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Home My WebLink About10279-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. y.9.6..~? ........... Date ...S?p.~.o..m.b?.z:. 2../4 ................. 19.7.9. THIS CERTIFIES that the building ................................................ Location of Property .l.~ ? .0..H?.~. ?~.e.a..d. ?.a.¥ ........................... .G.~ ? ?.n.iqo?'. ~ .... House IVo. Street Hamlet County Tax Map No. 1000 Section . .O.l~.O. ....... Block .... 2. .......... Lot ..... ~..~ .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... d'.u:O e..'1.(5 ........ ,19'9.. pursuant to which Building Permit No ..... J .0.2.~..~ .......... dated .... ,.Y.u.n.e.. 8.6 ................ 19 .V~., 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 issued to Rober'c ~;ril'tse ..................... ...................... of the aforesaid building. Suffolk County Department of Health Approval ............ ~.-~.0.-.~..~ .... 9. ./ .'l .T. /. ~. .9 .......... UNDERWRITERS CERTIFICATE NO .................... ./5~5Q ~. ....................... Rev 4/79 Building Inspector TOWH OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10279 Z Permission is hereby gronted to: .... ~'g:Z'-7 '2,:,'~'~ ............. · .~..~....~.//.z ...... ~.~.~.;..~ ~ ..... ~~ ........ ~.~.r~ ............. ,o ...C~~o~.....~..~,~.?~...~..~...~,~...~.///~ .......... ................................... ~"'~"'~:~z:'~'y"~Z~"z~7 ................................................ at premises located at .~.....~.~.~.~.~ .... ~ ~,~ ...................................................................................................... ~~%...u,.~ ....... ~rs~nt to ~ppli~tio~ d~ted ........... :D~'~ ...... ~ .............. lt.~.~, and opprove, d,. by the FORM NO. 6 TOWN OF SOUTHOLD Building Depai i,,ent Town Hall 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 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 $5.00 .ete.. ...... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ....... /90 ~? /~ ~. ~/~//z /J .L~.' ................................................... House No, Street Hamlet Owner or Owners of Property / / County Tax Map No. 1000 Section ''~7~ 0 Block .............................. Lot... ............. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No........../~ 2 ? ~.~OateofPermit .;..: .... ./Applicant.......... .. ff. (: 4.: ........ ...................... ~ ~or T~ore~ ~Jficate ..................... FJ~I ~Jficate ~ s~i~ ~...~.~.8 .................... Construction on above described building and p~p~rmit meet~,~ll a~.~. lc/able codes andj__egulation~ ~pp~cant. ~ .... ; ........ /. ~...; ........................... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRI~IT~ ', .... , ~ ~5~OHN STREET, NEW YORK, NEW '~' in the following I~c~ation; )[] Basement [~lst 1;7. FIXTURE OUTLETS IECEPTACLES 29 [~ 2nd FI. Section Block Lot and found to be in c~mpliance with the requirements of this Board. SWITCHES FIXTURES RANGES OVENS DISH WA~H~"=.~ EXHAUST FANS DRYERS SYSTEMS S E R OF CC. COND C OF HI LEG ~. Th,s cerhflcote must not be altered in any manner return to the off ce of the Board ~ lnc&rect ns~ecto ............. 7 ~ . ' ~FOBM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMEN¥ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ....... .......... ..... ..... ~ ,~ .... %[ ............. ~~toO ' ........ APPMCATIO~ FOR BUILDIN~ PE~IT ~ ~ ......................... ~ ~ ............ C~%X,~~ INSTRUCTIONS a. This application ~-ust be completely filled in by typewriter o~ in ink ar~'_..~, trod in triplicate to the Building x!Lr~o~ ~i[h~ 3 sete OTTpft~-J~'~/ratecolotCelan to scal~'~~j[.' x~ ~ b.-"PIc~t~l~'n showing locat~ 6~l~io~'\d~'~uildings on premises, ~~o~'~joining premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram Which JS part of this application. c~c. The work co~e~;~t~i~c~l~J-[cot~n, may nat be corr~en~for~i~sub-'~e~f B~l'~llJing Permit., ~.\ u~c~r~K~pprovc~l ~ t~is~p~li~n?