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Home My WebLink About9684-zTOWN OF $OUTHOLD BI~.BING DEPARTI~NT Town Clerk'e Office $outhold, lq. Y. Certificete Of Occupency No..Z..~168~ .... Date ....A!~,B~..t...9. .............. , 19.7.8.. THIS CERTIFIES that the building located at .~.~.~7...~..all'..l.c.h...L..a~.e. ....... Street Map No ............. Block No ...........Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...April,....1.7. ....... , 19. ?f~ pursuant to which Building Permit No... 9t~8/~Z dated ....Ap.r.i. 1. .... ~..9 ........ , 19.7.8.., was issued, and conforms to an of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is ~ued is ............. .m...~y~..~..~..~...F..~.~.~.~..m/?.~.!-.~.n~ ........................... The certificate is issued to ...... .R.o.b..e.r.~..D..~. y. .................................... ( owner~i~g~ilgg~ of the aforesaid building. Suffolk County Department of Health Approval . .A.u. g9..s.t....9.,.. ~..97.8.... .8.-.S. 0..-.~.6. .... UNDERWRITERS CERTIFICATE No ........ .N...~.97.~.~..9 ........................... HOUSE NUMBER . J.~?.7 ........ Street ..... .A~..d~..i.c.h...L.a~..e. ....................... .......................................... ~..ur..e.Z.:..~:~.. ....................... Building Inspector FOI~f NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON TIlE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 968~ Z Date .......................................... .~ ............ Permission is hereby granted to: ...... ":/...c.. ...... /.~.:(...r.~/::..~..,-..: .......... ~.~.~:..~ ............... at premises located pursuant to application dated ........................ ................................ 19 ........ , and approved by the Building Inspector. 7U Fee $....Z.~2....~... Building Inspector FOI~M NO. 6 TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This application ~nust 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 all buildings, property lines, streets, and unusual natural or topographic features. 2. Final appraval 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, 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 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 New Building................/ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ~..4D..~?C'/..~. ..~..4~.....~..~'. ......... Owner Or Owners Of Property ~> ~ ~. ............................................ Subdivision ................................................................ Lot No ............. Block No ............. House No...4/..~..~.~7 Permit No. ~.~ ~.~. ZDate Of Permit .~:l.L~.lT..~Applicant Health Dept. Approval .... .<~./.~..J.~...~. ...................... '~ '1 Labor D~n,. Ann,,~,,~! ........... · . /v gFz --- . ........................................... Underwnters Approw~l ..~.'~.~.G .................... ~;~.~Pl~nning B~rd Approva ............... ~ '~/ '/ z ~ ~ .................. Request For Tempora~ Ce~ificote ........................................ Final Ce~iflcote .......................................... F.. S. it .d S ......... ............... Construction on above described building and permit meets oll o,alicoble ~es and regulations. ................ day of ............................................ (stamp or seal) Noto~ Public .................................... Coun~ TOWN OF SOUTHOLD OFFIE::E OF BUILDING INSPEOTOR TOWN OLE:I~K,'S OFFIOIE: E~OLITHOLD, N. Y. 11c~'71 ..~r~9 F~i~- c~-T/ o ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~-- ~;f ES JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT on~y the e~ctrlcal ~lulprn~r~t as described be~o~ and introduced by ~ aDolieant narnmt on the abo~ application number in the premises of Robert Dalye s/s Private Hd.. UO(~S W/O Aldrich La., Laurel, L.I. in the following location; [] Basement [] 1st FI. [] 2nd FI. Section Block Lot was examined on AU.~US~ ~1, !~?'~ and found to be in compliance with the requirements of thls Board. FIXTURE r FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT ]7 35 22 17 DRYERS FURNACE MOTORS FUTURE APPUANCS F~EDERS TIME CLOCKS UNIT HEATEI~ MULTI-OUT~ZT DII~U~ERS SYSTEMS NO. OF F~ET E SERVICE DISCONNECT S E R OT R~ T : 1 Brooke Deteotor OF CC. COND. C~HI-LEG O~ NEUTRAL 1/0 · i/o Joseph D. 5~azzoni / 227 Waverly Ave. ' Medfox'd, L.I. ]1763 LIe. 4 82!!'. amana This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERID IN ANY MANNER. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Ex°mined ................. /e .... ..... Approved ..................... ~ ............ , 19..:~mit No. Disapproved .................... ' ' '~=' '~': ' '~:'7: '/'Z~c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Dote ......................... 7 INSTRUCTIONS Application No.....~...~.~.:~Z ............. 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 schedule. b. Plot plan showing location of lot and of buildings on premises, relationship 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 ir~ buildings for necessary inspections. (Signature of apl:~cant, or name, if a ~rl~'or~'ii~'i ........ ...................... ...... .................. (Address of applicant) .... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................................................ ................................................................................... Name of owner of premises x/~..D.. ,z~ ..~,-T- f~.....~ .~--:..y If applicant is a corporate, signature of duly authorized officer. ............ ": ......... ......... Builder's License No ..... /....~.. ........................................ Plumber's License No ......... ~./... Electrician's License No. Other Trade's License No ............................................... 1. Location of land on wh ch proposed work w be done Map No' ..~.Z~- Number J..~.. ~. /~ Z /)/~ tC'/4 l'i~I ........................... ~4°~ ........................ Street and ...................... /. ......... : .......................... .m ......................................... :.,.~.....z ,. ........................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ....................................................... b. Intended use and occupancy .~... ' - .~.~.. ~ X~-/,,~ C~ 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 4. I:stimated Cast ........ i ................; ..................... Fee .......................................................................................... (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 ......................................................................... ' .................................................................... 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 ................... '6 ............ 8. Dimensions of entire new construction: Front ........ ~...c~. .................... Rear ....... ..~....~. .............. Depth .~.~'....,,~? .............. Height ...../..~.. ..........Number of Stories ........ ..~.. .......................................................................................................... 9. Size of lot: Front ............... ..~:...~:~... ............................ Rear ............'~....~'.,z~... .................... Depth ................................ 10. Dote of Purchase '7¢ .................. Name of Former Owner .................... ~ .............................. 11. Zone or use district in which premises ore situated ....~...: ......................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ../...~.....o. ............................................ 13. Will lot be regraded . ......... .4Z..~. ........... Will excess fill be removed from premises: ( ) Yes ('~) No 14. Nome of Owner of premises ..~..<.~..t/~/..~..~..t .......................... Address ................................Phone No ....................... Name of Architect .............................................................. Address ................................Phone No ....................... Nome of Contractor ..~...,~..~.../..Z,...~...~....~:...~...~.,.~'...~.. .................. Address ..~..~.~: .......... Phone No. PLOT DIAGRAM Locate clearly and distinctly oil 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 and indicate whether interior or corner lot. ~.~u ~ L/~ I//. ~'u~/~/) STATE OF NEW YORK., COUNTY OF ................................ .............. ~....~.~'J.,~ ..~.. .......Z~.......~... ............. .'..,~... ............ be,rig duly sworn, deposes and says that he is the applicant (Name of individual signing contract)' above named. Fie is the ~U/~-~..f~.~ ................................................................................................... .... (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 applicotion are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........................ dayof ............................................ ,19 ........ Notary Pub c,. ...................................................County ...~'././~'J~.~;,....~:~..:...~ ........................... L~ gnature of applicon/t/)' Serqloe~ ' ) T ct. L~