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Home My WebLink About9385-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No... ~.9.~.~. .... Date .... .D.e.q .c~..b.~r... J.2. ........ , 19..7..~ THIS CERTIFIES that the building located at .2305..E. 1..tJ.a.h. ! Map No...6Q65 ...... Block No ........... Lot No ........ '[0 ........................ conforms substantially to the Application for Building Permit heretofore filed in this office dated .... August .... /* ......, 19.7.7. pursuant to which Building Permit No .... .9.385Z dated .... Au~a~ .... 4 ....... , 197.7.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ........... t?.r:~.v.a..~.e...O.n..e..F..~..~.Zy...~.e..1.~.£n.g ............................. The certificate is issued to ............ .~.aqn..e.$...A.,..R..e.ly.e.a. .......................... (owner, of the aforesaid building. Suffolk County Department of Health Approval ... ff. uly. 25,..1.978 .... 7.--S.O-.99 ..... UNDERWRITERS CERTIFICATE No ........ .N3~.2. gQ.2 ............................. HOUSE NUMBER .... 23.05 ..... Street ........ .F~J.~h; $. L ~.ax~.e .................. ........................................... (. . . ......... ,,J I.'-- Building Inspector County Tax Map Number 1000-108-4-7.13 TOWN BUILDING PERMIT i ~ (THIS PERMIT MUST BE KEPT ON TItlE PREMISE~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9385 Z Permission is hereby granted to: ............ ~...~:...~.~.~ ............................... ............ ~.~...~.86 ................................................... ............ .~.~.~.~ ,t..~.~...~.:... Z.. ............................. Construct a .R rivate one fam~.y. ~*~P,~,~,*J/Ag ,/ at premises located at .~.,/S .~...,~0~.. E]Li~ .~.lS ZS,~..~. ~.'~..~..~...o~l: N~ Y~ Sub DJ, V. EXt~ahs T~me gst~.~..~,,.....~...t ~lO~ . ................ pursuant to application dated ....... ~13~l, JJ~.l~..?/:e ..................... .~...., 19...~.~-., and approved by the BuildLng Inspector. Fee $...~.~...~..~.~ ......... FOF, M NO. ~ TOWN OF $OUTHOLD , Building Depo~tment Town Clerks Office Southold, N. Y. 11971 APPUCATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must 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 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.of property showing oil 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. 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 Rte ........ /...~.L.~/:Z .Y. ...................... ti blew Building ................ Addition ................ Old or Pre-existing Building ....... ......... Yacont/and .............. ~o~ation Of Prope,~ ~..O.~...~.~.~..S~....~,a.~.~ ....... ~.&Z./.t.~.O.~..~.....~./.../~.~.~2.~.. Owner Or Owners Of ~roper~, ...... .~...Y~...(~.a ....... ~.1...~ ................................................................. Subdivision~ ///~'J~~...(~0~--o.~ ....... Lot No..../.~.... Block No ............. House No.~[.~..~... Per-it I~o Q,:~r'V~ ~J./~,~ ~,,,~ ~/ Da.~ ~f Permit ...~.],.~.l..~ ~ A,~nllcant .......,. ........ -, .......... ~ ~_ f~:2-r-.r-,..,.... ~ ................................................................... Health Dept, Approval .../..~....~..?..~..~...'[ ................. Labor Dept. Approval .....'~.. ......................................... Underwriters Approval .~/....~..,~....~..~'...~.....~.... ................. Planning Board Approval ....'~. ................................... Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ ~..'i~)..~ ....................... Construction on above described building and permit meets all applicable ~le~s and regulations. Applicant .~....-.~- ......................... Sworn to before me this ~_~/' ................ dayof ............................................ (stamp or seal) ~ota~ Public .................................... Co,~n~, ~ ~, ~ The ;'ater supply ~=nd sewage ~isposS~ systems for tht~ residence ~.~'~ c~o~ LO tho '~ k LOCATED AT LOT ~ / ~ I - ~ r~ SURVEYED ~'~,/,~ ~o ~ 247 WILSON BLVD. ISLIP, NEW YORK 1175~ PAGE ~,~ GRID THE NEW YORK BOARD OF FIRE UNDERWRITERS I$ BUREAU OF ELECTRICITY EE JOHN STREET, NEW YORK, NEW YORK 10038 ~ J u ! y 5 ! 078 THIS CERTIFIES THAT [] ~nd FI. ~ection I Bilk Lot I 0 and found to be in compliance with the requirements of th~s Board. fiXTURE L EPT I ~ fiXTURES RANGES ICOOKING OC<KS I OVENS [IH~H WASHERS EXHAUST FANS OU~TL:S,_,~ [E~4~I,Ac~$ SWITCHES, i INCANDETENT~2 FLUOEE~CENT ~*. K.W. O'[ H.P. OAS H. OTHER APPARATUS: I S~oke de?actor ~lchard Relyea Oalmar Dr. r Laurel, ~J.Y. 1194B LIc.214RE / This ceflificote must not be ultered in uny monner~, mfurn to the office of t~ ~ord if incorr~, Insp~tors muy be i~ifl~ by their cmdentMIs. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. r~ .,/~ .... .-Z. ........................ 19.