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HomeMy WebLinkAbout7171-ZFO~M NO. · TOWN OF SOUTHOLD BI. nI.BINC. DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. g6[0¢ ....... Date ..........J~.. ~ ......... , 19.7.5. THIS CERTIFIES that the building located at . .lt/~;. l/,ain..Road ........... Street Map No..xx ........ Block No. xx ........ Lot NoJ~x.. ~uthald.. I~,Yo ........... conforms substantially to the Application for Building Permit heretofore filed in thi.q office April ..0 ~ l:'e .....71 '}'1Z 1.19.~.. pursuant to which Building rnu~ ao.722~.. dated ...........Iqay'" ' I' ' dated .......... A.l?.r.~i~ay..1.0.3, 19~., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which thl.q certificate is issued is ~r~t.vate..one. family..dwe~.l~Jag, with. additian. &&lter. at Ions. AI~. ho,p~tal The certificate is issued to .Dr,..14~i;[.$am. Z,$tek ..... f&~ne~ ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. l~.dt, ............................. UNDERWRITERS CERTIFICATE No..~ ~ ~70+9-..~/~ -1/-7~- &- '~ 1 ?~3~. -'7/~'1'/~ HOUSE NUMBER .... ~Sf>O~ .... Street .. l/~.]a. ~oa~l. · .Szu.~hold ................. ....... ..... ........ FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERIC'S OFFICE SOUTH'OLD, N. V. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N® 7171 Z Date ........................A.Pril........IQ........ 197 t... a Permission is hereby granted to: ... Q...Inc..A/.C Dr. IV l�.ar;l Zi teL ...... outb.Rl.d..........N..Xp.................................... .wild an addition on existing dwelling/office to .................................. . ....................................................................................................................... ................................................................................................................................................................ atpremises located at .......................................................................................... Southold .Y. ................................................................................ ................................................................................ ................................................................................................................................................................. pursuant to application dated ...........................AT?z'.1. .....1.0........ 19.7.k.., and approved by the Building Inspector. Fee $„�i.n�............. .......:. ,:..... ...................... Building Inspector ' FORM NO. 6 7' ( •�^ TOWN OF SOUTHOLD Building Department fp Town Clerks Office , Southold, 'N. Y. 11971 If 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-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 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 $1.00 r Date ......�p�l S�7J .............................. New Building ................ Addition ..... .... Old or Pre-existing Building Vacant Land ff � Location Of Property .... .1 ....M i41 N...r�.�.!-1b....1.... 0 0.....W.•.F.!.l Y C? ,O.1J...q.56uT(#oC A.j.N: ......... OwnerOr Owners Of Property .... ...................... ............................ ..... _ Subdivision Lfvl ..X..... Block No. ... v D5 Cyr.........��.�.................. .............Lot No. ...... House N .......... Permit No. .... Date Of Permit AIJ�bl...Applicant .................................................................. Health Dept. Approval .... . ...... .......................Labor Dept. Approval ..........(................................... ��///'476� 3 i11( Underwriters Approval .....4�!!N.............. ...... Planning Board Approval ....!!/k!........................ Request For Temporary�ificate ........................................ Final Certificate ....!1.................................. Fee Submitted $ . ........................ Construction on above described building a ermiome s all,applicable codes and regulations. Applicant ... .............................. ....................... .. .. .."... ...... . ................................. Sworn to before me tflo W5-j ...........X day of .. ... ........... ......` ..... .~ (stamp or seal) Notary Public ..... . ...... �� County 1.3 FORM NO. 1 r 711�Z TOWN OF SOUTHOLD ell l��► S/ 3/ 7y BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......... .....l.o...... 19...2Y Applicatiori No�..(..2...f.......... Approved .............................[.. ....., 19...2.VPemit No. I Z� .... .... ......................... Disapproved a/c ................ .............. ..................................................................................................... ................. ............................ .............................. . ............................... (Building Inspector) OC APPLICATION FOR BUILDING PERMIT d Date ...... ?°,2/G....�d.............. 19. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wits 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 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 I n the premises available for inspection throughout the work. e. No-bu'ilding shall' be, occupied or used in whole or in part for any purpose 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 Ordiri'anoe of the Town of Southold,Suffotk County, New York, and other applicable 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 inspectors on premises and in buiIdings r necessary inspections. t ..... . ......................................... . Sit4ure of applicant,or name, if a corporation) ........................................ �...././...:. ...o................ (Address of applicant)l State whether applicant is owner, lessee, agent, arc itect, engineer, general contractor, electrician, plumber or builder. - 1.. rz :ii�:....... .!�. rL ?/ ,.,...................... Name of owner of premises ...... T...- =............................................................................. If anplicant, is a c orate nature of dul uthorized officer. (Na and title corporate officer)' � 1. Location of land on which proposed work will be done. Map No. Lot No. I Street and Number .......IVA.4d...Ti.EB'A.Q.... .. Q 1� f�.....?................................................................. . � Municipality 2. State existing use and occupancy of premises and intende use and occupancy of proposed construction: a. Existing use and occupancy .......... 1. -1. ,... ...8r�l.T.. ..�-.......................... b. Intended use and occupancy 3. Nature of work, check which applicable): New Buildin Addition ` � pP .): g ...................... .....�............ Alteration.:........ .... Repair ............:............ Removal ......................:.. Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost �r 0���•• •• •.......... Fee .... . ......... ............................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .................Number of dwelling units on each floor ........................................... Ifgarage, 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 ......119....... Rear ......���............. Depth ...... ./.................. Height ......................................... Number of Stories ........Z.. .................. .......................................... Dimensions of same structure with alterations or additions: Front .......................... Rear .......1 ............................. Depth .......... 1........................... Height ......................................... Number of Stories ...... ............................... i 8. Dimensions of entire new construction: Front .............. ......... Rear ............................ Depth Z/...................... Height ................................................. Number of Stories .........../............................................................................ 9. Size of lot: Front ................:..................... Rear .......................................... Depth .................................................. Height ..................................................... Number of Stories .............................................:........................................ 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation 13. Will lot be regraded ............... Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises ..... ...vox.... .. ` . :4:�J.........r.T.. tz..... .tA . !!!. ©....Q�. ��Q......7.6 ..:: ...... (Address) (Phone No.) Nameof Architect ..................................................................................................................................................... Addres (Phone No. Name of Contractor �1 ti ... Jaf�.r� C �.� ..`.6....... ... f✓ Q................�� ...... ;Address (Phone No.) PLOT DIAGRAM Locate.clearly,and distinctly al.l.buildings,whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. -rlAA� STATE OF NEW YO ) COUNTY OF ., ...........) .............................:..................... .:........... ................................ being duly sworn, deposes and says that he is the applicant above named. ( f individual si in Name o � g J Heis 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 contained in this application are true to the best ofjjjN*fi'7.v0ffTVa6d belief;-and that the work will be performed in the manner set forth in the appltion filed therewith. Notary Public, State of New York No.52/0344963 uffolk Count Commissio Ex arch 30, 19- . ............................. ....day of ................. ........., fs .. ....... • y .�Count ...........0 Notary Public, . . .. �.L......... y �-............................... /.Ci " iro of�'Iitl ,.; THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY F_ 85 JOHN STREET, NEW YORK, NEW.YORK.10038 t o Date Application No.on file THIS CERTIFIES THAT U! �u �I :' `il only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of �SS v� ti•q r c, '1`! f,� ,r I' h " 11 ,,Cyr" T k. .Wk. ggr ��-,����(t.vyl .��pA�l+s i..J ul�ai 1 sa.....Yd :ck n R �.h... F.;J .^. k.� �'.;t .`�:....��e7i. ems. i•_ U in the following location; ❑ Basement lst Ft. D 2nd Fl. I; ". ' Section Block Lot was examined on 'K� &j ' �+y'�} and found to be in compliance with the requirements of this.Board. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS RECEPTACLES ,SWITCHES INCANDESCENT1 FLUORESCENT MERCURY vgpoR AMT. K.W. AMT. K.W. AMT. I K.W. AMT. I K.W. AMT. H.P. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT.: AMPS. TRANS. AMT. H.P. NO.OF FEET AMT. WATTS SERVICE DISCONNECT NO.OF S E R V I C E METER NO. CC.COND. A.W.G. A.W.G. A.W.G. AMT. AMP. TYPE EQUIP 1.,0'2W 7,0'3W 3,B'3W 3,0'4W -PER,B" OF-CC.COND. NO.OF HI-LEG OF HI-LEG NO.OF NEUTRALS OF NEUTRAL OTHER APPARATUS: i E'Iti o sBCrr� �'.r;.�:I f' "�3 ° �� CFI++ c�L'• I:� ' .., Y..P�}3 o T',1��-G,{L�C�h •!'�.Y!.�C,}��.'h n�'.,:,:«L,�'•�'.l 4`- i�/ME��I���, �f/11 GENERAL MANAGER X` r Per > COPY FOR BUILDING DFPART{1f r2NT_ THIS COPY nr. CERTIFICATE MUST NnT R@ ALTVRFn nu amy AAArjra,mcn ........ !o~ T,~M '-I 4