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Home My WebLink About5485-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. No. ...... Certificate Of Occupancy Date ............ .J~a~, THIS CERTIFIES that the building located at . E'/S' Na. rr0~e .t~vew .Road. Street Map No.~x .......... Block No. xx ....... Lot No. x~. .... Or~,en.t · .~..~o ........... conforms substantially to the Application for Building Permit heretofore fried in this office dated .......... ~ept ..... 2., 19.?1 · pursuant to which Building Permit No.. dated ......... Sept ..... 2..., 19.7~., 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 .Pr~.v~te. one. £~.1~,..dwe~.lZng ....................................... The certificate is issued to .Fl, al~..&. ~leanol, · · Ve~eeek ........ 0~n®z'.s ............ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Heaith Approval .. ?fa-.. ex:Lst~,~g, po.o.15 ........... UNDERWRITERS CERTIFICATE No. N. ~ 3567 ~ ....... J. an...~ ...... ~ 9~ ......... HOUSE NUMBER... ~0 ...... Street . E&rro~ .l~&r. · Road .................... ...... ........ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER~rr (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5485 Z Permission is hereby granted to: .............. ~13....~m~Ll.lm4..I~ ............................. to ..~l~..e~ .~l~I.. e~.~l~e~z~. -~m~l~s~.&. ~mm~..e~.~m~l~4~ ....... at premises located at ...I~..~..~r,~'..~ ...................................................................... ........................................................ ~&e~t~ ........................................................................................ pursuan~ to application dated ................................ J~l~'""l .........., 19..~.., and approved by the Building Inspector. ,Fee $...~e~ ......... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electrical equipment ~ described be~ot~ ~nd introduced by the applicant named on the above application nu rnlmr in th~ premises of Frank Vaneeek, !~aerow Rieer Rd., Platt RLt. & Main Rd., Orient, L.i. in theyollotvlng location; [] Bazement [] 1st FI. ~]~2nd FI. 0 Ut S i (~e Section Block Lot waz examined on J ~ ~ ~,ary ~ ! ~ (.) 7 ll and found to be in compliance ~vith the requirement* of thi~ Board. FIXTURE OUTLETS 2 2 IECEPTACLES SWITCHES 2~ fiXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FLUORESCENT DRYERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET OTHER APPARATUS: 'Jater heater: ~-4.Skw E]ee.room heaters: Motor/s: 1-1/3bp 1- 10 amp. V~euum Unit E R V I C NO. OfCC, COND. A.W,G, PER ~ O~ CC. COND. 1 350mere 1-2. Okw, 2-1,5kw~ NO. OF HI-LEG A.W.G. OF HI LEG 1-1 · 2 5kw, NO, OF NEUTRALS 1 OF NEUTRAL 35 Om c~ 4-1. Okw, COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, in triplicate to the Building 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. New Building ...... ~ .........Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ..g~...~...k~'....~.~C~b......~...~...~.. ...... ~...,~./..¢,.~.../.. ............................................................. Owner Or Owners Of Property ...Z~.¢)..~. .......... ..~ ........ ~,..~C~./j~..~. .......... ...~...~...'?..4'...c...~..~ ..................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No .~..~.,,5~ Date Of Permit.:..~...~.~...../..Applicant ~~..~ ...... Health Dept. Approval ............................................ Labor Dept. Approval ............ ~..'~...~... ..................... r L.~.-.. ~.- In n B Underw iters Approval ..... ~ ................. ~ ................. P a ni g oard Approval ........................................ Request For Temporary Certificate .......... ~ ......................... Final Certificate .......................................... Fee Submitted $ .~...:.~.. ........................... Construction on above described building and~r~mit meets all applicable cedes and regulations. Applicant . ;. ,~..~.,~.....~...~: ................................. Sworn to before me this day of ..... ......... ..... .ota (stamp or seal),~'~ l(, 7~r TOWN CLERK'S OFFICE ,~',~'.~---- -" ~ '--~:~ ~UTH~D,N.Y. ~T ~-. ~ /~ ~ '~1~/~ T -- ~ ........ ............... ....... pr~e~ ........................................ , ly ........ e~ i~o ~....~...~...q ............... _ _. · ~-~ ~1~/~ ~ _~/ ~ ~ ~ ~ , ~o~od ~/~ ................ ~ ................. ~ ,. ~ ........................................ ~ ~~~- ~ ................. .......... - ....................... ~ ~ ~ ~~~ r~ ~ ~' 5 *PPLICATION FOR 'U~DING PE~IT / ................... . INSTRU~IONS a. This application must be completely fill~ in ~ ~ewriter or in ink and submi~ in d~licote to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to ~joining premises or public streets or areas, and giving a detail~ description of layout ofpr~e~ mu~ be drown ~ the diagram which is ~ of this application. c. The work c~ered by this a~licatJ~ may not be comme~ed before issuance of Building Permit. d. Upon approval of this application, ~e Building Ins~r will issue a Building Permit ~ t~ ~Jic~. S~h ~rmit shall be ~pt on the premises available for insp~ion thr~gh~t the p~mss of ~e work. e. No building shall be ~cupi~ or used in ~ole or in pa~ for any pu~ose what,er until o Ce~ificate of ~cu~ncy shall have been granted by the Building Inspector. i 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, housing code, and regulations. !Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~'~ ~ ~r'~"~i~r~'i~es .~..~ ...... .~....~..~z,~...~~ ............................................ :..::i If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed word, viii be dor~, Mop~lp.: ..................... ~ ....... ~ ........ Lot No ........................ ~reet and Nu~r~~~ ...... ~..,.~ ....................................................... ~ I ~ ~ ~ M~ici~li~ ~[at L~:: :iL~ ~: aC;d ~c~:;..~ f~__ . '--.~ .: ~~7..: .: .:....~:.:...: .: .~ .~..~f...:.......~...:..~..:.....~.: .:.. ,::. ............... ...nd ............................ : ................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ................ .~. Repair .............. .~ Removal .................. Demolition .................. Other Work (Describe) ........................... ' ............. 4.. Estimated Cost ...~.~...~..../.....~... ............................. Fee .......................................................................................... (to be paid on fiting this application) 5. If dwelling, number of dwelling units ..... ~ ......... Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, speci~-natu~'e-and extent of each .type of use ............................ .... / ! .Z ~ 7. D,mens,ons of ex,st/ing structures, ,f any: Front .......... ./.~....~. ...... Rear ........... Z..~.......~. ........ Depth ......~......~.. ...... He ght . .../.-2.~.. . Number of Star es ~.. ........ D mens ons of__,same structure, w th a terat ons or! add tons Front ... Depth · .. ~.~. :. He ght ./.,~... Numb,er of Stories . , ' ................. ~ / ~ ' ................ ~Z'""/ ..... 8. Dimensions of entire new construction: Front ............ /..~......~. ............ Rear ........ ~'.~....3,c ......... Depth ..... ...~... ............. Height ......./.~..~...~... Number,~ o , , .-.;r--...-.-.--.-.--o-f Stories ........ ~ ............................................................. 9. Size of lot: Front ...~...~....~.~.... Depth ............ ..~ ................ 10. Date of Purchase /~,~..~.1~1.~..../..~....~.../. .............. Name of Former Owner ~i~..~.~..~/,~:~ 11. ~ ~l / Zone or use district in ~f~ich premises are situated ....... ~ ............................ ,~...~;~..~, ....... '_'"-' ............ ~ ............. 12. Does proposed construction violate any zoning law, ordinance or regulation.;>//,~...~ ....................... Name of Owner of premiseJ, Z~.~9-~ .~./~!~.Address/.~~.~... ..... ..~Phone No. ~..~.[..-./...~..~. 13. Name of Architect ...................................................... Address.............................~.............../;;~"~/l~hone No. .................... Name of ContractoJ~.r~.~/~.~ddress Z~%~_~...~... Phone No. ~../:./~.~.~' Locate clearly and distinctly all 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 whether STATE OF NEW~,Y~I~. · iSS COUNTY OF .'~...~..~...~?..-~..~., ,.,¢~-,.....$ ' ..... ......................... being du y sworn, depots and says that he the app,con (Name of individual signing application) 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 ~ile 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 ~ ..... . da of ...................... , / · ,--~ . '~.... , -,,'.~,--"~-'-' .-~...:...~....~ ....... Notary Public~,~l~c~:.~ .................. Count~ .............................. i~i~'~'~'~;~- ;~ '~ ~;;~'~ ....................... ~' MARY O. KLOS ' NOTARY PIJBLIC, STATE Of NEW YORK ~52-73~76925 SUFFOLK COUNTY ~omm;ssio~ [xgires March 30, '1~,,