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Home My WebLink About9386-zFORM NO. 4 'fOWN OF SOUTHOLD BUILDING DEPARTMENT '[own Clerk's Office Southold, N.Y. Cedificate Of Occupancy o.. 9 09 .......... Date .... D. eoember 27 .., 19.7.9. THIS CERTIFIES that the building ................................................ Location of Property ...~0.~..0..K.~.nn.e7 Road .... .Sp.u.~hold~ !~I.*y: .. House No. ' .......... Street Hamlet 59 2 County Tax Map No. 1000 Section ............ Block ............... Lot ................. Subdivision ............................... FHed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated 93862 J.~?l.e 2'7 1977 pursuant to which Building Permit No ...................... dated ....A.uI~.~.~...5 ................ 19.7..7, 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 ......... Accessory Two Car Oerag~. loc~.~,ed in ~ide m~d front yard area. ~. ..... Board off Appeals Approval - Appeal No. 2~0~ dated July ~6, Ruth amd Ex-nest Th /d~;, ~,~~ .............. e certificate is issued to e of the aforesaid building. Suffolk County Department of Health Approval ....... ~[.R ................................ Building Inspector BUILDING i~ER/V~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE wORK AUTHORIZED) N? 9386 Z Permission is hereby gronted to: ..~.~.z ....... ¢...~ ............................................... ....... K....q..~.?..:i....~L...~....::.~.~..?./..:.~ ,~ ~--- /~ VA L: ....................................... ............................................................... ..(...~.~.....~ ........ .e..~....~.~,j.: ..... ot prem,ses Iocoted ot..l~.~.~.S.¥.....~-.O...~. ......... .4.......?.0..~..~.~..:~..~.~'.:~...~,.~.., ............. ............................... ~".T..~...0. ~ ~ ~:7..: ............................................................. pursuant to application dated ................................ , . .., and approved by the Building Inspector. ~.,...!..o...~... FOlt~ NO. 6 TOWN OF SOUTHOLD Building Depa~tment Town Clerks Office Southold, N. ¥. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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. 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 o~ 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. 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 .......................... Notary Public .................................... County New Building....................~e'g Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ~`~}~e`~-~;~b...~.~.~`.~...~?~..~.~`~.~.¢~`~[..~'..~..~.~....[~£].~..)...~.l~h~ Owner Or Owners Of Property ][ued]q 8~D.d . ,r~esl; [~_bson Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No?.~. ....... .v'. ....... Date Of Permit .~,,/.~./..~.~.....Apphcant ./.~3~[;h..~;.~c]....~.e,s.+...~),b.~g;~ ............ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Tempora~ Ce~ificate ........................................ Final Certificate .......................................... Fee Submitted $ 5~ ..................................... ................ ............................................ THE NEW YORK BOARD OF FIRE UNDERWRITERS ~t BUREAU OF ELECTRICITY I~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CER"rlFIES THAT only the e/ectr/~M equipmen~ as describ~d belair and intro~_ u~d by the applicant named on the abo~e application number ~n th~ pr~mis~s of E~nest C. ~ibson, n/e/e 3oundv~ew Ave. inthefollowinglocatio.; [] B~,~,,t [] t,trt. [] 2,d Ft. gat'age s~ao, Bto~t, rot ~as~n~nedo. D~embe',,'. 6, ].979 and found to be in compliance tvlth the requirements of thls Board. fiXTURE OUTLETS DRYERS IECEPTACLES 12 SWITCHES 2 fiXTURES RANGES OVENS EXHAUST SYSTEMS NO. OF FEET E OTHER APPARATUS: E R I C OF CC. COND. OF HI-LEG NO. OF NEUTRALS OF NEUTRAL 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 BUILDING DEPARTMENT. THIS COPY OF CERTIFICATII MUST NOT BI ALTERED IN ANY MANNER. $OUTHOLD, N. Y. examined ..~..~...L ....... :....~ ....... 19..../.. · ~oproved L,~,~,~. .~. .......... , 19...../.,, Permit No..J. .......... · ~..-... .... ...... · ..... ~-- ,d~ ~,-~vv-4x~', I_ £_O . ~5'/7/. ' .................................................... ................ ......................... ....... ............ ...................... ................................... (Building Inspectr) APPLICATION FOR BUILDING PERMIT Date ...... INSTRUCTIONS a. This application must be completely filled in by typewriter Inspector, with 3 sets 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 adjpining premises or public streets o~ 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 will issue o 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 NEREBY MADE to ti~e Building Department for the issuance of a 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, hous~;g code, and regulations, and to.~-~ admit authorized inspectors on premises and in buildings f~'iecessary in/sl~i~ctions. (Signature of'applicant, or nome, if a corporation) (Address of applicant) State whether applicant is owner, lessee, age , a cnirec~, eng near, genera~ contractor, emctrician, plumber or -builder. · 0 . .-: ~: .>'~: --? , , . ?' .,- Name of owner of prem,ses ........ ..~.~.~.~.-~,,~.....(~?,:.~..,:~..~..~...~....~....·~/.'.~...~.. ,~.~'.~..:....~...{.~:~a ................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ......... ~i' '~'~"~-- .............................. Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... xx~ ((/ a o w ic proposed work will be done. Mop No.: ....................... : .............Lot No 1.StreetL°cati°nand°f Numbernd n ..... h ~-.~.h '~"4~"~'~~'''''' ''~'''~'''f'''''~''O'''''~'z?'~'''''~/:'( '~'~':'~''''''~ .... .~. i~'..~'.~..:.~.:r:.(~:::: :::::::: Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ~ / ~' ~ ~ F~ ~C'~f'/.,~"~, ('~",C b. Intended use and occupancy .~...)..,~../~ ~;~ ~ A d' ~ ~" .... 3. Nature of work (check which New Building'. ................. Addi~l .................. Alteration .............. Repair .................. Removal .................. Demolitior. ................... Other Work .................................................. ~":' /~ ~)"t~ (Description) ....................... ................................................................. (1o be paid on filing this appJication) 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 ................................ ~ ~ ~"~ f ~ptk ~ ............ a. ~im~i~n~ ~ ~ti~ ~ ~,t~,~ti~m ~t ~,.-~--.,.,....,.,..,. ..... ~.~..~......~: .... Height ~....~ ...... Number__ ~°f Stories ..... 9. Size of lot: Front ....Z~,~.;.~..~.' - .............................. Rear ................................ /~ .~ ....... Depth Z~.~.,,Z~...' ' ~t~ ~ ~ ..z~.~ ................................... ~,~ ~ ~ o~~.t~...~...~ ~0. ~ ~. Zona or use district i~ whick prami~as ara ~it~atad ......................................... ~. ....................................... ~ ........... ~2. Doe~ proposed constr~cti~n ~ialata an~ za~i~g la~, ardi~a~ca or regulatia~: ........................................................ ~3. Will lot be r~gradad ....~ ................ ~1 14. Name of Owner of premises~Z~,..~ .............. Address~.~;Z~ Phone No. ~..~ ......... Name of Architect .............................................................. Addres~,~z..~,~.~.~ ..... Phone ~o ....................... Nome of Contractor ............................................................ 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 Io~. STA'I'~ OF NEW '~C),R,~,/' J/ I c c COUN'rY OF ..~.q:..'~.....f .... .............................~.~;~...?Z.~~....being duly sworn, deposes and says that he is the applicant (Nam~f i~ividual signing contract) abow~ named. ~ ~X ,s ...................... ..................... ........................................................... :-: .......... (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 fi'tis application; that all statements contained in this applicction are true to the best of his knowledge and belie(; and lha~ the work will be performed in the manner set fo~h in the application filed therewith. .S..~.~.~..t.~.~f~ d~tho~ ...~...~~-:...., 19.?Zz ' .............. ............................................................................................... ~ ~/ ' ~~ (Signature of applicant) ~, jr. FLOOR PLAiV ~": I Foot