The URL can be used to link to this page

Home My WebLink About10046-zNO. 4 TOnSil' OF SOUTHOLD BUII,rtlNC, DEPARTM~:~T Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No ..... Z.~..~.~.~... Date December 4 .78 THIS CERTIFIES that the bui}di~g located at .. ~.8.~... ??.~.v..a.t.e..R..d:..~.~..0.. ~ Map No ............. Block No ...........Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in th~ office dated ...No.v. em~e~..~0 ...... , 19..7.8 pursuant to which Buildin~ Permit No...~.Q0?..6.Z dated ...Deoembe~...4 ......., 19.7.8., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which thi~ certificate is issued is ......... ~.c.c.~.s.o..~., 5.~..m..c.~..~.~ ........................................ The certificate is issued to ............ .5..ab$~. J.~.a~..e ............................ (owner, ~c of the aforesaid building. Suffolk County Department o! Health Approval ............... N/R ................. UNDERWRITERS CERTIFICATE No ............ : ................................ HOUSE NUMBER ...... 485 ....Street ........ ?r£vat:a ~oacl..~..1D. ............. ......................................... ................. County Tex Number 1000-087-1-4 · TOWN OF $OUTHQI~D BUILDING DEPARTMENT~'" TOWN CLERK'S OFFICE SOUTHOLD, N~ '~'. BUILDIN~ PERMIT "~' (THIS' PEP, MIT'MI~S,T COMPLETION OFTHE wORK AUtHOrIZED) hereby granted to: Permission is ~ to,.. .c~... .~..~.~.~.~,... .~~y....~-f~. .............. , :~L- at ~r~mises ~ocated at~;.:.~.,,...~..L~,..~.....:...,.;, ~ ....... ..: .............. . } :; :~ ......................................................... ,. ............................ ~.~~.~,..~...~~ ........ -- ~¢ ' ~ 19 approved by the ~"' ~' Buqding, , ~ .~ns~ec*or. ~ : :' Fee $...Z~ ....... ~OP~ NO. 6 TOWN OP SOUTNOLD , Building Dep. rtment 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 in DUPLICATE 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. ^pproval 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. ^ccurate survey.of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Swam 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 dwelling or land use :$5.00 3. Copy of certificate of occupancy $1.00 ....... Date .... ~... ....................... New Building ......~. Additior~ ........... Old o: ,~-~s3i.ng Building ................Vacant Land .............. Owner Or Owners Of Property . .~ .... .~.L/2~.~ .................................................................. Subdivision .................. .~..:...., ............................ /......Lot No......-2~......[BIock No...~ ........ }douse No...~..~.. Health I~pt. Approval .... : ....................................... Labor ~IL~. ~pprovol .~.....~ ......................... Underwriters Approval .~.....~...~...~.~...¥...~... ........... Planning Board Approval ~ Request For Temporary Certificate ....X ............... 2~: ............... Fin~ Certificate .......................................... Fee Submitted $ ...~r.. ............................. Construction on above described building ar~ permit meets all ap(jal~coble codes and regulations. ^pphcant ...~ .......................................... Swam to before me this ................ day of ............................................ Notary Public .................................... County THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY THIS CERTIFIE~ THAT only the electrical equlp~ent as described below and introduced by the applicant named on the abo~e appllcat~ number in the premises of J~r~ ~agulre~South Harbor :(~do ~So~old~L~I. in thefollowlng location; ~ Basement ~ 1st Fl. ~ 2nd FI. g~ag~ Section Block ~,~i,~do,~ September ~]~0 7~9'[~ andfoundtobeit~compllancewlththerequirementsofthisBoard. FIXTURE FIXTURES RANGES OVENS EXHAUST OUTLETS SWITCHES FLUORESCENT DRYERS E R V I , C NO O ~E RCC~CON D. AWG. NO. OF HI-LEG NO, OF NEUTRALS OF NEUTRAL Paul Burns Town H~rbor Lane Southold~.Y. 11971 Li(,~28~E GENERAL MANAGER This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be idqntified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTII:ICAT~E ,MUST NOT BE A?ER~D IN ANY MANNER. FO~ NO. 1 TOWN OF 5OUTHOLD BUILDING DEPARTMENT TOWN CLER~('$ OFFICE $OUTHOLD, N. Y, Examined . '~'~.~.:.....~ ............ Approved .,.~..C ...... ~ ............. ,19.~. Perm,t"a. Z~..~..~ ...... D~sapproved a/c .......... ...._~._....._._._.~ .................................. APPLICATION FOR BUILDING PERMIT Application No..~.~..(~...~.....~.. ........... INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building 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 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 not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue o 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 Deportment 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 otl applicable laws, ordinances, building code, housing' code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ...... .................................. O ~-D~-u"'- ~//(Signature of appl~nt, or name, if a Corporation) -r- ',, ~ ...x~.~..~..~.~o,-,._~l_.,.....n.~.~....c.~,.I.:/,,.........,,..,~.~,.~....,..~.......,.,,.,,.,., (Address of applicant) .... ( ! ~ ~ 6, State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... .B.