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HomeMy WebLinkAbout9510-zFOB, M NO. ¢ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z90'[8 ..... Date ... May .... '17 .............. , 19..78 THIS CERTIPIES that the building located at 'E/8' 'Second' St'.' '&' Main' ' Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated October "2/* ........ , 19.77 pursuant to which Building Permit No .... 9510Z dated 0ct0ber. ~ 2/4- ......... , 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 'FAMILY' D~ING 'WITH 'ADDITION .................... The certificate is issued to ...... A:' 'Zamphiro/~f .................................. (owner, ~t ) of the aforesaid building. Suffolk County Department of Health Approval ......... N/R ....................... UNDERWRITERS CERTIFICATE No .... I,I3856.96 ....... l~Ia.y....10,..~97.8 ........ HOUSE NUMBER ............. Street. E/.S.. Second .St.. & .~le. in .$~.eet ...... ....................................... New. Suffolk,. New.York ............... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 95i0 Z Permission is hereby granted to: ~o~..~t,~e~....~/~....,~,..~o:~. ..... ........... .'~g.~.h~l...{~ ....... {kev, ei~el,i,~ ................ at premises located at E/~ :~eCOl~ Bt ~ ~&~ St ................................................. ~e~...Su/'~olk .................................................... .............. ...... . . ..... . .... pursuant to application dated ............................... 0~f~....~li ........ , 19..~.~.., and approved by the Building Inspector. FORM NO. S TO~N OF $O~TSOL~ Building Department Town Clerks Office Southoid, 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 fallowing; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusua~ natura~ ar topographic features. 2. Final approval of Health Dept, of water supply and sewerage disposal--(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 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 housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dweiting or land use $5.00 3. Copy of certificate of occupancy $1.00 Date . .~...//J~/7 ~ ...... ..¢..." New Building ..... ' ....... Old or Pre-existing Building ...................... Vacant Land ............................ Location Of Property ..l..V~.f...J.~.~-~/.....(~..c?..~...~...~...t'.. ...... /.?...~..,.'2.....~:..~:...0.?.....~.....~......~.....~'.. Owner Or Owners Of Property ..................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No..~, .~.J.~.'..-~ Date Of Permit ............................ · ~. .........................~ ............... Health Dept. Approval ...................... ~ ............... Labor Dept. Approval ............. ~ ................................. Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Sworn to before me this NO. 52-9377594 ~S~ Expire~ March (stamp or seal) (~¢) .~ ~0 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY BE ,JOHN STREET, NEW YORK, NEW YORK '10038 :~a:~ .1,3 ~978 N385696 THI~ C~IFIE~ THAT the e~t~ ~uip~nt ~ ~ ~ ~ int~ ~ t~ ~i~t ~ ~a~ ~ ~m~ ~ t~ p~s of [] 2~ ~tslde ~t~on Block ond ~o~nd to ~e ~n conzplionce wit~ the requirements o~ t~i~ Boord. 2 2 .!3 RANGES R DRYERS FURNACE MOTORS FUTURE APPUANCE SERVICE DISCONNECT I.~ 1 s OTN~,~'I)(~EeATU~oo~J~ Heatez-a: 6-1.25[C~s 3-° 75KW 1-C.~.C,.I. 1-~.SKW t~ot W&ter COOKING DECKS OVENS IDISH WASHERS I C EXHAUST FANS DIMMERS 3/0 1 3/0 Alexander O. Hubbard Box 222 AqueboKue, L.I. 11!)31 Llc.304 f 12 i~ Per- This certificate must not be altered in any manner~ return to the office of the Board if incorrect. Inspectors moy be identified by ~'credentigls. COPY FOR DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. lr-~ E ;.~VE EXCESS FILL F~ CM ABOVE pREMISES BY ~ ~PLICATIO~N FOR BUILDING PERMIT INSTRUCTIONS ................ , State whe~er applicant is owner, lessee, agent, ~it ect, engin~r, general con~ac~, electricl~, plumber or ~ builder .......... ~ .............................. ............................................ Name of ~w~ of premis~...''--~~~ ~.~.~ .... ~ ~..~..f..~... ~.'.~ .~.~ ................. H a~lic~t is a cor~ate, signature of duly author~e d ~icer. 1. ~atBn ~ land ~ which pr~ work will b e dono. Map No ................. ~t No ......... Strut and Numar ~. ~ ~O r ~ · ~ ~*~ 'q ~. ~. ~.(. .. ............................. 2. State exis~g uss and ~p~ of premi~ ~ d in~end~ u~ ~ ~p~ ~ ~ ~lon. a. ~isting use streets or areaz, .and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may n~ 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 progress of the work. e. No building shall be occupied or used in whole o~ in part f~r any purpose whatever until a Certificate of Occupancy shall have been' granted by the Building Inspector. APPLICATION IS l-tl~Y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building ~one 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 demo- lition, as herein described. The appl~grees to corn ply with all applicable laws, ordinances, building code, housing code, and regulations. a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspec~r. b. Plot plan showing location of lot and of buildings o n premises, relatkmahip to adjoining premises or public 3. at re of work (check which applicable): New Building ........ Addition ... Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 4. Estimated Cost ...tt.~.J. ,.,Z~J~..~.,-.~..~ .......... 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 ...2. ~ ...... Depth . .,~. ~. ...... Height ... 3..~. ........ Number of Stories ..... ]. .................................................. Dimensions of same structure with alterations or additions: Front ...~. ....... Rear ...~,?.,F... ...... Depth ....~. ........ Height ..... ~..~. ...... Number of Stories .... ~. ............... 8. Dimensions of entire new construction: Frrmt ..... ~ .~-~.. ........Rear .... Sl..~. ..... Depth .~. ..... Height .. i~-~.'( .... Number of Stories ..... l ....................................................... 9. Size of ~ot: Front .../..~.~. ..... Rear ::...]...~...~.... Depth ... ~.~f ........ 10. Date of Purchase .... .~-~... ~....[.~.... ].~. f. ~. .... Name of Former Owner .. :..~.g..(..~'. ............... 11. Zone ar use district in which premises are situated .................................................... 12. Does proposed construction ,violate any zoning law, ardin ~ance~p.r. regulptiorh?,. ~ .......... ~. ¢. ~:z~-.,2.? 13. Name of Owner.of premises-.- ........ ~.~;~ .~ze.. F... :Address .Af-t~,. · ./F,P~,. t~,~,%¥ Phone No. 27....,...(_. Name of Architect ...~.~..~.~..~ .... Z'..~ ,.~.~ .... ~ddress ./..~.,~..~..~'~.~..~.~. '.~ Phone No.~. Name ~of Contractor ../.~,~.~...,.,('..~.~. ~C.~.~... Address ~ .?.o. ~....~:.e'. ~, ...... Phone No. PLOT DIAGRAM -- ~ ~ - Locate clearly and distinctly all buildings, whether existing or ~tn~oposed, and indicate an set-back dimensions from property lines. Give street and block number ar de script/on aceording to deed, and show street names and indicate whether interior or corner lot. STATE OF ~ YORK.. )S.S. COUNTY OF .~..~..%.~.~.~.\.&.. ) ...... ~..~O.x-/....~.?..~..~ .~.~. ............... ; .......... being duly sworn, deposes and says that he is the appli- (Na~e of individual signing applicatwn) cant above named. He is the ..................... .~...C?..(~)...'~..~-...~..~r..'~...(~.. ~ .......................... ~(Oontracto.r, agent, corporate officer, etc.) of said owner ar owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements oontained in this application are true to the best of his knowledge and belief; .and that the work will be performed in the mann er set fortl/in the application filed therewith. Sworn to before me this Notary Public,..~.~.~ .-~..o.{~! .(- ..... County NO. 52.9377594 ..........