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Home My WebLink About9647-zTOWN OF SOUTHOLD BUn.nlNG DEFARTU~'T Town Clerk', Oliie~ Soud~old, N. Y. Certificate Of Occupancy THiSCERTiFiESthatthebutld~wslocatedat 11712 :)r~,,~&~,o .~.~. '~ Street . .~..:~. - ~ Map No ...... Block No. .Lot No. ~/~' ~ ~ conforms substantially to the Application for Building Permit heretofore fled in i~i* office dated ....... ,~//~... ~., 19/./.., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is '~' ~'~'~/ .../~t'.. ........ ~ ...... ' ....................... The certificate is issued to ........................................................ (owner, of the aforesaid building. Suffolk County Department of Health Approval /t/~ . UND~RWRITEES CERTIFICATE No ............................. ,~ous,. ~,.,.,m=, (.,. y..o ....... s~ ....Cf~.'¥.~f. ~..5 ...... .:f~.,. ...... o~d 7 /¥r2L ~ Blli]dlng Inspector BUILDING DIPA~.TM~NT TO~,I CLERK'S OFFICE SOUTHOLD, ~ Y. BUILDING (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9647 Z Permission is hereby granted to: at premises located at I ( -~ (~ ~'-t(/^~DE/,'~ ~A~'H pu~uant ~. a~li~tion dat~ ~ ~ i~ ~ 7 7~ ........................................................ , 19 ........ , a~ a~ by ~e Buitding In~t~. Fee $....~ ............... Building Inspector FO~M NO. S TOWN OF $OUTHOLD , Building Deportment 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, end 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 Cede 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 ]957), Non-conforming uses, or buildings end "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 prepere a certificate. C. Fees: ]. Certificate of occupancy $5~00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $].00 V' ....... .......... .... New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..... ..~...o...~...~.~.~ ........ .~.....~...?'...1..~'.. ............ ...'~...o..?.?T..../~.e...~.~.. ........... .~..;..~.. ................ Owner Or Owners Of Property ............................. .~... ................... ~ ................................................... Subdivision ................................................................ Lot No. ~..~..~...~ Block No ............. House No...//.~.?.... Permit No.C~...~...~.~,....Z:.. Date Of Permit ...~..~..?/~?...Applicant . ~.~..~'.C, .......4~'.~.~......'.~...~.. ......... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Bcx3rd Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. App cant Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY r- 85 JOHN STREET, NEW YORK, NEW YORK 10038 ,eJune 7. 1978 N389 2 THIS CE~IFIES THAT Alex ~. Elak, rounae~s rains s/w/~ ~n~on ~ne, ~ou~noza~ ~.~. inthefollowing~ation; ~ a~e~&t ~ IstFL ~ 2nd Ft. outside ~ti~ w~exami~on June ~1 ~gT~ a~found~incomplia~ewitht~r~ui~ntsofthb~. RXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUE~E~CENT OTHER A~ARATU~ Panelboards: ]-~clr. 1 (Swimming Pool) This inspection only. to have frequent OF CC. COt4D. C 100 amps certificate covers compliance at the date of Decause of unusual environments it is advisable test and/or repairs msde by a qualified person. Paul Burns Town Harbor Lane Southold, L.I. 11971 Llc. 282E ~ 1 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN AHY MANNER. FOR~I NO. It TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned . . ~...~f] ~'~ 9 L/7 Disapproved a/c ............................................................................ ......... ~' ................... i'~'U ilding Inspector'~'""-"~ ............................. APPLIC*TION FOR "UILDING PERMIT ........ ............ , ..... INSTRU~IONS a. Th~s opplicmion must be completely filled in by ~ypowritor o~ in ink end submitted in triplicate to tho Buildln~ Inspector, with 3 set* o{ pi*ns, accurate plot plan to ~1o. F~o occordino to schedule. b. ~lot plon showin~ loc~tion of lot end of buildings on promises, relotionship to ~d oinin~ premises or public streets or~ oreas, *nd Oivino ~ detoi ~ description o{ ~yout ofproporty must be drown on the dio~rom which is po~ of this opplic~tion.