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Home My WebLink About9470-zFO~ NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No...Z900.7. .... Date .. May ..... '10 ............... , 19..~.8. THIS CERTIFIES that the building located at .~.'1.55.8.o.~rldy.l.~. R.o.~..cl ..... Street Map No. ,2777. ......Block No ...........Lot No ...... 2.'1 .......................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ... September. 26..., 19..77 pursuant to which Building Permit No .... .9.~.7.QZ dated ... September...26 .... , 19.. ?.7 was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ....... PRIVATE .ONE,. FAMILY .DWI~.J!~!NO ................................. The certificate is issued to ......... John. El~.I'ico. ................................. (owner, of the aforesaid building. Suffolk County Department of Health Approval ...... UNDERWRITERS CERTIFICATE No .... N3.8282.7. ................................ HOUSE NUMBER .... .11~5 ..... Street ..... Sot~dVl~.W .~O.a.d. .................... ........................................... 0rl.e.~!:,. ~t~w. ,Y.o.r. k .................. ..... Building Inspector (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 1~ 9470 Z Permission is hereby granted to: ............... .s...o..u...t.~..oA.~ ........................................... build new one .f..a...m..i..l.~...d.H.e...l..l...i~..g lot 21 Orient b S~ SeA I ...................... ~t pmr~d~ k~at.d at ............. ; ................ : .......... !r. ..... ~ ....................................... ....................... ....................... .$...o..u.~ v~..e.~. ...................... ~o,.a.a ~r~L~t ......................................................... pursuant to application dated ........................... ~p:L..2~ ............ , 19.~..., and approved by the Building In~ector. FO~M NO. $ TOWN OF SOUTHOLD Building Deportment Town 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 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 farm ar 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 fram 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 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 Date ........ New Building ../~..(~...~f~..... Old or Pre-existing Building ............................ Vacant Land ./.....~..-~....: ......... Location Of Property ~q~/~/~~.~/~`~`~`~``~`~ ........ Owner Or Owners Of Property ...~..6..l.i(.......~.~..(.~...i...~..~. ...................................................................... Subdivision ................................................................ Lot No..'.~..../. ..... Block No~'~...~..L House No...!.~.;.~... PermitNo..~...~..~..~!...?...D.43,eOfPermit?~..~...~./.~..~Applicant La ~.'bt~' ~'(D .~" /x~ ' Health Dept. ApprovoJ~./..~../'.~..~.. ...... ;,?..~.~..~..:..!~..~..Lobor Dept. Approval ................................................ ,J,J Underwriters Approval %..~/.~.~..'../~t.~.~..e?.~..~.../~...PJanning Board Approval ........................................ Request For Temporary g~rtificate ........................................ Final Certificate .-~../...~...Z~..~. ..................... Fee Submitted $ ..b?.f.....4~.. ..................... Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) ~'-~ v .. ~ ~ '~ I : T E NEW YORK' BOARD;OF FIRE UNDERWRITERS;,,' ~ ' ' - ~ : ,, , , t BUREAU OF ELECTRICITY , SS JOHN,STREET. NEW :YORK, o~y the electrical equipme~t ~ descrlb~ belo~ a~d ~ntrod~ced '.,: J :.~:,the Sea,;Ori~h~,::L,;i'7' ~.*,.,~*d,,. April 13.' 1978 DRYERS - ~RNACE MOTORS, .... -- ~'~ :' ~ 3~' ~ ::~: : ~ ~ ~n :' : 2-Smoke Detectors ~f~%~,flc~f..usf'.~~0 the Tow. OF UT,OLD BUI~ING DEPARTMENT , /~ ; _ / __. ~N ~ERK'S OFFICE ~//~ ~-~ ~omin~ ...............Ge~.....~....., 19...~. Application No....~. ................ " 26 77 OZ ~ ~ ;- ' ' ........................................ , ........ ................... ?'Y DJ~pprov~ a/c ............................................................................................ ~w .... ~.- ~ ~., ...................................................................... ;7 ................. .......... ....................... i~i&';~"i~';g;CT ..................... APPLICATI~ FOR BUILDING PE~IT INST~U~IONS a. T~is ~[ic~tion must be complexly fiil~ in by ~ewriter o~ in ink Qnd s~mi~ed in triplic.te ~ ~e Buil~ing~ I~sp~tor, wit~ 3 ~t~ of pl~s, QccurQte pl~ plQn ~ ~Qle. Fee Qcco~ing to ~h~ule. b, Plot p]~n s~owing I~Qtio~ of lot Qnd of buildings on premises relationship to Qdjoining premise~ or pub areQs, end gNi~g ~ detQil~ description of I~ut ofpr~ must be drown on the diQGrQm which is c. The work c~ered by this G~lic~tion mQy n~ be commenced before issuQ~ce of Building Permit. d. Upon opprovQI of ~is opplicQtion, t~e Building Inspirer will issue ~ Building Permit to t~e oppficQnt. Such permit s~QII ~e kept on t~e