~.;...l....4..~.c ...................................................................................................................................................... i .......... ..6.. H Nome of owner of premises ..... ...0~. ,.)D~......~,..~ .......... ..C&... .~..L.~ ............................................................................ ~f applicant is ~ corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No....~...'~.',..~. ........ ...~....-~. ................. Plumber's License No ................................................. Electrician's License No. ~.¢.v..~.........~....o..../~..~....~... Other Trade's License No ............................................... Location of land on which I~roposed work will be done. Map No.: ......... : ....................... ..~...... Lot No ......................... Street and Number ..~.~.~...~....~...~.~t.~..c~.~.~.~.~.~....~...~s.....~..~....~....~...~.~...~.~...u..*.~..I.~- Municipality State existing use and occupancy of premises and in.~ended use an~d occupancy of proposed construction: a. Exisiting use and occupancy .... b. Intended use and occupancy ..... ~.,, .~...~:. ,.,,,,, .~.....~..~.,. ,,. ~..c~..~.~ ..~, ./~:,~ .~.C~.~. ~,/~?.~. ............... : 3. Nature of work (check whichI applica~e): New Building .......... Addition .................. Alteration Repair .................. Removal i' .................. ~' Demolition .................... Other Work I (Description) ..z....0.,.-- 4. Estimated Cost ........ ..o...d,. ........................ : .............. Fee .................................................................................. (to be paid on filing this application) 5. If dwelling~ number of dwellilng units ............................ Number of dGelhng units-on'eCch floqr ............................ , , J ,' . . If garage, numoer or c~rs ..... , t .................................. .,, ............................ ,.., ...................................... ~ ............................. 6. If bus ness, commercial or ,mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structu;res, if any: Front .......... .............. Rear ............ .............. Depth ...~..,~'.,- ....... I Height ........................ Numl~er of Stories ......................................... ~ ....................................................................... Dimensions of same structur~ with alterations or additions: Front ..... ~. .............................. Rear ..:.....L~ ............... Depth ......... ~..~.. ................ :' ~eig~ht ...... ..... ii.....,....,.... Nc~m, ber of~S~fgries . ........ ! ......... : ............ 8. Dimensions of entire new coqstruction: Front .............. ,J...'~: ............... Rear ............. /..,~: ......... Depth ....... :.~ ............ Number!, of Stories Height .................... ~ ........................................... 9. Size of lot: Front ................. t ...................................... Rear .......................................... Depth ................................ 10.' XDate of Purchase ....:.;.,..'......u ..................................... Nome of Former Owner ........................................................ 1 1. Zone or use district in which ~remises,are situated ..................................................................................................... 12. Does proposed construction vi~late any zoning law, ordinance or regulation: ~..(~ ................................................. 13. Will lot be regraded ...... .f~).~ ............... Will excess fill be removed from premises: ( ) Yes (t,'~ No ~,%c:' ,~ t-t c~ d, '·'~- ..:?,/.?.:?.'.!:~SL!..~;... Phone No. 14. Name of Owner of premises ¥~.(: . , r, , ,r-' i ...... ~ . ................... .~ ........ ............. Address Name of Architect ............................................................ Address ........................ ........ Phone No ....................... Name of Contractor ~)~l'"~ % ,J)z~(¢)[~.%. Address ..... ;. ............. h~.,~No. ............................... :, ........................ PLOT DIAGRAM Locate clearly and distinctly alii buildings, whether existing or proposed, and indicate oil set4x~ck dimensions from property lines. Give street and block number or description oeeording to deed, and show street names and indlcote whether interior or corner lot. STATE OF NEW YORK, ~¢ic ....... -: ...4 ;. :' i . ';~,7,,,r;~,(,, ~x~,, .... ~,.k,~,,,.,.{,,!,~ .............. being duly · (Name of ~,pd~vldual mgn,bg contract) above named· , sWory~y deposes,a'n¢ says that he is the opplicom He is the ............. , ............................. ~ ............................................................. , ........................................................................ , 4 (Contractor, age~t/corporate of4icer, etc) ,of sa~d owner or owners, and ~s duly authorized to perform or have performed the sam work and to make and file this application; that all statements.,icontair~ed' in/this,'appllcatlon'a~ true ;to the best of his knowledge and belief; and thor the wo~w I be perfor~d n the manner set fo~h, n the appl~ation filed therewith. Sworn t~fore me this 711 ~ / ~ ~ ...... I ' (Signature of applicant)