HomeMy WebLinkAbout9402-zFORM NO. 4
TO~VN OF $OUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No...Z9023 .... Date ..... l~y.. 18 .............. , 19..7.8
THIS CERTIFIES that the building located at ...790 .Ruch -L~e ......... Street
Map No ............. Block No ........... Lot No ..................................
conforms substantially to the Application for Building Permit heretofore filed in this office
dated .. Augu~¢.. 15 ........ , 19.7'L pursuant to which Building Permit No .... 9/~02Z
dated .. Augu~.~ ·. '~.5 ......... , 1977.., was issued, and conforms to all of the require.
ments o£ the applicable provisions of the law. The occupancy for which this certificate is
issued is ..... I~R~[VATE. 0i~,. F/~I~[LY..D~rF3,I.INa ...................................
The certificate is issued to ....... Ntol~o3.a$. J, · Cu~.~'orle ...........................
of the aforesaid building. (owner,~)
Suffolk County Department of Health Approval ......... N'/R .......................
UNDERWRITERS CERTIFICATE No ..... N-~8/4829 ..... .l~ay..~..3~78 ............
HOUSE NUMBER .. -790 ........ Street ........ Rueh. Lane .......................
.............................................. Sou'l;ho,t.d, · New. York ............
Building Inspector
SOU! ~
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
cOMPLETION OF THE WORK AUTHORIZED)
No. 9402 Z
Permission is hereby granted to:
Richter 1]o~.~ I~p.~.o. 7.~.m..~P.~ .C...o...I..n..c...A./.g .N...i.9..h. olas Z. Cutleane
at premises located at ~/..~....~..kl.~J~..~.~k~ (~..~.~. ~,) ...................................................
pursuant to application dated ........................ ~l~,.....J.~. ............... 19.~.~...., and approved by the
Building Inspector.
J 5,00
Fee ~ ........ ? ...............
FO~ NO. $
TOWN OF SOUTHOLD
Building Depaftment
Torn 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 Buiiding
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 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 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 tand use $5.00
3. Copy of certificate of occupancy $1.00
Date
New Building .................... Old or Pre-existing Building .........~; ................ Vacant Land ............................
Location Of Property ..... ~t.-!,qJ')..~;~,.n.,Et....i~.,qJ-J.~;.t~.,q~.£~.~...~-..¥., ..........................................................................
Owner Or Owners Of Property ...... .Rj,~.,g.h.,~,),.],~,...~J.l..,.~.g.-~.o..g.~. .......................................................................
Subdivision ................................................................ Lot No ............. Block No ............. House No .............
Permit No....?..L,~!~t.~..../:.... Date Of Permit ...!5./.~/.?.~....Applicent ~.$.g.I;l~,..~,~.~BJ~...T~!2?.<W,~,~,~.~:,..i~l~.~ ......
Health Dept. Approval ..................................... ; ...... Labor Dept. Approvol ................................................
Underwr,ters Approve' ..... ......... p,anning Board ^pprove
Request For Temporary Certificate ........................................ Final Certificate ..........................................
Fee Submitted $ ......~!...!j.i:! .....................
Construction on above described building~ "/'a~' ~ ~/~ ~' ~ an¢-~//rmit mef~,e~aI,L-f~e~ c,~l~nd, reguloti~s.
Applicant ...~..~,~.~,...~ ........ ~..~/..~~ ...................................
Sworn to before me this
~s3. Oiq~, [-~Or~ ~r~l[3~t]vo~'h ~0.~ IRC.
................ 8~y of ............................................ (st~mp
Nota~ Public .................................... County ~ --. ~~/~/~g
THE NEW' YORK BOARD OF FIRE UNDERWRITERS
~1~ BUREAU OF= ELECTRICn'Y
May 5 ~ ! 978 85 JOHN STREET, NEW YORK, NEW YORK 10038
,~. ,~,,,,,~..t~. ~o. o..,,. ~ ~ ~ ~ N 384829
THIS CERTiF=IES THAT
oMy the ~I~M ~lu/pm~t ~. de~llm/~ ~/~trodaced ~y t~e .ppli~mt nm~do~ the .bo~ ~ ~4mber t~ t~ ~m~
NlehOles Cufrone,
'"'" e=°'"i'"a °" #ly It 1978
Ruin L3fl®, s/O North Rd.e $O¥~hold~ L. Io
a~u~ ~ be in com~ia~e with t~'requi~ments
OUllITS sWITcHES
Lot
OVENS EXHAUST FANS
S E R V I C E
°"t~..-.~'fl,'~.rdE~ 1-20clr. 2O0 ,~3
~o~orst i-F HP
GeF.C.t,
P3ul Burns
Torn H. rbor Line
LIC.
altered in manner~ re~urn to the office of the Board if incorrect
BUILDING OF CERTIFICATE MUST
ti
mo¥
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building
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 adjoining premises or public streets or
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 applicbtion 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 part 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
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, 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 ail applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in buildings for necessary inspections.
