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Home My WebLink About9519-zTOWN OF SOUTHOLD BIm,nllqG DEPARTmOfr Town Clerk', Office $outhold, N. Y. CertifiCate Of Occupancy Map l~lo ............. Block No ...........Lot No .................................. conforms substantially to the Application for Btli]dlng Permit heretofore ~ed in th;. office dated ...............~.C..~... ~']19.?~. pursuant to which Bull&init Permit Ho..Q.~../.?..Z-. dated ............. . .~.?....~.~., 19.7~.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy ~or which this certificate is m.~d a ...a.. ??..?.7..~ .... .6..~ ..... ~.a.:~./..~.'.( ..... }.~..¢.~..~.,:.,.~.. ........ n, ~m~,~ ,-, m,~d to....~..V..~ .... !... ~!.W.~!.". ~..a. ..... .~.u.~.e.~ ......... (owner, _~ , -t) o! the aforesaid building. 8u~o]k County Department o! Health Approval ....... . .A/:. ~ ** ...................... UNDERWRITERS CERTIFICATE N'o....~...~. ~ .?..~'..Q..O. ........................ HOUSe. mrMsnt..~. Y.5. ...... Street ..... . .~. ~.r. ~.N .V..~. 9. ..... 14~/~.~ .... ..... ~:...~...~.....-Sd.... ButldlntI Inspector BUILDI - TOWI~ SOl N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9519 Z Permission is hereby granted to: at premises located at .....]~....a.g..~..lJc..9..o..c]....~..o.~.dL.....(....J~...~). .................................................................. .............................................. ~!,~'~,~.!?.~.~?. ............................................................................................ pursuant to application doted .............................. g.O.~.....~,~....:....., 19....~?, and approved by the Building Inspector. Fee ,..!.~..:..o..o.. .......... ......... ~.. ..... ;., ...... , ..... i.~.~:~ ................. .. ~ , .Building !.nspect~r~,': CI ~, : TOWN OF $OUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLIGATION FOR GERTIFICATE 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--(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 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 formation required to prepare a certificate. C. Fees: ]. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $].00 Date ........ Z~.....'~.. ~ .~..q ·.... Z..~, 4..(./..4 New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ....... ~....~.}....~....~..~. ........ ..~....~..: ............ ..~...0_..~.~.~..~..~...~..~.....,...~..:./..:, ................ Owner Or Owners Of Property ...... ~.1.~.£8.,~0..;.~ ....... ~ L ~c..~..~. ~,(~ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit ................ ./..~pplicant ~.~' ./..~": ................................... Permit No ..................... uate Of ~)c~' ~'~ ? Health Dept. Approval ............................ : ............... Labor Dept. Approval ................./..~......:...} ................. Underwriters Approvol .............................................. Plonning Boord Approvol ........................................ Request For Temporory Certificote ........................................ Fine! Certiflcote .......................................... 5:..,% Fee Submitted $ ' Construction on above described building and pqr~it~ meets all applicable 9~des and regulations. Sworn to before me this Applicant ........... U~4.~.~...:..~ ................ day of ............................................ (stamp or seal) THE NEW YORK BOARD OF FIRE UNDERWRITERS dl BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CE~IFIES THAT o~y t~ ~t~ ~uipmnt ~ ~ ~ a~ int~ by t~ ~t ~ on t~ ~ ~plh~n nu~ b t~ pmmbs of Paul SuCer, Dean Dr. ~/ ~ew Suffolk Ave. CuCchogue, L.I. in the following ~at~n; ~ B~e~nt ~Is~ FI. ~ 2nd FI. 0 ~ ~ ~d~ ~tion B~k ~t ~ ~.~ o. Au~us~ 3, ~978 a~fou~tobe~ncompliancewitht~r~u~remen~ofth~rd. FIXTURE ~ FIXTURES RANGES ICOOKING DECKS I OVENS IDISH WASHERS EXHAUST FANS ECEPTAO~S SWITCHES ,NCANOESC~NT[FLU~ESCEPd! v~' ~x.! K.W. * 29 44 33 29 / L~3.8 11.2 3 SYSTEMS 4 600 SERVICE DISCONNECT IHO.OF I S E E E I 150 CB ' x I 1 0 ' * 7 ^'w'°' / OTHER APPARATUS: GFCZ smoke detector To~n Harbor Lane // ~--~ -, COPY FOR BUILDING DIPA~TM~. THIS COPY OF CETIFI~Ti MUST ~T BE ~ IH ~NE~ /"~"¢' ~'"~-"~ '"~/~APPUCATION FOR BUILDING PERMIT ~ · , a. 