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Home My WebLink About9494-zFOR~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No...Z906.9 .... Date ..... June...'15 ............ , lg. 7.8 THIS CERTIFIES that the building located at 8.7.0. Fa;l,~ay...I~$.v.~ ...... Street Map No.. 60.66 ...... Block No ........... Lot No ..... 5 ............................ conforms substantially to the Application for Building Permit heretofore filed in this offiee dated ..... 0el;obey'...'l.! .... , 19.7.7. pursuant to which Building Permit No .... 9./,9.~.Z dated ..... 0c~o.be~7...'l. 1 ....., 19.77., 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..F.~IILY .DIttE, LLII~IG ...................................... The certificate is issued to .... ~.a~'~el'..&. Flc~l~enD.e .Rusb.~az'e ..................... (owner,~) of the aforesaid building. Suffolk County Department of Health Approval .... 6./.~.~. f.7.8.... .......... UNDERWRITERS CERTIFICATE No. Pending HOUSE NUMBER .... 870 ....... Street ...... F.a.t~a.y.. ~.~.~.v.e. ................... ............................................ C. u.t.e, hog~.e. ~. N..e~..¥~r~ ............. Building Inspector · TOWN BUILDING TOWN SOUTHOLD, FI.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 9~9~ Z Permission is hereby gronted to: ....Z. fa ....... ..4/.i~..~.~.~..~: ........ ,~.!.:'.~/~/..~.'.~..~ ~ ~ pursuont to oppli¢otion doted , -(r~C..~... /[ , ]9...Z., end opproved by the BuiJding Inspector. Fee $ ........................ FOBM NO. 6 TOWN OF SOUTHOLD Building Depaffmenf Town C]erke Office Southold, N. ¥. 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--iS-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 oil property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os to use, occupancy and condition of buildings. 3. Dote of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare o certificate. C. 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 New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ........... .~.~......i~..~ ........ ~..~,¢ .................................. Owner Or O~ner, s~L..~ __ '~ .. _.O.f prope,y ...... ~~.....~:..~;~.....~.~ '~ ~..~ ....................... Permit No...~.~.~..~Date/Of Permit Z~.(Z...~pplicant ........ ~.~.~.~.~./.~ ....................... ..... ............ e,t. ,raw, ................................................ ....... ........ ........................................ Request For Tempora~ Ce~ific~te ........................................ Final Ce~ificoto ...... ~3 ........................... Fee Submitted $ ....... ~, .......................... Construction on above described building and permit meet~.all applica~le codes and regulations. Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or sear) 1E THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~- 85 JOHN STREET. NEW YORK, NEW YORK 10038 THIS CE~IFIES THAT / ~. ~) ~ ~~ ~vasexaminedon .~,,~e 2l 19 8 andfoundtobeincompliancewiththerequirementsofthiz~oard. FIXTURE RXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES 35 ~5 39 DRYERS FURNACE MOTORS TIME CLOCKS UNIT HEATERS MULTI-OUTLET ENMMERS SYSTEMS NO.O~ FEET SERVICE DISCONNECT S E R V I C OTHER APPARATUS: Electr/e roo~ heat:e~: I G.P.C.~I. 1 Smok~ deteotox- 1 ~.5 kw Ho~ water hea~er MotorE: 1-1 hp 1-1,5 kw NO. OFpECC. COND.A.W.G. OF CC, COND. OF HI-LEG Goodale Elee. RB1 Box 1SA Main Rd. Mattltuck, N.Y. 11952 LicX83E emauA, 11 This certificate must not be altered in any mannerr return to the office of the Board if incorrect, Inspectors may be identified COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS o. This application must be completely filled in by typewriter ac 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 ptan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets 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 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 NLADE tl 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 I Jaws, 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. . .;? (Signature of applicant, or name, if a corporation) ............................... ................ 7'- .......... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ............................................................................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No. / ..... ~' '-~ Electrician's License No ................................... ;; ........ Other Trade's License No ............................................... /c-~ ~ ~ ~ Location of land on which proposed work will be done., Map No,., ......... ; : ........ /' ................... F_.-~,,-~ ~ ~ "::'~"~'" Street and Number ........................... / ....................................................................................................................... Municipality 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 .................. Demoliti0n;~, ................ Other Work ................................................ . .... 4. Estimated Cost ....... ~.,.(.:.~..~.~..~.~.:.(.'.~..: ...... ;....J .............. F~e /,~/ ~ (Description) (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 ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... :...~ ...................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ................................................... : Address ...... , .............. L~ ........ Phone No ....................... Name of Architect .' .............................................. '. .............. Address ...,.:., ................ ;~.'..... Phone No ....................... Name of Contractor ............................................................ Address ................ .....:......,., Phone No ..... .-.... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock 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 ................................ ; ...... .~ ....... .