Loading...
HomeMy WebLinkAbout9682-zTOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at . .qg.0. .Q.s.s.e.~...Ay~ ........... Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated . .A.p?.1.~. .... q.~. ........, 19 .~.~. pursuant to which Building Permit No .... dated ...Ap~l. .... q.8. ......... , 19.7~.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ P. ~'£.v.~.t~..O.r~e. F.~Ly..L~.~]~l~ng ................................ The certificate is issued to ...... .V.~CI~O~o.~. Pl~e$~/.J.o~eph~-rle. L~Q ............. (owner~ of the aforesaid building. Suffolk County Department of Health Approval ..... ?-S0~,.177. ..................... UNDERWRITERS CERTIFICATE No ........ ]~,~9D5~.~. ............................ HOUSE NUMBER .... 1.90 ....... Street ........ 0s~.e~. A¥.~ ....................... .............................................. So~,,~, c1....l~e~..¥o~ ............ Buildin~ Inspector 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? 9682 Z Permission is hereby granted to: ..... .(~.....!:/.....?'..L.!L ~.:: ....... ~.....U.,......L.fi..L ].? ~ /g r l~ /~ 19 and approved by the pursuant to application dated ......................................................... , Building Inspector. Fee $ ~ ~ ~ . Building Inspector TOWN OF SOUTHOLD , Building Department Town Clerks Office 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 inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of oil 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: l. Accurate survey.of property showing oll property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent ina formation required to prepare o 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 $].00 Date Ju~. 7~ 1978 New B~lilding ..~ ........... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...0~.~f~.O...~.~D.g.~.~.....T~J~.g~,~..~/..~.~.~.~.~...~D.g~g]~ .................................... Owner Or ~ners Of Prope~y V~c~o~ ~[ese/~o~e~e Subdivision ................................................................ Lot No ............. Bilk No ............. House No..~g. .... Permit No. . - Dote Of Permit . ..Applicant .g.~g.~g~..,~.~.~.~....~.~.~.~...~g. Health Dept. Approval ............................................ Labor ~pt. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ....P~.~.O ~ .~...~.~ .~.~. ~.. ,... ~.1~-~.0 .~.~. ~..s ... ~ .q.., .................................. Sworn to before me this ................ day of ............................................ Notary Public .................................... County THE NEW YORK BOARD OF FIRE UNDERWRITERS  S BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK, NEW YORK 10038 THIS CE~IFIES THAT Victoria Pulese, r~ss~d Ave., Southold, L.I. in thefoll~ingl~ation; ~ B~ement ~ lstFl, ~ 2nd Fl. OUr'S I d~ ~t~n Bilk ~t ~eramln~on JU~ ~ ~7~ and found to be ln compllan~ with the ~quirements of thls B~. FIXTURE ~EPTA~=I ........ { fiXTURES ] RANGES I~ING D~KS ~ OVENS IDI~ WA~E~ EXHAUST ~T~S ~ ........ INCANDE~ENT [ FLUORE~ENT ~ ~T. K.W. ~T. K,W, ~T. K,W. ~T. K.W. dMT, SEn I~ DI NN I . S E R V I C E ~.~otors: I-3/4 hp I Smoke de,ec~o~ Custav Bartra 227 E Breakwater Rd. Hattltucks N.Y. 11052 LIc.152~E This certificate must not be altered in any manner; return to the office of the Boord if incorrect. Inspectors may be identified by their credentials, COPY FOR BUILDING DEPARTMENT, THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MAN,IR. TOWN I-IF SOUTHOLD FIFFIOE OF BUILDINfil INSFaEOTOR TOWN I'~.LEt~K'=: OFF'IOE SOUTHOLD, N. Y. 11971 TEL. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Examined ........................................ , ....... Approved ............,....~...[:./..~ ........ ./.~.~.., 19.f~'~. Permit No. .Disapproved a/c ................. ..~ ................................................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ............................................... , 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 or areas, and giving o 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. I',Io 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 Lows, 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. ....... g.C.O~g.