The URL can be used to link to this page

Home My WebLink About9722-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No...I9986 ......... Date ............. J~ne..lB .......... ,19.80 THIS CERTIFIES that the building ................................................ Location of Property., .... 350. F. our.~h .Str. .~..~%l~.o.],k County Tax Map No. 1000 Section .... .~.~.7 .... Block .... .1.0. ........ Lot ....... 0. q..6 ....... Ffl d Map N Lot No Subdivision - e o....- .............. conforms substantially to the Application for Building Permit heretofore fded in this office dated .... A~PlrJ.-~. ~{~ ........ ,19 .. 7~ursuant to which Building Permit No ....... 9T~2 - Z ........ dated ... ~8y..l.~ ................ 19..7~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 ......... ....... Mud. Raom. Additicm. to. F. xis.eAng. D~elllng ........................... The certificate is issued to ..... l~u~ .Glasaer ....................................... (owner, ~o~ or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... ~T/R ................................... UNDERWRITERS CERTIFICATE NO .... 4592.2 ,..h592.15 ............................. Building Inspector TOWN OF SOUTHeLD BUILDING DEPARTA4Et4T TOWN C:LERK'S 4X~K~ SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 9722 Z Permission is hereby granted to: ..... ~.... ~.~ ~.~..~ . at premises located at '~ '~ ~ ~c'-~// ~.t.t.t.t.t.t.t.t.t~~/V ~ ......................................... ~: / ~ , ..~.~CC~ ~..~: ............ Bulldlnl~. Inspector. Fees ........................ Bulkiing Inspectm FORM NO. 6 TOWN OF SOUTHOLD BuiSding Department Town Hall 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 Inspec- 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. §. 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 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 informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5,00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ...~./. ?/..~..~. .......... New Building .. ~. ......... Old or Pre-existing Building ............ Vacant Land ............. Location of Property J.~.~O.. .'~/~ ('J. (W~..~/~-/. ~/' ~.~ Owner or Owners of Property ...~Z¢. · ~/~-~ ............................. County Tax Map No. 1000 Section .../. ~.~ ...... B~ock .... ~ .~, ....... Lot.. ~ (.~; ........ Subdivision .............. -~ ............. , .... Filed MapNo....,..~...LotNo.....,~ ....... Permit No. ~. ~. ~. Date of Permit~/~ ~.AppEcant.~.. . . . ~' ~.-Z~ ~. · · · - · · Health Dept. Approval ..... ~/~ ............. Labor Dept. Approval .. ~./,~.' .............. gnde~ritars 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. J~-~,~.. / .~.'- ......... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK. NEW YORK 10038 Date THIS CE~IFIES THAT o~y the e~t~a~ ~.[. inthefollowlng~ttion; ~ a~men~ ~ lstFI. ~2nd FI. S~tion Bilk ~t w~ examined on D~C~ ~ . k ~ / ~ a~ found to be in compliance with the requirements of this Board, SERVICE DISCONNECT NO. OF S OTHER APPARATUS: 1-Smoke Detect:or 1-G.F.C.I, RANGES SPECIAL REC'PT E R CO0 KT!HO DK!CwKE A TOVE%.Sw. V I C DISH WASHERS MULTI-OUTLET SYSTRMS NO. OF CC. COND, PER ~' EXHAUST FANS DIMMERS AMT, WATTS A. W+ G+ NO` OF HI-lEG OF CC. COND. A.W.G. NO. OF NEUTRALS A.W.G. OF HI-LEG OF NEUTRAL GUB~aV BarCra Ma[t£~ck, N.Y. 1195Z L£c. 15Z9 g This certificate must not be altered in any manner; return to the office of the ~ard if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMEHT. THIS COPY. OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. THE NEW YORK BOARD OF FIRE UNDERWRITERS pta BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK. NEW YORK 10038 THIS CE~IFIES THAT ~al~a= G~aaser, ~Ch ~C., on ~ St. 250' d/o ~ac~s~ S~., ~ew~tto~. L.I. in the following l~atlon; ~ B~ement ~ }st FI. ~ 2nd FI. Section B~k w~ examln~ on D~ ~ ~ ~ ~ 7 9 a~ fou~ to be in compliance with the requirements of this Board. FIXTURE OUTLETS ~ECEPTACLES SWITCHES ~unY VAFC~ DRYERSI FURNACE MOTORS IFUTURE AFI~UANCE FEEDERS AMT. K.W. OIL H.P. GAS H.P. AMT, NO. A.W.G. RANGES FECIAL REC'PT SERVICE DISCONNECT NO. OF ' 70o TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET A, W.G. ND. OF HI-LEG A, W. G. OF CC. COHO. OF HI-LEG 3/O EXHAUST FANS DIMMERS E Daz~£e[ A. Fo$&r[y Jr. 1.000 I'~t;C:Lt;ucK, N.Y. 1.1936 L;Lc. 771. This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ~[ NO. ! TOWN OF SOUTSOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N. Y. Exa,ni,,ed ......................................... 