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Home My WebLink About9868-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office 5outhold, N.Y. Certificate Of Occupancy No ...... Z989.'1 ...... Date ...... M~rOh. A .................. 19 80. THIS CERTIFIES that the building ................................................ Location of Property .... ~./4. O.O..[.rl..d.i.a.~...~.p.c.k.. L..e~l...e. .................. P.e..o.o.~.~.c..,..N. ? Y.:. House No. Street Hamlet County Tax Map No. 1000 Section ....~.~. ...... Block .... .0.~.. ........ Lot ... 9.0.2. ..... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofOre filed in this office dated ...... 0'.l12,y. 25. ...... , 197..~1. pursuant to which Building Permit No ....... 9.~.6.~.Z. ......... dated .... 0~'t~y..~.~ ................ 19.7.~t, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .... Relo. ca~loi~, of..Studio. ¢on~er.t. ed. 1~o..Pr~L.vate. One. Family. 12well;Lng... The certificate is issued to ............. Ceo.ella. ~'~/al~ .............................. of the aforesaid building. Suffolk County Department of Health Approval ......... N/I~ ............................. UNDERWRITERS CERTIFICATE NO...N./45.3'I 2 .~ ...... 1~ ./45.~.122 ...................... Rev 4/79 Building Inspector FOKM NO. 2 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) Permission is hereby granted to: Robe~l; Hyatt a/c Cecelia Ewald at premises located at .................. ........ ~..~.,~,.,~..~.~'.?..0..~....~.?. ............................................... .................. ~....i .................. ':. .................. ~.o.~.,.~.o.,...~.X~r~ ........................................ ":> [:'~u~uan~t. to~ apPliCation dared .;.~:..~..~....~.L'. ,. , i9 78 , ..,...~:, ana, approved by the Buildi6 inspector. ~:~ · Fee' ~ Building Inspector 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 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 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 topograph ic 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.. ~..~. ~. ~. ............ ~. ~.~.4~_z-.~....~..~ House No. Street · Ham/et Owner or Owners of Property . . . .~., .~...~, ~'.'~ ...................... County Tax Map No. 1000 Section . .~..~. ........ Block ...~...~. ........ Lot. d~.~.,.~..~'. ~ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.¢z~-. Date ofPermit~~.~C;~pplicant .~'.'~., .~...~,~/..~/. .... Health Dept. Approvals,. . ....................... Underwriters Approval /~f.~.~. ~/~./ ............ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....... ...~.... ......... Fee Submitted $ .... .~'.,.~. ,~ .................... Construction on(ab~oveZ~escribed building and p, t meets all a licable codes ' tions PP , ' Applicant .~ ,~ .......... THE NEW YORK BOARD OF FIRE UNDERWRITERS ~: ]' BUREAU OF ELECTRICITY ~- O~tober 17, ~>HN STREET. NEW YORK. N~lO038 THIS CE~IFIE$ THAT ~ly t~ e~t~al ~u~nt a ~scd~ ~ ~ int~ by t~ ~pi~t am~ on t~ a~ ~pi~t~n numar in t~ p~m~s of C~:lea ~wald, 6300 a/s India Neck ~. PeconLc,N.Y. w~ exami~d on a~ found to be in complia~e with the requirements of th~ B~rd. "XTUU [~41 33 /t NXTURRS 33 26 DRYERS FURNACE MOTORS FUTURE APPLIANCE F~EDERS SERVICE DJSCONNECT NO, OF S METER AMT. I AMP. ~Y' ~UIP. 1~'2W 1~3W 3.~'3W 3~'4W NO'~ECC~CONO' 200 CB x ~THER APPARATUS: Elec. room heaters: 1-2.5, 2-2.0, 1 G~CI 1 8aoke detector Hot: water heat:er: 1-~.Skv. RANGES 'ECIAL REC'P1 COOKING DECKS OVENS DISH WASHERS AMT. K.W. AMT. K.W, 7 , MT.K, W, TIMECLOCKS BEU. UNITHEATER~ MU{TI-OUTlET V I C E EXHAUST FANS DIMMERS OF CC. CC~D. 3/O NO. OF HI-lEG OF NEUTRAL 1/o 5-1.5, 2-1.25, 3-1.0, &-.751G~S ,.o. ,,o,, ,,3 \ //'/ ~at~itucklN.¥. 11052 lic, 242S ~OPY FOR BUILDING DEPARTM~T. THIS COPY OF CERTIFI~TE MU~ NOT BE ALT~ED IN ANY ~ ~W YORK, NE~W. yQRK 10038 ,~o~ exami~d o. OC tobe~: 15 E 1979 anafo..a to be in compliance tvith the requirements of this Board. fiXTURE OUTLETS DRYERS FURNACE MOTORS EUTUI~ AE~UANCE FEEDERS RANGES ~PEClAL REC'PT SERVICE DISCONNECT I OTHER APPARATUS: TIMECLOCKS BELLIUNITHEATERSUNITHEATERS MULTI-OUTLET A~T AMPS TRANS. ~ SYSTEMS tl 40. OF R V I C NO. OF HI-I~G ~totoxs: 1-3/4hp EXHAUST FANS ~MMERS OF NEUTRAL Ru].and l~ec. Co. ~~~ \// ./ This ce~lflcate must not be altered in any manner~ return to the office of the ~ard if incorrect. Insp~ors may be identified by.ir credentials. ~VFI fUR BUlL ..... OiP~b,~m.~i, THI~ ~rT OF bIKIIrI~AII MUb[ ~UI Bi ~i'tKKU i~ ~T ~NNIK. TEL. ./ - ,- j 67.5' 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2N'D [ ] INSULATION FRAMING [,~ FINAL ~ ~'/-~ REMARKS: DATE IIrN~..PE~'~T~ OR TOWN OF SOUTHOLD B~JLDIN~ DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×am ned ..... ............... , Approved .....~Tu~.~.....2.8 ............... , 19..~...8.. Permit No ............... ~...8..