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HomeMy WebLinkAbout10081-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No...Z. 9.87...7. ......... Date ..... ~.~.l.U.a..r~..T. ................. 19~0. THIS CERTIFIES that the building ................................................ .... No~?~._ ~.g~ .0~...e....Z,~..e..(..P~....~.~t .~.d,.l ... ~S.~.14,. ~,¥,.,,,,,,~or Location of Propsl~ County Tax Map No. 1000 Section ... ~ ..... Block .... .~ .......... Lot .... P~... ~9 ...... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ... ~.qO .e~.~.qr. ~.~.. ~., 19 .~.~pursuant to which Building Permit No .... .'1..0Q .8.'l.z ........... dated ...Dg..o..e~.l~..~.~ ............. IS7~.., was issued, and conforms to an of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... of th~ ~ffor~id buildins. Suffolk County Department of Health Approval ...~'..~.0.-~./~ .... ~.0/~.~./.Tg.;..R.. I..Villa. u~O~w~mS~s C~RTIF~¢AT~ ~0 ......... ~ .~..~.~.~..~. ............................... FOI~NI NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~REMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~oo8~ z Dote .~.~..~.~.. .... '97~ Permission is hereby granted io: ...... ~.~...~.~.~. ........................ ..... ~~..~'~. .................. at premises Iocat~ed a'7~t ~~..~......~..~;.~..~.., ............ .............................................................................................................................. pursuant to application dated ,~.....~ ........ , lC~..., a'~"~"'"'o~v~"'~"i~ppr d y Building Inspector. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY [~ l~m 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CE~IFIES THAT only the el~t~ equipment ~ ~scH~ ~ ~ int~ by t~ a~i~t ~ on t~ ~ ~pl~t~ numar in t~ p~s of gilli~ Pollert, P~e Neck Rd., Ba~/aw ~ O~od, S~Chold, L.I. w~ exami~d o~oe~er 27, ~979 andZound to be in compliance with the requirements of this ~ard. RXTURE OUTLETS 55 rECEPTACLES SWITCHES FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FLUORESCENT 61 $l 5.5 DRYERS FURNACE MOTORS FUTURE APPLIANCE TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R V I C OTHER APPARATUS: 1-Smoke Datecto~ I~0. O~c CC. COND A.W.G. NO.OF HI-LEG A.W.G. NO. OFNEUTRALS 1 I/0 1 2/0 Paul Burns Torn Ha=bo= L~ne Southold, N.Y. 11971 Lie. 282 g GENf. RAL MANAGER Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials,i COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be tilted in Wpewriter OR ink, and submitted in duplicate to the Building Inspec- tor 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 featu res. 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 installa- tions, 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 peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 informa- tion required to prepare a certificate. C, Fees: 1. Certificate 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 Date ... ~-~"FtXJ.. '~'./, ,/,~-<~ ........ New Building ...~K~ ........ Old or Pre-existing Building ............ Vacant Land ............. Location of Property ......................... Z/~.?~Z~. Z~,~'~,../~..~'(/g; ........... ~-~-~2~.~'~.~.. · House No, Street Hamlet Owner or Owners of Property ...~J.l?.//. 4~?~ .... ~/,/ . .~/~.. .................................. County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ,/. .O ??. ./' . . . Date of Permit ./',z/z;..~/?~ ..... Applicant ... F_,~/~Z'./?/~'....~/.,/,-~¢,¢~ './~-. ........ Health Dept. Approval./.~/.2~/Z. ~'....~: ,~'?. ':-./'~/,.. Labor Dept. Approval ...... .Z~.Z'~¢, ............. Underwriters Approval ,: .~. ................... Planning Board Approval ................. Request for Temporary Certificate ..................... Final Certificate ..... , ,~,~' ............. Fee Submitted $ ....... . .~./.