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Home My WebLink About9649-z FORM NO. & TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No..Z?. ,~.9. ..... Date ...D.e.~..e~..b.e.r.... ~. .........., 19..7..8 THIS CERTIFIES that the building located at .~.0.~.. Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ....H..~..c.h.,,. 2.8. ...... , 19. ?.~. pursuant to which Building Permit No...9~.~.9Z dated ....N..~T..c.h. .....2.9 ......, 19...7.~ was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for whi,~eh this certificate is issued is ........ ~.f,¥~,~;e. 0~e .F~d.~,y. D~ge~l,~ ............................... The certificate is issued to ........... Chal-~,e~. P+ .~nol~soll ....................... (owner,~ of the aforesaid building. Suffolk County Department of Health Approval .... ~.~.50.-20... I~ovz~nbel UNDERWRITERS CERTIFICATE No ..... N.~'~.~ ..................... f ........ HOUSE NUMBER .... ~0~ ..... Street ......... ,~11. Lane. ........ ../. ......... /\ / ............................................~,~'~ ./~ ~'e,oFl~ (~,, ]~8W/?Zo~; .......... 1000 6'7 ~U~LDING D~*~T~N'r · 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? 9649 Z Permission is hereby granted to: C/~t,. ? / ? q ? 'T,/~~/,.~ 7:S~'/, ) at premises located at .................... J..~..>~.:~ ............. ?~..~.~..t: ......... ]:..~..~.~ .................................. ................................................................................ ~' [. ~ Building Inspector. Fee $ ........ :'g.. ............ TOWN OF $OUTHOLD , Building Depmtment Town Clerks Office $outhold, 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-0 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 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 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 $l.00 D te ............ New B~ilding ...... 1 .~......-- Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ......... .~:.~...Z~,...&..~&~a,¢ ........ ~.:v.f,.~.:.%.~..~ ...................................................................... Owner Or Owners Of Property .......... ~.,..~.,~.~../..¢~.¢~ ...... :~..~-..../.../~.O,~<~f.~.qO...~.~ .............................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No, ,,.,~,,~,~¢.. Date Of Permit ' Health Dept. Approval ,,/Jy/Z~.Z.~ ....................... Labor ~pt. Approval ................................................ Unde~riters Approval ../Z/D:z~Z,~ ........................ Planning B~rd Appr~al ........................................ Request For Tempora~ Cedificote ........................................ Fin~ Ce~ificate .......................................... Fee ~bmitted $ ..................................... Construction on above described building and permit meets all applicable c~es o~ regulation[~ [[ ~ ....... ........................ Swor~ before me t~s , THE NEW YORK BOARD OF FIRE UNDERWRITERS ~f BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEWi*YORK 10038 THIS CE~IFIES THAT Ch~e8 F. Thompso~ ~111 La.~ booth ~d.~ ~e~o,llo~ ..I. in the follmelng ;ocatioa; [] Bas~ment [] 1st Fl. [] ~nd FI. ~ectlon Block Lot tvas examined on ~Ov~mbel~ 16~ ~7~ and found to be in compliance with the requiremeflts of th~s ~mrd. RXTURE OUTLITS SWITCHES 31 39 29 RXTURES RAHGES OVENS 31 SERVICE DIS~NL~I' 1-Smoke Der ectoI' llte~ EXHAUST FANS DIMMERS Mike Gilt.Is P.O, Box 6~ East ~4aPlon. L.I. 11939 hio.617-~ 11 P~ This certificate musf not be altered in any manner; return to the office of the ~oard if i~correct Insl~ctors nm), be identified by their credentials. _ DIPARTMENT~ THIS COPY_ OF CERT!F_ICAT_I M~U~NOT BI ALTEBID IN ,AN~.J~.~_ FOKM NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. .................. ~._~......T...../., 1~ ........ _ __ Application ..................... i roved................ No ....... ..... ...... .............. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter o~ 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 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 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 o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, 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 necessary inspections. (Signature of applicant, or'name, if a corporation) :.C. ..~. ..../. '.~.,r:.(. .... . .~,,.~. 4.o. Z~ ....... /. ~.,. ~ ........... (Address of applicant) / ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. owner of premises ....... C>~/~.r;,.~r.,./,?,.~,~:.....~....~...~.~..~r~./~..~..~..