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Home My WebLink About9362-z FOR~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 9362 Z Permission is hereby granted to: ..... ~..o..~.~;.~ ............ ~.~ ...... .L~.....u..w at premises I~ated at .......... ~..~.~.~ ........ ~.~ ...... ~.~ ...... ~.~ ............................ ............................................................. ~.~.~:.r~..e.~. ..... ~....~.:..~ ................................ ,..,..,/. Building; Inspector.. ~ Foe $ ...... Buildin~ Inspector THE NEW YORK BOARD OF FIRE UNDERWRITERS -.-- pti1 BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~.,~ November 30, 1~77 'h'"t~*"'i°n"~°'°n/"*?b'OB65 N 368353 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the appllcant named on the above application number in the premises of Howard De Leeuw, n/s Soundview Ave. 300' e/o Lighthouse Rd., Southold. L.Io in the folloteirtg, lo~ation;g-~L_~Basement ~k 1~[ FI. [] ~nd FI. ,~ec[ion lllovk Lot ,,,,..ex.mi,,ed,,. November 28, 1977 andfoundtobeinco.rpliancewiththert, q~tlret,tent.~ofthi~Board. . ,, .., ~ !"~ .... ':'~':~ , ' t~- ' OTHER APPARATUS: Ruland Elec. Co. , Il P.O. Box 143 _ ~ 6EN£RAtI4ANA~EE ~' Mattituck, L.I. 11952 ' Lie.2,2 E . ~ D .... ~ ~ This cerfi,~cofe must ~o, be olfered 'n on, monner; return to the o~,¢e o, the ~ord ,~ incorrect. Inspecto~r ~dtlt,ols. ~ FORM NO. ~ TOWN OF SOUTHOLD Building Del)aliment 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~r:il~e to the Building Inspector with the following; for new buildings or new use: I. 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 cerhficate of Code compliance from the Architect Ior Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requiremen, ts 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 in- formation required to prepare a certificate. C. Fees: 1. Certffmate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00. Location Of Property .... .~,~,~..¢ ............................... z. ............................ I' ........................................... Owner Or Owners Of Property ..... ~.~.-~,?~....~..~.~.~ ............ ! ............................................ Subdivision ............... ~ ...................................... Lot No ............. Block N Jo .... ...~...... House No../'....~....~.~''' Permit No...~.~...~..?.:..(.~... Date Of Permit ~.~.~..'~.Z.~.~...Applican, ...~.'....~.,~.~.~...~r ....... ~.-;'. ...................... Health Dept. Approval ...... ...~....~ ....................... Labor Dept. Approval .......... I.¥ ....... J.~. ...................... Underwriters Approval /..~..-~.(~..'~...~.. ..................... Planning Board Approval Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ~.. d'O , Construction on above descr,bed building~d/~rermi, meets a~ ap,4~7//~le ~nd regulatigns~.~ ....... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE /(~¢,.~! /,,-~ 7'/ SOUTHOLD, N. Y. Approved 19 ........ Permit No ..................................... 'sapproved a/c ................................ ~~ ............ ........................................................... ........ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No .............................. Dote ....... .......... ..... , a This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Buildi~ 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, relationship to adjoining premises or public streets c areas, and g~wng a detailed description of layout ofproperty must be drawn on the diagram which is part of this applicatio, c. The work covered by this appl,cation may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector wdl issue a Building Permit to the applicant. Such perm 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 Occupant 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 t} Budding 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 describe, The applicant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and; admit authorized inspectors on premises and in 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 bu~Ide ........................................................................................................................................................................ Name of owner of premises ~..~.~..o~J~.,-~ ........ .~..J~....J,c~.~.~,~,U.V~ ........................................................................... If applicant ~s a corporate, s~gnature of duly authorized officer. (Name and title of corporate officer) Builder's License No ....................... ~. ............................. Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1 2 Location of land on which proposed work will be done. Map No .................................. Lot No ....................... Street and Number I.'....~.....~.D.~J.~.~).~L,~....~.~.C ..... ~,~.,~.~.~L,q. ~.../.t.~..~/. ................................ Municipali~ State ex~sting use and occupancy of premises and intended use and occupancy of proposed construchon' ~isiting use and occupancy ...................... ....... ~.~ ........ ~~/...~. ................................... ~ntended use ond occupancy ................ ~ ....... ~v ....... .~ ............................................................. 3. Nature of work (check which applicable) New Building .. . Addmon ............ /. ...... Alteration ............... Repair ............... Removal .................Demohhor ......... Other Work ................................................... ~ ~' ~ 0 '~-_ /'_~ (Descript,on) 4 Est,mated Cost ......................................................... Fee ..................................................................................... (to be pa~d on filing this application) 5 If dwelhng, number of dwelling un,ts ..................... Number of dwelling umts on each floor ......................... If garage, number of cars .................................................................................................................................... 6. If business, commercial or m~xed occupancy, specify nature and extent of each type of use .......................... 7 D,mens~ons of existing structures, ,f any Front ........................ Rear ................................ Depth .................. He,ght ........................ Number of Stones .......................................................................................................... D~mens~ons of same structure with alterahons or addmons. Front .................................... Rear .......................... Depth ............................ Height .................. Number of Stones ................................ 8 D,mens~ons of ent, re new construchon' Front .................. , ................ Rear ............................ Depth ....................... Height ........... Number of Stories ............................................................................................ 9 S~ze of lot Front .................................................. Rear ......................................... Depth .............................. 10. Date of Purchase .................................................. Name of Former Owner ..................................................... 11. Zone or use distrmt in which premises are s~tuated ...................................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulahon' ~ ....................................................... 13 W~ll lot be regraded .......................Wdl excess fill be removed from premises: ( ) Yes ( ) No ~4 Name of Owner of prem,ses ...~ ....... .~...~.~ .~. ~..~. .... Addre~ ................................ Phone mo ...................... Name of Arch,tect ...................... Address ................................ Phone No ...................... Name of Contractor ....................................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and d~stmctly all buddings, whether ex~stmg or proposed, and indicate all set-~ck d~mens~ons fror prope~y hnes Gwe street and block number or de~r~pt~gn according to deed, and show street names and indicat whether inter,or or corner lot ,~ ~ ,. ~'~ ~ ' ~ i~o ~ STATE OF NEW YORK, \iS S'-~ COUNTY OF ........................ .X,f" ......... ~'~1~.~..~..~'...~. .......... ~ ..... ~.~...~...~. .... be,ng duly sworn, deposes and says that he ,s the apphca~ (Name of indiwdual s~gn~ng cont~t) above named. ~ He '- ~(Con~actor, age~ corporate officer, etc ) of sa~d owner or owners, and is du~y a~ori~ed to ~erform or have per armed t~e sa~d work and to make and th~s application; that all statements ~ntameM ~n th~s apphc~t~on are true ~o the best that the work will be performed m the manner~et foRh m the apphcat~on filed therewith. Sworn to before me this 1 ................ ..................... / .................... .................... / ~Y E NOTA~(~BLIC, State of New York No ~.~43721, ~uftolk Cou~ty~ Term Ex=~res March Jo,