19 ........ ~i~ N//o~~ Approved ........................................ ~ 19 ........ ~ormit ~o ..................................... ........................................................................................................................ ' ................................ .............. APPLICATION FOR BUILDING~ ' I ~STRUCTIO~S a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate i'o the BuildingC,4~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. Lq 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 permn ~ 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 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~xinSpqc~,ions. , NOTIFY BUILDIN~ DEPARTMENT AT ~zm....,~..~.~/......~;:...L...L...L...: ......... n...'. ........ M.t._v. ................ 765-2660 9AM to 4PM FOR REQUIR (Address of applicant) ED INSP:CTIONS: State w~e~l~[.~rF~Aagent, architect, engineer, general contractor, electrician, plumber or builder,' TION OR START FRAMIN~ ........... .~,.~A~4,~.LI:~S~E~,Ti~y~ .............. .. ............................................................................................................................... Name ~f ~ ~ ]~ ¢O~PL'E~ ....... ;' .............................................................................................................. ,ca~i~:~S'~:~6~uly authorized off icer. If appJ 5. ALL CONSTRUCTION MU~T M~T / ~ - .............. , . . Builder's Lic~se No ..................................................... Electrician's License No. ,.~/.~.~.~<'JC...../...~.~..~..~ ..... Other Trode's License No ............................................... Location of and on wh ch proposed work wi be done. Map No.: ........................................ Lot No ......................... Street and ,,um ............................ · · 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 ............... ~ ............................................................ ./~ ........................... ¢...q....~ ..... U 3. Nature of work (check which applicable): New Building .................. Addition ~ Alteration · ~ ' ' Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... (Description) 4. Estimated Cost ............................................................ 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 ........ 'Z'~ ................... Height ........ ~..Z. ............... Number of Stories '2 ' 8. Dimensions of entire new construction: Front ................................... Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front Iq"/ . ~ Rear I ~[q, ~] Depth /0~ 10. Date of Purchase ...........,~,Q>..~;?.....!..q...~..~ ....................... Name of Former Owner ..... ..~....~...~ ....................................... 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 regraded , ........ ~.~.?..J. ........... Will excess fill be removed from premises: (~) Yes ( ) No .................................................... Phone No .................. ~.... 14. Name of Owner of premises ~' ~.-~%,F_~qAr ' ~: Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor~.~.~......!!t.?~.~..~.~..'..~.~.. .................. Address ................................ Phone No ....................... ~'" -- ~'""~'~ - (~'"~'¢ ~_OZ 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 lot 5TA"rE\OF NEW ~0. RI/,, p ~ ~S S , COUN'iIy 9F~_..~-~:~..... "--/ ...... (..~_.~.~~ ............... .,. ................. being duly sworn, deposes and says that he is the applicam (Name of in8iviaua~ signing contracr~ above named. (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 ali statements contained in this application are true to the best of his knowledge and belief; and thaf the work will be performed in the manner set fo~h in the ~ppli~ati~ f[l~ therewith, m Sworn to before me this ~ ~ ~X, ~ (~l~ ~M ................................................... ...... ............ ........................ .......................... 10~,77