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Home My WebLink About9205-zFOB,M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate O[ Occupnncy No..Z89-~.1 ...... Date . Janus-.fy ....... '~7 ........ , 19"~8- THIS CERTIFIES that the building located at .-,%0'7~ -Oregon. - ~. - - -: -- Street Map No ............ Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore flied in this office dated . April .... 2~ ........ , 19.. ?F pursuant to which Building Permit No. dated -Apr'il .... 2~ .......... , ,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 The certificate is issued to ~ - (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval '" Ui~DERWRITERS CERTIFICATE No .... ~30~.9.70 ................................ . HOUSE NUMBER .. -307~ ....... Street .. O-z-ege~. ~i,, ' ........................................ ~ia.~ituck, - I~Y. ...................... Building Inspector FOP~/I NO. 2 BUILDinG D~PARTME~? TOW~ GLER~('$ SOU?HOLD, N. Y. BU~LDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N?. 9295 Z Permission is 'hereby gronted:tO:r . ': :- ~o~::...~..~ .... ~:~ )~.z.~..~.¢.~... ~...:~.~..t~).,_~.z..~.:.~..~: ........ , ........... at.premises located at -~/~ ' ~'~ '~ pursuant, to apolicotion doted ............................ ~-~-:.-:~....,..~..~......, 19..~.'~,., and approved by' the Building Inspector. ............. ''T '-~,~,~ HE NEW YORK BOARD OF FIRE UNDERWRITERS I ~ ~ -'~ ~ ~-:; -' h - BUREAU OF ELECTRICITY " ~ - ..... 85 JOHN STREET, NEW YORK, NEW YORK 10038 Oore Dec~mb~r. I 9, 1977 ~pplicatlo,~%o. onf~e 940520 ';:s Rober~ RewehJ, n/s of_Oregon Road, 1000' e/o Mill Lane, Mattituck ~.,~oU~.~.,~.; ~ ~ B~.~ ~ ~,,r~. ~ ~.d r~. outs I de - w~a~e~on_December 15, 1977 a.dfoundtobeincompllancew,~htherequ~rementsofth~sBoard, FIXTURE L~ECEPTACLESl SWlTC~ES~ t FIXTURES RANGES SI:RVICE DISCONNT:CT ~ NO. O! ' $ E R PER ~' OF CC COND )THER APPAI~kTUS: '- ~ ' ~ .... ~* ecl I receptacles: 1-50 amps, 6-20 amps Panelboards:l-ll ,cir. I00 amps COOKING DECKS 1rIME CLOCKS .~ BELL ¥ I UNIT HEATERS MULTI-OUTLET SYSTEMS EXHAUST FAN NO OF HI*LEG DIMMERS AWG or NEUTRAL P.O. Box 243 River Road '~ .? GEN~[ ~: Calverton, t.l. 11933 Llc. 452E ~ , , Per This cerlificate must not be oltered in any manner; return to the ofhce of the Board ~f incorrect. Inspectors may be idenhfied by/t~eeir credentials. 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 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 disposal--(s-g form or equal). 3. Approval of electrical installation from Board of Fire Underwnters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, o 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 and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as 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 $5.00 3. Copy of certificate of occupancy $1.00 Date ~C~ ...).., .~l..~..Z....~.. ...... New Bu, ilding .... ~ ....... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..~./,,~....~.~..~..,~....~..~.J......~..#.' Owner Or Owners Of Property ...../~. ,..~..~,..,~% .~..:[...........~...: ..... ..'..~..~.....~......~....~.....~,~ ..................................... Subdivision ........... ~ .......................................... Lot No ............. Block No ............. House No ............. Permit No.~,..c~....,~..,,..,~.,. Date Of PerrnitL~L.L~.~Z?,. ,~,,,Applicant ....../~..,~...~....~....'~..,...~,- ..... ...~..,.../?..~....Z~...,~,./,~. Health Dept. Approvol ............................................ Lobor Dept. Approval ................................................ Underwriters Approval 6~....-~....~...,~..,..~..Z,,~.. ......... Plonning Board Approvol ........................................ Request For Temporory Certificate ........................................ FinoJ Certificote ....... ~ ........................ Fee Submitted $ ....~..~...D.....~. ................. Construction on above described building ar)d~ecmit meets all operable co~le,~and regulations. Applicant ...... .~.~. ~...~~ ..................................... Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) , ~t~ ~-/ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi, Inspector, with 3 sets of plans, accurate plat 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 areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this applicatio 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 perrr 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 Occupan, shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describec The applicant agrees to comply with all applicable lows, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or budde~ Owner Name of owner of premises ............... .~..Q..b.~.,z~..~.....q.:...~..°,.w..,e..h.! .......................................................................................... if apphcant 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 ............................................ ~/ ~7~ --/0 ~ ~ ~- Other Trade's License No ............................................... ~ ...~.. Location of land on which proposed work will be done. Map No ...................... Lot No ............... Street and Number ....... .N...o..r..~.h....,s..i...d..e.......O..T..~.qD...j~,~,, ..... ~,.~.~i.~.UD~.~,...,..N..:.Y.'......../ ................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction' a Exislting use and occupancy .............. .~..~.~.~.~-.~.t3.~;...W.~..~...?..~.~....~.~.~...~.~.J..~. ............................................ b. Intended use and occupancy ......... .~,.d...d.;Tl,..~.~.~f~.~...?..~.K~.....b..~..i...1..d..i...n.l~ .......................................................... 3 Nature of work (check which applicable) New Building ..... .~. ....... Addction .................. Alteration ............ Repair ................. Removal ...... ~ ....... Dem~ht~or. .............. Other Work ............................................... 4. Est,mated Cost ...~.~.~.Z'...O.~.: ..... .~..2..~.~.0...0..0.. ................. Fee / ~-- ~:D___ (Description) (to be pacd on filing thcs applicatcon) 5 If dwelhng, number of dwelhng un,ts ........................ Number of dwelling units on each floor ....................... If garage, number of cars ................................................................................................................................. 6 If business, commercial or mixed occupancy, spectfy nature and extent of each type of use .....A.~.~..J,..g..q~.~p 7 Dimensions of ex~stmg structures, if any: Front ...... ~.~.....~...~..'. ....... Rear ...~.Zt:..0.....~..~ .............. Depth ....~..0.....:L".t;.,. He,ght . .2;...0....?.~.: ...... Number of Stones ...... ~..~..~....~.:~.. ..... ~.~.~:~..~.* .....~l,~...~..~.,...~j.~:j~ ....................... D~mensions of same structure with alteratcons or add,roans Froht ................................... Rear .................... Depth ................................ Height ........................ Number ~ Stor~es ............................... 8 Dimensions of entire new construction. Front .... .8.Q...~..t;., .................. Rear ..... 8~...1.~.1~ .......... Depth .....~.Q. Height ......2...0....~..~... Number of Storces ........................................................................................................ 9. S~ze of lot Front ....... .A..o..~..e...~. .............................. Rear ....................................... Depth ........................... 10. Date of Purchase ....................................................... Name of Former Owner ..................................................... 11 Zone or use dlstr,ct in wh;ch premises ore s~tuated ......... ..A....(.~$..~.~..z'.~.g.~). ................................................... 12 Does proposed construction wolate any zoning law, ordinance or regulation' . .................. .~...O. ............................ 13. W, II lot be regraded ......... ~..Q ............. Will excess fill be removed from premises: ( ) Yes ( ~ No 14. IX4ame of Owner of prem,ses .... ~ab.e~.l:..~a~z. ehZ ................ Address ../~l~.I~..~ ........ Phone No...~.~.8..T..8.~..~. Name of Archctect ................................................... Address ................................ Phone No .................... Nome of Contractor ................................................Address ................................ Phone No .................... PLOT DIAGRAM Locate clearly and d~stmctly all build~ngs, whether ex~stmg or proposed, and end,cate all set-back dimensions ftc property hnes Gwe street and block number or description according to deed, and show street names and induce whether mter~or or corner lot STATE OF NEW YORI(., IS COUNTY OF ..... ~£.t'~LJ~ ......... f S ................ ~.o...'9.~.~....~.,.....~..o...W.~.,h.~ ........................................ becng duly sworn, deposes and says that he cs the apph, (Name of individual s~gning contract0 above named He ~s the .......... .0...w~....e..~. ............................................................................................................................................ (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and this applicatcon, that all statements contained ~n thcs apphcation are true to the best of his knowledge and behef, that the work will be performed in the manner set forth in the apphcation filed therewith. Sworn to before me thcs .......... .......... ........ .................... ....... Notary Pubhc, . .................... ..~....-,.-~.-.~:..~.~r.~.:.~. County ~.~ (Signature of applicant) ELIZABETH ANN NEVILLB NOTARY PUBLIC, $(a/e of New Yorl~ No, 52 8125850, Suffolk County