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Home My WebLink About5281-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .][a~ll. Poizlt. lk~5 ...... Street Map No. II&mS.,..Pi:.. Block No ........... Lot No...16~ &¶6~ .... ~lt~ho~e ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............... liar..~., 19..~.¶ pursuant to which Building Permit No. ~281Z.. dated ......... ~ .... .6. .... , 197.1. ., 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 . .l~l.~t~. ~e. fa~ilT, llvel,ltal~ ...................................... The certificate is issued to . ]~1~..J., .~l~, ....... (~1' ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .I[?.R.? ............................... UNDERWRITERS CERTIFICATE No...pe~l.ill~ ....................................... HOUSE NUMBER .... 1t~ .... Street...i~n~. ~ ................................ 31~0 i~&se&u Po~t Road Building Inspector FO~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5281 Z Permission is hereby granted to: pursuan¢ to application dated .......................... ~Jll~,.~ ..................... , 19.~.., and approved by the Building Inspector. F~ $.~.00 ............. IFOBM NO. I TOWN OF soUTHoLD BUILDING DEPARTMENT TOWN CLERK'S OFFIC! SOUTHOLD, N. Y. Examined .... · ................. Approved ........................................ , 19 ........ Permit No ........................... Application No..~......'~....~../. .......... Disapproved a/c ......................................................... ' ................. Ybui dina ,nsaector) / ........... - , -! APPLICATION FOR BUILDING PER~I'T "~ Date ~~ g~ ,9.Z..(...~~- INSTRUCTIONS ~ ~ a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationshio to adiolnina oremisas or public streets or~: areas, and giving a detailed description of layout of properly must be drawn on th&diagram wh'[c'h Is part of thee appllcation~ c. The work covered by this application may not be commenced before issuance of Building Permit. d..,, U.pon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit sno oe 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 for any purpose whatever until a Certificate of Occupancv'l~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bu Iding Perm t purduant to the Building Zone Ordinance of the Town of Southold, Suffolk County, N~v York, ~.nd other applicable Laws, Oral nonces or Regulations, for the construction of buildings, additions or alteratJon.~, or for removal or demo Ition, as here n clescr bed The applicant agrees to comply with alt applicable laws, ~ig..~~regulatlons. s of applicant) , (/ State whether applicant is owner, lessee, agent, architect, eng Ineer, general contractb'r, electrician, prumber or builder. Name of owner of premises ..................... t ................ ~.....~.../. ............................................... If applicant is a corporate, signature of duly authorized officer. 1. Location of land on which proposed work will be done. Map No.: .................... /......'... Lot ...................... ~.~ 2. State existing use and occupancy of premises and Intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~.,.(~.~,.~.. ............................................................................................................. 3, Nature of work (check which applicable): New Building ~ ................. Addition .................. Alteration .~ ............ Repair .................. Removal .................. Demolition ................. .~her Work (Describe) .................. .~...fl .............. 4. Estimated Cost ....../...°...~..~.Z.~...°.. .................................. Fee .....~.. ................................................................................. (to be paid on filing 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, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ...........~.~.°..~. ......... Rear ....~...O. ....................... Depth ....c~...~../. ........ Height ,~c~..~.....~...~.; ........ Number of Stories ..... .~......~.....'C?....~....~. ................................. ' .................................................... 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 .................... Number of Stories ............~ ..................................................... ~ ....................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ..../..O.....-....~....0..;....~..~... ........................ Name of Form~ Owner ../(.~.;...~..~..~...~...~..x.~...../~...4'...~...~...~...'~...~'...5-. ..... 11. Zone or use.district in which premises are situated .................~.'.~..:--~ ........................................................... 12. Dc~s proposed construction violate any zoning law, ordinance or regulation? ........... ..,~....o. .......................................... 13. Name of Owner of premises ..~...~....~..~..~...:..~....G...A....C~..!.U~ddress .............. ~...~...~...~ ................ Phone No..7..~.?.;..J'.5..~.?.. Name of Architect ...................................................... Address ............................................ 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 property lines, Give street and block number or description accordin.~ J;g ~eed. and show street names and Indicate 1 STATE OF NEW~OI[I~ , ~. tee COUNTY OF ..~/4]L~.~[. ........ ~: (Name of ijlidj~Idual s-Tgni(tg application) above named. He is the .......................... :....4~RK'J~. ............................................. JL ....................................................... (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~rue to the best of his knowledge and belief; and that tl~e work will be performed in the manner set forth in the applic~qon filed therewith. Sworafto before me this ~. ~a, / / / ...... ........... ddy of ................ . Notar~ Public, .... Co~,a Si~' '~''''''~''''''-' ~/ ELIZABETH /~IN NEVILLE /'' H NOTARY PUBLII;, ,State of New Yo~ No. 52.8125850, Suffolk Cot/~t~ Term ExPires Mareh 30, '19./oL THE, NEW YORK*BOARD OF FIRE UNDERWRITERS ' BUREAU OF ELECTRICITY ~ : 85 jOHN STREET, NEW YORK, NEW YORK 10038 aqu~ment ~ ~ed~ ~ and lnt~uc~ by ~ ~l~t named on t~ a~ ~plicatlon numar la ~ ~gli~, N~s~ ~. ~ad, & Won~ta ~ad, ~t~, N.y. : inthefd~ingl~ation~ ~ B~oment ~ IstFt. ~ :,~ rt, ~tsi~ - ~L S~ao. m~ I~ot :' ~y 21, 1981 and found to be tn compliance with the requirements of this Board. FIXTURE fiXTURES RANGES OVENS DISH WASHRRS FANS OUTLETS SWITCHIS FLUORESCENT DRYERS MOTORS ~ITURE APFUANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUT,~T DIMMERS SYSTEMS NO. OF FEET SERVICE'rOISCONNECT :: S S R V I C OTHER APPARATUS= ' ~ 1-G.F.I. L (Swi~ Pool) Th~s~ ~e~ctificate covers compliance at rim date of inspection made by a qualified perm2n. ~ Gl~a R. Brt~l.ey, - lic. 1227 ~ Horto~ Av~, Mattituck, N.Y. 11952 P~r ~S This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credefltiaJ~.