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Home My WebLink About9395-zFOR~ ~0. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z8908 ...... Date .. J~n~lar.y ..... %3 .......... , 19.. 7'8 THIS CERTIFIES that the building located at . 6.7.~0. bia.in. B~yvie%, .R~t.... Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore tiled in this office dated . .AUgust ..... 8 ..... , 19. ,7.7 pursuant to which Building Permit No.. 939~' dated ...AUgust ..... l0 ......, 19..77, 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 ...Prt.v. ate. One. Fe~lit.y .l~et.1 .ing ..................................... The certificate is issued to .... Stetvhe~i. J.,. ~4cGol,.nell ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...... 7..".~.0.-9,~ ..................... UNDERWRITERS CERTIFICATE No .... I~.37..1.2.6.6 ................................. HOUSE NUMBER .. 67.~0 ....... Street .Main. ~ayv.iew. Rd., ...................... ....................................... ~ou~hold~./~,Y~ .... 1.1.971 ............... Building Inspector ~pER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9395 Z Permission is hereby granted to: Ge o...A)~le.~, s.. 3uil~e;,-... ~e...... [J.a.. ~.tephen: Me~olme11 ............ gnm.~La......~tuho~e ........................... to ..]3=J~Ld ..~w...o~e .. f. ami~.., dws.13J.o¥ ................................................................................... at premises located at ~.G Z~e ~£e~ ~D~- & ~..~,~,..~ ................ .................................. ~ e.~ o.~4... · .~. ,- '~., ........................................................................... 8 ' 19,..~-~', approved by the pursuant to application dated ............................. ~l,t~ .................. , arid Building Inspector. Fee $... TOWN OF $OUTHOLD , Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUFANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the fallowing; for new buildings or new use: t. 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 buJldlng. 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 all property lines, streets, buildings and unusual naturot 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 inspect[on 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 ....... New BHilding ~.,. ..... Addition ................ O[d or Pre-existing Building ................ Vacant LGnd .............. ocation Of Property .~-.~...,~3~.)~,,,,,..~,~,~,,~ ~_{/ ~., ~-..P ...... ~, '~,~,, ................................. Owner Or Owners Of Property .,~.~..~,~,~,,~.....:~, .~,,r...C,~,,~,,/-,~ ............................ Subdivision ................................................................ Lot No...,~,, ..... Block No. ,.C.~, ..... House No ............. Permit No..~..;~.,Z.~. ...... Date Of Permit .............................. Health Dept. Approval(~....~...../..~...~.~. ............ Labor Dept. Approval ................................................ Underwriters Approval ~.~..:~:~.,..~../..~..~-~... .......... Planning Board Approval Request For Temporary Certificate ........................................ Fined Certificate .~ ........................... Fee Submitted $ .................................... Construction on above described building and permit meets all applj~ca~le codes and regulations. Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) ':' -' '-~"' THE~NE~/ YORK ~ %~ BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ I S ES JONN STREET. NEW YORK. NEW YORK 10036 S~eve VcCo~nel~, ~aJr 8avvi~w ROOd, 5ouf~o[~, ,..I. I S 8 .I 30 I I /~"" '" ~ t ~ t · ohio. o~ t~ gooro .~ mcorrec,. Inspec*ors mov be identified by th ~r credentiols. ~xamined .......,~.....C~..I,..~. .............. , 1~..~.... . ,~c)plication No ................................. e~ Approved ...................... /..~. ............ , 19 ........ Permit No..(~..~.. ........................ :~ Disapproved a/c~ .......................................................... ~' '~:~ ...................................................................... ._. ....... .. ........ ~ ......... ~ I~- -~Z.