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Home My WebLink About5319-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Occupancy Z10626 August 18, 1981 Date ................................. 19... THIS CERTIFIES that the building ................................................ E/8 275 Harbor Road, Orient, l~®w ]fork Location of Property ......................................... ~ ................... Hou~ No. Street [ Ham/et County Tax Map No. 1000 Section 026 .Block 03 ..... Lot 012 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed ~n this office dated Nay 24 71 ...................... 19... pursuant to which Building Permit No. 5319 Z lay 24 71 dated ............................ 19..., was issued, and conforms to aU of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Private 0ne-Family Dwalling Vincent Hatthawa The certificate is issued to ..................... /o'~,;n~,:~:l~t ..................... of the aforesaid building. 6/10/74, K. R. Jansen Suffolk County Department of Health ApprOval .......................................... N100361 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 FOI~I NO. ~ TOWN OF SOUTHOLD i BUIL~ING 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? 5319 Z Permission is hereby granted to: to pursuan¢ to application dated ............................. :J~,~. ......... ~........., 19..~.]., and approved by the Building Inspector. Fee $...$0,0~ ......... FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Soutbold, N.Y. 11971 APPLICAI'iON FOR CERTIFICATE OF OCCUPANCY instructions : A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor 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, Comrnercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect orl Engineer responsible for the building. ,5, Submit Planning Board approval of completed site plan requirements where applicable. B, For existing buildin~s (prior [o April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: ' 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res, ~ 2. Sworn statement of owner or previous owner as to use, occupahcy and condition of buildings. 3. Date of any housing code or safety inspection of buildings o~ premises, or other pertinent informa- tion required to prepare a certi£icate. 1. Certificate of occupancy $5.00 2. Cer~ifi¢ete of occupancy on pre-existing dwelling or land use 3. C(~p¥ of certificate of occupancy '~1.00 $5.00 New Building ......... Old or Pre-existing Bkdlding ............. Vacant Land .... Location of Prop~.rty ~ 0 ~ ~D' / 5 ' . ..................... House No.~/ ~ ~ ~ Street~ Ham/et Owner or Owners of Property ~ " :~ ~ ~ County Tax Map No. t000 Section ., . ~ .?-.~ ..... Block ... ~ ~ ~ ....... Lot. ~ .A ,2 .......... Subdivision ................................ _ , Filed,MapNo. ......... LotNo.~ ~:~:~. Permit No. ~b.I. ~. :'~Date of Permit~'~] .Apphcant ~,.~/C~O~ ......... Health Dept Approva .......... ........................ Underwriters Approval.. Request for Temporary Certificate ..................... FinalCertificate ...~ ~ X[~ ~0~ ~ Construction on above described building~d~rmit meets all applicable codes and Rev. 10-10-78 TOWN CLERK'S OFFICE SOUTHOLD, N. Y. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted inl~luplicate/~o the Building ~ Inspector. · , 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 ofproperty must be drawn 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 applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No bu Iding shall be occup ed or used n who e 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 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 cede, and regulations. ..... ...... ............................ (Signature of applicant, or name, if a corporation) (Address of applicont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. premises ....~..~/~C~J~..~"...~ ~.~,~.~ ................................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No.: ........................................Lot No ......................... Street and Number ..~J~i~.J~eJ~....J~,J) ............. j.~J~,~...~.......'J~...~./~.~...~; ..................... J~.~.J~.~. ............................. ~ 7 ~ Municipality State existing use and occupancy of pre~nises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...... .~.....~..C..~ ................................................................................................... b. Intended useandoccupancy....~.J~H,J.l~,~'. ...... ............................................................ 9. 10. 12. 13. 3. Na~ture o~ work (check which applicable): New Building .................. Addition .........'~.. ...... .%Alteration .................. Repair ............... d~ Removal ..................Demolitia~ ....... ; .......... Other Work (Describe) ........................................ 4. Estimated Cost .:.!~..~.v.?.5.~. .................................... ~...Fee ............ ; ............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units .............. ( ............. Number of dwelling units on each floor .......... ;J. ............... 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 .. ~-- .... 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 ........... ,~,~.! ............... Rear ...... ..~':....~..~ ............ Depth ..~.....~. ............... Height ...... ~,(~: ...... Number of Stories .............~, .................................. ~ ........................................................... Size of lot: Front ........... I...O..(~.~ ....... Rear :. ....... .~....~ .................... Depth ..~..~.~...Z..J.~..~. ..... Date of Purchase ...... -- ----(z:~.:~,O...':...~/..~. ......................... Name of Former Owner .............. ~..~...(~/(~ ............................ Zon? or use district in which premises are situated ............... ~.....~....~.~J~/~r,/Z£~.....~....~.~-.,l~/~/~.~,~'~JJ~... Does proposed construction violpte any zoning law, ordinance or regulation? ............................................. ~ ........... Name of owner of premises! J~......~.~t~Jr~f,~.~,.Address/~..~,~,~lZ J./~......~.....~.fl~/~e No.~.t;~.~. ..... Name of Architect ..... ;..;..Z..~.' ...................... : .............. Address ............................................ Phone No ..................... Name of .Contmct0r' .~.~.&~J,lf-)...~..~.4~-~i..il,.Z..Address ...(~.~4.1~/,J.~... .................... Phone No~,~.~.~..~../~.~.'~ PLOT DIAGRAM Locate clearly and distinctly all buildingsr whether existing or proposed, and indicate all set-back dimensions from pr. operty line?. Give street and block number or description according to deed, and show street names and indicate whether inter,or or comer lot. L r L STATE OF NEW_YOI?J(, ' 1. c c ' COUNTY 6~.~:~- ;",~.~L'Ji~.t Lc,,. ............. ~' '"'"" . ................ J~~.....'......~..'l:l.]~.~J~./k/. .................. being duly swam, deposes and say, that he is the applicant (Name of individual signing application) above named. He is the .............................. gl~.~.Ji..~.. ........................ : ............................................................ ~J (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 of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swam to before me this .....· ~'~ta Publi~'~'~'~';-E~':'~~ C~*'''~' ~'"'(Si~/a'~' .................................. ry ,~. ~.~. ty O~'~_~k ('gnature of applicant) ELIZABETH ANN NEVILLE NOTARY PUBLIC, ~ate of New No. 57-8125850, Suffolk CouQty Term Expires Mar~h 30, HE~NEW YORK BOARD.,OF, FIRE UNDERWRITERS BUREAU OF ELECTRICITY ,'r~ '8S .JOHN STREET NEW YORK NEW YORK'IO038 - . .- D~uglass Rd., Orient, . .~.~.,.i~ on~ June~ 28,,, ~, 1973, a~dfoundtobeincomplia~cewiththereq.lrementsofthisBoard. FIXTURES RANGES OVENS EXHAUST FANS FLUORESCENT