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Home My WebLink About10271-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate O[ Occupancy I~c~.. ~.qg.'] .9 .......... Date ..... THIS CERTIFIES that the building ................................................ Location of Property 7~..~1~.~..Pl~oe. ............... G~eerm.o~t,. ' x .~.. ..... Block ...~. .Lot .~6.,.1 .... County ra Map No. I000 Section ..................... Subdivision ............................... Filed Map No ......... Lot No .... .......... conforms substantially t ...... Cer ti~ioa~ of..QDcupancy dated . .~.D~. ~ ............... ] 980., was ~ssucd, and conforms to ali o~ the requkements of the applicable provisions o~ the law~ The occupancy for w~ch t~s ce~ficate ~s issued As ......... The certificate is ~ssued to . ~illimm .~. Mill~,.. o~ thc a~orcsa~d building. Suffolk County ~epartment of Hea~th Approval ............ UNDERWRITERS CERTIFICATE NO ................... ~, · .N '&$$7~ ......... Building Inspector Rev 4/79 FO~ NO. $ TOWN OE $OUTHOLO , Building Depa~ment Town Clerks Office $outhold, N. Y. 1~971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application rnust be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; fo,' 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 Unde~riters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsib~ for the building. 5. Submit Planning Board approval of completm:l site plan requirements where applicable. B. For existing buildings (prior to April 1957), Nan-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey.of property showing all proper~y lines, streets, buildings and unusual natural or topographic features, 2. Sworn statement of ownar 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 pml'tnent 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 $1.00 New Building ................ Addition ................ Old or Pre-existing Building ~ Vacant Land ocotio, of Propert ................ ...... ................ Owner Or Owners Of Pro;elty ....... ~....Z..~. ~ ~.Z//..~., ~ ii ~,~' i~c~. ~ 3~- /~/Z'""~":,',~'~"~'-,.~'~. ................................................ Subdivision ................................................................ Lot No. ............ Block No ............. House No ............. Permit No ..................... Date Of Permit .................... Applicant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ....~...'...~.~/. ..................... Construction on above described buildin/,g a~d~~ble codes and re~ulotlo~s. Applicant(--,'J~ ~'g~'"~/~ ~'J--~/~ .......................................................................... Sworn to before me this ..... of ....... Notary Public~,~_~_~_~_~_~_~_~_~~/~,, County Tarm Expires Mm-ch ~0, ] e8 ~ (stamp or seal) THE NEW YORK BOARD OF FIRE UNDERWRITERS ~'~ BUREAU OF ELECTRICITY ~-- 85 .JOHN STREET, NEW YORK, NEW YORK 10038 THIS CE~IFIES THAT ~y t~ e~t~ ~u~nt ~ ~d~ ~ a~ int~yc~ b~ t~ ap~i~t ~m~ on t~e a~ ~atlofl num~r.~n t~ p~m~s of ~i~a~ Hi~L~ II~, sl.:~ C~.m~lin PL., ~' ~,/o ~a~ey Ave. , ~reenporU, L.i. in the/~lowln$ I~ation; ~ ~emeat ~ 1st FI. ~ 2nd FI. C%lt S :~.d~ .~tlon Bl~k ~t ~ examin~ on ~e c e.~ e r 2 0, 19 7'.~ and found to be i. co.pliance ~ith the require.eats of this S. rd. ~HAUST flX~RE ~ ~ ~ fiXTURES I RANGES [~ING ~KS ~ OVENS E~SH WA~S FANS DRYERS ~RNACE MOTORS ~RE A~A~E ~ S~I~ R~'~~ .ME ~KS BEK UNIT HEATERS M~TI~T~T ~ TRANS~ SYST~S ~0 ~R~ ~N~T ~. ~ .