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Home My WebLink About9563-zFOll~ NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Ot~ice Southold, N. Y. Certificnte Of Occupnncy No.. Z907.7. .... Date ..... June.... 22 ............ , 19.. 713 THIS CERTIFIES that the building located at . 17.0 .Pl.e.~sant .Pl&ce ..... Street Map No...29.01 ..... Block No ........... Lot No ...... 52 .......................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ... Navemher. 28 ..... , 19.7.7. pursuant to which Building Permit No ..... 9563Z dated ... N~vemher. 28. ...... , 19.. 77, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...... PRI.VATE. ONE. FAMILY. DWELLIN/I .................................. The certificate is issued to ..... D~.,. & Mrs,..V. inc.en~c. Ray ......................... (owner, ~ of the aforesaid building. Suffolk County Department of Health Approval ...... .7.~S0~l?'~ .................... UNDERWRITERS CERTIFICATE No ...... N~897.6N .............................. HOUSE NUMBER ·. A?0 ........ Street ......... Pleassl'l$. Place ................ ............................................... ~.~u~hold,. N...¥. ................ DUllUIng mspeclor BUILDING 'DEPARTMENT TOWN CLERK'S oFFICE SOUTHOLD, N. Y. BUILDING PrERMIT (THIS PERM,IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9563 Z Permission is hereby granted to: T~,,~,~*-~.ncl :,:~e~:"-~:~ Ine .~./C Vincent Ray ........ Xxo~th~l& .................................................... to .~,.,~..]..1..X-..,,'...o4'~.~...:~',,-~..'.~.-~-,.:.,.~ ........ ].~,.r, 2,, ............................... at premises located at .:,~,k,,.~ .................... }'/ ................ ~ .... ~;'~ ..... ,,~ ~ ~ ..... ~01~A~.~,~ ........................................................ "· ~ 19,.?;~Z.., and approved by the pursuant to application doted .......................t~:,~.....,2.~; ................ , Building Inspector. F t~ Fee $..~.~.Z.~ .......... FOBM NO. 6 TO~/H OF $OUTHOLD Building Deim*tment Town Clerks Office Saul'hold, N. ¥. 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 buildings or new use: 1. Final survey of property with accurate location of alt 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 $I.00 Date ................................................ New Building ...... y/.27}:} ....... Old or Pre-existing Building ............................ Vocont Lond ............................ Loco. on Of Property .... ..L..::...r. .......... ....... Owner Or Owners Of Property ......... .;.).~.;-- ~.l.../~.,~..,....t.~.4.'.x/o.~'.4~.~.Z.....~/.~(~.7.\/ Subdivision ................................................................ '~/ e'/~ Lot No ........... ~ Block No ............. House No ............. Perm,t No. ............... ,. Date Of Perm,t .//...:,t/.,~..7...App ,co ....... .: ............. Health Dept. Approval ..... .~...>.~'/:'.)....~..:~..' ~. .............. Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all ~pplicable codes and regu!.~atlons. Sworn to before me this .~'/"q"~ // day of ........ ................. Notary Public ...-;~...~.. ~,,/~.... County /~/ I~I,I~ASETH ANN NEVfI.L~ . ,/ r~OTARY pUBLIC, State of New Yerk No. 52-8125850, Suffolk County (stamp or seal) ( -4 -7o THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET[ NEW YORK, NEW YORK 10038 THIS CE~IFIES THAT in the ~ollo~vin~ locution; [] B~ement .,,.e,,...,,~o. ,.Tune 8. 1978 and found to be in comjdiance with the requirements of this ~omrd. FIXTUI~E L,,~,,,~.~A I I EXTURBS ' r~'' I20 I 29 I 2 ~ I 3 10 150 Nu~-Outlet Systems No. of Feet: ~-0" ~oto~s ~ ~-ff Smoke detecto~ R 1/0 track 3 Lites. EXHAUST FANS l/o Joseph Crocombe Box 1175 Center Norlohes. Lie. 7~6E This certificate must not be altered in mannerr return to the office of the Board if incorrect. Inspectors be identified by credentials COPY FOR BUILDINO DEPARTMENT. THIS COPY OF CERI'IFI~ATI MUST NOT Il ALI Itl ANY .~JJPLICATION FOB, BUIU)IN~ fiR.Mn' INSTRUCTIONS a. This application must be completely filled in by t~)ewriter o~, in ink and submitted in triplicate to the BuildingS' b. Pl~ p. la.n sho.w.i.ng.,Io.c.a, tion. o.f..lot a?l. of bul.lding~ on preml.ses,.relationship t.o. adjoining premises or public streets o, areas, aha giving a aetauecl ~m:rlpgon ot layout otpeaporty muSt be drawn on the d~agram which is Ix~rt 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 isme a Building Permit to the applicam. Such permit shall be kept on the premises available for iml:mctlen tfiroughout the work. _L_e;, LNo ~bu. ilding .t~l! .be .,occ.upi.,e~, or .used in. whole or in part for any puqx~e whatever until a Certificate of Occupancy 5ha, nave oeen gramea ~y me i::luilaJng Inspector. , .A,P,.PLI _CATIO~N .!S HEREBY.MA_DE to .th.e B.ull.dlng_ ..I..