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Home My WebLink About9562-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. Z90~7 ...... Date ...Jttne.. 6, ................ , lg..78 THIS CERTIFIES that the building located at .. '~ ~0~..llay~.~,~. ]Rc~li ...... Street Map No.. ~. ........ Block No ........... Lot No...20,..2'[..+ ...................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...Nov.~bel'...25 ..... , 19.7~. pursuant to which Building Permit No. dated .. Iqov.~ll~e!'...25 ...... , 197.7.., 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 ...i~tI.VATE. 01~. FAIqlLY. D. lg~..,!;ll~ ..................................... The certificate is issued to .. O.~.~.ar.cl .&. Ba~.bal~a .(}oeht~irll~ele ...................... (owner, ~ ) of the aforesaid building. Suffolk County Department of Health Approval ....... .N/R. ......................... UNDERWRITERS CERTIFICATE No ....... ?.~..d..~.~..; ........................... HOUSE NUMBER 1305 Street Bayvlew Road Building Inspector BUILDING ~£RMIT I'miS PERMIT MUST BE KEP'r ON THE P~M~SES UNTZL FULL CaMPL~'nON OF THE WORK Ne 9562 Z Permission is hereby granted to: M~tt~tuek ,, ..,.:~..,,t,.~- .n & ~t 21, :Shove. at premises located ~, .~¢¢.....,..,. ...... .................... pursuant to application dated . ....................................................... 19.t..(..., and approved by the Building Inspector. TOWH OF $OUTHOLD , 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, o certificate of Code compliance fram 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 Building ......1~..... ..... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .~.;.~f/.) ~ ~ ~- , ~ , ..... Owner Or Owners Of Property ~. .............. P.~.~ ' Subdivision _~..~:¢~_../~...~¢..~.o_.J~...~....~/ ..........Lot No. ~..0.7.~../:.+. Block No ............. House No ............. Permit No...~...~...~.~.... Date Of Permit .].J.-~..~'-.~,~ Applicant .............................. .~....~........~ ........ {~ ....... Health Dept. Approval ...... .)~...o.~.. ............................ Labor Dept. Approval ................................................ Underwriters Approval ..~..~.~:J,s.~ ......................... Planning Board Approval Request For Temporary Certificate ........................................ Final Certificate ~ ..................................... Fee Submitted $ .....~-'..~ ...................... Construction on above described building/~d, j~e~mit m~/ll .applicable codes Omi regulations. Applicant .~...~..~....., .-~. ~'.~ ............................................................. Sworn to before me this ................ day of ............................................ Notary Public .................................... County (ston~ or s_epl) ~.8 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~-- JLL12e 7R 1978 88 JOHN STREET, NEW YORK, NE~Ni~)~lOO38 ,~,,. ~.,~,~. ~o. o.S,,. N 389108 THIS CE~IFIES THAT ~ e~tlm, i~d on ~'lM~e ~ ~nd ~l. Section Block end ~oand to be in compliance teit~ the requlrementa o/ t~i~ Board. Lot FIXTURE OUTLETS 19 fiXTURES RANGES OVENS DISH WASfl~RS EXHAUST SWITCHES FLUOr~CENT h6 27 19 TIM! CLOCKS MULTI-OUTUc~ DIMMERS SYSTEMS SERVICE DISCONNECT OTHER AFPARATUS: 1 ~moke detecto~ ', ! O.P.C.I. Richard O. Relyea Delmar Dy., P.O. Box 372 Laurel, L.I. 11048 Lie. 21~8E ~ This certificate must not be altered in any mannerr return to the office of the Board if incorrect. Inspectors may be identified COPY FOR BUILDING DEPARTMENT. THINS COPY OF CERTIFICATE MUST NOT BE AL11RED IN ANY MANNER. 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, areas, and~ b Pot plan*.show ng ocat on ~of tot and of buiJdings ,on premises relationship to adjoin ng premises or public streets or glvtng a detailed descrlpt;on of layout of property must be drawn on d agram wh ch s part of th s appl cat on. % c. The work covered by this application may not be commenced before issuance of Building Permit. ,T d. Upon approval of this application, the Building.lnspeotor 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 pert for any purpose whatever until a Certificate of Occupancy shall have been grent~l by the Building Inspector. ~ APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Z · Ordinanca of the Town of Southold~ Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the coelstructldn of, buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable I~ ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for negellaW In~pectionL eprporation)"~%~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder~ Name of owner of premises ..... ~oP.