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Home My WebLink About10187-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No ..... .Zg.~.SQ ....... Date .... &Uglll~:l;. 2.~ .................. 19 '79 THIS CERTIFIES that the building ................................................ Location of Property ....~.~.~.0. ...... .Br.~.d.g.e' .L.a.n..o ...................... Cu'l;chog'u~ .... House No. Street Hamlet County Tax Map No. 1000 Section . .~./4.. ........ Block .... .0,~ ......... Lot ...05 ............ Subdivision ......... J{~ ................... Filed Map No .... XX. · .Lot No... ~ ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...Ap.~.~.~. ~.I. ......... , 197.?).. pursuant to which Building Permit No...10.~B.7. ............. dated . . . .g'P?.]:.~.. ~ ............... 19 79. , 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 ......... A~l.~.tion. · .~o. 9.n.e...fv.a.m.l:.]:.Y..D.w.e.~.n.g ..... enc.~osed: ~atio ..................... The certificate is issued to .... De~t~z~es .~A.'gohe~. [~'~n'~~ ...................... of the aforesaid building. Suffolk County Department of Health Approval ........... IXl/.t~ ............................ UNDERWRITERS CERTIFICATE NO.../455 .'1.3. ......................................... Rev 4/79 Building Inspector TOWN 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) No. 10187 Z Date ........................................................ , 19 ........ Permission is hereby granted .................. at premises located at ................................................................................................... ;:z ..................... pursuant to application dated ....................................... , 19.../..., and approved by the Building inspector. Fee $ ........................ i~o- £¢- ~- . .................. ~(41. ................................................ Building In~ector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION'FOR CERTIFICATE OF OCCUPANCY Instructions 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. Fees: 1. 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.O0 Date ...A?.~.e.~..3...~t .3,~'~) ......... New Building ............. Old or Pre-existing Buildin~,~, ~?.~ ..... Vacant Land ............. Location of Property .4..4.3.0. ~.~.~ .b~..~.~e... ~.tt.~.~.~.O.~,e, .~',~. ,~? ................................ House No, Street Ham/et Owner or Owners of Property A.~.q~.e..~ .~.~, .A .~.~.o.~?.e.~.~.e..~e,~]~ .:Ii? .~ ................................ County Tax Map ~lo. 1000 Section .. ?..4 .......... Block ,..~ ............ Lot..~ ............. Subdivision ................................. Map No ............... Lot No ............... Permit No.].O],~l?. Z... Date of Permit .4./.2.3/77...Applicant . .A.~.~.~.e.s..~..~e.a.~.~.e.e. ................ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certifi.c,~te ..................... Final Certificate ....................... Fee Submitted $ .~,,, ? ....................... Construction on above described building and permit meets all a~pplicable codes and regulations. App~cant ..; .............. =..'...~; ......................... Rev. 10-10-78 ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ ak . BUREAU OF ELECTRICITY ~,~ September 28, 1972 ,lpplic.tio.~oo,,~le 579374 Atche~ L. Desp~es, e/o B~dge Lane, s/o No~th itvthefollotvingl~atiott; ~B~etnent ~ lstFI. ~ 2nd FI. Outside September 25, 1972 andfou~tdtobeinco~npliancetvlththerequiren~entsofthlsBoard. FIXTURE *T FIXTURES RANGES OVENS EXHAUST FANS -10'- ~ 39 8 i0 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS DIMMERS SERVICE DISCONNECT S E C OTHER APPARATUS Motor/s: 1-1/2hp *Furnaces: 1 R V I AWG OF HI tEG FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Disappmvcd~/c .............~ ....................... APPLICATION FOR BUILDING PER~IT' Application No. J.( .0. !...~..~..... INSTRUCTIONS' a. This application must be completely filled ~n by typewriter or in ink and submitted in triplicate to the Building Inspector, wi~h 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 or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Bmlding Inspector will issue a Building Permit to the apphcant. 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 pnrpose whatever until a 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, as here~n 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 necessaw inspections. · .4430 .Ba~i~ge. L~,,...C.a~ohogue.. I~o Y,. 