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Home My WebLink About9501-zl~'OlI, M NO. 4 TO~N OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No .... Z9060 ' ' ' Date ..... Jun~ ' ' ti ............. , 19.78. THIS CERTIFIES that the building located at 2095 'Lake .I)r-J. ve .......... Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... 0'd%bb~; .... l'L~' '" 19 77' pursuant to which Building Permit No... dated .... .(j6%0b.~ .... 4/$ ...., 19.. 77 was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is ...... Pt~/gTE' 0NE' F~IL~ DWELLIN~ .................................. The certificate is issued to .......... ;Yc~t~' ~ 'Sh~l~£ ' Oxee .......................... (owner, l~ss~ of the aforesaid building. Suffolk County Department of Health Approval ........ ?;-S'0-~/d4 .................. UNDERWRITERS CERTIFICATE No ......... iq~88~5:~ ............................ HOUSE NUMBER .. '209~ ...... Street .......... Bake' .DrY,re .................... ................................................ Bout'hold',' 'N~Y', ................ ~uilding~ Inspector TOWN BUILDING TOWN SOUTH'OLD, y;r BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9501 Z Permission is hereby granted to: · ~.~e....c...o..n..~...g.o.....z..n.~....z./...q...~'°'~...O. xe...e. .... 8outhold pursuant to application dated ............................... .O(~.t,.....l.~ ........ , 19...~.~.., and approved by the Building Inspector. IK)ItM NO. 6 TOWN OF SOUTHOLD Building Delmftment Town Clerks 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 ar new use: 1. Final suwey 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 disposol--(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 aT 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. Date of any housing code or safety inspection of buildings or premises, or other pertinent formation required to prepare a certificate. C. Fe~s: 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 &~..~.. Z;~ Date ....................... f../..Z~.... ..... New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Property ......... ' -- ................... -- ................................ Location Of Ow.er Or O ners of property ........................... .,-........,...... ...................................................................... Subdivision ........................................................ ~ ....... Lot No ............. Block No ............. House No ............. Permit No..~.~/......,.~. Date Of Permit/..F.~_~..~..Z...Applicant ~,,~.,.,,.~.. ,~....~',~,:...,,~,.....' ........................ Underwriters Approval .............................................. Planning Board Approval .................. ~. ................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ~-~ ~ .7//.. App leant Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County /~. / Y ~ Z U THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~- ,~m 85 JOHN STREET. NEW YORK, NEW YORK 10038 John Oxe~ Lake Dr. w/o Kenny Rd., SoutholdR L.I. in the following location; ~ Basement [] let FI. [] 2nd FI. Section Block Lot ~as examined on X X an~ found to be in compliance with the requirements of this Board. OVENS DISH WASHERS EXHAUST FANS r. K,W. ~'.T. K.W. ~.Y~T. H.P. UNIT HEATERS /~KJLTI~I~ ~AMLI~$ SYSTEMS 1 May 30. 1978 FIXTURE ] I " '1 fiXTURES I RANGES ICOOICING DE~KS { OUTleTS ECa~/AOES SWITCHES INCANDESCENT FLUORESCENT A~ClK~ T. K.W. AN~T, K.W. "I~FUENAC~I~'~OTOES 3,3 RJTURE,aJ~d&N~.EDEEE 'EQALREC'F~ ,I~,~,.CI~Cj:. AMT, K.W. OIL H.P. GAS H, P. ADVT. NO. A.W.G. AMT. AMP. SERVICE E~SCC)NNECT I t,~o. m [ s E I~ V I. .,.,,. ,,.,,. ~ ~'~,,,.'. ,,,.,,,,,, ,.:,w :,..'.,,, .'.w ,.,o.%,~,?,,,,. o,*.~¢o~,:,. ,.,o.o,,,-~o OfflER AP~S~ ~o X X ~/u ~4otor/s ~ 1-1/2bp ?anelboard/a: ~-3clr. 125amp. 1-30amp. transformer switch 1-G.F.C.I. 2-Smoke Detectors 1-10eO~W }{eat P~p l~0~p Compactor f _ 1-".5~ Hot ';~ater Heater ~[all Elco. 760 Longcreek Dr, Southold, L.I. 11971 LIc.55~ p~ ~is c..ificale mu. no, be altered in any manner;, return ,o the oHic. of t~ ~ard if incorr.. ,ns~ may be id.~i,~ ~7'he% c~. ......................... COPY FO{ BumLD{NG D{FA{YMINY. YMI~ ~OFY OF ~I{YIFI(AY! MU~ NaY {l ~Y~ IN 4{ {NNIL ' BUILDI~ DE~RT"~E~T//~/-- TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~.~,.,~ .......... ~..~../ ........ . ,~.~. .. ~,,~,,o. ~o~~.~ ............ ....................... .............. ........................... ....................... ~U~TlO~ ~OR 8~l~l~ ~[R~lT ~ ........... ~.~...z~: ............ . ~.~2...~ 1 NSTRUCTIONS ) a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with/~j 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pict 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 of property must be drawn on 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 onE 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 beent~ 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, 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.,j~ I ..... (Signature of applicant, or name, if a corporation) ~ ................................................................... /,.!...%.7../. ....... