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Home My WebLink About9728-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No...Z.!gP.S.9. ........ Date Augus~c 21, 19 80 THIS CERTIFIES that the building ................................................ Location of Property .... ~.1.~...~r.a.n.g .e. go.a. ¢, ......................... ~Oul;b_old ..... House No. Street Ham/et County Tax Map No. ! 000 Section .... .T~ ...... Block ..... 1. ......... Lot ...... 6 .......... Subdivision..SP.U.~.t3..H.a.z?..Bp?..H.o.m.~s. ........ Filed Map No../413.96...Lot No....17 ......... conforms substantially to the Application for Building Permit heretofore filed in this office dfi~ed · . . .Ap.~.~.l...2.~. ......... 19 7.~. pursuant to which Building Permit No ..... .9T.2.~...Z .......... dated ............... Fl..ay..1.6., .....19. ?~3, 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 ......... .... 9.n.e..F~¢n.~&¥. D.w. ell±ng. (Adcl±~:ia~a) ........................................ The certificate is issued to ..... George. F.. McAclams. &. &no ........................... (owner, le2~:~X~x of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO ....... .~... 59753.2 ................................. Building Inspector Rev 4/79 FOP,~ NO. 2 TOWJ4 OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH*OLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9728 Z Permission is hereby granted to: at premises located at ............................... {./../..-.~...~il./il.~..{~/-:.!~. .......... Z.~...~.~..:: ................................ SO ~7 t7 ,c~,~/-:'/~ /I~', pursuant to application dated ........ ............................... 19...~%., ond opproved by the Buildino Inspector. Fee $.../.. ........ Building Inspector FORM NO. 6 TOWN OF $OUTHOLD Building 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. 5. Submit Planning Board approval of completed site plan requirements where applicable. 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, C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of ce~.rtificate of occupancy $1.00 .~...f/l.~..~..~' ~Date ............ New Building ... Old or Pre-existing Building ............ Vac~t Land Location of Property ..... .~...~~:. ~.~ ......... ~~,-~.. Hou~ No. /~/~~ ~ ~~ ~ StOl ~ Hamlet Owner or Owners of Property .... ~~. ~~~..~. ~.~: .............. /. County Tax MapNo. 1000Section .~.~. Block ...... .... ... Lot...~...~ .... Subdivision ~,~:~:,t~.~, ,~. %. ,7.t.: .;. ".'.. ..... .'/: :'. ~iled Map No, .~ .... Lot U Permit No. ~~Date of Per~. Z¢~pplicant ~~.~~, ................... Labor Dept. Approval ............... ~ ........ ~oquost for Tem~orarg ¢ertificato ..................... Final Gortif[cato ....................... Fee Submitted $ ..... ~q~ ................. Construction on above described buitdin~ and~ meets all aO~l~cable .. ................ Applicant ~ ~ Rev. 10-10-78 APPROVED AS NOTED DATE: -'~//'G' / FEE: /.~ BY: ,~ NOTIFY BUILDING DEPARTMENT AT 765-2660 9AM fo 4PM FOR REQUIR. ED INSPECTJO['~5: 1. BEFORE gAC~FILLIN~ 3. BEFORE COV:~[IN~ P :*'" OF ,~NY KIND 4. FINAL WNEN JOB C~): NOT RESPONSIBLE FUR D;S;GN OR CONSTRUCTION ERRORS 5. ALL CONSTRUCTION MUST REQUIREMENTS O; N.Y. STATE CO~ AND TOWN HOUSING COD; & APPROVED AS NOTED D,~TE.. .5-- / ~ _ -~ FEE NOTIFY ~U~L~H~ DE~ 765-2660 9AM ~ 4PM FOR ED 1, ~EFORE ~CKFILLING TION THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF' ELECTRICITY , ~. ~o.. **REM*..E,~ ¥oR~..~'~ ,ooze ~ e~ami~d on and found to be in compliance with the require~ts of this B~rd. DRYERS FURNACE MOTORS FUTURE AFPUANCE FEEDERS SERVICE DISCONNECT NO. Of S E OTHE~ A~ARATUS: RANGES SPECIAL REC'PT, R TIMECLOCKS BELL UNITHEATBES MULTI-OUTLET EXHAUST FAN~ , AMT.~ H,P, DIMMERS KJI A. W. G, NO. OF HI-LEG A.W.G. NO. OF N~UTRALS A.W.G. This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by credentials. COPY FOR BUILDING DIPARTMINT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. TOWN O; SOUT,O~ "- '~- - ~' ~ BUILDING DE~RTMENT ~ ~--~~ ~ TOWN CLERKS OFFICE ~ ~ ~ ~~~ ~UTHOLD, N.Y. ~_ ~ ~7~ '_ ~7 -~ Examined .......................... ~.'L ...... . .... 19 ........ A~Jic~lion No. /;' ~) .5~ ~ , ,, . . 'P', :" ~" 2-.~' .~ . ~ (Building Inspector) ~ APPLICATION FOR BUILDING PERMIT .......................... o. This ~pplicotion must be completel~ filled in by typewriter o~ in ink end submitted ~n triplic~t* to th~ Buildin~ Inspector, with 3 set~ o{ pl~ns~ ~ccumte plot plan to ~le. Foe ~ccordin~ to schedule. b. Plot plon showin~ Iocotion of lot end o{ buHdinos on premises relotionship to odjoinino prem scs or pub c streets o a~eas, ~nd ~ivin~ ~ detailed description o{ l~yout ofproper~ mus~ bo Or~wn on tho dloorom which is po~ of this ~pplicotion c. Tho work covered by this opplicotion moy not bo commenced beforo Nsuonce o{ Buildin~ ~ermit. ' d. Upon *pprovol o{ this applicotion, the Build[n~ Inspector will issue o Bulldin~ Pormlt to tho opplicont. Such permit