issuance of a I~uildi,n.g Permit pursu,a, nt to the Building Zone Ordinance of the Town of Southold, Suffolk County, Now York, and other apph~:able 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. ......... ........ (Address d~applicanff //~.~.,.,.,,./- .~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................... -'r'_ ......................... :'"='": .......... .................................................................. Name of owner of premises .....~./..L~J.........~..(~........~.....,~....'~.......~...,~'3~.,~..,.,~..~../.......: ............................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of~rl~rate officer) Builder's License No .... ...~.....~.... ..................................... Plumber's License No. '~ Electrician's License No ............... .. ............................. Other Trade's License No ............................................... ~ ~/ /~ , ~, Loca,on of ~and on which p,~osed work w"Lbe done. ~p No.:E~5~.~./..~.:.~,ot No ..... ./.....~... .......... Street and .Number .....~..'~.x~....~./....,~...~......~/~r~...~ ............. ~...~....~'..~(~.~...~.4~..,~...~..~......: ........ ~.. " / Mu~lcipohty 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Exisiting use and occupancy ............................................................................................................................... use and occupancy ........... Intended 3. Nature of work (check which applicable): New Building' ...~....... Addition Alteration Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) 4. Estimated Cost .................. 2..~./...~ ...................... Fee Y ~- ~':'--~ . (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 c~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 ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... ~'.~.. ....................... Rear .~.L~.. .................. Depth .~.~...~...~.~..... ! Height /.~.. ............. Number of Stories ..../.-~'.~. .................................................................................................. 9. Size of lot: Front ...... ~.0.~. ............................... ...~:...... Rear ..../...~...O. ............................ Depth ~...Y.Z....':T..~.~.....~..... 10. Date of Purchase ........................................................ NoT of Former Owr~r ........................................................ 11. Zone or use district in which premises are situated ........ ~,,~:'~./..~.;~.....~1~../~ ......... ........../..i .............................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ............/t,~'~ ,~e,....., ............................... 13. Will lot be regraded ............................ Will excess fill be removed from premises: (~/Yes ( ) No 14. Name of Owner of premises ....~.~.,.~.~,...'~...~'.~....~...~....... Address =~..'+~'.,~ .~...../~.a....~.~...~Phorte No ....................... Name of Architect ............... / /---'~/~O~'.~....: ........................................ Address ......................... ';~-~' ':~'7' Phone No.N° ....................... .~.../..~..~.....~......~::~ Nome of Contractor ..~..~ ....... ................... Address ~,~.~d.,~...'.~i~'.. Phone / PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back 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. CTATE OF NIc-W YORK, ~:OU NTY OF ,-~ .................. ........... ~~.~..~'.~. ......... v....,being duly sworn, deposes and says that he is the applicant (Name ~f. ind~al ~nihg. c~tr~ , ~,, 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 ~ke and file this application; that all statem~ts contain~ ~in }his application are true to the best of his knowledge and belief; end tha~ the work will be performed in the manner set foffh in the application filed therewith. Sworn to ~fore me this .... ...... ......... . Nota~ P~lic, . .................................................. C~n~ .... ~..~..~-:....................~ ...... ~.....~:....~.~-.....'.'"'"'~ ~ : ............... N~ARY P~, State of New YArN No. 52-4~3721, Su~k ~u~ Term Exlires M~rch 30. i~ ~ L '~ ~,~ ~.,~ '~o~ 'o.o ,o-~ ~~ ~ "~ :iF_- _ - _= _~ ~ - .... ' " ' ':--' .l/~ ~ ','.': ', , , ' ' ,I : ', ' , , ~ = I ' ~ - = ; ~ , , i~0 k, . '. ".:,. ' ',, ' 'f, , I I " ' , : I ' ~' ,: '-: ' __ , , , ~ , ,,,,,, ,, ,,, , , , '~ '~h ' I