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~.