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Home My WebLink About9871-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13033 Date November 30 19 84 THIS CERTIFIES that the building ......... .A.d.d..i.t.i.o.n. ............................. Location of Property 16995 New Suffolk Ave.&3rd St. New Suffolk iol ....................... 'S'de i ....................... County Tax Map No. 1000 Section ...1. 1. 7 ...... Block .... 0. 8. .........Lot ...0. 0..8 ........... Subdivision ............ ;~ .................. Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .G,u.l. Sz .........2.8.., 19 .7.8. pursuant to which Building Permit No...9. .8,7,1.g. ............. dated ........... .J.u.i.y ..... 2. .8 ..... 19 .7.8,, 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 ......... Addition to Existing One Family Dwelling The certificate is issued to .... G..Q .~.N..RQ.BBINS (owner, 'l~e'~t¢~'~': ........... of the aforesaid building. Suffolk County Department of Health Approval ...N/.A .................................... UNDERWRITERS CERTIFICATE NO .... Iq4 5 3 12 0 Rev. 1/81 Building Inspector FORM NO. ~ TOWN OF. soUTNGLD TOWN GLERK'S OFFIGE SOUTHOLD, N, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIE FULL COMPLETION OF THE WORK AUTHORIZED) N? 9871 Z Permission is hereby granted to: Fee $,.....'.~ ................ - "~ ~'~TBtJildlng tbspector . FORM NO. S TO'~N 01: $01JTHOLD Building Department Town C:lerks Office Southold, N. Y. 11971 APPLICATION ~R ~EKTIFICATE OF ~CUPAHCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate 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, o 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 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 Date ................/I/'~.~...~.......1.'~°/..~.~.. ........ New Building .................... Old or Pre-existing Building ....... ~. ................. Vacant Land ............................ Location Of Property .......... .~..~. ........ ~ ................ ~..~......~ ........ ~'"'~'~ ........ ~ ........................... Owner Or Owners Of Property ,,,,l~.~..~..,.l~l~.....,.~.!..~.(l.~.~'1'~' ................................................................... Subdivision .................... ~.J~.i~.. ...... :..~%.....~...~,.~....... Lot No ............. Block No ............. House No ............. Permit No..~..~...~..J..Z... Date Of Permit ...'~../~ .~./...~.Applicant ...~.¢~"~.~.8~......~..~..~...~'././k~. .................... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval "/'~'~J'g'/"~"7 ................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ -- Final Certificate .... ~ ................................. Fee Submitted $ .~./.,(~.~, ......................... Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me this Applicant ......... ~~.............~..'...~ ................ day of ............................................ (stamp or seal) Notary Public .................................... County .~,~~ ......................... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK. NE~V YORK 10036 ~,. Octobe= [7. 279 ~..,,ca,,o. ~,,.~?~. 044240 N 4 CERTIFIES THAT, Newton Robbins, n/s New Suffolk Ave. cor.3rd. St. New Suffolk,N.Y. in the following Ibc~tlon: [] Basement ~ 1st FI. ~ ~nd FI. Section ~ =-.,ni,,~u on October 15,1979 .~o.,~ to be in co,,,pllan,'e wit h the reqt,irett,en ts ,~ this Board. RXI~E ~ S SWITCHES ~ FIXTURES --~ ~'b~ OVENS ]DISH WASHERS · taek ~ght~g: 4~-0" 5 EXHAUST FANS Ruland Elec.Co. P.O. Box 143 Mattituck,N.Y.11952 lic. 242E 11 Per ........ Th,5 certificofe must not be altered in any mcmner; return to the office of the Boord if incorrect. Inspectors may be identified their credentials, FOKM lqO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No.~.~-.,~.Z~ .................... APPLICATION FOR BUILDING PERMIT Dote ................................................ , 19 ............ 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 schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o7 areas, and giving a detailed description of layout ofproperh/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 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 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 necessa~' n~~. '/~/~ '~ ............... ................................. (Sigr~r'e of applicant, or name, if a corporation) ............................