~uilding Inspe~. i~,~ '-B~ilc~t~ 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 port for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New york, and other oppllcobie Laws, 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 !nspectors on premises and irt buildings for necessary inSPections. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer g~ene;a-'l~n~t~ac--~o~)elect~;icia,, plumber or builder. applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder'S License No .. /. Plumbers' License No ................................................. . Electrician's License No ..... .~.,. ................................. Other Trade's License No..i ............................................ Location of land on w~h, ich propose~w0r~k ~yill be done. Map No.: ................................. ~ ...... ,Lot ~ ................... ~,/.., State existing use and occupancy of premis~ds and intended use and occupancy of proposed construction: c. E×isiting use and occupancy ....... ~ ........................................ .~ ...................................................... b. Intended use and occupancy ...~.Or~....~.....~...~ .......................... 3. Nature of work (check which applicable): New Building' ...~ ....... Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ..................................................... ~~' ~. (Description) 4. Estimated Cost ...... ...~.....~,..~.~.. ................................ Fee "~'~'"'~;;~"/~;':~i~";~"~'Jii~'~"~t~i~"~ii~'[~i__ 5. If dwelling, number of dwelling unffs ..../ .................... Number of dwelling units on each floor ............................ if garage, number of cars ...........~ .............................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each ~pe 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: Front ...~ ...................... Rear..~ ................. Depth .,~,~ ............ Height ....~Z. Number of Stories ..~ ................................................................................................................ 9. Size of tot: Front ,../~.~ ....... ; ....... ~ ........................ Rear ....... /.~.~ ...................... Depth .....~...~ .......... ]0. ~,~ of ,,~,ho,....~Z~/.~..Z. ........................ ,~e of Fo,m,r Owne, ........................................................ ] ], Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ~ ............................................. w,,, ,o, ....... M~me of Architect ...~ ...................................................... ~ddro~ ............ ~~o ....................... PLOT DIAGRAM Locate c~e~rly ond distinctly oil buildings, whether existing or proposed, ~nd i~dicete ~11 set-~ck dimensions from prope~y lines. Give street ~nd block number or description ~ccording to deed, ~nd show street names and indicate whether interior or corner lot STATE OF NEW YORK,, ~-- ~¢ c COUNTY OF~...~ ~D .................... ~~..~.. ................. being duly swc~, del~se~ and s~ys that he is the applicanl (Name of individual signing contrac~ above named, He is the ............................................................................................................................................................................ a~*nt~ co~.) 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 applicatio'a a~ true to thebest of his knowledge and belief; and thaz the work will be perform~ in the manner set fo~h in the application filed therewith. Sworn to be~re me this / I ........... .............. , Nora% Public, . ....................................Coun~ .... ~ ................ / / ~ ~ 3~--~ ~ignature o~ applicant) ~Y ~UBLIC, SI~Io of New ~ - ~ros ~ch 30, SUFF. CO. DEPT. OF HS~LTH I,~...~VI~ ~'rA'I1/M~NT OF I~ FOR APPROVAL OF ~N~N ~LY ~d, J~, L~ ~, ~., ~ WA~ SUPPLY ~ , APPLI~ ' il 4 -~ 3' FOR A~OV~ ~ ~U~N ~LY ~E WA~ ~U~Y A~ ~AQ; 17' ~ AP~ ItlO /17o I ~1 ', ~,o 7 ~. ~ez = P, lUI (,t~ o. o~? Ill i I I ..... ~ t I L .... APPROVED AS NOTED NOTI~Y BUILDING DEPAll. TMENT AT N. L ~ J (..)~'--' CD,O& 4* Cc:,,-', C. ~9 JOB Ho, SHEET i% 4