11,5~3~5 .... (Mailing address of applicant) State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .D.e.s.p. ,re..s..3..t .o.h??...~...{ .~. f. .... 9~.e.r.s ........................................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duty authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No...1. O. 1.3'-.p~ ................ Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ................................................. ·. A~30 .l~r~lge. iua .... 4;.at;chogae.. t[~,~, .... ]-.J~935 .............................................. House Number Street Hamlet County Tax Map No. 1000 Section ~' £/ Block '~ Lot.,. Subdivision .................................... Filed Map No ............... Lot ............. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ol0e~:, p~io ....................................................... b. Intended use and occupancy ... ?n. 9.19.s.eg. ,p.~.,~.,i.q .................................................. property lines. Give street and block interior or corner lot. 3. Nature of~vork (check which applicable): New Building .......... Addition .~ ..... Alteration .......... Repair .............. Removal.,, .............. Demolition ...~ ........ Other Work .~.~.q* P. ~. ! .r/~ . .(D escr ipt, on 4. Estimated Cost ..... '~,~QQe, . p~,¢,~. ~h.o.~.. ........... Fee ...................................... ' (to be paid on filing this application) 5. If dwelling, number of dwelling uhits., erin; ......... Number of dwelling units on each floor..one ........... If garage, number of cars .... ~/o,. ................................................................ 6. If business, commercial or mixed !occupancy, specify nati~re and extent of each type of use mo~ ................ 7. Dimension~,~f existing structuresi if any: Front., .6.6. *. .........Rear . .6.6.~.'. ........Depth Height ............... Number of Stories ........................................................ Dhnensions of same structure wi~h alterations or additions: Front . 6~*. ............ Rear . 66*. ............. Depth . .37'!-6':....fi./. t..q.'~. · i. Height ....~ .................Number of Stories.. or~e~ ................ 8. Dimensions of entire new constnlction: Front . . .6~ ~. ......... Rear ~.6~. ........... Depth .3'~ *.-6". · .~./. ~. ~.'. H.eight .... ~.~ ......... Number of Stories .... o.~q ................................................. 9. Size of lot: Front . .:L.35.~ ...... i~ .......... Rear . .~.I .~ ............... Depth 379, .74. .....36~,47/' ..... 10. Date of Purchase . ...g.;O.E~.l..1.~(~. ............... Name of Former Owner . . .1:~ .1~1~1~1~$. ................ 11. Zone or use distr!ct in which prehtises are situated ..................................................... 12. Does proposed construction wolate any zomng law, ordinance or regulation: . ,~o ............................. 13. Will lei'be regraded .... Ilo.. ,. .................. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises lt.~$p:ee~. ~',&~£:, ..... Address 4430. b~id~, .I,~ .... Phone No.?,3e~'~3tO~ ........ Name of Architect .......... ~ ................ Address ................... Phone No ................ Name of Contractor ...z.~.~.~.'.. 1 ................ Address . 4~-30. b~,~..d~ .h~... Phone No.~3/MT~30~ ....... PLOT DIAGRAM Locate clearly and distinctly all ibuildings, whether existing or proposed, and, indicate all set-back dimensions from rumber or description according to deed, and show street names and indicate whether , I, trru?sk/ STATE OF NEW YORK, COUNTY OF .......... S.S ...........--------//}.~..~../~, .~,~..-- ~'... , . . . . . . . . . . . . . . . . .',D ~ --~/~"~--~ being duly sworn, deposes and says that he is the applicant ' (Name ofindividuai sig~ing contract) above named. He is the .................... . .................................................................. (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 con~ained in this application are true to the best of his knowledge and belief; and that the work will be performed in the man,er set forth in the application filed therewith. Sworn to before me this ............... da ............. ,19 ... County Notary Publi cl.,.~*~.~ rx~lr~ ~nrch 30, 7~ (Signature of applicant)