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Home My WebLink About9615-zFORM NO· 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occul ncy THIS CERTIFIES that the building ................................................ ~5~9 .(.R.:.O:.'(.:) N/Cox Neck Road Location of Property ~ Ho[ ............. ~e~t' ............... H~w~et County Tax Map No. 1000 Section .... 106 ..... Block .. 0,q .......... Lot ... ~1~ .......... Subdivision ...... ~ ....................... Filed Map No.. ~ ..... Lot No .... X ......... conforms substantially to the Application for Building Permit heretofore fried in this office dated ·..ffar~a-v'y. ~[0 ...... ,19.7~ursuant to which Building Permit No....96'J 5~, ............ dated ..... O'anual'~y'..30 ........... 19 ·78, 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 ......... The certificate is i~ued to .... .~l~.l:LJ,em. ;I.,..&. 0'~anne. D,. 0';~meor~ ............. of the aforesaid building. Suffolk County Dep~ment of Health Approval .... ~/.~ .................................. UNDERWRITERS CERTIFICATE NO .......... Pending,...~ 652A 50 .................... / Bdflding Impector TOWN OF BUILDING: TOWN cLERK'S SOUTHOLD, N. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL~FULL COMPLETION OF THE WORK AUTHORIZED) N°. 9615 Z Permission is hereby granted to: at prem ses ocatea ar ........... ~ ............... ...~....z ....................................................................................... ............................................................. ' h~'Fr/T ~/~ :..~.,--' pursuant to application dated ,.,l~q .q/ 3~ 1L.~. and approved by the Building Inspector. Fee $ ....../. ................ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions Ac 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 unusua) 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: I. 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 .... ....... New Building ............. Cid or Pre-existing Building , ~ ....... Vacant Land ............. ,,?/l. _ Location of Property 55 /~O O~ k?.~.--~./.~.,../?.-./~.. ......... ~/)~..~././.~./.~/~ ....... House No. Street Ham/et · .................. Owner or Owners of Property ............. ¢ County Tax Map No. 1000 Section ,. {,~. ~ ....... Block ,, ¢?. ~.. ........ Lot.. ~,~7,/. ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.~/,/¢'~/5,-. .Z%.., Date of Permit¢~¢Z~. Applicant ...~./.~.&//~J[....-J.~¢[~.~'~. ........ 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..~¢~.~¢.~,,:...~...~.~.~{-,¢~.~,,.. ......................... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ e5 JOHN STREET, NEW YORK, NIEW YORK loo~a THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above ~pplication nu tuber in the premises of i~ the following location; ~ Bose,te~t ~ 1st Fl. [~ 2nd Fl. Section BJoch Lot was exa,~ined on and found to be in co,~pllance with the requirements of this Board. OUTLETS RANGES OVENS DISH WASHERS EXHAUST FANS DRYERS OTHER APPARATUS: S E R V I C E JNO OF NEUTRALSI Lic#1889 GENERAL MANAGER Per~ 11 This certificate must not be altered in any manner return to the office of'the Board if in.correct. Inspectors may be [dentlfied by ther credentc~s CO~Y FOR BO LD NG DEP~RTM ENT, TH,IS COPY O~ c~E~ TIFJGJ~T~ M~J~T NOT BI'ALTEReD N ANY MANNER.- I~OI~,M NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved ~/~ ...... ~...~T.~ .......................................................... ............................................................. :.:.7..Tl.b~.:.: ......... =:: ...................... ..................... .............. {Buildin~ Inspector) APPMCATION FOR BUILDING PERA41T INSTRUCTIONS a. This application must be completely filled in by typewriter o¢ in ink and submitted in triplicate to the Building Inspector, with 3 set9 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 what, ever 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 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, os herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, one, regulations and to admit authorized inspectors on premises and in buildings for necessary inspections. ..... (Signature df applicant, or~/rmme, if a corp~f:Jation) .... .~...~.~c~.... ~.).......~..~¢. ~. Z...fl~.~:ct?. Z~ ::v.~... ~.. f~ ....... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............. P..~.U.!~.../.....L;.~..~. ....... (.b..e'.~..~.~.c.,.-:~_ ................................................................................................................... Name of owner of premises ...~V.l.~..~/.~)......l~. ...... ~......~.~.~.~.....~.....~,~.~lu. ................................................ If applicant is a corporate, signature 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 ............................................... Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number .......................... .~ ................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ........ ~.~.~..~. ........... i .................................................................................................. b. intended use and occupancy ....... ~.~..~. ............................................................................................................... 3, Nature of work (check which applicable): New Building., ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ...,.?,I~.'.~..(.~..O;?.!.R..~ ................ (Description) 4, Estimated Cost ~/.:~.f?.~,...,~..~ ............................... Fee (to be paid on filing this application) / 5. If dwelling, number of dwelling units ............................ Number af dwelling units on each floor ............................ If garage, number of cars . . .~.. ............ ~..~..~:.w. .................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ,Z D ' ~tOeo/ Rear ..... '~.;~......~;...W..~..,. Depth ..0..?...~..~.~?ltF) Height ..~.2...../3~.....~.x4.. Number of Stories .............. ~..~. ............................................................................................ Dimensions of same structure with alterations or additions: Front .... .?.f~?~ .................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8, Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... ~ /~c~-'-~ /~ . ............................... 9. Size of lot: Front .................~ ............. ~../~...../~.. ............. Rear .......................................... Depth 10. Date of Purchase .....A/...~..0.,.,,~,3. ......... /...fl..'~.~ ............... Name of Former Owner ..,l~".*?.~{.5.~,...,~:.,..e.~.:.5,{~.~ .............. 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 premises: ( ) Yes ( ) No 14. Narne of Owner of pram.sas .W....~....~ ................ .~..,...q0:f...,~: .... Address ................................ Phone No. Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from or description according to deed, and show street names and indicate property lines. Give street and block number G~;~'~J0 PO whether interior or corner lot. ~,,h~x~.~,....5.~m~.,~~~ .......... being duly sworn, deposes and says that he is the (Name of ind~ual signing c~r(cf) above named. (Contractor, agent, corporate ottJcer, 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 oil statements contained in this application ore true to the best of his knowledge and belief; and th, at the work will be performed in the manner set fo~h in the application filed therewith. Swor,~ to before me this ~ ~ ~ z {Signoture ~ applicant) NoD~ PuNic, State 0f New No. ~24730350 ~uahfl~d m Suf/~k g0tmty ?~