~ c. The work cowred by this opplic~tion may not be commenced before [ssuonce of Buildino Permit. d. Upon opprowl of this opplic~tion, the Buildin~ Inspector will issue ~ Buildin~ ~ermit to tho opplicont. Such permit shell be kept on the premises *voiloblo {or inspection throuohout the work. e. ~o buildin~ shell be occupied or used in whole or in port for ony purpose whatever until ~ Certificote shell hove been ~ronted by the Buildino Inspector. APPklCATIOM IS H[R[BY MAD[ to the ~uildino ~ep, rtment {or the issuance of ~ guildin~ Permit pursuant Buildin~ Zone Ordinance of the Town of Southold, Suffolk County, ~ow York, end other ~pplicoblo kows, Ordinances or~ Regulotions, {or the constru~ion o{ buildlnos, odditions or ,lterotions, or for remove! or demolition, ~s herein descrlbed.~ The oppHcont o~rees to comply with oll ~pplicoble laws, ordin*nces, build~n~ c~o, h°us~no code~ ~nd reoulotions, end to~ odmit outhorized inspectors on premises end in buildings for n~ess~ inspections. ............ ...... .......... ........ (S'~no/uro of opplicont, or name, ff ~ corpor~tlon) ....... ~.~.M.'...~ .................... ~.., .................................................... (Address of applicant) State whethe~ applicant is owner, lessee, o~ent, architect, engineer, ~enerol contractor, electrician, plumber or builder.~ ~ o~ ow.~ o~ ~mi~ ....... ~]..~.~.~. ........... ~..: ........ ~.....~ ......... ~.~.: ....................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No Electricians License No ............................................. f~_~¢~. ~Z~.~ /.1L.,q. ~ L/::_~ ~ Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ...................... Lot No. ...... .,.~,~ Street and Number ...... , T/E'~.2..~.~.,~.,~...'C. ............ .~. ,~..~...~.. .......................................................................................... ' 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 ............. '~..~...~..f...~.zJ..~....~'.. ............ ~.~i.~ ..................................................................... property lines. G-Ne street and block number or description according to deed, whether interior or corner lot. 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior, ................... Other Work .°...~...~.?....~..~.~:.c. ....... f.~.~..~.. ...... ~f ~,x)/ (Description) 4. Estimated Cost 660 .............................. Fee I ~ (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, ,,,pacify no[ure and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ........................... Rear ................................Depth .................... Height ........................ Number of Stories ............................................................................................................ Dimensions of same stru~,ture with alle~ations or ,~ddidons. I mat .................................... Rear . ........................... Depth ................................Height ...........................Nu,'nber of Stories ................................ 8. Dimensions of entire new constructions: Front ............... , ............ Rear. ........................... Depth ........................ Height .................... Numbei of Stories ................................................................................................................ 9. Size of lot: Front ....................................................... I)-c)a~ ......................................... 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 ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. 1'4arne of Owner of premises ..~.~.~.q ..... ~.~ ...... ~.6.,/~.].6. .......... Address ~'~.~ZEL4.~..D. .......... Phone No..~.~...~...q..2.~.~.~/. Name of A~chitecl' .................................................... Address ................................Phone No ....................... Nome of Contractor .............................................. Address ................................Phone No ....................... H_LYf DIAGRAM Locate clearly and distinctly oil buildings, whether exisling or proposed, and indicate all set-back dimensions frore and show street names and indicate 5TA-i'E OF NEW YORK, COUN'TY OF .................... .~. ...... ..................... :...~ ................... ~ ~ ~ ................. hein~j dnly sworn, deposes and says fhct he is the applicon1 (Name of individual signing contract) above named. (Contractor, agent, corr~orc~fe 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 all statements contained in this application are true to the best of his knowledge and belief; and thfl~ the work will be performed in the m~nner set forth in the ~pplication filed therewith. Sworn to ~e~ore me this