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Home My WebLink About9704-zTOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z91.6'~ ...... Date ........... Auclus.~ .11., ..... , 19.7.8. THIS CERTIFIES that the building located at .275. ~-Iarion Map No .... xxx ...... Block No... X~X .... Lot No ..... ~}i~ .' ........................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ .Aprt.t. 26.,..., 19.7.$ pursuant to which Building Permit No.. 9704Z dated .......... I~la.y..3 ......., 19..7.8, 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 .... ~.I.V.~.~..E..O.N~..F..~i. IL~..9~LL~IG .................................... The certificate is issued to .. ~.~aRD..F .. ~I)ltl~$G .................................. (owner, of the aforesaid building. Suffolk County Department of Health Approval . .8/.3./.7.8 ......... 8.-..S.O.-.4..2 ........... UNDERWRITERS CERTIFICATE No. p~/a/~- N HOUSE NUMBER .2.7.5 .......... Street...~.a.~.i.o. rl .l~.a~e.,. ~.~.~l;. ~4.~XiOI~.,..~e!~..York. Building Inspector FO~[ NO~ ~ 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) N9 9704 Z Dote ........................................................ , 7~ Permission is hereby granted to: pursuant to application dated /\ ~:1, ' L r~!, (~ 19-7~ and approved by the Buildin~l Inspector. I ('~ Fee $..Z.~'...~i.. Building Inspector FOKM NO. 6 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 all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage dlsposal--(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 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 ote ............. New Building ......X~....X...... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .~.~.7....5.~..H...~.~?.n..~..~..?.~?.?~.~.'s~.~*M..?..~.~.~.'~.~L~..N.'~..Y..?. ................................................ .. . F. dwa~d F. Pohlig Owner Or Owners Of ~roperry ....................................................................................................................... Subdivision ................................................................ Lot No ............. B~ock No ............. House No 27~ Permit No.?.?..O..~...~. ......... Date Of Permit ..5../..3./..7..8..o...Applicant .!FA.~.~.~....H.m~I.e.~.,...~D,~ ...................... Health Dept. Approval ..8./..3./..?..8....~...8..z..S..O-'...~..2...o..kabor Dept. Approval ......... ~..q.s.. ............................... Underwriters Approval ........ ~.~. .................... Planning Board Approval ........... ~'..~,,~ ...................... Request For Temporary Certificate ....... ~.s, .......................... Final Certificate ........ ~-e.~- .......................... Fee Submitted $ $°00 Construction on above described building and permit meetsall amplicoble codes and regulotions. Sworn to be{ore me this Applicant ..... .~ ~"~ ........ ~"~';'i~'~ ............... 4t;~ day of AU~US~ .......................................................... :, (stamp or seal) Nota~ Public Suffglk Coun~ ~//*- ~ ................................... NOTAry PUBLIC, St~te ol New Yo~ ~uffolk ~unty No, 52-~792808 ~ gf TM~S CERTIFIES THAT THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ES JOHN STREET, NEW YORK, NEW YORK 10038 N397228 ave. R FI. [] 2nd FI. Section Block Lot and found to be in compliance with the requirements of this Board. 13 [50 26 13 3 Fr RANGES ~PECIAL REC'PT R DECKS I OVENS I mSN WASNERS TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET SYSTEMS ~p$. TRANS. H' P' NO. OF ~ 1 NO. Of CC. COND. A, W, G, NO. OF HI-LEG A.W.G. ~ER ,e' OF CC, COND. OF HI-LEG EXHAUST FANS DIMMERS Rich al'd Re]yea DelmaP 91% Laurel, L.I. 11928 Llc. 21~-E IA TMs certificate mud not be elfered ~n e.¥ menner; re~urn to ~he office of the Boer~ i~ incorrect Inspector~ racy ke k~enfifie~ ky their COPY FOR BUILDINO DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. TEL. ~65-~660 TOWN r-If 5OUTHOLD OFFICE I"lf BUILDINI~ INSPEP. TOR TOWN P. LEEK'S OFFICE SI3LJTHI3LD, N. Y. 119'7'1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No Y. proved ............. ............ ............ Disapproved .................... {guildino Insp(ctor) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No. ~)7~ ~/' April 26 78 Date ................................................ , 19 ............ 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 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 in buildings for necessary inspections. INLAND HOMES (Signature of applicant, or name, if a corporation) Box 117, Ma¢¢ituck, N.Y. 11952 (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................................................... G.~.~.~.~ ~..Z.,..g..o. ~ .t. ~.~ .c., .t..o..~ .............. . . Edward Pohlig If applicant is a corporate, signature of duly authorized officer. .... ............................. (Name and title of corporate officer) Builder's License No. Plumber's License No..2:.?:..~.8.:Tl~. .................................. Electrician's License No ............................................. Other Trade's License No ............................................... Sec. 031~ B1.8 p~ of lo~ 12 Location of land on which proposed work will be done. Mop No.: ........................................ Lot No ......................... Street and Number ~.~`..~..j:..~...~.~t.e.~..~..~...~'.d.~..W..e..?.~....S.~d.?.....~.&...y..~.~.~t..~.~.~.~.~.~ ..................... Municipality State existing use and occupancy of premises and in,~ended use and occupancy of proposed c'onstruction: a. Exisiting use and occupancy Vaca~ 1 - Family b. Intended use and occupancy ................................................................................................................................ XXX 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Oth~rDW0rk .................................................... 4. Estimated Cost $30.,.QD.Q^.QO ..................................... Fee '7 ~/ ~ (Description) (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 ............................ Deptb ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front 60 60 38 .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ;338 167 9. Size of lot: Front 2,38 Rear Depth 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 Iow, ordinance or regulation: ........................................................ 13. Will lot be regraded . ......~..e..s. .............. Will excess fill be removed from premises: ( ) Yes (x) No · Edwazd Pohlig '" Phone No ....................... 14. Nome of Owner of premises .................................................... Address ................................ Name of Architect .............................................................. Address ................................ Phone No ....................... Box ll7,MattitAzck No29,8.-9696 Name of Contractor~.~...~..~..~...d.....~-~..al:..e..s. ................................. Address ................................ ~'none ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate o[I set-back dimensions from property lines. Give street end block number or description according to deed, and show street names and indicate whether interior or corner Iol. , ........ ~~...bfing duly sworn, deposes and says that he is the applicem (N~I signing contract) above named. ~o~¢~¢o~ He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, ~tc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and fil~ this application; that all statements contained in this application are true to the best of his knowledge and belief; and th~ th~ work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this ................ ~.~... day of .~.~.~ ............................... , 19..Z~.. _ .................. ................................. : ,; HOL~ I SURYEYED ' 315 Westphalia Rd. i17 '~ Mattituck, I% Y, qd,9§2 btOL.~ 970 ~ APPROVED. AS. NOTED G DEPARTMENT AT k~' ~1' I to'-o" ts'--(o"