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Home My WebLink About9836-zFOB,M NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No..Z. 9..~.0. ..... Date . .D.e..e.e.m.b.e..~ .... ~..2 ........... , 19..7.8. THIS CERTIFIES that the building located at . .2./%..~.5...B..r.i~ .a~..t.i.n.e...DF.,... ~ Map No..../~.~.6.2. ..... Block No ........... Lot No ...... .6.5. ......................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .. J..u%.y ....~.0 ......... , 19.. 7.8 pursuant to which Building Permit No.. ~9.8~.6..Z dated .. J.uly .... 17 .......... , 19...7.~ was issued, and conforms to all of the require. ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .P.~.~.¥.a.~.e...0~..e.. ~.a~..~..]r..y' .I~..e.~.~.~.ng. .............................. The certificate is issued to ........ N.o.r.'q.h...F.o.~.k...E. qu. $.t.~.e.$. ......................... (owner,:~a~) of the aforesaid building. Suffolk County Department of Health Approval 8-S0-8~4 December 12, 1978 ....... Rbb.~l~t. %riIl~ ............... UNDERWRITERS CERTIFICATE No ....... ~4.'121.86 ............................. HOUSE NUMBER ..... 2.4.~.5. .... Street .......... l,..B.r.~g..a~..t?t.n.e...D.r.,~,,: ............ .......................................... .~. s..°.u~..°.~,a.,.. ~~'. ........... ~" Buildin~ Inspector County Tax Map Number 1000-79-4-6/* FOB~ NO. ~ TOWN OF sOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9836 Z Permission is hereby granted to: ...~,~..~. ~.=..~... ~Lc...o..,...:.z..a...% .............. ....a/.~ ....~m~_.h.. ~.ork .:~.~Aea .................. premises located at .... ~z~,~..~..~,..~a~.~.~ ..~..~.~.~ ....... ', ....... pursuant to application dated ...... Building Inspector. : Fee $.... J.f~.,~ ....... ......... :'"-'l"'"'"-h ~etorBui ding :1sp ..... :'" ~.s. ~ .8-S0-84 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall 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 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. 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 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 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 $5.00 3. Copy of certificate of occupancy $1.00 / .~_.//../...~/~....~.. Date .......... New Building .... .¢~....,.. Old or Pre-existing Building ............ Vacant Land Location of Propertyf<..~../~.. ~~S~..h~.. ~q ' ~..~,g~J~. ~.. House No, Street ~o ~ ~ Hamlet Owner or Owners of Property ~(~ ~T.~ ~.~..~.~ ........................ County Tax Map No. 1000 Section ............... Block ............... Lot.. ~ ~ ......... Subdivision .... ~ .... ~~..Map No ............... Lot No ............... Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval . ,~. ~.~..~, ,~, .......... Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ Construction on above described building and per~n_~_ eets pl~applica,ble codes and regulations. Applicant . .,,~...~, -~.... !~o . . .-~.. ........ \ '~HENEW YORK BOARD OF FIRE UNDERWRITERS ' BUREAU OF ELECTRICFI'Y ~ ~ .' 85 JOHN STREET, NEW YORK, NEWyORK IO038 THIS C;;IFIE$ THAT Ho~th Fo~k Equ~t~o~,~/s Br~nt~fle D~, 200v e/O ~o. ~vze~ So~thold~L,~. in the fol~ing ~at~n; ~ B~e~nt ~ 1st FI. ~ $~ FL ~t~n B~k ~t ~exami~on Hove=bet PO, ~ a~fou~tobein~mpl~ewithther~ui~n~ofth~. DRYE~ ~CE ~T~ taTUm ~ m~ ~RV~ m~ I~.M[ S E R V I C John T, Sapanaro [] 102 Oak ~ve. Shirley,N.Y. TOWN I-IF SOUTHOLO OFFICE OF BUILDINB ~NSPECTOR TOWN P-LERK'S OFFICE SOUTHOLD. N, Y. 11971 TEL. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, Examined ........,~.~ ,3..~...,.. ,?, .~. .............. Approved .........~..~.~.~.......'i. 7. ............. , 19..~..~.. Permit No ........?..~...~..~...Z. ................. Disapproved a/c ...... .~.....~..]..~..__ (Building Inspector) 9836 Application No ................................. APPLICATION FOR BUILDING PERMIT / Dote ....... ......................... , 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 oF areas, and giving o detailed description of layout ofproperty must be drown on the diagram which is port 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 o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o 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 inspectors on ~remises buildings KJ°c~ admit authorized and in for nec~,~ary inspections. ......... ...... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer~electricion, plumber or builder. of prem ses Name of owner ..~. ................................................. ~-~...'~...- ................................................................. If qpgli~a~gt is c~c~rporate, signature of duly authorized officer. ...... ........ ............. (Name and title ~ corporate officer) BuiJder's License No ..................................................... Plumber's License No. C~.....J~Ji.~:_/~.Z.l.~J.(~,./.~...'~.J~ Electrician's License No. ~..'......~..r.)..~..../~T. Jb(.~J:./~.....~. td(~. Other Zrode's License No ............................................... 1. Location of land on which proposed work will be done. Mop No.:~-~..../~. -.~. -~..... l...~./~l.,?~Lot No./ "~ .~.~... ............. Street and Number ................................................................................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ......... V""~'"~'""~x"!'"~'""'"~J~",,7_//,~c~A,--,~l,,,,,1,_:;~zL ................................................. use and occupancy ......... /.....~....J.~.~...i~..~:,.~. ........ /...~..f..~.....~-~,...~.J,,~. ,.~...!....~.~..~... .................................... b. Intended 3. Nature of work (check which applicable): New Building........~.~_,w~... Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior ..................... Other Work ................................................... (Description) 4. Estimated Cost .~..c~..~....O..~......-~... ............................. Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on egch floor ............................ If garage, number of cars ............ 1. ............................................................................................................ ' ................... .~. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ ~ Dimensions of existing structures, if any: Front ............................ Rear ................................Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ............... I ................ , 8. Dimensions of ~ntJre new construction: Front ....~ .......................... Rear .........~. ................. Depth .~ ............... Height ..~ ....... Number of Stories ...... J, ..................................... i ....................................................................... 9. Size of Io~: Front ....]~.~ ............................................. ~ear ..... ~.~ ............................. gept~ ..~....~ .................. 10. Dote o~ Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district Jn which premises are sffuated ..................................................................................................... 12. ~oes proposed construction violate any zoning law, ordinance or regulation: .... ~..~...~ ....................................... I3. Will lot be regraded ...~.~.~ ............. Will excess fill be removed f~om premises: ( ) Yes (~ No · 0 ~ ~1. r ~O.~ ill Ph ...................... 14. Name of Owner of premises .~L.~.~...~.~ ...... ~.. Add ess?....~.v'~..~...~ ...... one No. Name m Architect ............................ ~ ............................... Address ................................Phone No ....................... Nome of Contractor ...'.:/~.~...~.~..A~.,..~,...~A~.~dress ................................ Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~ck dimensions from prope~y lines, Give street and block number or description according to deed, and show street names and indicate whether interior or corner lo~. ~O ~ ~ // 7 STATE OF NEW YORK, ~c c - ~' CQU N'FY, OF ............ t~ ................. ~' ~'~ ................ .~..~,[b ....... ~'~.~J"~)'J~"~"~ ................................ being duly sworn, deposes and says that he is the applican, (Name of individual signing contract) above named. He is the ............................................. ~~ .............................................................................................................. ((Coqtractor, pgent, corporote officer, etc.) of said owner or owners, and is duly ~ perform or hove performed the said work and to make and file this application; that ~11 statements, contained in this application are true to the best of his knowledge and belief; and that the work will be performe~n the manner set forth in the application filed therewith. ~ Sworn to before me this / )~ . ~--- / ] ~ .......... ........ .................... Notary Public, ....~~ ............... Coun~ ........................ M,..~.g~...,,.~.~.~ .......................... ' ~ ~ (SignatUre eT applicant) ",~ : FOR APPROVAL. OF- ~-.~N~YI~U(~T~ON ONLY [I APPROVED ~$ NO~ED~ NOTIFY BUILDING DEPARTMENT AT ED INSPECTIONS: 1. BEFORE BACKFILLING FOUNDA- FRAMING INSPECTION 4. FINAL WHEN JOB COMPLETED CHECKED BY DATE