......
.............................. ~l~;~'~i"~Ji~d~t)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
If applicant is a cqfporale,.sign_ature of ~ authorized officer. .,
..... ..................
(Name and title of corporate officer)
Builder's License No. ....... .....~/.(~., ,,~,, ,~,,,. . ...................
Plumber's License No ........ ~.Z..~,......~,. ........................
£ ectr an's L cense No .... ....................
Other Trade's License No ....................................................
1. Location of land on which_Drpposed walk will be dc~.e. Mgp. No.:...~,,~Q~e~N.~,~..~ .........
Street and Number ..... ~..Jo....o...<;.~....~.~..~.f...~ .~..'.o..~..~.~.01,~
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Exislting use and occupancy ....... .~..~.~.~-.LP........b.~:?.//.~.~.. ........ ~. .........................................................
b. Intended use and occupancy ........................................................... ~...2~ .......................................
3.. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration
Repair .................. Removal .................. Demolition .................... Other Work .....................................................
(Description}
...Fee
4. Estimated Cost ................... .~..;~. ................................................................................
(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 ..... ..~...~.~.f.[~. ....... Rear ...3..~..I.~.] .............. Depth .....~,.~..-:~.....
Height ....... ~....~ ......... Number of Stories ............~. ....................................... ~.....~.,~ ...................................... ,.,, .......
Dimensions of same~ structure with alteration~ or additions: Front ..... r~....~...~.....~. ............... Rear ..:~...~..~.....6. ...........
Depth ........ ~....~. ~. ~ ........... Height ......../...Z.. ............... Nug~ber of Stories ......~ ...... t' ',~ ..... ~-'-
8. D mens ons of ent re new construct on: Front .~...[. , . Rear ...~.. .................... Depth ... ,~... /... ...........
Height ...... ././~ ........ Number of Stories ........ Z ....................................... ~ ..............................................................
9. Size of lot: Front ........... 7...,~...'~... .................................. Rear .............. .7...;.~. ..................... Depth ....... ./.~.~.. ..............
10. Date of Purchase ..... ~ ............................................. Name of Former Owner ........................................................
or use district in which premises are situated .......... Z~..'~'-,~... .............................. ;"'X .............................................
11.
Zone
]2. Does proposed construction violate any zoning law, ordinance or regulation: .... .Z~.....~.. ...........................................
13. Will lot be regraded' '"'"' '/~"?"~'"":,x ~ -- :--~Will excess fill be removed from pre,m sas: (~'J' Yes ( ) No
14. Name of Owner of premises .../~.../..c...~..~../..~..~......~'.,..(:.~...~..v....c~......~m. Address/~..~..~...~. ............. ~ .~..~.....'.'~.... Phone No .......................
Name of Architect ............................................................. Address ............................. Phone No .......................
Name of contractor ../~...(.~...~...~.~..K/...../~.....c=:~.....~....?...?.~....~...~.. ...... Address Z~.~.....~T~.....7~.. .......... Phone No. ~...7.~.;.~..?..?..~
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 lot.
STATE OF NEW YORK, ~ ~ ~ .
COUNTY OF ................................ f'~' -- / / ,
.......................... .~.~....¥...~.....~...~.Z.i:./..:../..(.c..c:-...~.t.C.~....~. ....... :...being duly sworn, deposes and soys that he is the applicant
(Name of individual signing contract~
above named. ~. /
He s the ~...?....~..~. C.-....~....°:..?.. .......................................................................................................................
(Contractgr, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to p~rform oF have'p~rformed the said work and to make and file
this application; that all statements contained in thi~ 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 x~
' ....71 'g ) ...............
. IAJ~' E. DAWSON
f{~'~l~y P~8'LIC, Stats of New York
"o. 52-4643721, Suffolk Count~.
Term Expires March 30,
B'~DR. OOM L~
DAT~
NOTIFy BUILDING At
765-2660 9AM to 4PM FOR ~ll~
ED INSPECT ONS.
3. BEFORE COVE,,I!;,? p ;%$ OF ANY KIND
4. FINAL W~IEN JO~ COMPLETED
NOT RESPOHSlDLE ~R D~SIGN
OR CONST~UCTION ERRORS
REQUIREMENTS OF N.Y, ~TATE CODE
~ND TOWN HOUS~ CO~ & ZONING
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