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Home My WebLink About6115-zlt~O~3t~ NO. 4 TOWN OF SOUTHOLD BI~.rqNG DEPARTMk'~IT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z66.~1+. ..... Date .............Aug.. 2c) ...... ,19.2~ THIS CERTIFIES that the buLld~ng located at ...Cenf~r~l. D~.ve ..........Street Map No. Cap.t, .~:Ld~. Block No ........... Lot No. :1 ..... ~s;;t.t.u,q]~...N.~¥: ......... conforms substantially to the Application for Bugd~g Permit heretofore fried in ~h~, office dated ............~ep.~.. 1 .~., 19.?~. pursuant to which Bufld/n~ Permit No..6.~ 1 ~'~.. dated ............. .S.ep.t....1.3., 19..7.2., was issued, and conforms to all of the requiro. ments of the applicable provisions of the law. The occupancy for which thi.~ certificate is ~ued is .. ?~.t.v.a..t.e..s.¥./..~., .~. ~ ~.o..o~..~..~.th...f.e.n.c..~. ~ .~....a.e.c..e.s.s.o.r. :f.s. ............. The certificate is issued to .J.o. ~.e~.l~..C/a~.],tg~ .... .~.~F ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .N.e.H.o ............................... UNDERWRrrERS CERTIFICATE No..~.~.8.~..7. .... ~e..~. f....~9.7.~. .................. HOUSE NUMBER .. ?.?3.O. ...... Street ....C.e.n..t?.a.Z...~.r~v.e. ....................... FORM 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) 6115 Z Date .................................................. , 1 . Permission is hereby granted to: ...~..~...7. ........ ~~....L.~...: .............. ~o...~~...,~.~......~~..~ ...... .~ ....... ¢~.~ ............. .............. ~z.....~...,~ ............... ~/.~::~..~.~......~../..,... pursuant to application doted .............. .'~.,,../~........./'../ ............. , 19.~.....~., and approved by the Building Inspector. Building Inspector / FORM NO. 6 TOWN OF SOUTHOLD o Building Depmtment Town Clerks Office Sou~hold, N. Y. 11971 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 New B~ilding ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..~.~...%....~......~.~i!.~..~..!.......LI.~ .......... ...~..i~.:~ .................................................................. Owner Or Owners Of Property ........ ~.'.~.:-;::..: ......... :..~.!.; ...... .~.;.'..~ ...................................................................... Subdivision .......:.'..~.: ................................................... Lot No. ........ Block No...,~:..':..'House No...~...~..,,'?. Permit ~o ..................... ua~e ~r ,ermit ...~. ............... ,~ppficanr ............... ,..~ ............................................. ~. Health Dept. Approval .~ ...................... ~.~.,.-... ........... La~or I~ot. ,~pprova] ...................... ~ ......................... Underwriters Approval .............................................. Planning Board Approval ..... ..~.!..~../..~.. ...................... Request For Temporary Certificate ........................................ Fina] Certificate .......................................... Fee Submitted $ ........ ..~.....~..... ................. Construction on above described building and permit meets all applicable codes and regulations. Applicant ........... ~ ....... Sworn to before me this ................ day of. ......... ~..~.. ............. Notary Public .................................... County (stamp or sea ) THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ,--- B5 jOHN STREET, NEW yORK. NEW yORK 1003S o.,~ 5 1972 THIS CER~c~ ~ . · ~ '-.roduced by the appticmnt named on zhe .bore apptica~io,, .umber in the prem,ses o~ -'~ theetectrieate~.ipmentasdescr'be~°~a~""~en~a1 D~lve, Ma~i~uek, N.Y. omy Joseph ~0~s ~x'. ~ ~ ~ Lot FIXTURE OUTLETS DRYERS SWITCHES 2 FURNACE MOTORS FUTURE APPUANCE FEEOERS IMECLOCKS SYSTEMS DIMMERS SERVICE DIscONNECT S E R v I NO Oic Hi,LEG C E OT.ERAP.