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HomeMy WebLinkAbout9318-zNO, · TOWN OF $OUTHOLD BU~.n~G DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z???.~. ..... Date ............ -~ov ..... 7..., 19..7.7 THIS CERTIFIES that the building located at N/S. R~2~. (S~.ont. ~t) ..... Street Map No. z..z ........ Block No. x...x, xLot No, x"' 'x .... 6~*eenpovt.. ~.~Y~ .... cenforms substantially to the Application for Building Permit heretofore fried in this office dated ........ J.l~ne..2~ , 19.77. pursuant to which Building Permit No..9318Z · dated ........ J.u~. ?..2.~..., 197..7.., was issued, and confo~-ms to ~11 of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .B~..s.~.n..~ s.s b.u.~.ld, ing~ .~..2.~.h..a..den...~..~.~..t .............................. Tl~e certificate is issued to W.$11.~am ~ .~r;t,ce ..... ~ne~. ........................ (owner, lessee or tenant) o£ the aforesaid building. S(~olk County Department of Health Approval ~;.R.o ............................. U.NDERWRITERS CERTIFICATE No....N3.6.0.7.~. ...... .0.c.g.. 3.9..]. ?.7.~. ............. B,OUSE NUMBER .... 7~.~.~.. Street ....M.~l.~..R.q~¢..(R..T2~.)..,, .G.~el~D~X~t ..... .. ,,',, .. ....... Building InspectOr FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N: Y. BUiLDiNG~PERMiT (THI ~E~RMIT MUST BE KF-~T ON THE PREMISES UNTIL FULL COMPL~ION OF THE WORK AUTHORIZED) FOI~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 m DUPLICATE to the Building Inspector w~th 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 disposol--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters 4. Commercial buildings, Industrial buildings, Multiple Residences and s~milor buildings and installations, a cert,ficate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te plan requirements where applicable. B. For existing buildings (prior to April t957), Non-conforming uses, or buildings and "pre-existing" land uses: 1 Accurate survey of property showing oil 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 inspechon of buddings or premises, or other pertinent in- formation required to prepare a certificate C. Fees: I. Certificate of occupancy $5 00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 ..................... New Building ................ Addition .....~. ........ Old or Pre-existing Building ................ Vacant Land .............. Owner Or Owners Of Property ..... ~$.];~$..n..m.,..H..:....P.~.'.z.g.R ............................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ........... Permit No .... ~,.~.~.f~..Z... Date Of Permit ..G/Z.~/27....Applicant FJJ..ch~e.t'...Ham~...T,~p.~.o.~fl~J~...~i~., ..... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fin~ Certificate Fee Submitted $ ....D..'.~D. ......................... Construction on above described building anc~ permit me, its all app!i~ble c.,ode,~j~nd regulations. ............... ........ Sworn tobefore methis Rioh~e~ Home Improvement Co., Inc. Notary hc ............................ County ~1?~, '~v r,~o,,~ ........ NOTARY PUBLIG. State ~f New York Suffol~ County No 55 3933725 Term Expires Uarch 30, 1979 ",-~ THE NEW YORK BOARD OF FIRE UNDERWRITERS pTI] BUREAU OF ELECTRICITY ~-- 85 JOHN STREET, NEW YORK, NEW YORK 10038 , Vo,. October 19, 1977 .~,,~.,,~0.0.,~,~ 933360 N 360754 THIS CE~IFIES THAT ~ onJ~ the elect~cal equipment ~ described belo~ a~d intr~uced by the appllcan~ ~med on the able appllc~Hon number in the premises of ~illiam P~ice, ~2~ Fron~ S~., Greenpo~, L.I. ind, efollowlnglocatlon; ~ B~ement ~ lstrl. ~ 2nd Fl. Outside s~ot~o, m~ ~ was examlnedo~ 0c~obe~ 17 9 1977 ~ndfound to beln compliancewith the reqtdrements of this Board. FJXTURE FIXTURES RANGES OVENS DISH EXHAUST FANS OUTLETS SWITCHES . FLUORESCENT 35 52 25 30 5 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET ~ SYSTEMS NO. OF FEET ~)IMMERS DISCONNECT NO Of: CC COND A W G PER ,6' OF CC CONO 1 3/0 OTHER ,APP,ARATUS: · /Pane'lb0ard/s :, Y-17cir. 125amp., 1-3cir. 125amp.~, $ E R V I - C" 'E AWG OF NEUTRAL 1-12cir. 125amp.? 2/0 Paul "Burns Town Harbor Lane ' Southold, L,.I..~11971 Th~s certificate must not be altered ~n any m~ I SOUTHOLD, N. Y. ......... ~oproved ,(../..~.~...ZZ. ....... . ,,..Z..TPerm,t No..7.h7./..~..~ ......... Disapprovei~/c .................... :.~ ................................................................... BUILDING DEPARTMENT TOWN CLERK'S OFFICE ,</Z/TZ- /~ 0/~ ~ .0 ~ Application No..~ ............... (Building Inspectorl APPLICATION FOR BUILDING PERMIT ~o, .... ~.!:.~...~../.. .................... , ,,....7.....7.. INSTRUCTIONS a. Thi.<, application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Buildin~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationsNp to adjoining premises or public streets ot areas, and !;living a detailed description of layout ofproperty must be drawn on the diagram which ~s part of this application_ c. The work covered by this applicahon may not be commenced before ~ssuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Budding Permit to the applicant. Such perm~i 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 Occupanc~ shall have been granted by the Building Inspector. APPLIO\TION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o, 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 admit authorized inspectors on premises and in buildings for necessary inspections. ..... (Address of appli~t) State whetlher applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .............. ~,~.