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Home My WebLink About9595-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Sou(hold, N.Y. Certificate Of Occupancy No .... Z~9.63 8 ........ Date .............. &ug'us.b .15 ........ 19. :19 THIS CERTIFIES that the building ................................................ Location of Property .. 76/.~;. ;L~r. aakw~ter. Rd ................... ~atti~zuc/k .......... House No. Street Ham/et County Tax Map No. 1000 Section .. ~0.(~ ...... Block .. 9 ............ Lot . .1 .............. Subdivision ........ XX. .Filed Map No. " .Lot No.. X conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... De c~]~t0er..3~ ~;;..., 197.7 · pursuant to which Building Permit No... 9~9 5 · Z ............ dated ........ Docembsr · 16 ....... 19.7."1, was issued, and conforms to all of the requirements of the applicable provisions of the law, The occupancy for which this certificate is issued is ......... ...... i~cldition., to..Brea3cwat~r..Co~.tage.'s .Cabin. ~3 ........................ The certificate is issued to ....... Guss£e. Ca~no~e .................................... (owner, i~.l'~2['~r/~~ of the aforesaid building. Suffolk County Department of Health Approval ..... .N/.R. ................................. UNDERWRITERS CERTIFICATE NO .......... 4 4 0.0.7.Q ................................. / Rev 4/79 oFFICE BUILDING PERMIT (THIS PERMIT MUST BI=' KEPT ON THE PREMISES UNTIL F~ILL COMPLETION OF THE WORK AUTHORIZED) N? 9595 Z Permission is hereby grante.~tS~ ,, /~.~, ~ ,/% pursuont to eppllc~tion doted ......................~.;, ....; .............. ~. ......... 19./..~.., end opproYed by the Building Inspector. ! Fee $./..,.f. ................ FO~tM NO. 6 TOWN OF SOUTHOLD 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 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 aT 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 prembes, or other pertinent formation required to prepare a certificate. Fees; 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelHng or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date New Building .................... Old or Pre-existing Building ..........~; ........... Vacant Land ............................ Location Of Property ........ ~./~.. ...... ,~x~.~f~..~.~.~..,,~...Z~.~.......~...j..~ ....... Z~.~..,ZZ...T_...~..Z~.~...¢~.~ ........ Owner Or Owners Of Property ....... ~..c,:...~...~..~...~. ......... ~.~.~j(~/~..~.,~' ................................................... Subdivision ......... .~.~,;~..~.'~;.i~Ji.~ ...... ., ......................... Lot No. ;7J;;[.;J.,. Block No......~. ...... House No..~... ...... Permit No..~.~.~..~-~ Date Of Permit Z~.~x~/~..7..~.Applican, ..~..~..~.~../..4~. ....... .~./~..¢'3~....,~...~...¢~..¢~'.. ........ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .; ........................................ Fee Submitted $ ...,~...~...~a~ ..................... Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in dup!icate to the Building Inspec- tor 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 installa- tions, 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 peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of anv housing code or safety inspection of buildings Or premises, or other pertinent informa- tion required to prepare a certificate. C. 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...~.~. ~. :../.~.~. New Building ............. Old or Pre-existing Building ~ Vacant Land Locat,on of Property . .~.~.~...~.~ ~ ~.7~ ). ,~.~.:4~.~......~t~, .~ ..... ~]~:~/~-~'... ~ ~ ,~ HouCe No. Street [ ~ o ~ ~ / Hamlet -- ~'- /~X~ Owner or Owners of Property . ~.,4 ~7 ~/.~' ..... ~4~.....~~ ~/~, ~ ,~: County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No ..... / ......... Permit No..~,.~..~.'=~...~. Date of Permit ,/o?~/////ZTApplicant .~. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval....~.~-. ~.0.~.~.~. ........ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets all ap~j~ble codes and regulations. ......... Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ BUREAU OF ELECTRICITY ~-- 85 JOHN STREET, NEW YORK, NEW YORK 10038 m,~ J.l,y 2, 197'9 ~pp,~.,,onNo. on/i~022738 N 4 40070 THIS CE~IFIES THAT ...... o~ly t~ ~t~M ~u~nt ~ ~cd~ ~ ~ int~ by t~ ~t ~ ~ t~ ~ ~ numar ~ t~ pm~ o~ ~. ~ N~ Joseph C~o~o~ Luther Rd., ~t~tuok, N.Y. Cabin f3 in the following location; ~ B~ement ~ 1st FI. ~ 2nd FL ~t~n Bilk ~t w~ exami~d on ~ Un~ 2 ~ ~ ~ 9 ~ 9 and found to be in compl~e ~ith the r~uiremen~ of this B~. FIXTURE /ECEP'r &¢LESI SWIT I FIXTURES DRYERS FURNACE MOTORS FUTURE AFFIANCE FRE~EI~ RANSES C SXHAUST FANS A/AT, H, P. DIMMERS Ouas~e Cannone P.Oo Box 1135 ]v~ttltUOkR 11952 Per 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 BUILDI COPY OF ClRTIFICAT! MUST NOT Bi ALTERED IN ANY MANNIR. TOWN OF SOUTHOI. D TOWN CLERK'S OFFICE . . .