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Home My WebLink About9573-zFORM TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .831. North .Bal~.iew. Road. ~,~X Map No...X.X.F.X.X. .... Block No...x.x.x.x..x... Lot No .... XXX~ ......................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .. ~Decen~ber. ,2, ...... , 19.7.7. pursuant to which Building Permit No.. 957~Z · dated ...December..2, ....... , 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 ...V.~..~.VATE. ONE...F~..I.L¥..O.~. L~IN.~. ..................................... The certificate is issued to .. p.o. qg~.a.s..~r~l. ,~rllou. ~er~clel~ ...................... (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval Aug.u~t..4.,..19.7.~ ..... 7.-.$0.-.164 ..... UNDERWRITERS CERTIFICATE No...~..3.9.3.4.4.6 .................................. HOUSE NUMBER..8..3.]. ......... Street..~.o.r..t.h. ....... .N.e.w..¥Q~J~ ~ .............................................................. Building Inspector FOI~M ~ BUILDING TOWN CLERk'S ~'mC~~ SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9573 Z Permission is hereby granted to: ..~.z~.~.~,~.,~y.....~.u.z.cD.~..~.~..~...~ ~ .............. ~o.u...~.b..~x.(../:~ ................................. ~o ...~o./..:~.~......~.~.......~..~.E: :....(.~...~...~..~.y....~.~.,..~.~. ................................. pursuant to application dated ......... ~..~..........c~.... .................... , 19'~..Z..., and approved by the Building Inspector. Fee $..~../.:...~.~.- ...... · ~, ' ' Building Inspector FOBM NO. 6 TOWN OF $OUTHOLD Building Delm~tment 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 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 Beard 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 Date ............. J..,......,...; .................... / New Building ..... .~.... ........ Old or Pre-existing Building ............................ Vacant Land ............................ Owner Or Owners Of Property ~).~,~...~,.~. ~' ..~..../-2',~.~.:Z,~, ,,,r~, Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No.....:.~...:........'mlJ~tD gf Permit .................... Applicant .................................................................. Underwriters Approval .... .~...,.~?.~..<~]...,'~...~'.. .............. Planning Board Approval ....... .'~/...:.C.: ...................... Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ .................................... ~ ~/~'~/~/~/ App cant ...... ........................... , ...................................... Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) Rc, / CO Z_ THE Is rote July II, THIS CERTIFIES THAT NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF EI. ECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 19','o ..,,,.,,,.t,,.., N,.. N393546 Wlndsway Bullding~ Private Rd.,off/North Bayvle~,Southold,L.I. in the foll~ing ~atb~; ~ B.e~.~ ~ xa~ r~. ~ ~ rt. outs I de ~. a~k ~ ~ exami~ on July ~,1978 a~ fou~ to be in ~mplia~e wlth the r~utrements of th~ ~. RXTURE FIXTURES RANGES OVENS ~ WASHERS FANS O~TLETS SWITCHES FLUORESCENT S~RVICE DISCONNECT S E R V : I C )THER AI~ARATUS: Notorst I-I/2 ho I G.F.Col. I 5make detector Ooodale Elec. RR I BK.15A ~&ln Rd. ~4attltuck, N.Y. 11952 LIc. TR:SE e~m~z ~ueumae II / 'his certificate must not be altered in ohy manner;, return to t~ office of the ~ard if incor~. Ins~ may ~ i~if~ t~ir c~e~ls. _ _ COPY FOR BUIL~IN~G D~EpA~RT__M?NT~, T~H~I~_ C_O?~ ?F_ CBI_ !IFIC~ TI M~ NOT BI ALTERED~ IN.~ MANNER. a. This ..?l, icot. ion,mu, st be completely ill]ed in by .typ_ewriter or. in ink and sabi~itted in triplicate to the Bu Iding mspector,b. PIotW~m' ~ se~ ay Iocatic~Pmm"~ pmn to ~3~r,~ording to sc.h, edule. ~ ' plan showing 0~J~at'~a ~'f build ngs~on ~remises/~eelatiorfship to adJo n ng premises or public streets or areas, end 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 com,.me,nced before iss~ance~of. Bu!lding Permit. d. Upon approval of this application, the Build!ng InsPec~- Will i~sue ~ Building Perm t to the app cant. Such permlt~ shall be kept on the premises available for impact,on 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 Build ng Department for the ssuance of a Building Permit pursuant to the B~uild!ng Zon.e Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Kegulations, tar 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 admit authorized inspectors on premises and inbulldlngs for necessary, inspections, to ._ ......................... ....... (S,gnature of applic6ntu..or name, if ' ........ /...w...&. .... ............. ............ (Address of applicant) ! State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder."~ ..................... ~:X~. L .L .~....t~ ~,~. .............. Nome of owner of premises ................................................................. . ............ If opplica~a corporate, s~gna~:~e 9~uly authoriz~d~of~er. (Name and title of corporate officer) Builder's License No ..................................................... P umber's License No ~I~l;;..~..~° ~ ........................ ....... Electricians License No. ~,*,..~?,*,l~.,i~...,....kk..,~.,...t~3~. 7-$o- Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ...~L'~i;...~..~..~.~l~.~;~ ...... Lot No....~,;.i ............. Street and Number ................................................. .~....~. ~...~..'~.../4d..~.....{~..'~_~....~..?...~.~fi.~.~.~.~.&~.~le~, Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .....~ ............................................................. . ..... b. Intended Use and occupancy .~..~....?..~; ( ,~- 3. Nature of work (check which applicable): Ne Buil g. ...... Addition .................. Alteration ........... :,.... Repair .................. Removal .................. Demolition .................... Other Work ................................................ ..., (Description) 4. Estimated Cost ..........:,~....,...0,0. ................................ F e '~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... .~../~....~.ii'.~ ........ Number of dwelling units on each floor ............................ If garage, number of cars ........ ~,.....(..'~..~..Z),.~.....r~....~ ..................................................... 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 ....... C//'t.~....~.~' ............ ~l Depth ~..(¢~.I ............. A Height ...... ].~ ......... Number of Stories ...... LC.O..~..'.~.~. .............................................................................................. 9. Size of lot,: Front ......... 1.~.~! ...................................... Rear ........ 1..~.~.~. ........................ Depth ....f~.....O. .................... 10 Date of P6rchase .... .[,~..~. ~..~./.~..~...~..~.,.~'.. ............ Name of Former Owner ..... ..~..F.~¢....~..'~...~. ............................. 12. Does proposed construction violate any zoning law, ~;'~'i~'~' ~ ~;~;~;;~; 13. Will lot be regraded ..... ~/./~... ............. Will excess fill be removed from premises: ( ) Yes ( I~No ]4, Name of Owner of premises ~)O tl~.. .............. ~I,. Address ~ ......... PhoneZi~ ..... ...'~..../...~. ...... Name of Architect .....'r_..., .................................................... Address ..~..~.~...'.Z ................. Phone No ....................... Name of ontroctor I'~, '/Z)~ .......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 whether interior or corner lot. ........................................... : ........................ I ............................ O lng duly sworn, dep d says that he is the applicant (Name of individual signing contract) above named. He is the ................................. .~..~...~..'~...C..~C~"~..~.. ........................................................................................... (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 t~qe/~est of hi~ F, Tfowf~e and belie,~ff//~nd that' the work will be performed in the manner set forth in ~he application file~i~j~/'/z,~/'/~ ./,~/~ '~'~'~'~7 ¢~-~r~ Sworn to before me this . ~ ~' '~ -- ~'/ '~ '/ / / .......... ......... . Notary Public, . ...................... ,,,~.dc,~.~v(.~..... Coun,ty ..;~ .................... ;;::,,,,,.., ........ 7 ....... ;: '"".','"",~') ..................... ,~ L~lgnarure OT oppllconr)/~,.~ · 2oo. u- 0 .J FRONT APPROVED AS NOTI~D bOUCLAS W % .~ O~'TH O~b, N.Y. ' DitLL O: FOUNOATiO~ ~ Pi,..~'t~" £L P~6D KO0~ ~ CL I I /. F__ F i' ° LLF_¥AT