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Home My WebLink About9652-zFOI~M NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office South&d, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at ...i~0..Sun,.et. ~.~. ......... Street Map No ............. Block No ...........Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated . Flarch.. ~.~ .......... , 19..7.6 pursuant to which Building Permit No.. 965.2Z.. dated . ?p?.i.l.....~ ........... , 19..7.8., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .....Rr~va~e. O~e. ~ ~y ~.. 1.1~g. with Addition ........... The certificate is issued to ........... Jotg~ .Go~r~ley ............................... (owner, ~ of the aforesaid building. Suffolk County Department of Health Approval N/R UNDERWRITERS CERTIFICATE No ........ 1~3.9755.8. ............................ HOUSE NUMBER ..... 4/~0 ...... Street ........ 5Un;s.o,~. }'f.ay. ...................... ..................................... , ........ .Z.o..r.k. Building Inspector FO]~M I~0., 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT 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? 9652 Z Permission is hereby gm,ted to: ....... at premises ocoteo at ................................................ :~ ................... i. .................................................... .............................. '7' .................................................. ','~ ........ "5,'- ........... ~';:';: ........ r' .................... to opplicotion doted ................................ (./,'.7 .~... ....... '~r"', 1~)'-/'"~', ond opproved by the pursuant Building Inspector. Fee $ ........................ Building Inspector FOR*M NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office So~thold, N. Y. 11971 AFPL~GAT~OH FOK GERTIFiCATE OF OCCUPANCY Jnstruction~ A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of ali buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposaI--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildlngs 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 o~ property showing oll property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, ~ccuponcy 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 SB.O0 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 New Building ................. ^. Old or Pre-existing Building ........'......'~. ............. Vf~cant Land ......., ............ f~ .... Location Of Property ..~.-...~... ........ 1...b..,~....:.~.....~'-'~'~.~'''~''''' '~''''''''¢ ~ Owner Or Owners Of Property ......~-/~.~...-'.~..~.,,.....~.....~~..~'C'x * 4~/' ' : .................................... (J Lot No. "['~'~'~:'~c~ ,),ack ~o~.....,D ..... House I~1o ............. Subdivision Permit No..~....~...~.. ~.ZDate Of Permit(~..~.~..'~..~.Applicant ~"~,'a~l '" ,~,';' · "~"*" ~~ ........ Health Dept. Approval ............................................ Labor Dept. Approv .......................................... Underwriters Approval 1..~..~....~ ........................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ~,~...,...0...~ ..................... Construction on above described building and, pe~nit~,~ meet,~s all ~ol~icable code~and~ regulations. ...... .............. ........................... Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY [-- A~gust 10, 19785 JOHN STREET, NEW YORK, N~0Y~K 10038 ,,o,e .,,.,~,,c,.,,o. No. ... /,,. N39755,~ THIS CERTIFIES THAT J.Gormley, Sunset Way, Son,hold, L.I. 162 OUTLETS ECE CLES SWITCHES INCANDES NT DRYERS FURNACE MOTORS I FUTURE AKIUANCE FEEDERS ~CIALREC'PT SERVICE DISCONNECT NO. Of S R ~.. ,. w. o. glec. room heal:e:s: 2-2.0,2-1.75, 2-1.0k~. TIMECLOCKS BELL UNffHEATERS MULTI-OUTLET SYSTEMS Aj~T. A,~pS, TRANS, NO. OF FEET V I C NO. OF HI-LEG A, W, G. OF HI-LEG SXHAUST FANS AMT. H, P, DIMMERS ANAT. WATTS Gene Heacock Cedar Beach Rd. Southold, L.I. 1.1971 lic. 943E [his certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified cOPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ~amin~ .................... ~'v'"'~' 19~:' Gg ~ 2 ~ ~licati~ .~ .................. ~ .................................................................. ......... {~,m~ ig~g;i .......... ~ ~ ~ ~ g APPLI~n~ mR mulmmN~ PE~IT ~ / ~ 7 ~ _ ....... .......... , IN~RU~I~S ~ a. This a~lication mu~ ~ complexly fill~ in by ~ewriter oe in i~ a~ s~mi~ in triplicate to the Buildi~~ Ink,tar, with 3 ~ of pl~s, ~cum~ ~ plan ~ ~le. F~ occo~lng to ~h~ule. b. Plot plan shying I~ation of lot and of buildi~s ~ premiss, relationship to ~jo n ng premiss or pub ic str~ o~ areas, and giving a detail~ d~ription of I~ ofpr~e~ must be drawn ~ the di~ram which is ~ of this application., c. ~e work c~er~ ~ this a~licatJon m~ n~ ~ commenc~ before i~uance of Building Permit. ~ d. U~ appel of ~is a~lication, ~e BuJld~ In--tar will i~ue a Building Permit to the app cant Such perm~ shall ~ ~t on the premises ~ilable ~r in~t~ ~gh~ ~ ~r~ e. No buildi~ shall be ~cupi~ or u~ in ~ole or in ~ ~r any pu~e wh~er until a Ce~ificate of ~cupancy shall have ~en grant~ ~ the Building Ink,tar. APPLI~TION IS HEREBY ~DE to the Buildi~ ~ment ~r ~e ~uance of a Bud ng Pe~ t pu~uant to the~ ~uild?