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Home My WebLink About9367-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy THIS CERTIFIES that the building located at .~.?~.~....B.~.i.g .o~. }~.n.e...D?.: ... Street Map No...f~../47. ..... Block No ........... Lot No ........ 6..9 ........................ conforms substantially to the Application for Building Permit heretofore filed in this office dated . J.t~.y ........ '~9 ......, 19.7.8. pursuant to which Building Pemit No....9.~.~.?.Z dated . .J.t~..y ........~.9 ....... , 19.7.8.., 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 ...... P?.!¥.a.~.e...0~..e..F..o~n..i.~.y..D~..e.]..~i..rig. ................................. The certificate is issued to ........ ~..ch.a.e.~...D!w.s..o.n. .............................. (owner;ztezme~y.k~r~) of the aforesaid building. Suffolk County Department of Health Approval ..... ?.--~.0.-.9.8. ...................... UNDERWRITERS CERTIFICATE No ....... .N .~ .8. 7. 2. ?.2. ............................. HOUSE NUMBER .. ~.7.~ ....... Street ...... .B.I~..ig..~.~..i.n.e..D..~: ................... ............................................' .............. .. ,,: .~,.f:~r ........... %~..' ...... Building Inspector TOWN cOMPLETION OF THE WORK AUTHORIZEI~i;!J; N? 9367 Z UNTIL FULL Permission is hereby granted to: .... :~./...e...~...5.~ ....... ~:.~.~.~./. ............. ..................................... ~ ................................................................................... ~'~ ........ t ......... ~ ................. pursuant to application dated .......................] ......... ~.~.~.~.....f2 19.Z~., and approved by the Building Inspector. ~ee ~..J.L::~...!..L.:. TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application musi' be filled in typewriter OR ink, and submitted in DUPLICATE 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 disposol--(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, o 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 existiog 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 os to use, occupancy and condition of buildings. 3. Dote of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare o 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 / ~ _ pete ..... ................ New Btlilding..,...../ ...... .. Addition ..,,,.,,,,,,..,, Old or Pre-existing Building ....... : ........ Vacant Land .............. · ocat,o, of Property .... Owner Or Owners Of Pr~perty~:~q~d.(~..~/.~..~-~/..~-`.~...`...-~.....~..~..~.'4~.`'.`.`?`~.c~.~.../...~...~ ................................................ Subdivision ./..-/..~,.~....~.,~,,~.. ...... ..L...,/._~,,.,~,.....;~] .......... Lot No...~...~.., Block No .............. ~,ouse No.!..~.,~..~. Health Dept. Approvnl -.?..,~.,,.~-~..;..,.~..~,, ............. Labor Dept. Approval ................................................ Underwriters Approval ,,.~,~,~.~.!,.,.,;~,, ................ Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificate Fee Submitted $ ..... .'7,,.,.~.,. ..................... Construction on above described building and p~ermit ~,e~s all applicable codes and regulations. Applicont .~.P..~.~.~...~ ........................................................ Sworn to before me this · ..~.....,~..o day of ..~,~..'~ .......................... (stamp or seal) THE NEW YORK BOARD OF FIRE UNDERWRITERS May 22, lO78 BUREAU OF ELECTRICITY ~ 83 JOHN STREET, NEW YORK, NEW YORK 10038 ,~,. ..,~,c..o. No. o. /,. 936~.~,9 N 387212 THIS CE;IFIES THAT in the foltotving location; ~ Basement ~ 1st FI. ~ 2nd Ft. O tl ~ 5 ~ d e Section Brock Lot wasexamlnedo. May l~, 1978 andfoundtobelncompliancewiththerequirementsofthisBoard. RAHGRS SPECIAL TIMECLOCKS BELL UNITHEATER$ MULTI-OUTSET t T N ~ SYSTEMS A~T. AMPS. RA S. H.p. NO. OF ~ET SERVICE DISCONNECT i NO. OF i s ~ ]. 1.~0 (~BMETER x o~ R V I C E EXHAUST FANS .~ "'"'2 DIMMERS A. w, G, NO. Of HI-LEG A.W.O. OF CC. COND, OF HI-LEG 1/0 NO, OF N~UTRALS OF NEUTRAL Motors: l-I 1/2 h~ 1 Smoke detector Mike P.o. nox East Marion, COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST HOT BE ALTERED IN ANY MANHER. l~Ol~I NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ................ .~.,.~, .... Z..~.., 10-7.7 Approved ............... ....... ./.¢...., Permit ..... Disapproved a/c ............. ~ ..................... (Building Inspector) Application No....2...~....