~,..8..Z. .......... Disapproved a/c ............. ~.. ............... ~ .......... ............... ................ '9868 Application No ................................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedu e b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets os 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 rem~,~,va or demolition, as herein described. The applicant agrees to comply with all applicable Paws, ordinances, build ng,~6~de/hous ng code, and regulations, and to admit authorized inspectors on premises and ir~ buildings for necessary ir~ecti~s. .......... ( ~i~/'n~lrure of applicant, or name, if,6 corl~oration)- ........... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ................................ Name of owner of premises ...... ...~.i~C,~..LI,/~. ...... .~..(~.&bi~.. ........................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No....~....~.T......~..:...~..~.~T.~..T. ..... Plumber's License No. H~ ~iV~i~J.'J ~ ~::)~.J EIectr eion's License .... ........... Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ....................... . ................ Lot No ......................... Street and Number NL IC 17Z2& . . ............................................... : ...................................... ~..LC,. ............. Municipality 2. State existing use and occupancy of premises and intended use and occuponcy of proposed construction: a. Exisiting use ond occupancy ....... ~.~_~.L~.~.~.......~..T..~..~.L.~.......u~...!.~.I.'L.~...T.O..!..~....'~. ............................................... b. Intended use and occupancy ..,..~..J .J~J....~.........~f~!.~.~......)Tf~....~...F'~,., .............................................................. 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration . .~._. ....... Repair .................. Removal .................. Demolitior. .................... Other Work .................................................... 4. Estimated Cost ....~ ..~.0.. ~.....-~...~ ..~.q~00 Fee j~7/~-~ g.~,_ (Description) " ...................... (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 ................ ~.J~'. ..................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..~.~ ................... 7. Dimensions of existing structures, if any: Front ..... .'~..~.'.C.~.~. ........ Rear ...~...~.!:.~I ............... Depth .~...~...L:.~.~.! .... 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 ....]~.~lv~.~. ................. Rear ............................ Depth ........................ Height Number of Star es ......................................................................................... .................... ~ ~, ,I I~-! 9. Size of lot: Front ...... E...~.l.~. ..................................... Reor ....... ~'.~.,.c~ ......................... Depth ..... ~.....6~........~.. ........... 10. Dote of Purchose .................... Nome of Former Owner ....~.~.~;..J...~.,~..O..l~,l. ....................... 1 ]. Zone or use district in which premises ore situoted ........ ~-..~...~. ;. ................................................................................ 12. Does proposed construction violote ony zoning Iow, ordinonce or regulotion: ..t~.~.. ............................................... 13. Will lot be regroded . ....... .~.0 .............. Will excess fill be removed from premises: ( ) Yes (v~No 14. Nome of Owner of premises ...C..~r..~...Lrk~....[..I~..~...Lr.I'P. .......... Address .,~/i,~..~..~...(~.~.~. ....... Phone No ....................... Nome of Architect ._,T~0...~,~.,~.~.....?'~...A...¥.~.~.¥. ................ Address ~..L.~."]...~.u..r..~...a~. Phone No ....................... Nome of Controctor., ..~....~.~.....b.:...~!..~....~..T...T. ................. Address ~.~..T...r,/~...~...~..T.. ....... 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 ar description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~,.Y-~RI~-~-- COUNTY OF ~.,~"Z,~../'.~,..f""~ ~..~ ...................... ~.~..~.~.~.'~ ............. ~.~.~../~.~..being duly sworn, deposes and says that he is the applicon, (Name of individual signing cgn~f) above named. He is the ..................................... ~ .................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to m~ke and file this application; that all statements contained in this application are true fo the best of his knowledge and belief; and tha~' the work will be performed in the manner set fo~h in the applicati~erewith. · ......... ..... ....... ................ NOTARY PUBLIC, State of New York No, 52'~125850, ~Uflolk Term Expires March 30, ~9 _ LZ-$o,o' t'q C~ P-..'T ~-t ~L.F-VATION N~iN JOB COMPLETED ~'~ co~s~uctlo~ ~O~S~'~ 5 ~.ALL cON~i:~UCtlON ~St.'~T O~ .. ?p - 4LOG~ ~ST, FtO0~ } o? N E ~,vv ^~! A41 ^41 --1