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Home My WebLink About9584-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.. Z9.1.10 ..... Date ....... July .... ~./4. .........., 19...78 THIS CERTIFIES that the building located at ...2.~25 .Kormey.~a .Ro~,c~ ... Street Map No.. 2180 ...... Block No ........... Lot No ........... .'1~ .................... conforms substantially to the Application for Building Permit heretofore filed in this oi~iee dated .... Dec.ember... ~2 .... , 19...7.Tpursuant to which Building Permit No... 95~/4Z dated .... Dec.ember .... .~P_..., 19...77was 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 ............. L~.ivate. On~ .Fam~l.y..I~elling. .... ~ ..................... The certificate is issued to ......... John. I~I,. Albert, son .......................... ( owner, ~t ) of the aforesaid building. Suffolk County Department of Health Approval ...J..urn, .e...2.0. !..~.9.~.8 ..... .7.-.8.0.-.?.5.~... UNDERWRITERS CERTiFiCATE No .......... ..... ...... HOUSE NUMBER 2~25 Street Kenneyts Road Southold, New Yo~k FOW-~ NO. ~ BUILDIN~ ~PARTM~NT TOWN CLEIUC'S ~ SOUTHOLD, N~ Y. BUILDINQ FEItMIT (THIS PERMIT MUST BE KEPT ON :I'HE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 958t Z Date .............................. 1~......1.~ ......... , 19...1[~ Permisslae~ is hereby granted to: ,~...~.,...I~ ....... aZ.~...,l..vltu ..albe. r .t.~ ~... ~uild new one famill~, dwellin~ at premises located at ...... Je.e.~...l~...l~...~.~...1.c~....llell-rl,e. lCe:.QO~ ....................................................... .......................................... ~Z.s....~...~...~...~g.~ ....... ~.~.~.t,l~.~li ........................................................ pursuant to a~llcation ~ "'- ~ ....................... a~,.c.....l~ ................. !~:..., a~ ~p~ ~ ~e Buil~ I~or. Building Inspector ]~O~tM NO. 6 TOWN OF $OUTHOLD Building Delm~tmenf Town ClerkS Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructlons 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 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. §. 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 / / ,..... . ...... .................. New Building ................... :~OId o~ I~re-existin~uilding ................7¢~.... Vacant Lgnd ............................ Location Of Property ........ ~...~...~...x~.. ........ ..~....:L~.q-,?/~. ........ ~.~...~.~..~.,.~..o..~..~..../..~. t ...... ~ ............. Owner Or Owners Of Property .....~.~.Y..¥.N....,)..('.~.bb~..X::~.,;-~...~ .......................................... ............. Perm,t ,o..fl. Sit Of Perm,t ..bT.. ................... Health Dept. Approval ~.~,.~....-:..~.~....C.~....~.....~..~.l ...... Labor Dept. Approval ................................................ Underwriters Approval ~..~...2.~..~?~.....Planning Board A~.i..proval7 ................................ Request For Temporary Certificate ...... ~: ................. Final Cert'ticate .......................................... Fee Submitted $ ...:>.~..'~.., ......................... , /(~ Construction on above described ~~mi t ,~s~,pfica~ and regulations. Sworn to before me this Applica"r~~~'~J~~'~': .............................................. ................ day of ............................................ Notary Public .................................... County (stamp or. seal) ~/~ THE Is D.te July II, THIS CERTIFIES THAT NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 was examined on [] 1st · nd~ound to be in compliunee witk the requirements o~ this Board. FIXTURE LKB, TAC SWITCHE EXTURES "/ 291 2l 17/ I ~1 lO0 CB M~.. x R EXHAUST FANS DIMMERS ~otors: I-F ho I I S~oke detector Harold H. Haup?. Crlttans Lane Southold, L.I. Southold Elec. 11971 LIc.?O2£ This certificate must not be altered in any mannerr return to the office of the Board if incorrect. Inspectors may be identified by their credentials: COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BI ALTERED IN ANY _AU?r~N~I~.: ~ ,,.... ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWu (:LE...,,~ .......... ................................... ................................................................ :: ............... ...... APPLICATI~ FOR BUILDING PE~IT ~te INSTRUCTIONS a. This aPPlication must be completely filled in by typewriter oe in ink and submitted in triplicate to the Building-~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedulet b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout ofproparty must be drawn on the 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 on 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 Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, ahd other applicable Lows, 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, ~ousing,code, and regulations, and to admit authorized inspectors on premises and in buddings for necessary inspections,/ / ~ .... · ...... % (A-dd ss of applicant) State whe~'JeLe/~ppplicant~is owner,,Jessee, g~ent, architect engineer general contractor, electrc an, p umber or builder _ . ..... · '~'~f O'~W~;~'of pre~;~"" ii~.~.~'i~i~ ....... ~'~.' ................................................ If applicant Js a corporate, signature of duly authorized officer· (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................./ oOU ~ ,~, /~ - 7-~9 Othe~rElectrician'STrade,s LicenseLicense Ho.N° ............................................. · ............................................. Location of mona' on whic~h~l)roposed work~'~l b~e~jlonelc,~AAap N[~, .~.~.~. ............... LotNo~(~.,~....~..~ ........ b r ~ ..... ' ........................................................... Street and Num e ..... Municipality State existing use and occupancy of premises and infe~dec~use_..~__% and oc~fl~l)ncy of proposed construction: a Ex s t n use and occu n ·'"g pa cy ""~~'""~"'"'t'-'~~ ............................................................... b. Intended Use and occupancy :...~,.;..~J~:~.~.~..%~.~ .....................................................................,. 3. Nature'of Work (check which applicable): New Building.. ................. Addition .................. Alteration ........... : .... Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 4. Estimated Cost ~ ..~....O O · 1 ............................................. Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... .J .................... Number of dwelling units on each floor ............................ If garage, number of cars ............ ~, ............................................................................................................................... 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 ............... . .~... I~ber of Stories ................................................................................................................. Dimensions of sarhe-str~lcture with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ _Number of Stories ........... ~, ................... 8. Dimensions. pf ~ntire new construction: Front ...... ..~'...~ ...................... Rear ......~..~. ............... Depth .....~......~.. ........... Height ...~,.~... ........... Numbe~ of Stories ....... .I ........................................... ~ ............................................... ~ ................. 9. Size of lot: Front ..... .~i~l.~l ....... .-. ................................. Rear ...~ ............................... D~pth ...[~.~ .................... ]0. Date of Purchase ............~.~ ............................... Name of F~rmert~er ..... ~.~[~ ..................... 11. Zone or use district in which premises ore situated ...... ~~.~..~.~.~ .................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..~ ........................................... 13. Will lot be regraded'~[~..~ ......... WiUexcessafill be rem~r~mmis~: ( ) Yes ~No 14. Nome of ~ner of premises ..'~.m.~~. A~re~ ~.~,~&[.. Ph~e N~.~.~.~ , me ......................... , ....... , ............................ ...................... o, Co. r c or .................... N~.~.~.... PLOT DIAG~M Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set~ck dimensions from prape~Y~hether interior or corner I~lines' Give street number~ or description~~~according to deed, and show street names and indicate STATE OF NEW ~DJ?.IF,,_,,_ [ S S COUNTY OF ..... ?..~...~..~...o..~..~.. .......... ~ . ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract0 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 make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. J Sworn to before me this ~ /~ / / .......... o, ......................... , Nota~/ Public,. ........... ~ .......... :~.~,~.~.O..~ ........ Co,,nty ..... 'Z ....... ,~..~,~.:;;...%.~...x.L-.~.~::"?. ........................ ,/~'-" ,~ , /~,~_./ /// '/J' } ,y// ~/ (Signature of applicant) / EL~ABETH ANN H[VILLE I~OTARY PUBLI~. State 0f New York No. §2-8125859, Suff01k Term Expires March 30, ~s~s -I;" o.c? 1" ~5" P. C..ONC WA La, ~ VAN DI[JED: /V, ~7 4-3 s~age d~posaliand ~atcr supply ~ae~t~%ie~ for this location have been tn~peoted by this d~ar%ment and '.Chief of General Engi~m~ril~l .