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HomeMy WebLinkAbout9496-zNO. 4 TOWN OF SOUTHOLD B[m.nlNG DEPAR~ Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located -' Map No ...... ~. ......Block No ...........Lot No ........ ~. ......................... conforms substantially to the Application for Building Permit heretofore ~ed in this office dated ............/?.f.7. .... I.t., 1977. pursuant to which Bugdlng Permit No. ?.'./.?.~..7'. dated ............O.C..~.... !?., 197..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 The certificate is issued to ..... .~.~ .-[..[...~,.. ~ (owner, ) of the aforesaid bu/lding. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No. ~/ ~ HOUSE NUMBER ~E~qO Street ]~t G/~ ~ TOWN OF $OUTHOI~D Ii~ ~ r BUILDING DEPART/~ENT~ TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING ~E~t~lT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9496 Z pursuant to opplication dated ........................... ~..~f~.~.....[..L .......... 19..~..Z, and approved by the Building Inspector. ¢ Budding In~P~t6~;L / " FOP,~ NO, 6 TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This opplicotior, ~ust be filled in typewriter OR ink, and submitted in DUPLICATE 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 dispasal--(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 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 all property lines, streets, buildings end 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 in- formation required to prepare a certificate. C. Fees: l. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existin~ dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 / / 'l 'l' blew Building ................ Addition ................ Old or Pre-existing Building ................ ¥ocant Land .............. location Of Property ...... L!.O.. ........ a].a ...... O Owner Or Owners Of Property ....~. ~L~.~ ...... ~.~/~/~.. ............................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No ..................... Date Of Permit .................... Applicant ....~..~,..[..~.. .......... ,~..~..~../~..~,w..~?.,,~. ......... ~ Health Dept. Approval ~..,~....~.~..~._.~,.,1...~.~. ............. Labor Dept. Approval .., ............................................. Underwriters Approval ..~.~,.~L~.,.~.~,.~. ....................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building an.d_germit ,q~eets all applicable codes and regulations. App cant Sworn to before me this ................ day of ............................................ Notary Public ................................... County ~.6~(stamp or seal) THE NEW YORK BOARD OF FIRE UNDERWRITERS pm BUREAU OF ELECTRICrTY ~-- 85 JOHN STREET, NEW YORK. NEW YORK 10038 o,.., ~=' 20 [978 A,,,,,,,i.,.o.~,o.o./..gq850~' N 384717 THIS CERTIFIES THAT rtve~ ~aras~ e/~ Dx~an~ ,d, ~uo ~o O~egon Rd.~ Cu~ohogue~ L.I. FIXTURE ~IPTA [ WIT I RXTU~S 1 200 CB x I -ll.~X¥/ ttot ~/a~ez, Hea~er 1-10amp. Vacuum Unit 1-1~KW Heat Pump 1-5 Ton Ae Unit ~ANO~S t 12.2 SPECIAL REC'PT 1 3o E E [CO~IN~ DECKS I OVENS I D~SH WASRERS AMT. K.W. AMT. K.W. I JRT. K.W. X 1.2 TIMECLOCKS BEU. IUNITHEATEIISUNITHEATERS MULTI-OUTLET I I EXHAUST FANS OF CC. COND. NO. OF HIAEG O~: NEUTRAL John T, 8apana_-o Inc. ,"' /,/- = 102 Oak Ave. ~,, ~.nt*t~u~A~.. i g COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIfiCATE MUST NOT Bi ALTERED IN ANY MANNER. BUILDING DEPARTMENT,~/~?7 ?. 2- ~z , ~._ ~,,~e~ ~- ~-~- ~ Examin~ . ~ ~./ / 0 · · / ~ /~ ...................................... , 19...~. ~ . ~pl,cot,~ No ................................ ~ ~pr~ . .." ~.~ ........ , 19~. ~e~itNo ~ ~ ~ ~. ~7~-~/~~~ ~ ............................. .......................... } ................. ~ ................................................................ ~ ......... ~ .......... ~7 '~ ~ ~~-~ APPLICATI~ FOR BUILDING 'E~'~~/ k ........... ........................... , ...... :N U iONS o. ~is opplication must ~ completely fiJl~ in by ~pewriter oc in ink o~ s~mi~ in triplicate to ~e Buildi~ Ink.tot. with 3 ~t$ of pl~s, Qccu~te pl~ plQn ~ ~le. F~ Q~o~i~ ~ ~h~ule. ~. Plot plon S~OWlng I~otion of lat on~ of buildings on premises, relationship to ~joining premiss or Du~liG stree~ oz oreos, o~d giving o detoil~ d~ription o~ I~o~ ofpr~e~ must ~e d~wn on the ~ioGram wKic~ is ~ Of ~is opplicati~. c. T~e work c~ered ~ this o~licoti~ moy n~ ~e comme~ ~fore i~uonce of Building Permit. d. U~n opp~vol of ~is opplication, ~e Building Ins~tor will issue o Building Permit to the opplicont. Such permit s~oll ~e ~e~ on the premis~ ~oilobJe ~or Jn~ti~ ~gh~ the ~rk. e. No building sholl be ~cupied or used in whole or in pa~ for ony pu~ose wh~er until o Ge~ifico~ of ~cupancy s~oll ~ove 5ee~ 9~ntod by t~e Bud ng lnsp~tor. 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 code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspe~ons. (Signature of applicanfl, lor name, if a corporation) (Address of applicant) / ! 7 7 ~ State whether applicant is owner, lessee, agent, architect, engineer I electrician, plumber or builder. ap.~licae/~is a corporate, sianatuce of duly authorized officer. .......................... (Name ~lnd title bf corporate officer) Builder's License No ..................................................... Other Trode's License No. ~ .............................................. ,,E.~- x.fZ~,-.~l¥~- 1. Location of lard.on ,~hichoproposed=lt. _,, _n_,, - ~7,,w°rk will be done. Map No.: ........................................ Lot Street and NuC'~m/be~r ..J~(l_~.....~......~......~l... ............................................... ~...U.?~,~.....~.,.~..~.=.. ..................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. ~xisiting use and occupancy ...... ~,/~r...~... .................................................................................................. b. Intended use and occupancy ......... ~.~..[..~.~'~.~J~...~... ................................................................................ 3. Nature of work (check which applicable): New Building.. ....... Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) 4. Estimoted Cost,tn ~I~/,~.{~.j~....~T..__ .................... ................. 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 ~pe 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 ................................ ...... c~' .~. De th ....~.....~. .............. 8. Dimensions of entire new construction: Front .......~... ....... . ............... Rear ........................p Height ...)..~./. .......... Number of Stories ....~. ................................................................................................................ 9. Size of lot: Front ....... .~..~....~T.. ......................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 Name of Owner of premises ~ ~,0~{~.~...~. Address I. ' Phone No. ~..~-~;..".~.~.~.~ 14. Name of Architect .............................................................. Address ....... ~.,,.~;~/,.,,.,.~,;_. ~ph_one I~1O ....................... Name of Controctor~.~.~?~../~..-.~....(~ ...................... Address ....~'-,~T~4f~..~. ..... Phone No..~.~'...';..~.-~,~.~ 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. ........ ~uu.~..'~.'~.~"...:i~'~.~::..-'.- ................................... being duly sworn, deposes and soys that he is the applican, (Nome of individual signing contrac~ obove nom~. He s the ................................................................................... ; ................................................................... ~ontra~gent, corporate officer, e c.) of said owner or owners, and is duty ou~ to perform or have performed the said work and to ~ke 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 fo~h in the application filed therewith. Sworn to ~efore me this _ ..... o, ................ ... ...... .H ....................................... ..... ................................. V' Ne. 52~372~, Su~lk 'il .I The sevase disposal md vator supp~ tao~li%lss for %his location h~x~ besn ~nspoc%od by this ~p~tment ~d foun~ staoto~ , ~ Chi oneralEn~ne~ -- CC/TC/'4OC_~4J~ N APPROVED AS NOTED NOTIFY BUILDING DE[~ARTMENT AT ED INSPECTIONS~ 5. A~L'CONSTEUCT[~N MUST MEET EEQUIREMENT5 ~ N.Y. 'S~ATE CODE r' AND TOWN HOUSING CODE & Z~.