~ -~,~ ? ~ ................... ................................. a. This aPPlication must be completely filled in by typew~iter ac. in ink and submitted in triplicate to the Building~Lm Inspector, with 3 sate of plans, accurate plat plan to scale. Fee according to schedule. . b. Plot Plan showing location of lot andof b~tdings on premises, relationship to adjoining premises or public streets ol~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application.j~ 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 pa rt 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 BuildJag Zone Ordinance of the Town of Southol.d., Suffolk County, New Yank, 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 inspections. of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, amhitect, engineer, general contractor, electrician, plumber or builder. ome of owner of premises ........................................................ If applicant is o ao%~,~7~,~re of du,y authorized officer. ~q~a~e and title of co~rote officer) Builder's Liconse No .......... ~../. ................................. Plumber's License No ....... .,~,..,¢~',..~, ...... ~ ............... Electrician's License No. '7'5'-2-- r o o o ~ f-r-(,,- / Other Trode's License No ............................................... ~ Location of land on which proposed wo~k will ~ done. Map No.: ........................................ Lot No .......~ ............ Street and Number ...~/~.....~lt~/l~.~.L/~..Je~...Jl~-13.A.~. ........ ,,~6..~/..Z~..~I.D.(~ ........................................ Municipality State existing use and occupancy of premises and intended ~r. me and'occupancy of proposed construction: a. Exisiting use and occupancy ................. ~,~ ....................... b. Intended use and occupancy ...... ..~l~~....~,~,,~m~~ -- 3. Nature of work [check which applicable): New Buildifig .;4~, .......... Addition .................. Alteration ................. Repair .................. Removal .................. Demolition~ ................... Other Work .................................................... (Description) 4. Estimated Cost .. ~:~.c~.¢ 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, specie, 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 w th alterations or addition~ Front .................................... Rear ............................ Depth ................................ Height ............................ Nun~l~er of Stories ............................... 8. Dimensions of entire new construction: Front ..... ~'.'.'.~......~...'...~. ........ Rear ...~...~.. ............... Depth ....~. .......... Height ..~. ......... Number of Stories ...... ~, .......................................................................................... 7 ......... 9. Size of lot: Front ........ .L.7.~...~. .................................. Reer ......... L.Z4~...~. ..................... Depth ...... .c~.~. ................. 10. Date of Purchase ........................................................ Nome of Former Owner ....................................................... 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 ( ~ No 14. Name of Owner of premises .................................................... Address ................................ Phone No ........................ Name of Architect .............................................................. Address ................................ PhoneNo ...................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM ~ ' · Locate clearly and dJstinctly all buildings, whether existing or proposed, anc~ indicate all setJoack dimensions fro~: ,r property lines. Give street and block number or description according to deed, and show street names and indicat~e whether interior or corner lot. STATE OF NEW Y,~It;,-, COUNTY OF ....... .-~...-~;..-..~?-...~.. ........ [ '~'" ........................................................ : ........................................ ~ing duly sworn, d~o~s ond says t~t he is the applicam (Name of indi~dual signing c~trac~ above named. He is the ~ (Contractor, agar, co,orate officer, etc.) of Said owner or owners, and is duly authorized to peHorm or have perfor~d the said work and to ~ke ond file this application; that all statements contaiqed i~ this applicat~n are t~'to the best of his knowledge ~d belief; and that the WOrk will be Performed in the mb~ner ~t fo~h ih the a'pp'lJcatioh filed therewith. Sworn to before me this ....... ~ ....... ~y of ..... ~ ........................ , 19...~. Nota~ Public, . .................................... ~ .......................................................... - .................................................. ~""' '~/~ "['~e ~ ~ , ~, ~/~ (Signature of applicant) HOTARY PUBLIB, ~nte of H~ H0. S2-812~, Suffolk 70.0 EXCAVATION , IN,SPECI'ION REQUIRED ( ~:~cHo~u[, N. y. ~' H~ALTH ~VI~ APPROVAl. OF CON~T~UC'RON ONL, H B REF NO,: A AppROVED AS NoT~ k Off/ce Of Gordon K. Ahlers, P, E. Gordon Gordon