~u..~.~..~.~...L~..~ .................................................................................................................................. Name of owner of premises ...................... Z..~..t.f.] .................. Z.% .~ ......................................................................... If applicant is a corporate, sig.natur~ oJ~ dully authorized officer. ..... ..~. ~ :~.~...~,/~...~.. (Name and title of corporate officer) Bu~Id,:,r's L,ce. se No ............ Z./...Z...~ ............. Plumber's Lmense No ................................................. Elect,rician's License No ...... ~..~.....~...~ ............. License No. ~,~;~ .~. ~ Other Trade's .............................................. ~ ~ ._ ~:~ .................. = ............. Location of land on which proj?osed work..will be done Map No "L' ..... Lot No Stn.;et and Number ......... .././~'..~........~....~ ......... ...~....~..~...e...~,(~ ~ Municipality Statle existing use and accupancy of premises and intended use and occupancy of praposed construchon: a Exisiting use and occupancy ......... .ff...~..Z..~....?,/.~..5'.,.]. ............................................................................... b Intended use and occupancy ....... ./J..~.../..,~...,.~....e'.,.?....5. ............. ~1 /' . 3 · Nat~','e of work (check which apphcable) New BuHdmg ........ Addmon ........... Alteration ... Repa r ............... Remov..al ................. Demohtlor ......... Other Work ................................ ¢'~ ;~. (Description) Estimated Cost ,..'~-...~ 20~O ~ Fee ~... ~ (to be pa~d on fihng th~s apphcat~on) 5 If dwelhng, number of dwelhng umts ..................... Numbcr of dwelhng umts on each floor ............... If garage, number of cars ................................................................................................................. 6 If busmess, commercial or m~xed occupancy, specify nature and extent of each type of use ............. 7 D~mens,ons of ex,stmg structures, if any From"... .~..~.. .......... Rear ......... ~..~.. ............... Depth ....... ~.~.. He,ght ...... .~..t .........Number of Stones ..... /. ................................................................................. D~mensions of same structure with alterations or addmons' Front ...... ~..../. .................... Rear . .~../('. ......... Depth ..... .~.~..~. ...............Height .......... ~.~...f ...... Number of Stones ...... / ....... 8 D,mensions of entire new construct,on: Front ......... ~.../~. ............... Rear ..........~..../.. .......... Depth ........ Height ..... ~.~. ~ .... Number of Stories ..... ./.. .......................................................................... ........... Depth ..... Z ~.. ............. 9 S,ze of lot. Front .............. ,~...~...~).....~ ....................... Rear ....... ~..~..~....~.. 10, Date of Purchase ................. ~ ............................ N~me of Former Owner ......... .~..~..Z.?..~, ........................ 11 Zone or use d~stnct in which pram,sas are s,tuated .... ~...~../..~, .... . .~...~.../.. 12 Dces proposed construct,on v,olate any zon,ng law, ord,nance or regulat,on :::::::::::::::::::::::::::::::::::::::::: ...... 1,3 Wdl at be regraded .../.~..~. .......... Wdl exce.ss fill be removed from premises. ( ) Yes ( ~)--'r,,Io 14 Name of Owner of prem,ses ...~?¢~././/.~.~,.L .~....~..~..,.~;...~ .......... Address ~.~.~ .~..~/.~,.[~. ....... Phone No ....................... Name of Architect :~ ........................................ Address '"L~L~'~'~,' ..... ~ ....... Phone No ....................... l'~on~e of Contractor/J t.¢,.~ ~.. ,/~q. ~.l ~f~.,/.~..~.. Address ...~.. ..... .~.~.~/,1..,~ .......... Phone No. PLOT DIAGRAM Locate clearly and dlstmctly all buHdmgs, whether ex~st~ng or proposed, and red,cate all set-back dimensions from property hnes Gwe street and block number or descnphon accordmg to deed, and show street names and indicate ~'hether mtenor or co~ner lot C~TATE OF NEW YORK¢ ,~r'z/,.4 c c COUNFY OF ......... ~..~J[...~./,Lf~'' .- / / ..................... ~..~.N..~.~.~.~...(~.(.~..~..~... be, ng duly sworn, deposes and says that he ,s the apphcon (Name of individual smgnmg contract) above named. ~ .~.~. ~ He is the ............................. ~ .~. .~ .......................................................................................... (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to ~erform or have performed the sa~d work and to make and frei this applicahon; that all statements contained in th~s apphcetmon are true to the best of his knowledge and behef; cs tha~ the work wdl be performed mn the manner set fo~h in the apphcatmon filed therewith. Sworn to before me thms ~ ~, ...... .... ......... , Nota~ Pub I ic~/ ................ ~r ............................ Coun~ ..... ~..~ ~., .~ ............... ~.~:~_~ .......... ~/~~~~__~ --~ (Signature of applicant) I ~ E NOTARY ~SLIC, State of New York ~o 52-4643721, ~u~folk Cou~ ]erm ~p~res Uarch 30, © N 70,0 t L co:qcz. 240.0 0 0