-~ - ~ ,-~ / ~.~ SOUTHOLD, N.Y. ~ /~~/~~/x~ ............... ,, ............................. ~ppli~tion No...d.......d..../.....Z ......... ~ro~ ................................ L.~..., ,~.::~.:~ ~er,,, ~o..?~.ZZ:'~C.~: ....................... .............................. ' ' g p or; ~ ~P~LI~TIO~ FOR IUIL~I~G ~EI~IT I NSTRU~IONS o. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to t~e Buildlng~ Inspector, with 3 sets o~ plons, accurate plot plan to ~ale. Fee occo~ing to schedule. b. Plot plan s~owing location of lot and of buildings on premises, relationship to adjoining premises or pub c s~reets areas, and giving a detailed description of layout ofproper~ must be drawn on the diagram which is po~ c. The work covered by this application may n~ be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the app cant. Such perm t~ shall be kept on the premises available for inspection throughout the work. /v e. No building shall be occupied or used in whole or in part for any purpose whatever until a Ce~ificate 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 gf the Town of Southo d, Sulfa k County, New York, and other applicable Laws, 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 c~e, housing code, and regulations, admit authorized inspectors on premises and i~ buildings for n~essa~ in,actions. .... ............................ (S[~noturo of opplicont, or name, i{ ...... ............................................... o, ....... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...~..t,~..~.,~-r..~..~.......O~,~..~d:~.~ ............................................................................ (Nome and title of corporate officer) If applicant is a corporate, signature of duly authorized officer. -7-~ -~7 /~o .- / o~-/ Builder's License No ..................................................... Plumber's License No ................... i?.. ......................... Electrician's License No. ~ Other Trade's License No ............................................... V 1. Location of and on wh ch r posed ark w be done Map No L~t No , . .............. .......................... ......................... Street and Number ......... ~.~.:'~.~.~..~.¢.~:(-!.~.-~,.L:..W ............ :.~. .............................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy .............................. '~----7--'?-:~-~" ................................................. 3. Nature of work (check which applicable): New Buildinw. ................. Addition ~ Alteration Y~ Repair .................. Removal .................. Demolitior. .................... Other Work ..................................................... (Description) 4. Estimated Cost 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 ............................................................................................................................................. 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 ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Dote of Purchase ................................................. ~lame of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ...~. .......................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............ ~ ...................................... /~zr0 r re s 13. Will lot be regraded . ........................... Will excess fill be removed f or~p mists: (,) Yes ( ) No ~/~'-' ''" C~ .~.~J.~,..'.~..~.. Phone ' e i ~ Address I~1o ....................... lA. I'~ome of Owner ot pr re'see ............................................ ............. Nome af Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-b~ck dJmensio,ns from property lines. Give street and block number or description according to deed, and show street names and ~ndicote whether interior or corner lot. STATE OF NEW,~QRK,~? /),~ ~- c c ................................ ¥///. ......................................................... being duly sworn, deposes and says that he is tile opplicam (Name ~Tind'widual signing contract~) He is the ...... ............. .................................................. " (Contrac~r, ~gent, 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 fo~h in the application filed therewith. Sworn to before me this . ~ , ~ . ................. ..... Nota~,~bblic, . ................ ~ ~, ~.~/~~.~ ~YD~.... ~oun~ ....... ~..: ...................... (S~gnature: ................... of apphcant)~:~'"~ .............................. No. 52-464312[. Suffolk Term Expires Marc~ 30,