~... ............................................................................... Name of If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ...... /...C2.~.'.~...:~...~.. .................. Electrician's License No ...... ~../..~..z:.~/~z~ ................... Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number ........... ~.'..~./.././.....~.~.o~.~.~ ................................................................................. ,..-.~.¢?..~!.,~.~ ...... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: ....... ~.~..~.~,~.~...,4.~.~../.~::~.~...../.~.z(., ........................................................... Exisiting use and occupancy O b. Intended use and occupancy ..... .~..~..~.~..(~),zz./.......~..~:~.~.c.:.~.~. ........................................................... 3. Nature of work (check which applicable): New Building........~..... ..... Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................... (Description) 4. Estimated Cost ........8,o,/~y...A..0..(2..f~. ........................... Fee ......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... /.. .................... Numbcr of dwelling units on each floor ..... , ...................... If garage, number of cars .......................................................................................................................................... 6. If business, commercial or mixed accupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, iF any: Ftor,t ............................ Rear ................................ Depth .................... i-leight ........................ Number of Stories ............................................................................................................... Dimensions of same structure with olierations or c~dditions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of S[ories ................................ 8. Dimensions of entire new construction: Front ......... ~'..~- ................. Rear ...... ~'~..¢~. .............. Depth ....,~...-7. ........... Height ...~.~.. ......... Number of Stories ............../.,~, .............................................................................................. 9. Size of lot: Front .......... ,.%,,,2~.,Z ................................... Re(ir ....... ,2~.2~../ ....................... Depth ....... /....~../. ............... 10. Date of Purchase ...........;2../../L¢?./..7...~. ....................... Name of Former Owner ....~'..RC.,....~,~c~c4Z~4;...~l,. ................... 1 1. Zone or use district in which/rpremises are situated ....... .xS.¢.¢,,'.¢~.e~.~.~.'¢¢ff,./ ............................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ...... ~',',',ZO. ........................................... 13. Will lot be regraded ..... /.~Z~ ................ Will excess fill be removed from premises: ( ) Yes 14. Name of Owner of premises .....C'~.<~¢~..../~..zs.w>~.~c~ .~...... Address .~..~.~,3Z,/~ ./~'.. ...... 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 frorn property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YOP, I<, COUNTY OF ................................ ................. ~..,~.~../c,,.d.......,~7~.,.._.../.~..C..~'~.,¥Cq...v~. .................. being duly sworn, deposes and says that he is the appficam (Name of individual signing'contract) above named. He is the .................. (~.C¢~.J,~?~!.. ................................................................................................................................... (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 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 application filed therewith. Sworn to before me this .... ~ ........ day of ....~0-~ .................. , 19k~.~'.. Pub,,c,. ............. ........... Co,n,y ...... ........................ O ~ ~l'~. k,_~~ (Signature of applicant) ~#O.~:J~4853§OB, Suffolk CoanPJ Tram Exp~Tes March 30, 19~'/~ "~t,T~o2a( cOU~ ~ALT; D~ARt'~aZ The sewage disposal 2nd water supplF f[,ci]itJ~,s for this location have beech ln~p~cve~, by this department ~nd fo~d to be satisfactory~ ~ ~ ~' ~' N 0 / IIOOBIMC:K VAN T~/L.. P. ~. x I~ C,~I~IENT 2AT/O I<I 7TQNEN PO cK~T ~ £1VIN¢ IfboM . I$ ,6~ ,SCALE I$~/1" 16' 0." /~ 7:: :~:~ .~M fo 4PM FOR REQU R- ED INSPECTIONS: 1. BEFORE BACKFILLING FOUNDA- 2. FRAMING iNSPECTION 3. BEFORE COVERING PtPZS OF ANY KIND 4, FINAL WHEN JOB COff, PLETED NOT RESPONSIDLE FOR DESIGN OR CONSTRUCTION ERRORS -f-/-/OMPSO N CH,qRL£..S f ~¢0 ? 6, T U./{ E H /¥ 0 5Z' 0' /7O I,? 7 /v'OUNI)hTION ,~NL~ ,~/')S£ME'NT- CH,qRLE..C ~ /:lZ. t C/,q ~-Ho n,~ ?S ON l I ! I I I I 'Y/fO/vl P,~ 0 FL