~.../~hl.a~, .. J~tzil ~er.,... Z,nc ......................... (Signature of applicant, or name, if a corporation) 250 COX Lane ....... C ~.. ~; ¢.h e~ue y .; .,Np.w. · .Y.o.Fk... · ;.] t~5~ ........................... t^aaress orapplJcont) ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ......... .~.f.$g..~Q.~..$~...]~,~...~.~./.~];O.~.~%7~,..Le~.o ................................................................ If applicant is a corporate, signature of duly authorized officer. ~eorge Ahiers, (Name and title of corporate officer) Builder's License No. 51 President Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number ............. .0.~.ftg...~.~.~U~.r...~.§~.~.~..~f~e~.~.~....$~t¢~o[~ ....................................... Municipality 2. State existing use and occupancy of premises and in¢ended use and occupancy of proposed construction: a. Exisiting use and occupancy .................................... ~ ........................................................................................... b. Intended use and occupancy ........ .d..~.~..~.t...~.g ..................................................................................................... 3. Nature of work (check which applicable): New Building......x ........... Addition .................. Alteration .............. Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 4. Estimated Cost .......~Z£~O-..O~ ............................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............ -t .............. 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 ~pe of us~ ............................ 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. Dimensioos of entire new construction: Front '~ ~t ~c~t '?Z~ ~ .............. ~.,..,. ............... Rear ........... ,~v ............. Depth ........................ Height .....~,~.~. ........ Number of Stories ........................ -t ......................................................................................... 9. Size of lot: Front .................... ~.Q.~. ............................. Rear ...... .~ ............................. Depth .f~.~...[z,t~: ............ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ............... ~ ..................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........... n~' ........................................ 13. Will lot be regraded ..........ne ............. Will excess fill be removed from premises: ( ) Yes (.~) No 14. Nome of Owner of premises ...~.~..~.~...O..~...i.~....~..]:.~..~.~ ............. Address ................................ I~® No. ,.,,~.~=~.c~ Joseohin~ Left,no Name of Architect ...................... a ...................................... Address ................................ ~ho-e N~ ....................... b~ome of Contractor ............................................................Address ................................~h~n~ No ....................... PLOT DIAGRAM kocote clearly end 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 end i~licate whether interior or corner lot. STATE OF NEW YORK, [.S.S COUNTY OF .zZT.~:~__.~t:../~ ........ ............ ~'"~:2'"r',-,'~'z~'~ .............. /~,C"'~r"/'t"'z'9'"-';,' ................. being duly sworn, deposes and says thor he is the applicom -~(Ndme ~ individual s~gning coHtracr) above named. He is the ........................... ~:z..~.,,.~4.~..,,..~N~..z..,, ................................................................................................................... (Contractor, agent, corporote officer, etc.) of said owner er 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 applicetion are 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 before me this ..... ./,.~;q.... day of ............. Notory Public,. ........................ :~.~,,/~. ..... County . ............. ~~ .......... ~.~'3. ............................... ~ , .~ / /m~ ~" ~"~"" / ~Signature of opplicant) o¢' ,'-'~,e /¥ .( APPP.~V~D ~ AS ~IOTED DATE: ~/'7 ~ NOT~FY EU~LDIHG DEPARTM, ENT AT .~ ~_(~~60 9AM to 4PM FOR ED J,:: ~lJ 1. BEFC~E ~ACKFtLU~-]Q TICH OR 5TA~[ 3. ~E~D[(E COV~F-It~S [::';S CF /,NY KIND 4. FINAL WHEH JO'; O~ CONSTDUCT~ON 5. ALL CONSTrUCT[OH MUST REQUIREM~riT5 .F ~LY. STATE CCDE APPROVED AS,NOTED FEE: ~.,-'~7 '~'- ~Y: NOTIFY ~U,LD.b~ D~PART~ENT AT ED I :zP~.~l 1. BEFORE BACKFJLL~Hg r.=~.~.~ ' 5. ALL ~ONSTRUCT~OH REQUIREM~'~ :. STATE COPE ANg TOWN ~;O~.