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Home My WebLink About9861-zNO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at fl../4.~.~....~.a.t..zyq.ay..D.r.: ....... ~r,~c~x Map No...6.9.6.6 ...... Block No ........... Lot No ..... 2.8. .......................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...July.....'12. ........ , 19..7.~ pursuant to which Building Permit No. 985.1..&. 9862 dated ...July.... 25 .......... , 19.7.8., 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 .... .PT,..i.v.a..~?...0r~..e..F..~..i.ly...1~..e.l,l.i.n.g..w.i. th...F.e.n.q? ....................... ....... '.?TV...~...': ..... ' ................................. The certificate is issued to .... ¢,~c~,s ;~a. nner (owner, ~I1~ of the aforesaid building. Suffolk County Department of Health Approval 8-.30-82 ----Janu.a,...~. 22, 1979 ........ FtGD~P'~ 'a~' Vill~f ......... UNDERWRITERS CERTIFICATE No... N/4~/~-gk.6 ................................. HOUSE NUMBER .............. Street .q?.~.~. .... 2i'.a.~..r~.a.-.jr..D.~.~.v? .................. Cutchog%te, New York County Tax Number 1000-109-5-14.28 Building Inspector BUILDING DEPARTMENT TOWN GLERK'S OFFICE $OUTHOLD, N. Y. BU~DiNG PERMIT (THIS pERMiT MUST BE KEPT ON 'I~I~I~,~REMISES., , , U!,ITIL~ FULL COMPLETION OF THE WORK AUTHORIZED) N? 9861 Permission is hereby granted to: premises Iocoted TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, No 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,Approval 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), Nomconforming 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. 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/ .(/. · · .'-~....~../.2 .~. Date ......... .. ............ New Bqilding ..... Z...../. Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Owner Or Owners Of Property ....... /~'~....~....'~...~..'~ ........... ...~.~/~....~.....~,...~..~ ................................................ Subdivision ..~.~..,C..~..,.~/~,.,.~,../.~,.,., ,,Z~.,.,~.,:.~.,...~....~i ....... Lot No..'.~.~...... Block No ............. House No ............. PermitNa. - . Health Dept. Approval ..¥..~....~.?,~.':...f~.....2~.. ............. Labor Dept. Approval ................................................ Underwriters Approval ~/ z/~j~ ~ ~(~ Planning Board Approval / P~equest For Temporary Certificate ........................................ Fincd Certificate .......................................... Fee Submitted $ ...~.....'"~'" .................... ................ day of ............................................ Notary Public ................................... County Construction on above described building and permit meets all~p~licable codes and regulations. Applicant ........... · .~. ~......,~ ~-~-~,ar~. ........................................... Sworn to before me this (stamp~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OmCE ~UTHOLD, N. Y. Exam ned ~ ............. , 19.~ ..... A Iication No. .... ~. ................ . .Z.Z. .......... , ..... ...... Disapproved ~c ............ ~.':..................~....;~;;...~ ......................................... m~,~~; ................... APPLICATION FOR BUILDING PERMIT ~to ........ ~.~ ............... . ~.Z ....... INSTRU~IONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to Jhe Building Inspector, with 3 sets of plans, accurate plot plan to ~ale. Fee acco~ing to schedule. b. Plot plan showing lecatio~ of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detail~ description of layout ofproper~ must be drawn on the diagram which is pa~ 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 a 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 Ce~ificate of ~cupancy 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 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 admit authorized inspectors on premises and ir~ buildings for necessary inspections. (S'gnature of a~plicant, or name, if a corporation) ........ .¢ ...... (Address of applicant) ~ ~ //J'~6 ~J State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of ....... f .... ;~ //¢~,4L~, ~)/~.~ ~,£~ ,*) ~ -"~/~/t,'z:z~_ applicant is o corporate, signature of duly authorized officer. (Nome and title of corporate officer) Builder's License No ..................................................... Plumber's License No ............ :. ................................... 7 Electrician's License No ....... ~ ..................................... Other Trade's License No ............................................... I. Location of land on which proposed work will be done. Map No.: ~..~k.~/~ . .~/;~¢.~...~.L~SLot 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 .......... ..~..~...~..~..~.~..~...... ........................................ b. ~ntended use ond eccupancv ......... ~5~........:¥~.~i~.-_.A.~.r.~.~...~. .OX~...P..~.~.~ ........ 3. Nature of work (check which applicable): New Building.· ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ..................................................... ,. _ ~ / (Description) st mated cost ........ ................................. tee (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... .