shell be kept on the premises owiloble for inspection throughout the work. e. No buildin~ sh~ll be occupied or used in whol* or in port for ony purpose whatever until ~ Co~ificoto o{ ~cup~ncy shell hove been ~r~nted by tho Buildin~ Inspector. APPkICATIO~ IS ~EREBY ~AD~ to the Buildino Department {or the issuance o~ ~ Buildinfl Permit pursuant to lho ~uildino Zone Ordinance of the Town o{ Southold, Suffolk Count~, Mow York, end other opplicobl~ kows, Ordinoncos or Regulotions, for the construction o~ buildings, odditions or oltorotions~ or for romovol or demolition, os heroin described. The ~p~licont ~roes to comply with ~H ~pp[iceb[e I~ws, ordin*nces, buildin~ c~% housin~ c~e, ~nd roOu}otion~, ~nd to odmit outhoHzed inspectors on premises end i~ buildings {or n~ess~ in~ectlons. .................. (Si~nomre et oppuc~nt, o~ nome, if a corpomfion~ ~.,~ ~ 4gh[,.,~ '"~ ................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.\ ....................................... .......................................................................... if applicant is a corporate, signally authorized officer. ............. ...................... ~,/(Nome and titl~of cort~6rote officer) Builder's License No. ~ 0 ~ Plumber's License No ................................................. Electrlcion's License No ............................................. Other Trode's License No ............................................... i~oo -- 7~ ~1- (¢ Location of land on which proposed work,~j?l be done, Mop_No.: .................. .'2.. ............... ~. PDt No ........... Street and Number ............................ .~..~..~.~..~.... ........ ~~~k~Z ........ i.;iiiiii Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy .............. ~~,,~....~...~.~,-~,. ................ b. Intended use end eccuponcy ................................................................... 37 ~ature of work (check which applicable): New Building.. ................. Addition ........... Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work .................................................... · . (Description) 4. Estimated Cost ................. -~.~..~,. .~..J. ........................ Fee ........................................................................................ (to be paid on filing this application) 5. If dwelllng, number of dwelling units ........... ~.. ............. Number of dwollin~ units on o~ch floor .~ ...................... I{ 0oro~e, number of c, rs ............................................................................................................................................. 6. I~ business, commorciol or mixed occuponcy, specif7 noture and extent of eoch type of uso ............................ 7. Dimensions o{ oxistin0 structures, ff any: Front ............................ Reef ................................ Depth .................... Hei0ht ........................ ~umber of Stories ................................................................................................................. Dimensions of some structure with alterations or odditians: [rent ....................................Roor ............................ Depth ................................ Height ............................ Number of Stories ~// 8. Dimensions of entire new construction: Front ................... , ................ Rear ............................ Depth ........................ / Height ...~ ........ Number of Stories ..................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Fo~er~ ~/~ ~Owner ................. ~ ...................................... 11. Zone or use district in which premises are situated ..................... ~~~.~.~...:..... ............................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded . ........ ~.~.~ ....... Will excess fill be removed from~mise~: (~es ( ) No 14. Name of Owner of premises ...~~.C~ddress ~k~....~' Chono ~o. ~ome o{ Architect .............................................................. Address ....~ .................... ~hono ~o ....................... Name of Contractor ....... ~..~/.C~ ....... Address .C~Z,/~Z~ Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~ck dimensions from prope~y lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. /00 STATE OF FlEW YORK, [ ¢ c COUNTY OF ......... ~ ............... ~-~' ~,~ .............................. ..~../c~.~.'..~.~..r~..~...~....'~..~.~..~.~ ................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the //-~'~'~r"/"~:~'~'~':'"~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and tg,41~ and file this application; that all statements contained in this applicatipn are true to the best of his knowle~g"e and I~elief; and that the work will be perfo~rr~:l in the manner set forth in the g~plication filed therewith, x'~ / Sworn tc~t~ore me this ( ......... d ,f ..... ...................... ,