~.o. ................. Rev. 10-10-78 Construction on above described building and permit meets all applicable codes and regulations. ...... A~:PLiCATION FOR I~UILDING ~ERMIT INSTRUCTIONS '- a. This application must be completely filled in by ~pewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets o~c plans, accurcrte plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings an premises, relationship to adjoining premises or public streets m areas, and givin~ c~ detailed description o~ I~yaut ofproperW must be drawn an the diagram which is pa~ of this opp~icatlon. c. ~e work c~ered by this application may not be cemmenc~ before issuance of Building Permit. -; .. . '. d. Upon oppr~al of ~is application, ~e Building Inspector will i~ue ~ Building Permit to the applicant. Suc~ permit sh~ll be kept on the premis~ ~ail~ble for inspection throughout the work. e. No building shall be ~cupied ar used in Whole or in pc~ for any pu~ose whatever until o Ce~ifica~e of Occupancy sh~ll h~e been grant~ by the 8uildln~ Inspe~or. 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 $outhold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, far the canstru~tian of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply wlth?ll appllcable.laws, ordinances, building code, housin~g code, and regulations, and to admit authorized inspectors an premises and in buddings far necess~ inspections. /,) ' (Signature of applicant, or r~me, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Owner (Presently under eontra~t) Nome af owner of premises ..._.~....~.~.~...~...g. lb~i~L.....Gon.~m.a.a~.ad..f.a:m.~Ze...~o..W~.L~am..~.t .............. If applicant is a corporate, signature of duly authorized officer. (Name and title of camor~te afficer) Builder's License No. Plumber's License No ................................................. Electrician's license No ............................................. Other Tr~de's License No ............................................... 1. Loc~don of land on which proposed work will be don~. Mop No.: ~QO..~..~Q ................... Lot No ........................ Srree~ ~nd Number Lighthouse ~n~ ~D~ivg~ ~dl.. Sou~h~d.. 2. 5to~e existing use and occupancy of premises and intended use amd occupency of proposed const~ction: o. ExJslting use ~nd ~cuponcy ............. ~.g.~ l~Rd ............................................................... b. intended use and ~cuponcy .~.~9..~,$1~..~.9.~0~ 3. Ncture af work (check which applicable): New Building ...... -~ .......... Addition .................. Aherotion ............... Repo:,r Removal Demolition .................... Other W'ark ......................................... .................. ' ................. (Descr[ptlan) 6. ....... ............ : .............. ............................................................... (to be paid on filing this application) 5. I~ dwellir, g, number of dwelling unils ............................ Number oF dweffMg unffs on each fl~r ......................... If ~arage, n~mber of ~rs ........................................ : ..... 6. If bus'ness, commercial or n~[x~l occupancy, spec~fi/ n:~ure ~nd eMent of each ~e of use ......................... 7. Dimensions oF existing structures, if any: Front ............................Rear ................................ Depth HoUgh? ........................ Number of 5~orles .............................................. ' ............................................................. Dimensions of same s~ructure with alterations or ~dd, tk:n~. Fron~ .................................... Rear . ............................ N~mu=r of S~ories ~ ~' ..3~.~.~ ....... [,ep,n ................................ H~i~ht 8. Dimen~i:ns of entire new construction: Frant ~ 8~. Rear ~f~' Depth Height ..