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Home My WebLink About9461-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.Zfi. ~. 5. .3.8 ........... Date ....... THIS CERTIFIES that the building .... .g'9.°?. ~..~ .~?.¥ ................................. Location of Property ..../4.KO...B~,~.c} .~ .eKe...~.a.n.e...(?~..5=¥.a~?. ?. .o .e .d. . ~ .2 .) ......... 9~.~.e.~..~.. House No. Street Hamlet County Tax Map No. 1000 Section ....q?. ...... Block .... .~ .......... Lot .... ~. ........... Subdivisio~ ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... 8. o. p.~.~.m.~. 9~..2fl..., 19 .~.? pursuant to which Building Permit No .... ~G.?.Z. ........... dated ...~.eSq~.°..m.~.e.~...~.~ ............ 19 .~, 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 ......... ............ .~.i2~q .L~..d..~V¢.m..m.~.~g. ~.Qg.]_..;..~.o.~.qz.' .I~a;' .P99.~..hgB. s.~...~. The certificate is issued to . . . .Rg.5.d, ._¢,..H..~h~.~'y. ~..WS~:~.o .............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... ~/g. .................................. UNDERWRITERS CERTIFICATE NO. z~O~50 Building Inspector Rev. 1/81 FOBM NO. v~ BUI~ DEPARTMENT TOWN CLEKK'S OFFICE SOUTHOLD, N. Y. (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZE'D) N? 9461 Z Permission is hereby granted to: ........... ~=~=t ....................................................... to .~:u.: ,Ld..ae=..i~i, ga.t,e...sw.t,~ir~§...po~t. at premises located at ~..'J.~..~.Qa~..~,; .............. ~.o...b,~.t,rt..,Ro&d. ..................................................... pursuant to application dated ........................... ~t;.....L~T., ....... , 19.~.~.., and approved by the Building Im~ector. Fee $..1.~.~0 ........... PERMIT INCLUDEs APPROVAL TO REMOVE EXCESS FILL FROM ABOVE PREMISES BY REGRADING LOT ORWEWAy CONSTRUCTioN -~-~- C': ~P'OOL CONSfRUCTiON ~ ELtAR C~NSTRUCTiON ~ OT~ER ............ ...... .C,z.q.. ................ Building InSpeCtOr ~ Item No. 035641 FORM NO. 6 TOWN OF SouTHoLD Building Department Town Hall Sou~hold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and sub~ tted in duplicate to the Building Inspec- tot with the following; for new b~ildings or new use: 1. Final survey of property with-~ccurate 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 o~ electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Enqineer responsible for the building. 5. Submit Ptanning Board approval of completed site plan requiremer~ts where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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 informa- tion 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 New Building . Yes. &. P. ool .. Old or Pre-existing Building(X) ......... ~ fVacant Land ............. Location of Property ........ ,~..'~..J~ ~ r. dsey. e .Lane .(R~i. qCqe .Ro.¢¢)..0.ni.cRq ......... . .......... Hou~ No. ~treet Ham/et Owner or Owners of Property REID A. MAHAFF~ ~ ~, County Tax MapNo. 1000 Secton . .. ~ ......... Block ...~ ........... Lot .... 3 ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.. 946] ..... Date of Permit .9~l~..Applicant . .Q~ .~q!LqI.~q .~ .~q~sl.%~C3.l.0~..C9. Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Unde~riters Approval ........................ Planning Board Approval .............. Request for Temporary Certificate ..................... Final Certificat~ ........ Fee Submitted $ .... 5,00 ..................... Construction on above described building and permit~meets all aPpl~cable~co_des and regulations. Applicant . _. .... ,~ ....... ~, ........ ../ ........................... ..... Rev, 10-10-78 'i THE THIS CERTIFIES THAT NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 .JOHN STREET, NEW YORK, NEW YORK 10038 V I C E OTHER APPARATUS: (~;?~l:nnln,g Pool) 'Z'hL~ cor~L~'.Lc~e covers coml)lia~oe a~, tn~ ~t~ Of Inspection only. [tecause of 2nut.al envi~'on~e.ts It is adv.t~abl~ EXHAUST FANS AMT. H.P. OF NEUTRAL OX SO~;thold,~,~, I] ~71 Th,s cert,flcate must not be altered m any manner; return to the off~ce of the Board if incorrect. Inspectors~ may be identified by their~"'tt~ntials. CO~Y FOR BUlLDIN~ BIPARTMINT, THIS COPY OF CERTIFICATi MUST NOT BI ALTEBED IN ANY f~M4NEE, I~OB,M NO. 1 TOWN OF S04fl'HOLD BU!LDIN~ DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined Sept 21 19.,..?.?. It Approved ......... 9 77 91+6 lg ............................... , ] ........ P~rmit No ..................................... DLmpproved a/c ............................................................................................ (Building Inspecfor) ................................. Application No. 9~61 ~ APPLICATION FOR BUILDING PERMIT ~ ~ Date Sept 21 ?..?. · ..............................................., 19. ... ,.'.UCT.ONS ' a. This a.ppl_icatlon must be completely filled in by typewriter or in ink and submitted ntr p icate to the Buildir~ tnspector, with 3 sets of plans, accurate plot plan to scale. ,Fee according to schedule. ~t b. Plot plan showing location Of l~t and of buildings on premises, relationship to adjo n ng prem see or public streets or areas, and giving o 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 a Building Permit to the aoolicant Such nerm~ 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 Occupanj[~ 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 t~h~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicob · Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demo ition, as here n described The applicant agrees to comply with all applicable laws, ordinances, buildina code hous ~, cede and ~ula~ ,-,,o and ~;; adm't authorized inspectors on pram see and m build ngs for necessary insl~ct on;:. "a ' "a ' '"" ...... Orient Tr~cking & Const ' ......... ........ Orient (Address ' ' ' of oppllcont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. builder Name of owner of premise~ .~..~.;~.~......~L~.~'.~..~ ....... . .. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No.....0......T......C.~ ................................... Plumber's License No ................................................. Electrician's License No ........ ~.1~1~'.~.~.~.~.~. ............... Other Trade's License No. King Location of land on which proposed work will be done. Map No.: ....... ~ ......................... Lot Ncx ....... ..x~... Street and Number ..,~..~&~,..J~. ......... ~/J~..~,~:l,..~[Qi~ ....... ~.....~.~'~.~..t;;. .............................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy vacallt lot b. Intended use and occuppncy ~rivate swimming pool 3. Nature of work (check which applicable): New Building, ......,:T~,. ......... Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work .1~.o...O.~..~.!~.~.~.~..~...t],¢.~...]~,~g.. (Description) 16,000 + - 15.00 4. Estimated Cost ............................................................ t-ee .......................................................................................... (to be paid on filing this applicotion) o N 5. If dwelling, number of dwelling units ............................ umber of dwelling units on eoch floor ............................ if goroge, number of c~rs ........................................................................................ ,.. ................................................... 6. If business, commercial or mixed occupancy, specify nature end extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Reor ................................ 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:DOllseFront ....... 't'1~17~:~'"'"~'''2L~ Rear ....1~ .................... Depth ....... ~..~. ............ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of ~Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises ore situated ...n.A~..~l.l~,t; ................................................................................ Does proposed construction violate ony zoning law, ordinance or regulotion: .......... ]~3 ......................................... Will lot be regraded. ......... ~'P,~ ........... Will excess fill be removed from premises: (X) Yes ( ) No Name of Owner of premises JLe.id,.~Ja_ha.~f~...&..~., ........ Address .......0.~.~.~.~.~. ........... Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ....0z'tenl;...~r~(:ki~g..&..~.a~ls~z~t~lFriLc~tn....C[o ....... .~.'Le~.t;.. Phone No ....................... ~LOT DIAGRAM / ail buildings, whether existing or proposed, Snd indicate all set-back dimensions from block number or description according to dj!ed, and show street names and indicate ____- 12, 13. 14. Locate clearl~a'nd distinctly ~roperty lines. (~ve Street and #bother interio~or corner lot. es +d soys that he the opplicam k~TATE OF NEW Y..ORJ¢. ,, ........... ; .......... .~....O.~..~.~.~....~..9.1P,~.~ ....... i...:: ............................ being duly sworn, depc (Name of individual signing contracO above named. , (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 this application; that all statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. ~IOTARY PUBLId, ~fllte of New York N~*, ~;~-8125850, Suffolk Cou~t~ Term Expires March 30,