(.../...... a This a~lication mu~ be completely fill~ in by ~ewriter Z~X~n ~e B, ~n~ector, with 3 ~ of p~s, accurate plm plan ~ ~ale. F~ acco~i~ to ~h~ule ' ' 'p' u'ldi~g~ b. PIo~ plan showing I~otion of lot and of buildings ~ premises, relati°nsh to a~jo n nfl ~rem ses or DU Il eets r . . . P .... b c str ~ eas, and g~wng a detad~ descnptmn of I~o~ ofpr~ must be drawn on the diagram which is ~ of this applicatio~ c. The work c~ered by this a~li~ation may nm be commenc~ before issuance of Building Permit. d. Upon approval of this application, ~e Building Inspector will issue a Building Permit to the applicant. Such per shall be kept on the premis~ ~ailable for in~ti~ through~t the work. ' e. No building shall be ~cupi~ or u~d in whole or in pall for any pu~ose whoever until a Ce~ificate of ~cupancy shall have been granted by the Building Inspector. u.a ng ~on~ ur~inance ot the Town of ~uthold, Suffolk County, New York, and other aoo ~ab e Law~. Ord nanc o. tr. io et'on. or % ition. ~e applicant agrees to comply with all ~plieable I~s, ord nancy, buildi~ c~, ~i~ c~, a~ ~ulati~, and admit authorized in~to~ ~ promises ~ in bud ~s ~r n~e~ i~tions. F /~S'g ature of applicant, or ~ if a co~g;g;i;gi ........ (Addm~ of applicant) (Name and title of corporate officer) Duider's L ceflse No . .z'J-a-~ ''/7/'/-~ /~,e~ -~ Plul'rtbers License No.......~[~.......//.~4~/,~~/J'--~/~ E:te~::ic~:::~'sL:C;;::e NN:.' ..::::~'"i:': ......... : State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..~.../%,¥)...~.~ ....... ,,~,...j~.C_~../:=..I~F,,~. ............... -//'- ............................................ ; .............................. If applicant is a corporate, signature of duly authorized officer. __~ 1. Location of land on which pr~osed work will be done, Mop ~o.: .~.~ ...................... Lot ~o..~ .................. Street and Numar .~.L~hL.~ .......... ~.~ ...... ~.J~.~ ................................... ~4.~TZ.~e.~... Munici~li~ State existing use ond ~cupancy of premises ond intended use Ond ~cu~ncy of proposed construction: o. bisiting use ~ ~cupancy .... ~Z ....... A~~ ....................................... ~ ~ ............................................. 3. Nature of work (check which applicable): New Building' ...~... Addition .................. Alteration ................ .Repair .................. Removal .................. Demolitior ..................... Other Work ............................... ] ........... :..... (Description) 4. Estimated Cosf..~-..?~-...~..~..~.. .................................... .-Fee-.~.~..~......~-... ....................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number at,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 ................................ Dimensions of entire new construction: Front .....~..~..~ ........................ Rear ...~..ff.: .................. Depth _~,..~4.~ ............. Height ...... o~..~...~ .... Number of Stories ..... ~]~.....: .................................................. 9. Size of lot: Front .... ~.~...~......q.£ ............................... Rear ...../.,~.~..~....:.?...o. ................... Depth .,,~..~..:...~..~ ........... 10. Dote of Purchase ../..~/.,~..~.....2...~.1..../..~..2...~/. ........... Name of Former Owner ~-,~'.~.~..~.....,~.~t.~,fl.~. ........... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ...~....~. ........................................... 13. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( '~1~o ]4. Name of Owner of premises ..~..~.~.~,$....~-~,...~..~..~..~..}(..~.~A.. ........ Address~,,~.~.~:!.~..r.~./..~....~.:~ Phone No..~.~..~.:..~..~..-~/~ Name of Architect .............................................................. Address ................................ Phon~ No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck 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. VACAIOT LAk)D . 8. STATE OF NEW ~O~,. COUNTY OF .... ~.~.~ ........... ~'" ........ ~ g. ~.~.~ .being duly sworn, deposes an~ says that he is the applicam (Name of individual signing cant}act) 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 t0 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 7 '~lteration of this Document except by a Licensed Professional Engineer, is illegal". Section 7209, Sub- division 2~ N, Y. State Education Law. Engineer's Seal and Signature only good for initial use of drawing. Changes, alterations or revisions to or re-use of drawings without Engineer Approval voids Seal and Signature on same, ' i , ¢-/o ~ppROVEQ ~ NOTED NOTIFY ~U~u~'to 4PM ~0~ 765-2660 ~O iNSpECTiONS: 1. B~FOR~ BACKFiLLiNG TION OR START 3, ~FOR~ ~.., JOB CO~Dt~ ' "Alteration of this Document except by a Licensed Professional Engineers is illegal". Section 7209, Sub- division 2. N. ¥. State Education Law. En~lneer's Seal and Signature only good for initial use of drawing. CHanges, alterations or revisions Engineer Approval voids Seal and '~lteration of this Document except by a Licensed Professional Engineer, is illegal". Section 7209, Sub- division 2, N. Y. State Education Law. Engineer's Seal and Signature onlF good for initlal use o£ drawing. Chan~es~ alterations or revisions to or re-use of drawings without Engineer Approval voids Seal and "Alteration of this Document except by a Llgensed Professional En§ineer, is illegal". Section 7209, Sub- division 2, N. Y, State Education Law, Engineer's Sea! and SiEnature only good for initial use of drawing. Engineer's Seal and Signature good for initial use of drawin~ Changes, alterations or revisi( to or re-use of drawings withm Engineer Approval voids Seal Signature on same. L '~lteration of this Document exc,_p by a Licensed Professional Engineer, is illegal". Section 7209, Sub- division 2, N. Y, State Education Law. Engineer's Seal and Signature only good for initial use of drawing. Changes, alterations or revisions to or re-use of drawings without Engineer Approval voids Seal and Signature on same. _Ir