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................................... ~.~E..fi.~ .......................................................................................................................................... Name of owner of premises ....~r~.,.....~.~.,.....~...~A~.~ .................................................................................. If ~pplicont is a corporate, signature of duly authorized officer. (Name and title of c,~rporate offi?er) Builder's License No..~'."~~-~x Plumber's License No ....... E,ectr,cion's L,cense Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................Lot No ......................... Street and Number ............... /.lX~.(4Z....,~.12. r:~..~..~i,6r,..z~.~.~i .................................... ........ (Z, ,..,~.l.,.~. ........... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...... ..~.../~. I~..~...~.~ ....... ~. ~.......~..EA4. Z~ ./.~......~.C~./. ' ./~/~'A~.C.P~ ..................................... b. Intended use and occupancy ....../~2..~t-%J.~.~?..~.-... .~. ..A/.,~. .... .~. ~/M .I. ~ ...... ~. ~"q ~'" '~/~' '¢'~'~'" · · ": .... : '"'~"."~- '-~" ...... 3. Nature of work (check which applicable): New Building~· ................. Addition .... .)~ .........Alteration .~Z(i .......... Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... "-7 0 0 C') //~J 07~ (Description) 4. Estimated Cost ............ f' ............................................... Fee ......7...¢(.. .............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ v/ .................. Number of dwelling units on each floor ..../( ...................... If garage, number of cars .................. :....;;'; ........ .~...'~- ................................................................................................. If business, commercial or mixed occupancy, spec fy nature and extent of each type of use ..i..~...~.. 6. z¢'" 4 ., '(' 7. Dimensions of existing structures, if any: Front ...~?~ .................. Rear ..... ,~....~- ............... Depth ....... ¢~.. ..... Height ..... ..,-~.....~..'~-'~i¢~4umber of Star es ........... ~ ............................................................................................... Dimensions of s~nqe structure with alterations or additions: Front ...... .k.xJ...~. Rear ....%,~..~-- Depth r...%.~..~_.. Height .~.~.......Number of Stories ..'~ .......... ,. ............ Dimensionst-)°f ~ntire new construction: Fron~ ~z _ ~/'%~- ~.~ ,- r/D~,-/~//~ ~"^'Z'"~'~ ..................... ,Rear ....... ,~...~..A~,.~....//. Depth ..... {~,... ........ 8. Height ,....../4'.. .......... Number of Stories ...L~..~c..gF, CJ~... '~"¢rL.-L'd-~.~cK.....~..~.~; .......................... 9. Size of lot: Front ....... ;;....,.~ ............................. Rear ........~'~..... ............. De.~t~) ............. ,.~-~..~.: ......... ~.~r~./~. . L ......................... Na~, of !,o,~r }~ r 0 .~_/,] ,e~ ,'7-~ ~.~..~.~i~L ....... (~ .... Date of .rchase ....... -- ...... -- 11. Zone or use district in ~;hich premises are situated ......... /?k~O,,4~.(~?~C..~.Z..L-/~.....;,~.,;/ ..................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ......... .~..~.~..4~.~-. ........................... 13. Will lot be regraded . ....... /~.~ .............Will excess fill be removed from premises: ( ) Yes ( ) No 14. Narco of Owner of prem'ses .( , .~,../~, .,¢/~,./~ ....................... Address .x'.!4]~.;~,....';*..¢.'~X;/.~.. Phone No. Name of Architect ....~_~,.~];kT-....~/~._.....~..~.. ..... Address ......... ; ...... ?r'-'~'~," 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 blacl~ number or description according to deed, and show street names and indicate whether interior or corner STATE OF NEW YORK, ~¢ S COUNTY OF ....................... ................................................................................................. being duly sworn, deposes and says that he is the applicom (Name of individual signing contract) 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 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 in th~ apptication filed therewith. Sworn to before me this Notary Public, . ................................ : ................. County ......... ?~ ........ ~ ............................................................. ; ............. (Signature of abplicant)