(.O..7 ....... a. This application must be completely filled in by typewriter o¢, in ink and submitted in triplicate to the Building Inspector, with 3 set~ 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 at areas, and 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 commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector wi!l 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 pa rt for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APP/JCATtON IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk 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 code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary insoections. ..................... (Signature of a'pplicant, or name, if o corporation) 221 ~i~th .~ve.. Greenport (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .................~.L:k.9.1~.~e.~..~s'?-?(.s..o..n.. .................................................................................................... tf applicant is a corporate, signature of duty authorized officer. (Name and title of corporate officer) Builder's License No..V.T~lg/~.O.¥ilo..,...hlt.t,...,-l,;l.~.¢.;q~p,.c), .... Plumber's License No. .20~,~ ...................................... Electrician's License No....d'..n..k..~3..o~;~.}}.~.....b..u.~....2;.J:.~.e...n,.qecl Other Trede's License No ....... .u,..n.}.qn...o..w..n..~...l)..n..~....l.i~.g..e.~,sed Location of land on whic. b proposed work will be done. Mop No.: ............. .5lhe?. .................. Lot No ......... 6¢J ............ Street and Numb/e73...~,,~¢,e~,%n.J;&.lae...lar.&ve ................................................................... ........ State existing use and occupancy of premises and intended use and occupancy of proposed construction: e. Exisiting use and occupancy ..... llama .................................................................................................................. b. Intended use and occupancy ......... ~..e...P.~.o..'~.]r.....w.e...~.~.o:..e..i):..o..e. ...................................................... ......................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ................. Repair ................ ..,, Removal .................. Demolition .................... Other Work .................................................... (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... .~t ................ Number of dwelling units on each floor ............................ If garage, number of cars 2, , 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 ............. 2 ...................................................................................................... 10. Date of Purchase ...................................................... Na,,,~ of Former Owner ........................................................ 1 I. Zone or use district in which premises are situated ..... $f,.e.~.~.ql..~.~].~j,.~.~ ...................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .......... ~.a ......................................... 13. Will lot be regrade6 ...... np .................. Will excess fill be removed from premises: ( ) Yes (x) No Name of Contractor ............................................................ Address ................................Phor~e No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exifting or proposed, and indicate all set-back dimensions from property lines. Give street and block number or descriptron according to deed, and show street names and indicate whether interior or corner lot. As per ~ttached map by ~. ~an Tuyl SYATF_ OF NEW. >,_. ,,Y~)R~,, .~ I. $ S COUNTY OF ..'-~.......,:~,;4f ......... J' ' .................. · ~/ .............. r~..,..,~, ............. ~../..~.,,. ........................ being duly sworn, deposes and says that he is the app[icom '(Name of individual signing contract) above named. He is the .............................................. .~.,:,,,-~... ............ (Contractor, agent, corporate officer, etc.) of saic[ 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. Sworn to before me this //'"~ ..... /...'.~.7~../.~.... day of ................ .~.~.]~J~ .............., 19.,...~. . ./ , Notary Public,. .......... '~..~.'~..~7~:'....,: County ,.., ............ 'iii.~[~ ........ i ......... _/~] .......................................... ~ ......... · ' (Sign&ture of applicant) APPEOVAL QF CON~iON O~Y FOR DBNCE WILL CONF~M ~ THE ~ ~' ~ANO~8 OF ~UFFO~R CO, H, S. REF. NO,: , , o~ H~Cm. // 'I ~1 / / ,F,,O,R AP?ROVAL OP' ¢ONIi'i~,U~N H. S. RE:F. NO,: .... ¢ '~ t~,c, APPROVED~ AS NOTED NOTIFy BUILDING DEPARTMENT AT- 765-2660 9AM to 4PM FOR REQUIR. ED INSPECTIONS~ I. BEFORE BACKFILLING FOUNDA- TION OR START FRAMING 2. FRAMING INSPECTIOt4 3. BEFORE COVERING PIPZS OF ANy ICIND 4. FINAL WHEN JOB COMPLETED NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTI~,N ERRORS 5, ALL CONSTRUCTION MUST REQUIREMENT5 CF N.Y. STATE CODE AND TOWN HOU~i~G CODE & ZONIt~G -> ~L 9~' --4