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder; .......................................................................... ..~.~..~..~..~ ...~.... ...................................................................................... Name of owner of premises -~/,J,4,/ ~..~ ~ ......................................... (Name a d~itle of [;l~porat~/~fficer) 1. Location of land on which proposed work will be done. Map No.: ......... ~Lot No .............. .~ ...................... Street and Number .....................~,, ,~, Municipality 2. State existing use and occupancy of premises and.~nded use and occupancy of proposed construction: a. Existing use and occupancy ........................ ~.~..?./....4~...~....~...~..~.~;l (''- . ~, o~;5"'"~T ............................................................... b. Intended use and occupancy .................................................. ~ ........................................................................... 10. 11. 12. 13. 14. Nature of work (check which applicable): New Building ....................... Addition ..................... :AIterat~ofr;.r .............. Repair ......................... Removal ......................... Demolition ........................ Other Work ....i ............. :. ............. ' .... (Description) · Estimated Cost ...~....~...~.~ Fee ..~..~.. ............................................ (to be paid on filing this application) If dwelling, number of dwelling units .......... /..... Number of dwelling units on each floor ......... i ............................... If g f ca ' arage, number o rs ........................................................................................................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use ...... , ............................... Dimensions of existing structures, if any: Front .....................Rear ........................... Depth .................................... N be of St ries ' Height ..................................................... ..... . um r o .............................................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ........................................ Depth ............................................. Height ......................................... Number of Stories ........ l ............................... Dimensions of entire new construction: Front ......... .~..~.. ........ Rear ......... ~....~.. ........... Depth ...... ...~....~... .............. Height ................................................. Number of Stories ............~ ........................................................................ Size of lot: Front /.~ 47 / . Rear ............ /....~<. ........................ Depth ..~.~'~. ........ .~..Z...'~...~ ................ Height .................................................... Number of Stories ...................................................... ' ................................ Date of Purchase ........~./~..~. ................. Name of Former Owner ........................................................................... Zone or use district in which premises are situated ............................................................................................. Does proposed construction violate any zoning law, ordinance or regulation: ....... ~..h?~... ............................................. Will lot be regraded ~..~....~....~. ................. Will excess fill be removed from premises: [ ] Ye,, [~ No,_ Name of Owner of premises ............ ..~...."~)~.~.~,~. ........ .~,~. ....................................................... ........ E ~ /1 · (Address) Phone No.) Name of Architect .................................. , ................................................................................................................ (~ (Address) Phone No.) f £ x/,'; . Name o Contractor .................. ....................... i ................ .................................. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-I' property lines. Give street and block number or description according to deed, and show street name er interior or corner lot. Phone No.) ack dimensions from ; and indicate wheth- STATE OF NEW Y([II~"K, ~ ! ~/, ) COUNTY OF ...,..~.,.,~,.~'L/,.~-(~·.~,./~ ............... ) SS ............... ~..~.Z~/.~..~... ......... ~...:.......~L~...~_~.~__ ......... be,ng duly sworn, deposes and says that he Js tr applicant above named. He is the ................................... ~-..~..~.l~.s..k~-~--~.~..~., ......................................................................................... ! ....................................... (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 Pest of his knowledge and belief; and that the work will b~ performed in the manner set forth in the application filed therew;th. ' N~ ' -~ 'ec ' t .rAt S~LL ~Ot ~ CO.S~ ,..ZOHN ¢ ~ ......... , ':~°/Col/c Co. Wa: MODE~CK VAN TUYI- p. G. [ ~I'AMP ~ ' BUFF. CO. DEPT. O~ HEAL.TH ~.~q~fC~ BI'ATii]4~MT ~ I~NT O' ~ ~ WA~ SUPPLY AND 8~WAGE DATE: D~L ~8 FOR THIS ~ DEN~ WIL~ C~M TO THE H~ ~. REF. NO.: ~AND~ OF ~UFF~ GO. DEPT A~ROY~: !/L E_. ,/ P~ APPROVED AS NOTED DATE:~r ' ~' ~t~'~-~ --f .