~ Z~ O~inance of the T~.o~ ~thold, ~ffolk Count, New York, and ~er app cabe ~ws, O~inances or~ ~egu~at~ons, tar the constru~ion of budd~s, add t ~s or a ~mfi~s, or for m~a or demolJti~, as heroin d~ri~d.~ ~e applican[ agr~s ~ comply with all a~licable I~, ordinance, bu ding c~, h~si~ c~e, and ~ulati~s, a~ ~ admit au~nz~ i~to~ on premiss ~ in buildl~ ~ ~e~ J~t~s. ~ ......... . ....... . ............. ......... ~/(S~gnatu~of a~hcant, or ~me, if a co~mti~) .................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................ ~.~.~.~.6~ ................................................... . ..................... Name of owner of premises ...... ..~. ~.:......~D. kf ./~.......(~.(~.~..~..~,~...V.. If applicant is a corporq~, signature of duly authorized officer. ~/ (Name and title of corporate officer) Builder's License No ........................... ~.~.. ................ /880 -- P/ -- /- ~'/ , Plumber's License No ................................................. Electrician's License No. Dud 'r~ ~ Other Tmde's License No ............................................... 1. Location of land on which prggosed work will be done..Map No.: .............. .~...C~. .................. Lot No...g.~...,~,~, ......~ P~ ~ ..... Street and Number ........... ~1~ .......... .-~....,..~1~.: ........ ..~.~..,.t~..'~.,.~9..~=.,~.~ .......................... , ...... ~ ¥ff0 .~p- Oo~. "' MuniciPali~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy [ ~/v~,-~ c~ b. Intended use and occupancy ......................................................... ~ ............................................ : ................. 3. Nature of work (check which applicable): New Building-. ................. Addition ....... ration ................ Repair .................. Removal .................. Demolition ................... Other Work ................................................ . .... ~ ~, (Description) 4. Estimated Cost ...........~z,.,~.. ....... r ................................. Fee ............................................. t ............................................ (to be paid on filing [this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on ~ach 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 ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: I=ror~t~:., ........ ~...-..,0. .............. Rear Depth Height .....I.~.~.Z.... Number of Stories..~:~.:~ z~ ........ - ..................................................... ~, ............................................. 9. Size of lot: Front ........................................................ Rear ......................................... ~Depth ................................ 10. Date of Purchase ........................................................ Name of Former ~ner ........... j ............................................ 11. Zone or use district in which premises are situated ........................................................ ~ ............................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ........... J ............................................ 13. Will lot be regraded. ........................... Will excess fill be removed from premises: ( ), Yes ( 14. Name of ~ner of premises..~R~ .............. A~re~ ....... Ph~e No. Name of Architect . Addre~ . , Ph~e No ................... ,~.. , No Name of Contractor ~ .... ~ ................................ Address~ .................................. PLOT DIAG~M , Locate clearly and distinctly all buildings, whether existing or proposed, and indicate a~l set~k dimensions fro~ prope~y lines. Give street and block number or description according to de~, and sho~ street names and indi~fe whether interior or corner lot. (Signature of dpplicant) No. 52-4643721, Suffolk C0u[l~ty... '{erm Ex;,hes P~arch 30, 19~Z.~ Nota~/~ublic, . .........~ .................................... County /~ /~'ARY E. DAWSON NOTAR~PUSLIC, State of ~ew Yo~ STATE OF NEW YORK, [ c ¢ ~ COUNTY OFr~.-...~ .................. '~..' ~ ~ ...................... ~...... ~ . . . ~ .................................. being duly sworn, deposes and s~ys that he is the apphcam (N~me of individual signing contracf) above named. I He is the ......................... ~t~ I .~).~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 m~ke ~:bnd file this app cat on; that a statements contained in this application are true to the best of hi~ knowledge and belief; and thor the work will be performed in the manner set forth in the app cat on f ed therewith. Sworn to before me this _ - · ......of ............................ , r4 APPROyED ~.S NOTED ~AT,, f/~/7 ~_.~___ . ~,IgTIFY BUll. DING DEPARTMENT AT /65,2660 9~ to 4PM FOR REQUIR- ~ INSPE~IO~: I. B~E BACKFILLING FO~DA- T~ON OR STABT ~AMING ~., FRAMING I~SBECTION :. BE~R~ cOWRIm~ _P~__ ,_~,~mm~ :,, OR CONSTRU~[~ ~, ~ C~STRU~N ~ST M~ ~QUI~NT~ C~ N.Y. STATE CO~E ~,I~-~ TOWN ~Q~G CO~& Z~i~G /- ?,~£- /377