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Home My WebLink About9705-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate O[ Occupancy (:5' THIS CERTIFIES that the building ................................................ LocaQon of Property 1~920 St).u.~d '0'tevt Averltte .......... 8.o.tl%h~k.cl~ .N,.Y.,... ' ' ~ .... ~ .......... Lot Cpunty ~Fax Map~No. 1000 Section ....~.lk. . .Block ................... ~ubdivi§ion; .~.I{~IO.~.l~lq{)0.~..~8.~.~/$ ......... Filed Map No..~75...Lot No.. ~. .......... conforms substantially to thc Application for Building Permit heretofore fried in this office dated · . . .fiP. P:J-~-..~.7 ........ , 197.~. pursuant to which Building Permit No... 9.7..05Z ............. dated ...~l.ay...b, .................... 1 ~.~., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .................. Pr~.v.a~e..On~. F.~tiy..L~elli~g .............................. The certificate is issued to . .l~I'e~lqbl?~..l~OlltO8. ~l~.fl, .......................... ...... (owne~) of the aforesaid building. Suffolk County Department of Health Approval . .~.$0.~./~.~...~J./~/.7.9... UNDERWRITERS CERTIFICATE NO. N Building Inspector Rev 4/79 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? 9705 Z Date ///J ~'~ '/ 7~¢~ ........................................................ , 19; ....... Permission is hereby granted to: tO ....... : .......· ............................................................................................................................................ at premises located at ............................................................................................................................ ...................... '"'"2 .............. 2 ........................................................................................................................ ~'~", ) ~ ~ 19~ and a~roved b,, the pursuant to application aatea ......................................... Building Inspector. Fee $ ....... !.....t.. ......... Building Inspector FO~Y/ 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 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 responslble 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 BLlilding ................ A~ldition ................ Old or Pre-existing Buil~ling ................ Vacant Land .............. Owner Or Owners Of Prop' erty ..~..~'...~./..~..~.'~...../.~....~....~.;~...' ,.~...~, .................................................. Subdivision /..V.,~.'..~.~..~..:~.....~..~.,~-. ............. Lot No...~. ...... Block No ............. House No.~.'.-~..~, '.~~ Permit No. ~..Z.~..~.....~...~.... 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 building and permit meets all applicable codes and regulations. Applicant ~ ,~.,..~..~ ...~....~/~.~/'~' .. . day of . · (sta/~ or seal) ....................................................... P Nota~ Public .................................... Coun~ ~u FORM NO. g TOWN OF SOUTHOLD Building Department Town Hall ~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ' ' .~: .... ~nk, and subm tted-~:~, ...... to the Building I nspec. tor 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 installa- tions, 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 peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2.Sworn statement of owner or previous owne~ as to use, occupancy andqondition of buildings. 3. Date of any housing code or safety inspection of buildings or premises?or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land use 3. Copy of certificate of occupancy $1.00 --Fre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date ..... ~u~.u~.t.j.4.,. j.9.8.5 ...... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property T,~9~Q ~qqr~lvj,~ .4v.~r[Ltg Southold House No. Street Ham/et Owner or Owners of Property Frederick E.. and Betty_ A.,. County Tax Map No. 1000 Section . .03~ ,~O ....... Block . .Q3...QQ ........ Lot ..... .o.0.3...0.o.o .... Subdivision ........ Filed Map No Lot 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 $..1...Dp ........................ Construction on above described building and permit meets all applicable c'odes and regulations. Applicant JAMES A, SCHONDEBARE Attorney THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ November5, 1.979 es JOHN STREET, NEW YORK, NEW YORK 10038 ,,,.e ~,,~,,o.~o.o.~,,~ o33o~ N 45~.~ THIS CE~IFIES THAT een ~ nO~8 ~ kJ~-ZU~O~VXeW AVe. ~ ~O~Oka ~ N. Z · 6 w~ exami~d on OV~r Z i ~ ~ ] ~ and found to be in compliance with the requirements of th~ B~rd. OUTLrrs ECEPTACLES SWITCHES INCAN ENT. FLUORESCENT 20 28 DRYERS FURNACE MOTORS RITURE APPUANCE F~EDERS ~,Z~..w0 o~ H~. GAS H.,. ~,. ,O~ ~.W.~ RANGES ECIAL REC'PT COOKING DECKS OVENS DISH WASHERS · ,,T. ,.w, ,,,,. ,.w. ~,. i':2 TIME CLOCKS BELL UNIT HEATERS MULTI-OUT':T EXHAUST FANS DIMMERS AMT. WATTS SERVICE DISCONNECT I NO. OF I S METE~ ~THER APPARATUS: Hocors ~ 1-F V I C E OF C~COf4D. NO. OF HI LEO A. W.G. NO. C~ hlEUTRALS OF HI-LEG OF NEUTRAL 2 Joseph Crocombe Box 1175 C. Mor~J~kes,N.Y. 11934 LLc. 746 lin ,lk....o// [his certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by ~ credent~~ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERT[ICAZE MUS~T NOT BE ALTERED IN ANY MANNER. TOWN I-IF SOUTHOLD OFFIE:E I-lf BUILDING INSPEOTOR TOWN P-L£RK'50FFIP-E ¢~OUTHGLD, N. Y. 11971 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Yo £xamined .................... ~..