~..d..~..~&..~o.e)~.J.~e~. ........................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ............. .£~ ...................................... Plumber's License No ........... ,-, ........................................... E ectr c an's L cense No ...... Other 'rrade'~ I_icen~ No ................................................... 1. Location of land on which proposed work will be done. Map No.,~I1Q~O..J~g~.O~. .................. Lot No.~,~,~,~,.+... .......... Street and Number ....... ~.~t'.~.~.If....b,Y. lia..,~,tA~,~J~K~.Jga..~* ....................................... ~ ............................................ Mupicipplity 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~R~e~a~~[~e~a~d~[~ ............................................ b. Intended use and occupancy ....................................................................................................................... .~. ......... 2. ' 'N;ture of work (check which applicable): New Building ....................... Addition ..................... Alteration...'....:......~, Repair Removal Demolition ........................ Other Work .................................................. (Description) 4. Estimated Cost ....~,Q.,.OQ.0....(,e.h,ell.) ........ 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 ...Z ....................................................................................................................................... 6. If business, commercial or mixed occuoancy, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front .. ~.~.,..2.J.**** Rear ...... ~..~.,.;~.[ ....... Depth .....;~.O..,.[k! ................... 0' Height .......... .1. ............................................... Number of Stories ....... ~. .................................................................... Dimensions of same structure with alterations or additions: Front ..... J~QJ. .............. Rear ....... ~ ............................. Depth ........ .'~. .................................. Height ... 1.6.! ............... Number of Stor es .2.. ....... 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................. Height ................................................. Number of Stories ................................................ 07 9. Size of lot: Front ........ ./..~..2..~.~.~.~ .............. Rear .......... .br. ............................. Depth .......2.~.7..,.~.7. .............................. 10. Date of Purchase ....cJ/..~,/.?.7..A~I~.P.Q~,~. Name of Former Owner ..~).~...(~.~,.~.~],~ ................................................ 1 1. Zone or use district in which premises are situated ....R...e..a..~....A. .................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: rio ............................................ 13. Will lot be regraded ~.,3r.~.~l .................... Will excess fill be removed from premises: [ ] Yes [x] No 29~-9176 14. Name of Owner of premises ....cait,.v..e,;r.0,..f$...]~,r.b~r.$,..fiQ.~thr.~,llg~t3e. ................................................................... (Address) (Phone No.) Name of Architect (Address) (Phone No.). Name of Contractor ....... ~.~;.~..~.~.P,..~-fl.qD,~~;;I,~1 · ~;~.0,~k~...~0,a.-.~t~.~.~.~'l~'q.]~..'l~'~. ......... ;~"'"~/~'" (Address) (Phone No.) 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 wheth- er interior or corner lot. STANLEY SLEDJ'ESK! STATE OF NEW Y~ORK, , ) ,,,- Notary Public, State of New COUNTYOF ...~ ........................... )~ N~ 5~1175 Suffolk Countg ~ c~ ~pir~ M~3011~ He is the ...... ~ ...................................................................................................................................................................................... (Contractor, a~nt, co~mte officer, etc.) of said owner or owners, and is duly authorized to ~rform or have ~rformed the said work and to make and file this application; that all statements contained in this application are true to t~ ~st of his knowled~ and belief; and that the work will be ~dormed in the ~nner set forth in the application filed therewith. .......................... ..................... ....... .................. ..? .... ............................... ~,,.-..,. ~, -~-..., L~t /5~ Un~u,he¢;zed nlfemf;on or eddifion to this document is I ApPROVeD AS ~.~OTED ,jl L 12. $ T L~ ....... STEVE 't SO[4TAKIS CONSULTINr5 ENGINEER N¥S PEI/ 428t7