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Home My WebLink About9190-zFOB,~ lq{). 4 TOWN OF SOUTHOLD BUH,~ING DEPAI~TMENT To,~rn Clerk's O~[ice Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at . .3.8.1.0...0.1.e...J.u.l.e...L.a.n.e. ..... Map No ............. Block No ........... Lot No .................................. conforms sl~b~tanI;i~lly,tg,~e Application for Building Permit heretofore filed in this office du~y ~,, -,~o~ 3976Z dated ....A.p?.i..1..1. .8., ....... , 19.7.7.. pursuant to which Building Pemit No...91903 July 31, 1968 dated ... Ap~,il..1.8~ ......... , 19.7..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 ............ P.r..i.v.a.t..e...Oqe...F.a.m.i..ly...D~..e.l. 1. i.n.g ............................ The certificate is issued to ..... .G.e. qr.g.e..F.:..S, ql?..a.e.d.e.1.. &...w.f.: ...................... (owner, l~~x of the aforesaid building. Suffolk County Department of Health Approval ..... .9./.2../7.1... .-.-.-.TR.:..V.i..1.1.a. ...... UNDERWRITERS CERTIFICATE No. N847668, N424J30, N381619 HOUSE NUMBER ...3.8.3. .0 ....... Street .......... .0.1. .e . .J.u.1. .e . .L.a. n. .e ................ Mattituck, New York ....... ........ .x. ! Building Inspector FOEI~ NO. ~ TOWN OF SO~THOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT LTHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9190 Z Permission is hereby granted to: -~ ~ Building Inspector. ~fi;5~,~:--' Fee ~,,~.X~..O. ............. located ,rem.ses at ..... ..._e..._~.._~,..~. ..................................... z .......... ; ...................................... .....................................................--~.~.tJ,.l;.~;...,~ ;~.,. ....................................................... ; ................. ~'~/:2~x~--': j~rsuant to application dated .................... ,~ia~ii~'i'~"'"'~ ............. , 19.t~9..,' ' and approved~ ' I~y the ' ¢~.,. TOWN OF $OUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 AFPLIGATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector w~th the following; for new buildings or new use: i. 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 d~sposa! (S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commeroal buddings, 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 19.57), Non-conforming uses, or buddings 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 housfng code or safety inspectfon of buildings or premises, or other pertinent formation required to prepare a certificate. C. Fees' 1. Ceruflcate 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 .....Z~.,~.~.,......~.. ...... ~..~,.~.~... New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ..X~..~....~../. ..... ../~.C~..~:.ZLh(. ....... ;.~.~9./..~ ..... K;~.~.....\~..~.~......4(~. ........... Owner Or Owners Of Property ....... ~.~..¢-~'~,z,T ....... ~ ........ .~..~.~...~..~..~.~..4'.~ ....... ~..~Y.~.~ ................................... Subdivision ~'~.~....~.f-..~...../~/~ ..... ~¢/¢/~.~..~././.-(.Z.~...,~ ..... Lot No ............. Block No ............. House No ............. Permit No .... ~Date Of Permi .... Applicant .4~.~¢..~..~..~.. ..... ~ .......... ~,~t'.~.~..~..~..C.(. ...... Health Dept. Approval ...... ~./...A.~'~.~.Z~ .................. Labor Dept. Approval ................................................ Underwriters Approval ..... ~..~.~..//~:......v~... .......... Plann,ng Board Approval ........................................ Certificate'' ~ 7~ ,Z' ~ .... Fmal Request For Temporary ./.'~..~/./ ........... .... Certificate .......................................... / / Fee Submitted $ ......~. ....... ~ .................. Construction on above described building and p~J'~ meets all apl~icable codes and regulations. Sworn to before me this Applicant .~.~/~..2..:~~4....z~.,,~ ................ day of ............................................ Notary Public .................................... County (stamp or seal) THE NEW YORK BOARD OF FIRE UNDERWRITERS ~)! BUREAU OF ELECTRICITY I 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~ ~ , Apphcat~on No on fde ~ ~ ~ ~ ~ ~ THIS CERTIFIES THAT .... only the el~sctrlcal equipment as described below and introduced by ~he applicant named on the a~ bove application,, number in the premlses of in the follotving location; [] Basxem~e~nt~ [] 1st FI. [] 2nd FI. " ' ~ Section Block was examined on ~ and found to be ~n compltance u'~ th the requirement~ of thts Board. FIXTURE OUTLETS DRYERS FURNACE MOTORS FUTURE APPUANCE FEEDERS SPECIALREC'PT TIMECLOCKS BEI UNIT HEATERS SERVICE DISCONNECT I ND. OF ~ S E R V I C / OTHER ~PPA. IIAYUS MULTI-OUTLET SYSTEMS NO OF FEET E NO ~F NEUTRALS EXHAUST FANS DIMMERS AMT [ WATTS AWG OF NEUTRAL GENERAL MANAGER Th~s certificate must not be altered ~n any manner, return to the off~ce of the Board ~f ~ncorrect Inspectors may be ~denhf;ed by their credenhals. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. 3. Nature of work (check which applicable) New Budding ................. Addition .................. Alteration ................. Repair .................. Re,moval.,o .................. Demoht~on ................. ~,~o~.~:'"qther Work (Describe) ....................................... 4. Estimated Cost .~...../~..~..o. ............................. Fee ~/...~.--.~..... ......................................................................... (to be pa~d on filing this apphcation) 5 If dwelhng, 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 ........ ..:;~5....~.~. f.~ ....... Rear .......... ..~..../..6..:.~ .......... Depth ..~.:~..;..~...~[... Height ....... .g:....~.~ ......... Number of Stories .......... ~ .................................................................................................. Dimensions of same structure with alterations or add,t,ons' Front ....... ..~.~.~...~..'.'. ............... Rear ........ '. .... Depth ......... ..~...~.....~ ............ Height ......... .~...~...~. .......... Number of Stones ............. ~ ............. 8. Dimensions of entire new construction. Front ........ ~..~.o/..~..~[ ................ Rear .......... ..~..~ ............ Depth ....... ..~..~.~. ...... Height ...... .~..,~ ........ Number of Stories .................~.. ....................................................... ; ....................................... 9. Size of lot: Front ........ .~..¢..~ ............ Rear ......... ././..~ ~ ................ Depth ......... ..~..~.:~.~...:..~/~ ~ 10. Date of Purchase ............................... ./.?..~, ............. N~me of Former Owner ........... ~./...~.~..~..G.~5$./~.~T.,~. ........ 11. Zone or use d~stnct in which premises are situated ................ /~.~..-~44~./~%6':.Z4,f/...~. ....................................................... 12 Does proposed construchon violate any zoning law, ordinance or regulation~ ............ ~..U..~ ........................................ · t~, ~ S~,'~,~/~- /..&-.Y.~.../'.~tl~.4~.~¥.,~'..Z..~.~.~hone No ~ ~'.~..~.;'.~. 13 Name of Owner of premises ...................................... Address .............. Name of Architect ...d.~?...~..~/.....~..~$.~.~.~ ./~/.~ ............... Address..~..~..~..//~.~.'~..~...~..~....~,~,¢~(l~'..~.¢l~hone No ~.~..~..:./..~..~..2 Name of Contractor ............... g.~6/.~.f:.~,, ................ Address ............................................ Phone No .................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~sting or proposed~ and indicate all set-back d~mens~ons fron property hnes Give street and block number or descnpt~on according to deed, and show street names and ind~cah whether interior or corner lot. o/.E ,~,~.~ /,-~/'/~ STATE OF NEW YORK. ~ c ~ COUNTY OF ...... .8.. ~ ~ .~..9 ~.k.. ......... .............. g.~,oz'.g~,..~.....~.g.l~.8.effLe'l ................................. sworn, deposes and says that he is the appJlcan (Name of ~ndwiduaJ signing apphcat~on) above named. He ~s the ................ ~.~ ....................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and this application, that all statements contained in this appl~cahon are true to the best of h~s knowledge and behef, that the work will be performed m the manner set forth m the apphcatio~ed therewtth Sworn to before me this ..... ~.~ ......... day of ............ ~P~.$~ .................... , 19Z7...~~~~ ~~/~/Z ~ ~ )(....~~ ~/ , NOTtR( DPr~ J~ .t~t~ 0f New "~; ~~ I~o 52~!~5~59, ~c~nk Caus~ mt TJ APPROVED AS NOTED F 5CHAEDEL NO.?:TI4 OLE ,.Ttt LE T 0 N A A' i 0 0 ~ T' 0 N FLOQt~. E,t'T£NTION SEAL[ ~" I' 'OF .M,R¢ /vkR5 GEORG[ : $CHA~ ~XTEHTION /RATT TU C I< 'N.Y,