~ S ~E ~ V I C E ~H OTHER ~ARA~ William J. Hills Iii 2i7 Ckampiin Pl. Greenport, N.Y. 11~. Per This ce~flcate must not be altered in any manner; return to the office of t~ Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT RE ALTERED IN ANY MANNER. I t'---{ ~¢a L~,.T' I cD 1,5l BUILDING DEPARTMENT TOWN OF SOUTHOLD, N~ Y. }DUSING CODE INSPECTION REPORT Location___ %8~_C_b~j[jn P1a-D-e-~ ...... ' (number & Street) ....... ?~unlczpa~'tyJ" - -,- t( ) SuJ~d3.v~slo~ Map No. Lo s Name o£ Owner(s)_ wi~!~m J. ~,~jll~,~,III__ Occupancy R 1 ' I{Y-~--- ~ (owner-tenant) Admitted - ' d , by. Mr. ~:[ls ____Acoompanle by:.. s~lf Key available.. ......... ____~~Suffolk Co. Tax No-__~0_O0:3~-_3_u36o.J :. So~'ce of request Mr. Mills T2fpe of construction_~ Wood framed__ . Folmdation_StoDe & ceme~ blook..~ellar full,,__Crawl space____~ Total rooms, Ist. Fl__ 5 2nd. Fl_ 2 ~_~rd. FI___ Bathroom(s)_____J_J ..... ~oilet room(s) Porch, typ~w.oo_~d~r~pf/QverDeck, tyPe wood Patio, type.______ Breezeway ..... _Garage--_ Utility Type Heat oiL__'WamAi% Ho%water ,,,~y ~.. ~ , · free NO. ~llep±ace%s;_~+~n~liu~~ Exits.._2~ ~irconditionin~ Domestic ho~ater ~ es Type heater_ ~ankless . Other ACCESSORY STRUCTURE'S: Garage, type const% Swimming Other'. (small) ____Storage, type const.. Guest, type'const.. wood' ~IOLATIONS: Housing CodeC F2~ndation Stairs to 2nd floor Chapter 52 Description__ Foundation needs parchin_~__ No hand rail on stairway_ Sec. Remarks: This dwelling is being completely rebuilt. A new bathroom has ~ ., ~,-- ~just b~en, added. (Bldg.~ermi~) Curtis Morton Time star~l'.4.,5 .... end 2.-15 M~g:~ oF ~ t~:''~ * ....f.-~ -;'r: d ~MJlllIl~, N. T. b. Plot pkIn~ IJ~p~ang !~on at,lot ond of butldlng~ an premiIm, rItattonship'lO .acijoining pn!aniseI or public ~I m areas, and ghtlgg a~/,lblle~l cle~ripttan of layout of~ll~l~ty-ml~t be ~ ~ the diagram which il i~i~d-thi~ application. d. Ulpan ~ of ~ al:~iicutlen, the Bu~.~.tor. wd! ~ a ~u~mmg ~-erm,t to the alaplmam, aucn permit e. ~~I~ ~ bl, ~m'ln Ilmt for any IX~lX~e.whatever until e Certif;,~,b, of APPLICATION IS. ~ MADE to ~ Bul'~ng _Dq2et_ ment for the i. ~a~Fr, e of a auiltlin~ ~.i~i~!~it?, to the State whether applicant is owner, It, agent, architect, engineer, general contractor, electrician, plumber or builder. ................... ~,.~.,-.,~1...~'o.,,../.~.~.~...~.*.,,. ............................................................................................................... N,m, o~ ow~r o~ ,,..,,.. ......... ~:1/4,.,......7.....,~.,.'// , .............................................................................................. If applicant is a corporate, signature of duly authorized officer. Builder's License No ........ ~../..~...~..~ ..................... Plumber's Uceme NO ........ ~.~......~.~.~.,-~*.~.v~ ........... Electrician's License No....~(..,..../.'-~..~,,.,,,~., ......... Other Trede's Liceme No.....~....~,,~.~ .......... ; · 1. ~at~ ~ I~ ~ ~p~ ~11 ~ ~ Map/No.: ~.;~.~¢.~. ,~ ~'~ .......... ....... L ~ ~ t ~'. C~ ~ c'~: ~v~ Z ' ~,~, ~ .~r .................................... r .......... ~ ....... 2, StYe exI~ u~ ~'~u~ of ~i~I ~ inte~ use aM ~u~y of p~ ~: .) .,~ / /! ................................... a. Exlsiting I ~ occupancy ...>'-.~.~'~"-"m,'::'~'r~,,'~' ........................... . .... ,~ ........... b. Intencled me and occulxmcy ....... · ................................................................. ............. 3. Nature of work (ch~ck which applicable): New Building.. ............... A~ition .................. Alteration .............. Repair .................. I~moval .................. Demolition .................... Other Work ................................................. ~[/ ~./~,,~ ~)~, ¢~.C~ ~ (~ription) 4. ~mat~ C~t ...