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Home My WebLink About9688-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Ot~ice Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .2.9.~...~.1.1. o..w..~.e..~.r.a.c.e...L.a... Street Map No... 5./~07 ..... Block No ...........Lot No ......~. ~ .......................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... Al~r~-~ ..... '1.9 .... , 19.7..8. pursuant to which Building Permit No ..... .9.6.8.8Z dated ..... A~r;[~ ..... 1.9 ..... , 19.. ?.~ was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is ....... .~rJ.~ra~e..One. E~m~..~'r~e3.~;~ng ................................. The certificate is issued to ........ W~.L~.~ ~.~$..Jr, ............................ (owner, l~~k~x of the aforesaid building. Suffolk County Department of Health Approval 8-S0-31 UNDERWRITERS CERTIFICATE No. Pending HOUSE NUMBER .... 295. ......Street ....... Willow. ~errace. L~ue ............ ............................................. 0riehl.,. New..York ................ Building Inspector FORM NO. ~ ?0WH OF $OUTHOLD BUILDIHG DEPARTM;;HT TOW)q CLERK'S OFFICE SOUTHOLD, N. Y. BUILDinG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9688 Z Permission is hereby granted to: ....... · /~ ...... ~r.~'r~'~'~"~-'t~ .............................. ..... ~' .......... ~?~;~ ....... '~t'~'x/'Z~L~ .................. to ........ j_~*' P~"*"~1 ~) ....... ~ /-[,, t ~, ,c~' -.~,-*z,L ...... ~^~/~> .........~ ;J~ J J I £~'""L ....... ~';1 .......................................... at premises located at ............ ~..~.~.....~q,f.L.LL.;0.fCr.....~.-~r:..~T~.~.C~...~. .......... .,~.)~.~.~:~ ................. .................................................................................. ~r~-.~.~ ...................................................... ........ U~?r ...... r~ .............. b2'~'*~'~: ~'t,q'""'"~'WfC'~'Cz'E:"""'tc'~"y" ~ w ~'~'x'~'~"~,~">~"~ pursuant to application dated ........................... ~.'/~'~ ......... ./..~..., ]c~_~ and approved by the Building Inspector. Fee $....~..,~...~ TOWH OF SOUTHOLD Building Department Town Clerks Office Southold, H. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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, 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 oil 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.....~// ........... .... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ....~...~. .............. /. /~,.~ .~.. ...................... Owner Or Owners Of Property ..~.. ....... ..~...~, ..~..'..~...~......~....L-~...: .................................................................. Subdivision ................................................................ Lot No..~/..~'~.... Block No ............. House No ............. Permit No ..................... Date Of Permit .................... Applicant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described bu, ilding an/d per~ a,p~licable c~es and regulations. Applicant~'/~.~;~..~.~..~/~,;~-...~;~ '/~-~'~¢~¢"4~'~"~'~ ..................................................... Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) TOWN OF' SOUTHOLD I-]FFIOE OF BUILDING INSPEOTOR TOWN I~-LERK'S OFFIOE SOUTHBLD, N. Y. 119'71 TEL. '7~5-2660 THE NEW YORK BOARD OF FIRE UNDERWRITERS ~)m BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 N395830 THIB CERTIFIES THAT ~1111am Hands, ~lllov Terrace Lane, r~ns ~to, urzent oAnt, in the following location; [] Easement E~ist FI. ~]~2nd Fl. Section Block I~ot RANGIS S~RVICE DISCONNECT 1 100 CB OTHER APPARATUS: S E R O. Of ITER 1 EXHAUST FANS AMT.~ ~.~P. Motor/8:1-3/q 1-O.F,C,I, 2-Smoke Deteotors 1-4.~EW }~t Water Heater Richard Relyea ~elmar Dr. Laurel, L.I. 11948 LIe. 21~8 E 11 This certificate muss not be ~lSered in ~ny numner; return to the o~ice of the Board if incorrec$, inspectors mop/ be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BI ALTERED IN ANY MANNER. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~proved iiiiiiiiiiiiiilll ~.'~iiiiiiiii~ Jg.',Z...~. Permit No, ...~.~5 ............. Disapproved a/c .............. ~.~....~~ (Buildin~ Inspoctor) Application No. APPLICATION FOR BUILDING PERMIT Date ................. ..~.~...~. ....... ./...~.. ....... 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 o~ areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this applicntion 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 in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) po, / I State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ...[~!..~.?....!~.~...~...~.~. ............................................................................................................... If applicant is o corporate, signature of duly aathorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's License No ............................................... Location of land on which proposed wo~k~will be done. Map No ... Street and Number ..~..4.*~.'.~.?....:.~il...~.~.J~).~,~.'.~.-~: ......... .~..~.~..~.~....~..!:.(.-~..........~...~?. .............. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy b. Intended use and occupancy ......................... .~.......~D... ...................................................................................... 3. Nature of work (check which applicable): New Building,. ................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolitior, .................... Other Work .................................................... ~ ~2z'~ ~ (Description) ~'i,Estimated Cost ........................................ Fee (to'~"'~"b'e 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 ................................ 8. Dimensions of entire new construction: Front ......... -~..~v..C).. ................... Rear ....... ~.(~.. ........... Depth ..:..~..~.. .............. Height .....~ ........ Number of Stories ............./..~ ................................................................................................ 11. Zone or use district in which premises are situated ..................................................................................................... ]2, Does proposed construction violate any zoning law, ordinance or regulation: .~.....~. ............................................. 13. Will lot be regroded ...... ..~..'~--~.. ......... Will excess fill be removed from premises: ( ) Yes (/-~rNo Name of Architect .............................................................. Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck 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. STA"FE OF NEW .,~RJ~,//~ ~/~ I S S COUNTY OF./.~.....f ' . ....................... ~/...~.~.~.,,~I~.~. ....... ~ ...... :~..~..~..~.~[~eing duly sworn, deposes and says that he is the {Nome of individual signing contrac~ above named. C0 h c He i~ the .......................................................... '.~. ........................................................................................................... (Contr~to~, q~ent, ~o~por~te o~fiee~, etc.) of ~aid owner or owners, ond i~ duly ~uthodzed to perform or ~ve pe[fo~med the s~id work ~nd to m~k~ ~nd file ~h[s ~pplic~on; ~a~ ~11 statements ~onf~ined ~n ~is =pplicot~on ore ~rue to thebe~t o~ hi~ knowledge ~nd belief; th=~ the work ~ill be pedo~med in the m~nn~r ~et ~o~h in t~e ~pplic~tion filea therewith. Sworn to before t~i~ ~o~*~ vu~.~~..~~un~ ...~.~..~....~ ............................................................ ~, 4 TL"~IR~ {Signature of applic*nt) ~, 5'' 09'~33 coung~/ZI ! WI,AMP '-~ Q ~ ~- ~/ I~ v~ 1 I ~ RODE~CK ~AN TUYL, P. C. SU:IeF, CO. DEPT. OF HEAl.TH ~EIJVIC~II~ ~ ~TATEMENT OF INTENT FOR APPROVAL OF CONSTRUCTION oNLY THE WA~R SUPPLY AND SEWAGE DATE: ~ ~ , , DIS~L SYSTEMS FOR THIS RESI. H. 5. REF. NO.: STANDARDS OF SUFFOLK CO. DEPT. ; - , OF H~LTH. SERVICES. <s:) ,; APPLICANT'.7 F~MING INSPECTION NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS REQUIREMENTS OF N.Y, STATE CODE AND TOWN HOUSING COD~