~.~. ~.?~?......, 19 ........ proved .................... Ig.Z.. ermit No ...... -- Disapproved a/c ........... ~.~ .......................................................... (Building Inspector) Application No. ~'~ APPLICATION FOR BUILDING FERMIT Date ............ ~.~....~?~ ............................ , INSTRUCTIONS o. 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 a detailed description of layout afproperty 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 av0ilable for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until o 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 D, uilding 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 necessar,x ~ (Signature of applicant, or name~f'a corporation) .... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... ..................................................................................................... Nome of owner of premises .................................................................................................................................................... if appligon,( is a corporate~sigr~gture of duly authorized officer. ...... (Name and title of corporate officer) Builder's License No ..................................................... 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.: ............ .~i...':...~. .................. Lot No ..................... :::. Street and Number .................... ~...~..~....-~.....~....~../...~.,..~.........~....~....~..'. .................................. ..~.?.~'.'.x..*~.,-~..?.~¢~ ............... Municipality 2. 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 C'~"~xt/'<~"~/'~" ~ ~ ~ / 3. Nature of work (check which applicable): New Buildin~]'. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior, .................... Other Work ..................................................... (Description) ~. Estimated Cost ...... ~-~.~,~ ............................................ Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ ~NumDer 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 ........................... D p h ................... Height ....... ~..... ....... Number of Stories ....... ~ ............................................................................................ Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Oimensioos of entire new construction; Front ...... "~..~...~ ................... Rear ...... ...~..~ ............ Depth ..... ..~.....O.... .......... / Height ....... ./.~. ....... Number of Stones .................................................... ;; ............................................................... 9. Size of lot: Front'. ............. ./....~.....~.. .............................. Rear ....... ./..,.~....~.. ...................... Depth .....~.....?.....~'. ............... 10. Date of Purchase ............ ../...~...?..~.. .............................. Name of Former Owner ..~..A~.....~,...,~.~ -- ........................... 11. Zone or use district in which premises are situated ...... ~../...~,...~....'~...~...~.. ............................................................ ul ./?/~ , 12. Does proposed construction violate any zoning Jaw, ordinance or rag arian: ...................................................... 13. Will lot be regraded . ........~,..~ ............ Will excess fill be removed ir[tm gre~nises:,( ) Yes ( 14. Name of Owner of premises .~.~.~..~..~...~.....~.~...~!.~J~..'..!~; ......... Address ~.~.~..'./.~..~..'~.~.,. Phone No. Name or- Architect ..~3~..~../~....~.......A~...~./..../~.. .................... Address..~.....~.~..~....~....~.... Phone No..'~.~...'Z...-..~...,,~.,~. .................................. ...... Name of Contractor ...~j[[~[~l~ ~[~ l~t~o Address Phone Ne..~...~...~...'T~...~'~e...,~, PLOT DIAGRAM Locate clearly and 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 and indicate whether interior or corner Jot. STATE OF NEW YO~,~ / cou,N. TY OF ...... ..... ~..'~-~.~...'~..~.........'~...~....~.'~..~.....~......, .............. being duly sworn, deposes and says that he is the applicon, (Name of individual signing contrace above named. He is the ...... ~: ................................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performe~ the said work and to make and file this application; that all statements contained-in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the applic~iled therewith. Sworn to before me this .......... ~;Z. ...... day of ,...~ .......................... 19 ...... .................. Co,, ....... ........ . . ,n , - I~ / / '~ . (Signature of opplic~) N~ ~bllo, 8tote of N~ Yor~ ~ommisslon Explros ~.reh APPROVE:D; ~ DgN~J WiLL ~F~M TO ~E .TAN~~ OF SUFFOLK CO. DE~, OF (~) disposal andwa,e~' , supply ~, ( ~S/~"~~ ) ~' - / ~ ' ;t~<~:'''''''v " ~' i. :~ ~ TEST HOLi~ SUF~. ~,, 0EPT. OF, HI, AL"tH, ~ll{~V ~ '~ . ,, ,~T~ENT, , , OF IN~NT FOR APPROVAL OF ~C~N, ONly .; TH~ WA~R SUPPLY AND ,"/J; J DATE:: ............ ' DIg~L ~Y~EMS FOR THI~ : DE~CE WILL ~F~M TO ~TAND~D~ O~ ~UFFO~K ~o, DEPT. f I i i I .~+. .: I i 4 Ii APPROVED AS NOTED.~ NOTIFy BUILDING DE~ >1 I ,!