~ .......... ;; .................................. being duly sworn, deposes and says that he is the applicam (Name of individual signing contract~ above named. He is the ....................................................................................... :..i ...................................................................................... (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 thaz the work will be performed in the manner set forth in the application filed therewith. Sworn to. fore me this/ /'~ ~'-~-~,, ~4 ........ ..... day of ................. , Notary Pu, l~lic, . .............. ~ .................................. County Ne. $2'4gg3721,'SO~.~,,Ik Cou~j~v (Signature of applicant) 1~0~ ~0. 1 TOWN OF ~OUTHOLD BUILDING DEPAIITMENT TOWN CLERK'S OFFIGE ~UTHOLD, N. Y. ..................... ..... Di~pproved o/c ...................... ~ .............................................. ........... ~~ ........ ~..~~ .......... (Building In~tor) APPLICATION FOR BUILDING PERMIT ote ................. .................. , .... 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 ofprpperty 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 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 Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable lows, ordinances, building code, housing cede, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ............ ...... ......... (Address of PpplJcant) - / ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................... ....... ........................................................................................................................ Name of owner of premises ..... ~...~...~'~-- .~.....~..~...~... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ..... ~.~.',~.....~....~.~..~...~/--~- Electrician's License No.....~...~....~..~. ....... Other Trade's License No ............................................... 1, Location of 'and on which proposed work will be done, Map No,: ~../.'.~...~...~.y.,...r..~ ..... Lot No .....~...~.... ............. Street and Number ...... .~..~..~.~....~..7......~.....~.~...~.'...¢~....~....~.....~. ................................. ! ~.~ ..........."~ ' ~ Municipality 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 /U~'~O .~.o~....~...,,~...}.~.~ ~:~...~...~;" ....... 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................ . 5~-- (Description) 4. Estimated Cost .J.~.~.~.AI3.~.,.~.{).. 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 ............................ Number of Stories ................................ 8. D~mens,ons of entire new construction: Front ......... ..~..~.~.~..~1.-~-~. ......... Rear ......~...~.~...~...~/. ........ Depth ....,~....~..[. ............ Height ....~..~..~. ......... Number of Stories ............... ./. .................................................................................................... 9. Size of lot: Front ...............~.. ..................................... Rear ......... ~ ............................. Depth .....~.. ....................... 10. Date of Purchase ........................................................ Name of Former Owner ....... .~...~...~...~.-.~.....~...~ .............. 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .......... ./~...~ ....................................... 13. Will lot be regraded . ....... .~...~. ............. Will excess,fill be removed from prem, ises: (') Yes ., , 14. Name of Owner of premises ~'-'~.f.~,,~.$ ..~..~ ..~...~/~.~'Address/.~..~..~.~,~.{~..~;~n~e~No ..... · ' .............. I~' .~'~' Name o¥ Architect .z~.~.~......~.....~.~.~..f.......~-.~-, ........... Address ./~. ~.e~'9.rA~.)~.... Phone No ....................... Name of Contractor ..... ..~........'~........~...~...~...~..' ........................ Address ...~,~yt~/, 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, I c S COUNTY OF .............................. ............................ -~...~..-/~....~.~.R.~..~.~ ................................ being duly sworn, deposes and says that he is the applicom (Name of individual signing contracf) above named. He is the ............................. · .~....~ ...... "~'."~" 'l-~'"'"~k~'""l;'~'"'"l~'" ................................................................................. (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. Sworn to before me this dayof.... .............. J' -,.,- -4.,, '"'"" '"";' '"N°ta" p/~'bl'iC" County ~~ .... ~ ....... ............. .................................................. ...................... NO. 52-46 '.;2], Suffolk Courtly Term Expires n~arch 30, 19~ TEE THE LOCATtON OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD O~ERVATIONS AND OR FROM DATA OSTAiNED FROM OTHERS ~f ~., ~ ..... TEL N Lot NOTE: m -- MONUMENT SUED/VISION MAP FLIED IN THE OFF/CE OF THE CLERK OF SUFFOLK COUNTYON FEB, 16~ 1974 AS-H£E N0,6066 WATKH MAIN- 5 MI~S~ THERE ~RE NO DWE~UNGS WITHIN I~' OF THIS PPOPEHTY OTHE~ THAN THOSE SHOWN HEREON 4 30000 ' ~ N. 88 59 20 W. 200.97' 'Lot ~vls,oNs YOUNG & YOUNG 400 OSTRANDER AVENUE, R~VERHEADr NEW YORK SURVEY FOR: WAL TEH S. HUSHMOt~E ~ FLOHENCE K. HUSHMOHE LO T NO. 5 "FAIRWAY F~MS" ·owN o~' ~OUTHOLD ...................................... SLJFFOLK CO., ,,N. Y. . , ~ . / = 50 j SEPT. 13, TEE L41VE Lot 4 THE LOCATfON OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD OBSERYAT~ONS AND OR FROM DATA OBTAJNED FROM OTHERS THE WATER SUPPLY AND SEWASE DISPOSAL SYSTEMS FOR TH~$ RESIDENCE WILL CONFORM TO ~*HE s'rANoA.os OE ~*HE SUFFOL~ COUN*r¥ OF HEAL~'H SERVICES APPLICANT: ADDRESS TEL NOTE: I = MONUMENT SUBDIVISION MAP PLIED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTYON FEB. IR 197~I AS-H£E N0.6066 WATER SERVICE- Pt~IVATE WATER MAIN- 5 THERE ARE NO DWE/IINGS WITHIN I00~ OF THIS PROPERTY OTHER THAN THOSE SHOWN HEREON 2000Q ' ~ N. ee°59 '20"vl 200. 97 ' Lot 6 R EVISION5 dUNE 7, 197~ YOUNG & YOUNG 400 OSTRANDER AVENIJE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HO~'ARD W, YOUNG SURVEY FOR: W~l TEl? S. HUSHMOHE ~ FLO£ENCE K. HUSHMOHH IOT NO. 5 "FAIl, WAY FAt~MS, CU TCHOGUE zow~ o~ ~OUTHOID SCALE; I "= 50 ' 15, 197~ ~ SEPT. .11 DATE: FEE= BY: NOTIFY BUI DEp.~.P.T/~EHT AT fo 4PM FOR REC~U[R- ED INS '1 '1- .t I --il - /0 I I -1~ iL- II I "'1 .... /'",2 -I I t I I 1 I