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 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 or 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 nat 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, 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 ir~ buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ~,,~" ......... .................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................... ............................................................................. If applicgfft is a corporate, signature of duly authorized officer. (Name and ti · at corporate officer) Builder's Liconse No ..................................................... Plumber's License No ....... .~ ................. Electrician's License No ....................... Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ..... ~.~.?.::~...~.. Lot No ......................... Street and Number ....... ~~-,~e~....~... ............ ~ ............................................. 2. State existing use and occupancy o~p~rnis~ and intended use and occupancy of proposed construction: ~. Exisiting use and occupancy ............ ~Z.~.~--.~,.~~ ........................................................................................ b. Intended use and occupancy ................. ~....~.. .......................................... 3. Nature of work (check which applicable): New Building.. ................. Addition ........... Alteration ................ Repair .................. Removal .................. Demolitio~ .................... Other Work ..................................................... (Description) 4. Estimated Cost ............ ~/__.~.....~..~..~.... ........................ '..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 ....... ~....~..~...x~... ......................................................................................... Dimensions of same structure with alterations or additions: Front ............. .4~..JL..j ............ Rear ....... ~--,¢~.:........'". Depth ............ .~..~......~'.. .... Height ........... ~./. .......... Number of Stories .....~....~.~..z~.. ................ 8. Dimensions of entire new construction: Front ....... J....Z:.~,.~..... ..... Rear ....... ~....'~...~.....~'.... Depth ........................ Height ...... .~..'~? ...... Number of Stories ........... ~ ...................................................................................................... 9. Size of lot: Front ................ ......................... Rear ............ .~...O....'.. ................ Depth ....... ../..~..c~./.~....Z ........ 10. Date of Purchase ........................................................ Name 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 . ..........~_/ /~ h'"~'"~' ........ Will excess fill. be removed from premises: ( ) Yes ~No 14. Name of Owner of premises .~.~.~...~.~'4~.....~.4~...~Address ,..: ........................... Ph°ne Name of Architect ............................................................ Address ................................ Phone No ....................... Name of Contractor .......... ../?...~..~.../..#,~ddress ... Phone No.-~-~-~..~---~-./-~ PLOT DIAGRAM c~-~"-- ~ Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-J property lines. Give street end block number or description according to deed, and show stree' whether interior or corner lot. ~ck dimensions from names and indicate STATE OF NEW ,Y4)R~/ f/~ [ S S couNTY o? ............ ~...~/,~.~,..,¢,,.4,~4r,~c...~.. .................................... being duly sworn, deposes and says that he is the epplicam ~Name of md~wdual s~gn~'~ "'' ~ 'ng contrace above named. He is the ........... ~~.....~..........~....~~ ....................................................... ~ (C~ct?~, ~e?t, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that ail 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 fo~h in the application filed thereWith. Sworn to before me this .................................................. .......... Noto~ Public, . ................ ~{... Coun~ ................................................ {Signature of oppllcont) V RM, )DE D , E'AST NORTI~ ELEVATION 'v/t~._RT .E'LE V&TION .EXISTING HOtJSE..~::¢JT~t E~V^~ ,~ h fIR'ST FLOOR PLAN -I]. lip. 'mi .? ~,ST ~,E_~'F B'LEVATI ~ ~*~ ._L~UTH E-LE. VAT ~OS NO~T~t ~VATION J