~,~..~...%~.~ .......... Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. 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 ................................ / , 8. Dimensions of entire new construction: Front .......... ..~.....~.~.~ ................ Rear ......~....~.'....: .......... Depth ...... ..~...O.. ,/ Height .................... Number of Stories ........ ./...././..,2.,._.. ........... ~ ....... ~ .................................................................. ,~'. I::.,-,~,~- /-~O I~nr ~ '")¢"'/~'~"~-¢. Denth 9. Size of .......................................................................... ./ ........ r ............................... .............................................................. ,¢..,b/.-s 10. Date of Purchase "/4//--x~/ 1~;'/7 o~' Nlnm~, of Former Owner ..,..,.~ .......... · ......... .-.... .......... ,~ .......... 11. Zone or use district in which premises are situated ........ ~4~.~..~..~ .............................................................................. ]2. Does proposed construction violate any zoning law, ordinance or regulation: ..... ..x~..x.°. ............................................. 13. Will lot be regraded ...../~...~..~'~ .............. Will excess fill be removed from premises: ( ) Yes (tx') No 14. Name of Owner of prem,ses ......... ' ............................... ,.A~...~.~ Address ..... ~'"~'/~'~"6" '.~,...//~hone No. Name of Architect .............................................................. Address ............... ............ :.... Phone No. Name of Contractor ........ ..~.../~.....4~....~.~...., ............................. Address ................................Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner IoL STATE OF NEW YXDRK, , lc ¢ COUNT, Y OF ..,:I~.,..,..~.,~.~',:.'F..~.. ........ c, /4-J),x)/u (~_/J5 ,.~ -~ ~ N I~/~ ~ be n deposes and says that,the is the applicam ............. /...n. ......... ~- ................. ~... ........................................ g duly sworn, (Name of individual signing contract) above named. .~'He is the .......................................... ;' "i~;~;~;cto~"~'~ent,"~orporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth Jn the application filed therewith. Sworn to before me this ......... ./. ............. day of ........~...:.~.....~ ............. , 19..Z~. Noto Pub,c, ................. .............................. 'M. DOLLY ~II~FPL~NBA~H ,, ~ [~ignarure or applicanT) ~-IOtARY PUBLI~/ S+~ of New No. 3~,,0954200 9uallfled In Nassau County ~emfnJsslon -q~pJre~ March 30, TOWN DF-SOUTHOLD I-IFFIBE OF BUILDING INE~PEGTGR TOWN OLIERK'~ OF'FlOE BOUTHOLD, N. Y. '1197'1 TEL. 765-266G THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ Deee~.ber ..,'lQ ;~ ~97~35 JOHN STREET, NEW YORK, NEW YORK 10038 T~I~ CE~I;I;S T~T ~1~ t~ ~t~l ~uipment ~ ~sc~ ~ ~ int~u~ ~ t~ ~t ~ on ~ ~ ~pl~ ~m~r ~ t~ p~ o~ w~n,~e~ gannet, e/~ Fal~y, 200' n~o Woodw~y, ~utchoKue, L.I. was exam,nBa on and found to be in compliance with the requirements of this Board. RXTURE fiXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT DRYERS FURNACE MOTORS FUTURE AF~tiANCE FEEDERS TIME CLOCKS UNIT HEATERS MULT~OUTLET DIMMRRS SYSTEMS NO. OF I~tT EERVIC~ DISCONNECT S E R V I G OTHER APPARATUS: 1-G.F.C.I. 2-Smoke Deteotor' i-Post Li~rht 2/O 2. 2/O Ruland Elee. Co. P.O. Box 1~3 Mettituek, L,I. 11952 Lie.2~2 E This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. TITl £ IVO. 7808-01~52 '' ~ ~-- S. 88°59'~0''£. ~ , · -~ . ~ ,~' ~. ~.,' W00D ~ ~ SURVEY FOR ' ' ' AT CUTCHOGUE DAte dUNK ~, 1978 TOW~ OF SOUTHOLD FOR ~P~V~ TO OONST~UOT t~ P~son ~o~ ~o~ the suave ~ ~s ~e~areD, J YOUNG YOUNG J ~ 400 OSTRANDER AVENUE RIVERHEAD, NEW YORK ALDEN W. YOUNG,PROFESSIONAL ENGINEER IN ~EOFFIC[ Of ~ C:g~KOf AND LAND SURVEYOR N.~S.LICENSE NO. 12845 F~.IS~I~?~ &~ FILg~. S0S; HOWARD W. YOUNG, LAND SURVEYOR TIT££ NO. 7~0~-016~ tot ~8 Areo= 40,~.7~ sq ? ~OOD W~ Y SURVEY FOR SUFFOLK COUN~ DEPARTMENT OF HEALTH SERVICES F~C~S LOT ~0. 28 "F~IR~AY F~MS " FOR APPROVAL OF CONSTRU~ION ONLY AT CUTCHOGUE DATE TOWN OF ~O~HOL~ SCALE /" = 50' DATE g~ HS ELF. NO. , ~ ~ SUFFOLK COUNTY, NEW YORK NO /GL 0~l APPROVED AS/NOTED 7~5-2660 9AM to 4P~OR REQUIR- 1. BEFORE BACKFILLING FOUNDA~ 3. OEFORE COVERING PIPES OF AN~ KIND 4. FINAL WHEN JOg COMPLETED NOT RESPONSIBLE FOR D~IGN ~ CONSTRUCTION ERRORS 5., ALL CONSTRUCTION MUST REQUIREMENTS OF N,Y. STATE CODE AND TOWN HOUSIng CODE & ZOglNG -) ........... '27;6/ ~' /7L4.'l /4-'- JOSEPH AMATO, R.A. t64 MONTAGUE STREET BROOKLYN, Nl y. 11201 ' REVISIONS PALMQUIST & WRIGHT- ARCHITECTS RICHARD B. POLLMAN I DESIGNER DETROIT, MICHIGAN PLAN No. :.'512,5 DATE SHEET2 I£ ~,,= /!o'v '1 :1 i I i !il .... ~_~! I B. JOSEPH AMATO, R. A. 164 MONTAGUE STREET BROOKLYN, N. Y, 1120~ ,I'- TFP. kf~A,,g.D. ~LO~ o , R £ V | $ | OlN $ -PALMQUIST & WRIGHT- ARcm'rEcrs RICHARD B. POLLMAN - DESIGNER DETROIT, M1CHIGAN -I L / ,, ,l_Z ,= r Z~ lA T/OW .B. JOSEPH. AM~ATO, R.. A: - I[ROOKLYN, N, Y. 11201, Rl~ VISION $ PI.~N No. RICHARD B. POLLMAN - D£S=~- B. JOSEPH AMATO, R.A. 164 MONTAGUE STREET BROOKLYN, N.Y. 11201 q. .,I