^R^FUS: 'iance at the date of mming Pool) This certificate covers comp± ual environments it is advisable (Swl ...... ~u Because of unus .... ~,, a nuallfled person. inspee~x~A~ test and/or repairs m~u= ~ = to have Iraq~u~ James T. Ridge GENERAL MANAGER '31 Terry Lane " 'D Commack, N.Y. 11725 " This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. N OF SOUTHOLD . // TOWN CLERK'S OFFICE ~ '( ~ ~ APPLI~TION FOR BUILDING PE~IT ~ ' ~ ¢ INSTRU~IONS o. This oppli~otion must be ~pletely flll~ in b~ ~ewriter or in ink und submitted in ~pli~ote to t~ Building b. ~lot plon ,ho~in~ I~ation o{ lot ~ o{ building, on ~remi~,, relationship to odioining p~m~ or public street~ or areas, and giving a d~ail~ ~ri~i~ of I~t of pro~ must ~ drawn on the di~ram which is ~ of this opplicati~. c. ~e work c~er~ bY this application may not be commenCed before i~ua~e of Building Permit. d. Upon ~al of this applicati~, the Building Ins~ctor will i~ue o Building Pe~it to the applicant. S~h ~rmit ~al ~ kept on the pmmisK ~ailable for inspection througNout the pr~ress of the wo~. e. No building s~ll ~ ~cupi~ or used in who · or in pa~ for any pu~ose whatever until a Ce~ificate of ~cupa~y shall h~ been grant~ by the Building Insp~tor. APPLI~TION IS ~REBY ~DE to t~ Building De~ment for the issuance of a BuildJ~ Permit ~uant to the~ Buildi~ Zone Ordinance of the T~n 'of So,hold, Suffolk Count, New York, and other applicable La~, O~i~nces or Regulations, for the construction of buildings, additions or alterations, or for rem~al or demolition, as herein ~ri~d. The applicant ~rees to comply with all applicable laws, ordinance, bui~ing c~e, housing c~e, and regulations. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) / 1. Location of land on which proposed work will be done. Map No.: ......... ./.~,..~.~, ................. Lot No.: ........................ Street and Number ........ /.........C~.-...~.-T2~...-.~..(~ ........ .b...~....,~ ............. /'~I.~..~iT.~.~...~...~....~ ............................................ ' ' Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed conStruction: a. Existing use and occupancy .............. /~,.~..~x.~..~....'9...~ ..................................................................................... b. Intended use and occupancy' ...... /..~...X,.~..,~ ....... .~.......~...~...'~.....~../..~...~........~'...~..e.~,, ........... : ................................. 3a ~j~re of wo~k (check which applicable): New Building ....... ~... Addition .................. Alteration ...~...~ .......... Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .................... ~. ..................................... Fee ...................... . (to be paid on fi~ing this application) 5. If dwelllng, 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 ........ ..~...~_ ............... 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 .~.(~ · Reor /c, ... Depth .....~....~. .......... Height .................... Number of Stories ...................... . .......................... 9. Size of lot: Front ........ /..~.q.,..,o. ..... Reor ............ ,~,,~°.~.0. .......... Depth .........~..-~.....~.. ~' 10. Dote of Purchose ........................................................ Nome of Former Owner ........................................................ ] ]. Zone or use district in which premises ore situoted .................................... . ... 12. Does proposed construction violate any zoning law, ordinance or regulationP ~/o 13. Name of Owner of prem ses -'~..-~..~..-~-.-~.....~.....~..~.....~Address ../.......C::~....,~....'C~...~)~.~.u~,~p~one No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor x~../,~. ~..~.-~.m~...~........~.....c..:....Address ./...~..o..~...~_% .j.~.....j~,Ohone 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 according to deed, and show street names and indicate whether interior or corner lot. Z~o 7-- STATE OF NEW YORK, tS.S COUNTY OF .... .~..~...P.:.'.'.'.'.'.'.'~..~..,,~. ...... J' · .......................................................................................... bem~ duly sworn, deposes and says that he is the applicant (Name of individual signing application) above nome& 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 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 I -i%.-~, ~-- --~ I