premises ~v~ilQ~le for inspection t~r~g~out the work. e. No building s~Qfl be ~cupied or u~d in w~o~e or in pa~ for Qny pu~ose wh~eYer until ~ ~e~ificote of ~cupanc~~- s~ll ~ve been gm~te~ by t~e B~il~i~g Impector, ~PPLI~TION I~ HEKEBY ~E to t~e Building ~epartment for t~e i~suQnce of ~ Building Permit pu~uQnt to the B~ii~i~g Z~e Or~i~o~ce of t~e ~ow~ of ~thol~, %uffol~ ~ou~ty, New Yor~, Qnd o~her QpplicQble ~ws, O~inQnces ~egui~fions, for the ~o~stru~ion of buildings, ~dditions or olremtions, or for ~movQl or demolition, os he.in de~ribed. T~e opplic~nt .grees to comply wit~ ~1 ~pplicQble IGws, ordinances, building c~, ~si~ c~e, Qnd regul.ti~s, Qnd to ndmit Quthoriz~ inspocto, on premises Qnd in buildings ~r n~esso~ i~tions. ($ignQture of opplicont, or ~me, if ~ co~mtion) (~dd~ss of opplicont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. builder Name of owner of premises ..... ~.Q~......E.~t~.~..q..o. ......................... If applicg~:s a corporate, signature of duly authorized officer. (Name and title of corporate officer) ~. D,/~ 7- Builder's License No ..................................................... Plumber's License No. ? Electricien's License No. .~ .......................................... Other Trade's License No ............................................... ;~ '7'/-7 ,.~c~--- Location of land on which proposed work Gill be done. Map No.: 0riezzt by ~e& Lot No. Street and Number ...... RD.I,I~¢~...~..~f~.~'..~.$,~. O~.~.ent Municipality State existing use and occupancy of premises ond intended use and Occupancy of proposed construction: vacant lot e. Exisiting use and occupancy ......................... ~ ............................................................................ b. Intended use and occupancy ...~...~'~l~.]~Ir....~.w'.e...1..1...i..~.E ............................................... ~ ............................ 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior ..................... Other Work ................................................ . .... (Description) 4. ~stimated Cost ............................................................ Fee ..~..~).e.C~ ............................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ .o...~..e. ............. Number of dwelling units on each floor ..... , ...................... If garage, number of cars ........ ..~.1¥.~. ............................................................................................................................. 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 ................................ 8. Dimensions of entire new construction: Front ........ ~r~ ....................... Rear ......... ~.~. .............. Depth ..... ~.8 .............. Height .................... Number of Stories ..']..~. .............................................................................................................. 9. Size of lot: Front .... .~..QO. ............................................. Rear .......... 1.OD ......................... Depth .....~..6.0. ..................... 10.' Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district inwhich premises are situated ..... A....~I,:J,S.~ ............................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .~. .................................................. 13. Will lot be regraded . .......... ~'..e..s. .......... Will excess fill be removed from premises: ( ) Yes (Z) No 14. Name of Owner of premises .~.~.~X:l,..E..~'.~,g.O. ........................ Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ..l'.o...~'a~ZZ~8~:.:[ ............................. Address ...... P,O[tt,]:ZQ1 R ...... Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oil 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. See filed plans STATE OF NEW,.YO~,, ~ c ¢ COUNTY OF ....~.~1~.;I;-.0.~, ........... ¢¢'¢ .................... ~l~.q...~.~a,s~f~.s]r~l, ............................................. being duly sworn, deposes and says that he is the applicam (Name of individual signing contract0 above named. He is the .................................. ~13~,1c]e ........................................ (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 tk, az the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........................ day of Sept 19..?? Notary Public,. ....................... .~....'~....~.~1~. ........... County (Signature of applicant) TOWN OF SOUTHOLD Building Inspector's Office Town Clerk Building Southold, N.Y. 765-2660 / N ~he sewage disposal and wato,~, suppl~, 'facilities for this location hay8 been inspected by this ~ . - . . ~ ~ t~ / ......... ~.a~'; I LoC -8±-, / - AS ALCOVe' /2' O' APPROVED AS NOTED 765-2660 9AM fo 4PM FOR R~QUIR- ED INSPECTIONS: O~ CONSTRUCTION ERRORS REQUIREMENTS CF NN. STATE CODE AND TOWN NOUSIN~ CODE & ZONING ,I [[ I I · // -1