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HomeMy WebLinkAbout9867-z~lt~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No.. Zg./4.'IZ .... Date .....~..a~..~..e~.~....29. .......... , 19...7.9 THIS CERTIFIES that the building located at .~[~0 .Wa~el~sedge. 9/ay ...... Map No .... .~.~.0~. .... Block No ........... Lot No ...... ~.~. ......................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....,~U~.y...2~ ........ , 19.7.8. pursuant to which Building Permit No. dated ....~Tu~F...28 ......... , lg 75., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to .... R:o.~le~..&. C.~.~.FI1 .~e~' ..... . ..................... (owner,~l~ of the aforesaid building. Suffolk County Department of Health Approval . ~.enlta,-~.. ~.0~..~.7.9.. ~.~0.-.87.... UNDERWRITERS CERTIFICATE No .... p .~...d,~..~. ?..-0,K....~.o.s. ep..h..K.~b..e.c.k.t...-.~/.a~/79 HOUSE NUMBER...~.~.0 ........ Street ...... ~..a.~..er.~..~..g.e..W.a.y. ........... ........ ............................................ . . Building Inspector County Tax Number ~ N? 9867 TOWN BUILDING DEPARTMENT,!,~ TOWN CLERK'S OFFICE SOUTHOLD, N!. Y~ ~,~ilUiLDING PERMIT (THIS PERMit MUST BE KEPT ON THE PREMISES UNYIL FULL COMPLETION OF THE WORK AUTHORIZED) D~te Permission is hereby grant~ ~0: premises by the- ' ' 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 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. 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,O0 New Building ....~ ......... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ...... ~.~..0 ............. .~.~..~?.T..s.e..~.e..'~-. ,8.~¢~.,..~.o.~.'~.~.o.~.~, .............. House No, Street Hamlet Owner or Owners of Property P~ober'b County Tax Map No. 1000 Section . .0,~,~ .......... Block ~ .............. Lot ............... Subdivision .... ??.~.~.~., .~.~.~..e.~,~ ...............Map No .... 2.~..0~ ....... Lot No..5.~ ........... Permit No. CJ.~.~? ...... Date of Permit ~/.2.?/~. ,Applicant ,G.e..o~.~.e...A.~.~.e.~.s!..~.~.~.d:??', .~..~.~o.: Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ,....~. Fee Submitted $.. ,~. ~. ~ ................... Construction on above described building and permit p~ets all applicable (;,od_es and regulations. Applicant THE NEW YORK BOARD OF FIRE UNDERWRITERS D ~ BUREAU OF ELECTRICITY I--- 8S ,JOHN STREET. NEW YORK. NEW YORK 10038 ,,.. N420124 THIS CEK'rlFIE$ THAT in the followlng location; [] Basen~nt [] I~t FI. [] 2~d Fl. Section Block Lot wasexaminedon January ~# 1979 and found to be in compllance w~th the requirements of thi~ Board, RXTURE I;IXTUR~S RANGES OVENS OUTLETS SWITCHES · FLLJOKE~CENT ~0 ~ I ~6 30 DRYERS iqJRNACE MOTORS RJT~ AF~IANC! PNOBIS ICLOOCS SERVICE ENSCONNECT S E It OTHER AFflAUTU~ I-~.F.I. 2-Smoke Detectors 1-20,OKW Heat Pump I-4Ton AC Unit l-4,5KW HOt ~eter Heater 300mcm C 300mcm Gustln Bartra 227 East ~reakwater Rd. Uattltuck, N.Y, 11952 LIc, This certificate must not be altered in any mmmerr return to the office of the Board if incorrect. E P~* I I be identified ! their credentioJs. _~ ~;1~ mmm~ ~B~.B~,MENT..THiS.COPY OF_CERT!Fi_CAT~ - TOWN OF' SOUTHE)LD E]FFIDE OF BUILDING INGPEOTOR TFIWN r, LERK'S F'IFFIOE SGLJTHDLE). N. Y. llg'T'l TEL. FOlr~ NO, ! TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OI:FICIE SOUTHOLD, N. Y. ............... '"7 . ............. Examined ,. ~Z . 19'7/ No ......... ............. . ..... ....... .................. APPLICATION FOR BUILDING PERMIT Date July 25~ 1978 INSTRUCTIONS a. 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 schedulp. b. Plot plan showing location Of lot and of buildings on premises, r~lationship 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 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 Certificate of Occupancy 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 in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) 250 Cox Lane, CutchoRue, New York (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Builder Name of owner of premises ~'z~. and Mtso Rober'l; ABner If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ................ p ..... ~ec~ded ~'~ p~'esent time lumbers L~cense INO .......... L7.~[:~; ........ L....5~% ......... Electrician's License No ....... Other Trade's License No ........ .~..,..~ Location of land on which proposed_~ork~will be done, Mqp No.: ......... ~.~g.~ ..................... Lot No.....g.[~ ................ st.~t ~,d N.mbe~ .Y~:~;Z:L.~...i¢tS.~....~:'[~.Z ......... ~..Z.~ ................................................ ~~.. Municipali~ State existing use and occupancy of premises and intended use and bccupancy of proposed construction: a. Exisiting use and occupancy ......... ~.~(. .............................................................. ............. ..... b. Intended use and occupancy / 3. ' Nature of work (check which applicable): New Building' ...~ ............ Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .......... ~ ......... Other Work ................................................ . (Description) 68,oo0.oo ................................................................ 4. Estimated Cost ............................................................ tee ............. (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... ~.. ................. Number of dwelling units on each floor ........ .7, .................. If garage, number of cars ~.wO-O.a...~...,i.,~, ..qe..1..]¢..a..r. ................. 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 ......... ~.0. ...................... Rear.....~0.! ................. Depth ...~.0. .................. Height ]l,f~..t....+./.'r.... Number of Stories ...................................................................................................................... 9. Size of lot: Front ......... ~1,.0.0.! ...................................... Rear ............... ~QQ .................... Depth ...~..~.! ..................... 10. Date ef Purchase ........ .u.~.k...~..O....W~.. ............................. Name of Farmer Owner .....~.~.o....W~... 11. Zone or use district in which premises are situated ...... .~ ............................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ..~...O.. .............................................. 13. Will lot be regraded ....y...e..s. ................. Will excess fill be removed from premises: ( ) Yes (x) No . . 2q Lorraine St,.. 14. Nome of Owner of premises~.,...~..Mi~.s.,...~oo~r..~ ...... Add~ess ~y(~s~.$...~ ..... FMO~e ~o ....................... Nome or Architect ..G,or~on.,~hl.er,s. ............................ Address ...SouJ;ho~Ld .......... Phone No ....................... Nome of Contractor C-.eo~.g,e...Aia]Ler.s. ............................ Address ~Q~..~.¢ ......... Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buddings, 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 lot. STATE OF NEW YORK, lc c COUN-FY OF ................................ ................... .~.o. rg;e...,ih],e~8 ............................................. being duly sworn, deppses and says that he is the applicam (Name of individual signing contract) above named. , He is the ................................ .C...o...n..~.?...a..o.~.o.~ ........................................................................................................................ (Contractor, agent, corporate 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 statdments contained in this application a~e true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the, application, filed therewith. Sworn to be,fore me t~his , ~ .~.~.~'~ :~ : ,' ~'-~ /~11 ........,~ .,~... day of ..... kl~ ~,,~ ~' ' , ~ounTM ................... ~ .................................................... '~ ' ' [ ~ ~ (Signatd~ of apphcant) 65 k t~ NIVEP__ '-0 "ZOL o" APPROVED AS.NOTED S<cti(>n ,'2U9, Subd,vts~or~ 2, .! ,-% FwD. "Al!~rrdlon ot this Document except by ~ Licensed Prof~- sJonat Engineer, Is dlegol'L Section 7209, Subdlvisloa 2, ~. '~' Skate Educotlort Low.