~....rt_ment for. the .issuance of a Building Perm,t' pursuant to the ~ou,a~r~.. :on.e u..m~nance, at .the T.?n.,o,t. aaumola, buttolk L.~ _~, New York, and ..other appl~.able Laws, Ordinances or .~.he~eU,or,,o. ns, .tor the c.onstructl, on o..t, Du,~?ing~.: ,a~d, itions or alterations, or for removal or demolition, as herein described. .e .a. ppuc, an.t ag.r.ees To comply wire a, apphcaole laws, ordina~:.__~_, building code, housing cade,~end maulatiom and to aam~t aumonzed mspeators on premises and In buikllngl for necessary inspections. -'- ' ~ · .~.~1 . . . ..... i J~f£~....~.~.c-....~c. ....................... (Signature of appllcaht, or nan~ if a coq~omtion) ~ .... ..... ...................... (Add~ of ~c~licanU State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............. i ............. .~.,.,..~.~.~.~ .............................. :i .................................................................................... : ........................... ..V.~.~ ~w~~-.~ ........... Name of owner of premises .......................... ~: .... I f aP~ corpor~ture(~o~duly ~uthorized officer. ......... ~7"'r~;~"~;nd t.,, of co;~'~ o,~;~ ' ~ ......... .'i:~.....HZ. ........................... Builder's Liceqse No. ~1 Plumber's License No ..... ~..~...~..~....~'.~.~... ...................... Electrician's License No ............................................. Other Tmde's License No ............................................... -7'~/:J£~ ~AJf4?'e"R~ 1. Location of land on which_proposed work will be done. Map No.: ........ ~.~.~.J.... .................. Lot No.....~..~ .......... Street and Number ~...Z:...~.~/~.~... .................. .2.~e.~ .~... .................................................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of. proposed comtruction: a. Exisiting use and occupancy .................................................................................................................................. b. Intended use and occupancy ...... .Q.~.I~.....L~..,'~./'~.L..~.. Z~.~.~"L~.~..~ ......... Nature of work (check which applic le): New Building'. ................. ~' Addition .................. Alteration .......... Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... (Description) 5. If dwelling, number of dwelling units ..... 0)~'~'. ........... ,.Number of dwelling units on each floor ............................ If garage, number of c~srs ..................... ..~.~.~ ............................................................................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 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 ....... ~'.J...~ ..................... Rear ............................ Depth ..... ~..(. ........... Height .................... Number of Stories {3 ~/~' Depth ................................ 9. Size of lot: Front ............ l.~.... .................................... Rear ......... l.~..~. ....................... /.,~'O / 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ..... .~5~D.~-~..~.I~/~. ................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ............ /~..0. ....................... .~ ............ 13. Will lot be regraded ...... .~.~.~.. ............. Will excess fill be removed from premises: (' ~) Yes (v~o I,/ ,,7.~z _, ;-/,//,/~ye-'s ,,. Nameof Owner of ................. Phone No. Name of Architect ......................................./~ ...................... Address ................................ .Phone No ..... , ................. Name of Contractor ..~I~R~/-,0.-.~'¢).~.:...~/¢-~ ...... Address .~J~/~.~I:f[P~.../t~ 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 whether interior or corner lot. /Z-O' STATE OF NEW' ..Y~ORK, ~ S S COUNTY OF .... .~.~.~.P.J,/~ ........... [ ' ................................................................................................. being duly sworn, deposes and says that he is the opplicam (Nome of individual signing controcf) He .s the ....~ ..................... ~" ....................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, end is duly authorized to perform or have performed the said work and to make and file this application; that oil statements contained in this application ore true to the best of his knowledge end belief; and that the work will be performed in the manher set forth in the applicoti_.~3 filed therewithh Swam to be)ore me this // ~ '"'-[, ,. 3,~,O1~4-~ /-~OC · J-~/C,. ~/' .... ..... ............ ..... Notary P)~olJc, ~ ............ ~ .................................... County ...................... 7r./.-.;;L..-....· ....... ~,~-.,....;.....:-,. ........................ ~IOI'AR¥ P~LIC, State of New York No. 52-4643721, Suffolk lerm Ex~ires March SD. J ' i IL II APPROVED AS N,OTED ,'7 [-1'3