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Home My WebLink About9469-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z.1471.6. ......... Date ..... G..u. ,ly, ,2,8, .................... 19.8..6 THIS CERTIFIES that the building ...A.d..d.~.~.J:.q .n .................................... Location of Property ... 930.5... S. QUNDVIEW AVE. SOUTHOLD Hous io.' .................'S't/e i ....................... County Tax Map No. 1000 Section . ,5. .9 ........ Block 6 .Lot 21 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated 9/26/77 19 pursuant to which Building Permit No. 9,469g dated ....... 9./..2.6/.7.7. ............. 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 ......... Addition to existing dwelling. The certificate is issued to GEORGE L. PENNY IV fowner, of the aforesaid building. Suffolk County Department of Health Approval .......... IxI/, .A ............................. UNDERWRITERS CERTIFICATE NO .................. P. Or~gl~.r~g...7./.28/.8.6 ............. Building Inspector Rev. 1/81 i~M NO. e~ TOWN Of ~UTHOLD lUlLDIHO WARTMINT TOWN CLlltK'S OFFICE SOUTHOLD, H~ Y. BUILDilqO PE~iT (THIS PERMIT ~AUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9469 Permission is hereby granted to: · Oee-.~.r ..Pem,~...]~, .......................................... ........ ,~ou~c~.~.v..~,~e ......... ~o~i~et~, ........... to ...... /~ &.l~ ..~n...a, ~.~.~.~ .~ e>n.. ~n...e.~/.e,~./~g, el,~...]:t/:n~ .......................................................... at premises located at ..... ~ox2ml.'V~:ew..fi~e ..................................................................................... ................................................. ~ou~o~l~ ....... ~o~ ............................................................................ pursuant to application doted .............................. ~opt,.....2~> ....... 19..'~.., and opproved by the Building I~. Building Inq:mctor ! FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- I802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted I ~ to the Building Inspec- tor 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 installa- tions, 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 p~-~perty showing ail 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. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.00 3. Copv of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 .~. 5.Updated C.O. $15.00 Date .... ~ .~:.../.~..~. ,~. New Building ...... · ...... Old or Pre-existing Building ............ Vacant [.and ............. u-c. ............ Location of Property . .9 ....................................... House No. Street Ham/et Owner or Owners of Property ....~...~.o..~..~..~.. ~ ...... .~. .......................... County Tax Map No. 1000 Section ............... Block ............... lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. c~.~..~.~ .~... Date of Permit ,~.~,~,. ?..,..J~?..~.~..Al..~j..~'.. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ......... Planning Boar royal ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $. ~ ..................... Construction on above described building and permit meets all appl~le codes an~regulations. THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ 000~7~1 BUREAU OF ELECTRICITy ~-~[ 8;5 JOHN STREET, NEW YORK. NEW YORK 10038 THIS CERTIFIES THAT inthefollowinglocation; ~ naso~=t ~ IstFI. ~ 2Eld FI. ,Section Bilk Lot wasexaminedon ~1'~')~ ~ ,~,S~ at,dfou~tdtqbeincompla~cewiththe~eqttirementsqfthislioard. FIXTURES EA~O~ C~KINGDECKS OVENS DISH WASHERS EXHAUST FANS DRYERS FURNACE MOTORS IME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS SBRVI~C~ DISCONNECT S E R V I OTHER APPARATUS: NO OF CC COND/ PER ~' A W O HO OF HI.LEG A W O. NO OF NEUTRALS A. W G OF CC, COND Of HI-LEG OF NEUTRA[ Ch:~rtes U~ Hall--a~nni S~:rvice tic.#657~E f~otlthold: N.Y,, 119721. This certificate must not be altered i. any manner; return to the office of the Board if inc' : GENERAL MANAGER Per~ may be identified by their credentials. ANY MANNER. TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. Disapproved a/c ................ .~.~..~..~ ................................................................ ~ (Building Inspector) / APPLICATION FOR BUILDING PERMIT Application No....?-..~Z'..~..Z ............ 7~ INSTRUCTIONS o. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 2 set~ of plans, accurate plot plan to scale. Fee according to, schedule. b. Plot plan showing Jocatior~ of Jot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproper~y 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 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 Deportment 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, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ....... ~,~:.. C~...~......~.....f... ~.....~ .................... ~]~ignatur~f applicant, or nome, · .......................... ............................................ .C .......... State whether applicant is owner, lessee, agent, arckitect, engineer, general contractor, electrician, plumber or builder. .......... ....... ................................. .................................... ........................................................ N~ of ow.e~ of p~i~s .... ~,.~..~....:...~ ...... b ~ ...... ~. ~....,'.~. k': ~. ...... ~ ................................................... If applicant is a corporate, signature of duly autkorized officer. (Name and title of corporate officer) Builder's License No ................ ~.~...'~..~L....; ......... Plumber's License No ......................... .(. ...................... Electrician's License No. 1. Location of land on which proposed worl~will b.~done. Mop No.: ...~ ........................ ...~...~ ~.... Lot No ..................... Street and Number Z.~ C~ Municipali~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .~ ................. . ............... ; ................................................................................. b. Intended use and occupancy 3. Nature of work (check which applicable): New Building'. ................. Addition .....'~,. ........ '... Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) z t 4. Estimated Cost ......... ~....;f.~...~.......;.;;...~ ...................... 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, 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 .................... .,~....~l~mber of Stories ................................. ~ . Dimensions of entire new construction' Front ............. '"";'""%L' ............Rear ....~...'..~... ........... Depth ...~...~ ........... 8. Height .................... Number of Stories ..... ..~/.,.~.....~...,~..-(?.~ ......... . .~,.......D~...(~....~.......:........F...~.,....~...../../,t...~....~..~ 9. rSize of lot: Front ........................................................ Rear .......................................... Depth ................................ i0. ' Dote of Purchase .~ ............. ' ......................................... Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does prsposed construction violate any zoning Iow, ordinance or regulation: ........................................................ 13. Will lot be regmded ......~...~?. .............. ~Vill excess fill be removed from premises: ( ) Yes ,~") No 14. Nome of Owner of premisef, i .................................. .~.......'~... Address ................................ Phone No ...........~. .......... Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing,or proposed, and indicate all set-bock dimensions frorn 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, ' I S S COUNTY OF ...,.;~ .................. ~......~ ' ...... .f,.,~.~'...~../..(..~.~.......~t~.,.t....~,..~..~.j*.....~..'....'t~,~....i ........... being duly sworn, deposes and soys that he is the applicam ' (Name of individual signing:contrbcO . - ' above named. He is the ..... ~..~..~.~.~ ...................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, a~d s duly authorized to perform or have performed the,~id work and to make and file th s app cation; that all statements contained in this application a~rae to the be~ ~ his knowledge and belief; and tha~ tke work will be performed in the manner set fo~R in the appl~t~ filed th~. ~ before me th~s ........................ day of ............................................ , ............ .............................. co,, ............. ..................... ~/~, ~ [~.~oawso~~~ . ~.~ ,,~natu m or app,,can~, N~. 52.46437~1, S~tfolkCoU~ ~erm E~lraa Mar~h aO, 19