~1~.~.~. ..... Number of Stories .... ~. ......................................................................................................... 9. Size of lot: Front .... ~]~-'.'.~.~ ...................................... Reef ....~,~.. ......................... Depth 10. Date of ~urchase .-~.~-.~-~,~ ....................... N~me o[ Former ~ner ~e~..~t...~bhona .................. 1 1. Zone or use district in which premises ore situot'ed J[ ~OS[(']e~ 12. [)cas proposed construction violate any zoning Iow, ordh~cnce or regulation: ...... ~.0. .......................... 13. Will lot be regroded ........ ~ ............... Will excess fifl be removed from premises: ( ) Yes ' ~ ) No '.-. BOX ~;Tff Phone ~. N=~ ~ ~n~ o~ ~ _.~.~.~..k~?~ ............... ~,aar~ .............. , ................ N~me ~ Architect SaO0o & ~e~a ........... Addres~.~.~O[l[ ............... Phone N~me of Contractor .................................. Address ................................ Phone No PLOT DIAG~M Lcccte cle=rty and d s6nctly all buildings, whefher ex[st[ag or proposed, ~nd indicate oll set~ck dlmensions~ prcpe~y lines. Give stree~ and block number or descripHon ~ccording to de~, and shaw street names and indh whether interior or corner COUNTY CF ............ . (N~me of individual signing contract) c~ov~ n~med. me is the .......................... (Contractor, agent, corporate officer, etc.) of s¢id cwr, er or owners, and is duly ~uthorlzed to o~rform or hove performed the said work ~nd to n~ke cna this ~ppllcctlcn; th.3t oil stctements contairmd in t~is ~pplicction ore true to the best of his knowledge and tbar the w;rk will be pCr~ormed in the manner sef forth in the applicaHon filed therefor. ~,~,~ ~,~ ....... ~ ........... co~ .............................. ~'i~'~';~'~"~'~'ifZ~'f~ ..................... SUFFOLK CO. HEALTH DEPT. APPROVAL ' / ' ~AT[M[NT OF INTENT ~- ~" =-~- SYSTEMS F~R THIS ~ESIDENCE WILL x ~ ' ~PLICANT / · SUFFOLK COUNTY DEPT. OF HEALTH / SERVICES -- FOR APPROVAL OF / . ~o~,~uc,,o, o~ , . . : , , , {~ SEAL VAN TUYL, P~. GREEN~RT NEW YORK ' ' : - w .~..0,' , . ~h~,~ ~4~. · ' ..: .'~. ~. 1c :~,~o~.~ ' ~CFOLK CO HEALTH DEPT ' · . APlmoVAL THE WATER S~ AND ~WAGE BI--AL ~EMs F~ THIS RESIDENCE /' / / .-'f¢~ O, c.J cdr * ,Cb T ~ 'l .J ALBERT 5A655 MAIN A. SACCO AND G~ORDON K. AHLERS ARCHITECTS & ENGINEERS ROAD SOUTHOLD, N.Y. '{197t POLl_ 'Alteration o~thi's D¢:~'un~eni' except by an.Architec! or [iceesed Profe~,. sionnl Engineer, is illegal', ~ Section 7209, Su~ivision 2~ N, Y. State Education Law, ?¢chi[ec[ and £rlgineer's Sea~ and Signature orfly good for initial use ot drawmF,. ~h3nge's, alteratm~s Dr re- 10 · 0 /c: / Z. Z- , · 24 -4" -I- 2.~-~ ,,O/U RLz" q'-- 4" :'/-£~,,P /- ~o )'2'?t'z:'''~,: j ~ Z-lO [ " f' O U ",'i~ D A T!, C) N (91_. A r"',4 ALBERT A. SACCO AJ,~ g .¢RDO ~t K. A~,¢L~tiiS, ARCHITEC'IS & ENGINEERS t~fl,~ ~.l~"~rAD SOUTHOLD, N, Y, f!971 "A)teratien of this Document except · by an Archilect or Lid66'sed Erofes. sionat Engineer, is illegal". · Section' 7209; Subdi'¥isior~ 2~ ~ N. Y, Stale ;, .~ucat~on Law, drawing. ChanlNs, afferalion~ r~rm~ OTH F: -I "Alteration of this Document except by an Architect or Licensed Erota$- sonat Eogmeer, is llleoa Section' 7209, Subdwision N. Y, State Education ALBERT A. $AC¢O A.g GORDON K. AHLERS ARCHITEC'rS & ENGINEERS ~"©UTh'OL O ,N. Y ii "'Alteration of this Document except by an Architect or Licensed Profes, sibnal Engineer, is illegal", Section 7209, Subdivision 2, ,N, Y. State Education Law, Architect anti B~gineer's Seal Sigriature only geed for initial use of drav;ing Chan~os, aHarations or re- cut Afchi¢ect or [.g~eer's Approval ~e~4s Seal a~d Si¢ature o~ s~e. .TIge I. ~T~F~ ,i 4-, ;'AltermNon of this Dbcumenf e,<~'apt hy an ~Atc:hitect or F'roles,. N, Y, S~tate La;;9