~ ...................................... F~ (to be ~id ~ fili~ th~s ~plication) If dwelling, numar of ~elJing units ............................ Number of ~elling units ~ ~h fl~r ............................ if ~mge, numar of ~ ........................................................................................................ 6. If busine~, com~rcial or mix~ ~cu~ncy, speci~ nature and extent of ~ch ~ of u~ ............................ 7. Di~nsi~s of ~i~i~ structu~, if any: Front ........................... .. R~r ................................ D~th ................... Height' ..' ...................... Nu~r of Stori~ ................................................................................................................. Dimensions of ~ structure wi~ alterations or additions: Front .................................... E~r ............................ ~pth ................................ Height ................. J .......... Numar of Stories ................................ 8. Dimensions of entire new c~str~tion: Fret ....................................Rear ............................ D~th ........................ Height .................... Number of ~ies .~...../. ........................................................................................................ 9. Size of lot: Fret ........................................................ Rear .......................................... ~h ............................... 10. Date of Purchase ........................................................ N~>~°f ~e,FR~er~ner/~/~ / ........................................................ 11. Zone or u~ district in which pm~s are situated ................................................. ~/G ............................................. 12. Does proposed constmct~ violate a~ zoning law, ordinance or r~ulati~: ........................................................ 13. Will lot be r~rad~ .......................... .~ e~Ss~ll be rem~ fr~ premiss: (~ Y~ ( ) No 14. Name of ~ner of premis~ .................................................... A~m~ .............................. - ~ ~ ....................... Name of Architect ...~.~....~.~ .........~...,; ........ ~ ......... w~.... A~r~ ..v,.~..~7=&.,.~ ....... ,~ No...:.=~..~.==.~ Name of Contractor ............................................ Z.. ............ PLOT DIAG~M L~ate clearly and distinctly all buildings, whether existing or pr~o~, prope~ lines. Give strut and bilk number or de~ription according t0 'd~, a~ shew stre~ ~s ~ i~icate whether interior or corner lot. STATE OF NEW Y~ORK, _ .I ¢ S .,...~..~ ..~7...,.~ ......................... being duly sw0m/depos~, and says t~t he is the applican~ (Name of i~ividual,sig~c~t~_ ~ ab~enom~. "~ ~~~ He is the ......................................... ~ ............................................ "~ ................................................................. ' · (Contractor, agent, co,rate officer, ~c.) of ~id ~ner or ~ners, and is duly aut~rized ~ ~o~ or h~e ~r~ed the ~id work a~ to ~ke and file this app ~t~n; t~t all state~nts ~tain~ in .this app~icatio~ ar~ tm~..t~ ~e ~s~.of his knowledge and belief; and ~m t~ wo~ Will ~ perfo~ in t~ m~ner ~t fo~h in the app~icoTion tll~ t~r~m. Swomto ~fom ~ this [ J ~ ~ ~ [ ~ ~ · . ....... ................. , ...... ....... ..... ................... ~T~Y ~C. State ~ ~ Y~