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Home My WebLink About4378-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.. ZT(~..., · Date ............... ¥talr .... 9 ...., 19. ?7.. THIS CERTIFIES that the building located at . ~i'8. l~0~d, .............. Street Map No.~: .......... Block No. Xlt ....... Lot N~..]gantt% .lgar.~.ola...1~,¥.o ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ~.Ul~... ~. ]., 19 .~9.. pursuant to which Building Permit No. dated ......... J~l~r ..... 1 l.., 19.69., 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 .Pri.v.a~;e..o~te. familY..dwelli~ag ....................................... The certificate is issued to . .P.e..~er .Prt~.e.13..~t.. ....... . .(~..e~ . . (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval llSe~ .®l~ill~illg .ZlrS.t~e,, ......... UNDERWRITERS CERTIFICATE No.. ~88~ [~21 ..... ~[llla~..21, ..... 19.7.1 ........... HOUSE NUMBER ..... br22~ .... Street ... 8~a12~. R~a4 ..... 1~,. Yia~lm~l ........... FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL N? 4378 Z Permission is hereby granted to: .............. ~'~ ~..~r~u~n%~ .............. , ................. ...... · r/.9;-..-.L~-r~i'i~,tcl..-Roa~} ......... ; ................. to .... ~lemoLt sh .. ax~,t ~...d~e;L~ ~..~nd...~-~i.l~l. · ~e~ .. ~e ..ff~[.~y..~l.~g ..... ot premises located ot ./~2-~.~-.~.~t~,~..Bead~ .......................... : ......................................................... ..................................................... · ~a.s.t...~i~n ......... .~-?~'~." ......................................................... pursuon.t to opplication dated ........................... ~11]..~,.,...~.~1 ......... ,..., 19.~., and approved by the Building Inspector. Fee $..1D.O0 .......... ' ; building ,nspectO'~ / THE NEW YORK BOARD OF FIRE UNDERWRITERS ad BUREAU OF ELECTRICITY N881821 ~- 85 JOHN STREET, NEW YORK, NEW YORK 10038 ' ,,.,..J=e 1971 N 881 THIS CERTIFIES thefolloN'h~p, location; ~ ~S~e,,~,,t ~J L~ ~"~. ~ Z,.~ Iq. outside s,.,.~o, mo~.~ June 21, 1971 .,,,t.f,,,,,,,i to i,e ;,, co,,u',lh,n,'e w;d, the req,,ir,,menl~ qf thi~ Hoard. FIXTURE OUTLETS 35 1~ I FIXTURES 56 37 RANGES ]COC OVENS ]DISH WASHERS '1 EXHAUST FANS SERVICE DISCONNECT ~Furnaces: 2-i/Shpo~ 1-1/~npo, Motors: 1-1bp., 1-5 Ton. Air Conditioning Unit E R .... V .... r C '' ~E ! 3/0 I 1 AWG 3/o Orchard St. ~, GENERAL MANAGER Orient N.Y. 11957 ' Per This certificate must not be altered in any manner; return 1o the office of the Board if incorrect, bspectors mc:y be identifled ~)/ their credentials ACCUSATORY INSTRUMENT iNFORMATION - GENERAL C.P,L. 100.15 FORM NO. 2S6 ~ ~ILLI.~T~SOT~ LA~ ~OOK CO., ROCHESTEI~, N. Y. 14609 STATA~ OF NEW YORK : CO?=...N~FY OF_...~..C-~.~-_....~ ..................................... Defendant ] - .. .~.~ ...... ~ ................ ~~ ....., ~,~,~ written aeea~atio, ~s follows: : ~, 0,.~.._ ,~_..2.Z_, ~,._.~....~.~..~.~.~ ....................................... County of ~ ~ ' ,New York, did ..... ~~"~'; .............................. ;"~7'~ ............... - . .......... ~ ............ ~ ....... ~ ............................. ; ..................................................... a ;,~e~=..eaq:.~)(violatio.)i. violation of Section.~~.~.&~L~..~Z...&..) .......... of the State of New Yolk, in that ~he did, at the aforesaid time and place information is based are;as follows: L /c.~-~¢. The foregoing factual allegations are based upon personal knowledge of the complalnant (and upon information and belief~ the sources of complainants ~nfarmc~:ion and be(lef being, tYherefore, Complainant prays that ............................................................................. be dealt with pursuant to law. ~*Subscrlbed and Sworn to before me on ........................................................ , 19 ....... Complainant Title or Office *set forth statuLory language constituting the offense **use only one **Verification By Subscription and Notice Pursuant to CPL Section 100.30, subd. 1, par. d False statements madc in thc foregoing instrumcnt are punishable as a Class A misdcmeanor pursuant to section 210.45 of the Penal Law. Accordingly and with notice of the foregoing, I hereby affirm that the foregoing statements of facts are true, under penalty of periury, this day of 19 Complainant An appearance ticket has been issued herein on ................................................................... by .................................................................................................... , directing the said ...................................................................................... to appear before this court on the ................ day of ........................................................... , 19 ......... and bail in the amount of ...................................................................................................... has been posted with Complote above only if appearance ticket has been issued) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS /~, ~ ~-~ a. This application must be completely filled in by typewriter or in i~ submitted in duplicate to the_Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relat'i&nship to adjoining premises or public streets or areas, and giving o detailed description of layout of propertymust be drown on the 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 bpplicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part fo~any purpose whatever until~,a Certificate of Occup~3ncy ~-/3,'"/S ~ ~o ~ ~-~f~-'L ',.,~ ~,.'r/c~. u,-, '/-~ shall have been granted by the Building Inspector. (- 6'-7~, '~ 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 herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. (Signature of applicant, /t.~./ ~ or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................. ........ ........................................................................................................................... Name of owner of premises ....~..Z,~,~-,......~.~ ......................................................................................... if applicant is a corporate, signature of duly authorized officer. ~ ~o. /9 ~\ BUILDING DEP~RTMENT '~-~' ~,~.,, ~~l'~ / TOWN OF SOUTHOLD/,/..'~ ~- ~ ' ~~~, . ........... a ..... Disepp rovod ~lc .............. ~ ........................................................................... ............................................................................ _ (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: .............. ~..........~.. ................ Lot No: ..~...~.~.~.. ..... Street and Number ~ ~"~' ( ~ ~0c3 (~. /~ c~ ~-/- /~( J./,~. ~' Municipality 2, State existing use and occupancy ofpremises and intended use and occupancy of proposed construction: a. Existing useandoccupancy ...... '"~"~"'"~/73/'~ ,~ ...................................................................................... b. Intended use and occupancy .......L~.~ ...... .~...~ ...................................................................................... 3~ Nature of work (check Which applicable): New Building ~/ Addition .................. . Alterohon .................. Repair .................... Removal ......//.. ........... Demolition ............... .....~gther Work (Describe) ...................................... 4. Estimated Cost ..... .'~...?.:..~ ..................................... Fee .J..~.....~.. .............................................................................. (to be paid on filing this application) If dwelling, number of dwelling units ......... ./. ................. Number of dwelling units on each floor ..../. ...................... If garage, number of cars ........................................................................................................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use ................................ 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 ....... .7.. ................. Rear ............................ Depth Height ....:..~..(..I .............. Number of Stories ....... ,/, ................... 9. Size of lot: Front ..... /...~..q..! ............ Rear ...... .~....~'...[ ............ Depth / 10. Date of Purchase ...~.. ............................................... of Former Owner .................................................... 11. Zone or use district in which premises are situated .............................................. .~,~. .............................................. 12. Does proposed constructiop violate any zoning law, ordinance or regulation? ....?'....~. ............................................ 13. Name of Owner of premises~.~.~ ....... Address~..Z..'~....~..~..~...~'..;-~ ~,-,_ ...... Phone No..~.. ~:..~. ~.~./.... Name of Architect ..............././. ................................... Address .~ ........ A..~ .............................. Phone No ..... ::: ............. Name of Contractor .................................................... Address ......... ~ .................................. Phone No....'..:..~ ........... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from p~'operty lines. Give street and block numbers or description according to deed, and shew street names and indicate whether interior or corner lot. Read. -~' ¢~oe' STATE OF NEW Y~J~,K~/~,//j ~ S c ~ .... ...................... ;.~.....being du sworn, depose~ o id says that he is the applicant (Name of individual signing application) above named. He is the ....................................... ~ .................. i ........................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work end to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this 191~4~.t.. N at a ry pu b, i c ~. ~ll~S~~l~nty ~ (Sign6ture of opplicant) Term Expires March 30,