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Home My WebLink About9564-zFOR~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . ~/~.~....~.erJ~l.i~k..L..~.e ...... Street Map No..5..~.~. ...... Block No ........... Lot No ..... 2.0 ........................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....N.0¥~mb.e.r... 2.5. .... , 19 .~7. pursuant to which Building Permit No .... .9~/!.Z dated ....~IPY .e.mb.e.V.. 2.8. ....., 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 ... PR~VA.T~.. 0.I~...F.AYl..I.L.y. D~.LXN.G. .................................... The certificate is issued to ........... .I.t-..a.l.~..B..~..a. qh.iph ........................... ( owner, :~:~:34~I~ of the aforesaid building. Suffolk County Department of Health Approval ..... .7.-~$0.-.!69 ..................... UNDERWRITERS CERTIFICATE No .... N~.&6.~O~ ................................ t-IOUSE NUMBER ...6~5 ........ Street ........ .~.e..rn..t.qk..L..m~.e. ................... .............................................. .s.o.u. ,. yo.r.k ............ 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 COMPLETION OF THE WORK AUTHORIZED) N? 9564 Z Permission is hereby granted to: A~'!' l~hi LanC ,:c~r,. LIC Italo Balaehie~ Lh~ild new one family. at premises located at ..~.~,i.~...~.....j.,l-~,~.[.v.f~.~...,~.c~.~...,.~.~...,~ .................................. Jern~ck Lane Southold N.Y. pursuant to application dated ~:~' /' 19...Z.(., and approved by the Building Inspector. Fee $.,.,~,~..e.~O. ........ l~OZtM NO. 6 TOWN OF $OUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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: ]. 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. For existing buildings (prior to April ]957), Non-conforming uses, or buildings and "pre-existing" land uses: ]. 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. 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 s lz-xl) New Building / Old or Pre-existing Building Vacant Land ~ Location Of Property ...... .-,~.,-- ~--~.,T., ~s~ ()~ ~ z Owner Or ~ners Of Properly ......... ~F.~. ~ .......................................... Subdivision ~-~uc~ ~o~l~ 5 ~S~' ~ ............................................ · ~....~?~ Lot No ............. Block No; ............ House No ......... :... Permit No.~.~.~..~. Date Of Permit .................... ~pp,icant ......................................... g.pt. Appro ................... L. or pt. Appro . ................................................ Underwriters Approval ~..~:...~.~.~.~ ................... Planning Board Approval ........................................ Request For Tempora~ Ce~ificate ........................................ Final Certificate ~ Fee Submitted $ ..... ~..~ ......................... Construction on above described building and permit meets a_l,~ applicable codes and regulations. App cant .............. c - . ................... ................ day of ............................................ (stamp or seal) Notary Public .................................... County THE NEW yORK BOARD OF FIRE UNDERWRITERS 18 BUREAU OF ELECTRICITY ~- 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT on/y t/re e/eet~etd ~u~pme~t es d~gHbed b~/ote ,md t~trodu,~d by the ~op//~mt mm~d on the abo~e app/icatio~ ~mb~r ~a the pr~m~s~ o$ I.Bala~l~h,Jernlck Lane, Southold, L.I. ~examinedon ~ay l~R 19~ ~ndfoundtobei~compli~nce~e~ththerequirementsoythi3Bo~rd. RXTURI OUTLETS SWITCHES 11 1: DRYERS FURNACE MOTORS FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS SERVICE DLSCONNECT S E R V I C OTHER AI~ARATUS: 1 1 Smoke de~:ector 1 2 1 Walter ?ingot P.O.Box 991 Mattttuok, L.I. 11952 LIc.18~SE mm, mm~., This certificate must not be altered in any mannerr return to the office of the Board if incorrect. Inspectors may be identified by thei~ ~__ c~~__~ DE'ARTM__~. T.,__S C__OP_~Y O~ CnT,.__~Te _MU..~HO__T~ A~LT?D ~N~A~ ....................................... :~?~-~)'~.-..~ .X...~ ~-.~_ o/<_, ......................... ............................. ?. .......... APPLICATIOH FOR BUILDIHG I~ERMIT INSTRUCTION$ 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. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and~ giving a detailed description of layout of property must be drawn on 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 o 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 Occbpancy shall have beeri'l granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zon_a Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction buildings, additions or atterations, 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 inspectio~s._'~_ (Signature of applicant, or name, if a corporation) ~...3 ~.L.,...~.~..~..~..c..%..~:'..Y.:....,~. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bui)de~.~ ............ ~ ~.~.~-~ ....~ ............................................. ........ ................................................................. Name of owner of premises .... .~..r.. .............. .~.. .................................................................................................................. If applicap.t,js a corporate, signature of dulv authorized officer. .............. ...... ................ W ¢l~ame adfl,~title of corporate officer) Builder's License No .......................................................... /ooo - 70 - 3 - Plumber's License No ...... I~..~,..~......~..l~-..~....w~.....~..!..~..~ ........... Electrician's L~cense No ..................................................... ~ ~/_.~ .'-~-~-~ Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No...~....-~....~....~..~.. ............... Lot No Street and Number ~Ji~ ~ ~_:..l'~;...~..I eM .~=...~...~....~..-:..1 ....... ..~..O..~..~..~..c. j~. ...................... v~ C~,T' c~{= ~O.t.$ ~v~.- MunicipaliW 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy .~..~..~,..!..~....~...l~.....c....~... ................................................................................... 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair Removal ......................... Demolition .. .............................................. Other Work ........................... (Description) 70 4. Estimated Cost ........... i ................................... Fee .................................................... .,.. J (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 I C,4 ~-.- f~V ~ ~-~ 6. If business, commercial or mixed occuoancy, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front .~...~ ~/~ Rear Del)th ................... 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 ................ L...{~.. .......................... Number of Stories O 9. Size of lot: Front .......... [...)....~... ................. Rear ....... ./...)...~..~.. ........................ Depth ......... ./...~....~........~...~'....~'~....: ............ , 10. Date of Purcnase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which prem ses are s tuated ........ ~-~.t~.~.~.l,~,~ ........................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ................. ,,,/~T/....(~.. ................................ 13. Will lot be regraded ~.....~..~ .................... Will excess fill be removed from premises: [ ] Yes 14. Name of Owner of premises ..... .3~.~.~... ~..~..~.~..(~.~.,..~..~.~e.... ~.Z ..~?..~..,~b~ ~,/~-~!~..~-~ · (Address) ?;?'T';' ' '~ ...... iF~o;;; ~f;i'";7;'",'~T' ArrhJt.rt f~/~.l &) I~J I'~''' ~'-,'~ Name of ............................................................................................................ -- . -- ..~.e... ~... (Address) (Phone No.) Name of Contractor ~..~.. .. ~. ~- ~ '~, ~ ,.~.:.:..)..,....~.....t2. ...................... ~. .............................. t~aoress~ [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. J STATE OF NEW yOfH~/~ ) COUNTY OF ...~...~,"~'.-.~./,,~... ........................ ) ~..'TE-PH-.~...~.. (--, T'~'or-,T~/c~J' being duly sworn, deposes and says that he is the applicant above named. {Name of individual signing contract} 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 make and file this application; that all statements contained in this application are true to the be, E~_t~L~li~ ~<~o~_~ and belief; and that the work will be performed in the manner set forth in the application filed therewith. NOTARY PUBL1C. State of ~ew York -- -- ~ No. 52-8125~50, Suffol/( O6uJ~.y,. · -. ,. ......... .............. day of ............. ,,w __ , Notary Publi ..... -.... ,~,~,,[~ ...................... ~ [ (Signature ............. of app' /* licant) Z.o/- ~5" ('v~ c ~ ~.,'/' ) (,'es.) ll'&MP se4rveue4 ~/a.r.~, l~ 7' /+. ~ql WA111ll ll]Pllt.Y Alll ll[W'Aill I~L 1911?EMI ~ THII I1111 ~ MI.I. GONI~XIM TO TH1 O~ Hl.~JJl'l.I. IlliCitly. "~'PPROVED AS NOTED ,£ -/%, '-4 CON~ULI~NG ENGINEER NYB PE~ 42817