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Home My WebLink About6308-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerlificnte Of Occupancy No.~ .~222 ..... Date ............ ,~une -. P~.l ....... , 19 .?~. THIS CERTIFIES that the building located a~a~.n .t~l. & .Fac.tary. Ave .... Street Map No..~ax ......... Block No...xx ...... Lot No..x~ .... l~a~ti*c~ek- - .N ,E-. ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ Bee--.21 .., 19.72. pursuant to which Building Permit No.. 6~.08z. dated ............ Dee...22..., 19.72., 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~u~.ne sa .b~..~.l~i~g .... (- ~e s~anra~t ) ............................... The certificate is issued to ~'~m ,. ~2a. pp · · .~'er~a~:~ · ~.. J. an~es · ~'eh · · ©~.n.~e~ ............ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~...,~(o ............................... UNDERWRITERS CERTIFICATE No...l/°A.. .......................................... HOUSE NUMBER... ~2~ ..... Street.. 'l,~a~_n. 'i~oad .................................... ................... ............. qt..ory. Av.e .................................. Building Inspector / FOR~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6308 Z Date December 22 19. 72 Permission is hereby granted to: '.~..~. ,... 3am~ .. ~/.~...~..~.~. L~.r.e.k ........................ .............. ~ .~.~.;t.t~u,~ ............................................ at premises located at .....}~.a..~E...~...o..a..d.....&.....F.A.q..t.g.~:../:kYft ................................................................. ............................................... ~a.%~ 1.tuzk ......... }k,~.,. ........................................................................ pursuant to application dated ..................... ~.~, ......... 2.~ ............. , 19..~., and approved by the Building Inspector. Fee $.~.:.?...i ..... Bu~la~ng ~nsp~tor NOTE : u = MONUMENT ,';LIRVEY FOR dAM[:_S d. KREH. MA]'T 1TUCK ]OWN OF $OUTHOL[} SEGURII'Y IITLE SCAI..E: I" NOV. 5, 1965 ~" LANO SURVeyOR, ~.Y.S. LIC.NO.I?G45 RIV~RHEAD, N.Y. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y, ]]971 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 instaflations, 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 [J 3. Copy of certificate of occupancy $1.00 ~ / --~ ~.J~.~,..__ Dat~.¥ ................... L...~. Z../...... New Building ......... ....... OIdar Pre-exis, ng u,ding ......... .............. mo.,'ond Location Of Property ................... ...~...~..z.~........?/.,~.....~......~.~...~..~..~..~...~...~..f.:/? ~' V'~.../7~.~.~.~.. ..................... Owner Or Owners Of Property .~s,..... .............................................................................................................. Subdivision ................................................................ Lot No...~.. Block No ...... .../~.... House No ............. Permit No....~'../...~...~...... Date Of Permlt ./....~..~.....~Z~..Z~Applicant ........... ~"~. ....... ..~.~........~.~/.~... .................. Health Dept. Approval ......... .~...:.~ ..................... Labor Dept. Approval ........... .~.....~( ....................... Underwriters Approval .............................................. Planning Board Approval ..... ..~....:....~.... ................... Request For Temporary Certificate ........................................ Final Certificate ....... Fee Submitted $ . -~..'..~.. Construction on above described building and permit m~.~ a~l-gpplicable codes and App cant . ~~.' ..... Sworn to,b/efore me this of - · .~ ....... , ......~~...~..Z.~. (stamp or seal) JUDITH T BOKEN Nota~ Public, State of New york No, 52-0344963 Suffolk Count~ ~ommission Expires March 30, 1~ FOBBf NO. I ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE z~' SOUTHOLD, N.Y. ~ Examin~ ..... ~.~....~..~...., 19.~.~ Application No. ~..~..~.~ ..... ' ~proved ~t t ~ D ~ Di~ppr~ e/c .................. ~ APPLICATION FOR BUILDING PERMIT Dote ]-2 / INSTRUCTIONS w~ a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, 3 sets of plans accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas,~an ~d~ giving a detailed description of layout of property must be drawn on diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. [ r d. Upon approva of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit,shall be kel~ Onl the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have bean granted by the Building Inspector. 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, and to admit authorized inspectors on premises and in buildings for necessary inspections. Hain Road, Y~attitu~k (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ].eaeee Name of owner of premises Ja~e8 Kz'eh ~ .?....~... ~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Other mrade's License No ................................................... 1. Location of land on which proposed work will be done. Map No .............................................. Lot No'..~. ...................... Hai. n Road and Factory Avenues Street and Number ........................................................................................................................................................ Municipality 2. State existing use and occu@a C,[I~TO.. f premises and intended~u~_~nd occupancy of proposed construction: a. Existing use and occupaqcy I~-zT Quee~t ~ b. Intended use and occupancy ..... ~..~... ,, .~.....e..a.. .......... :.~. ........ ....~..~.......~...~...~...~.* ............................ Alteration....Z.. ......... 3. Nature of work (check which applicable): New Building ....................... Addition ....Z.. ............... Repair ............... . ....... .. Removal ......................... Demolition ........................ Other Work .............................. ~ ..... (Description) 4. Estimated Cost $1j, 000. Fee ..2E (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 c-ars ............................................................................................................................................ 6. If business. Commercial or mixed occupancy, specify nature and extent of each type of use .~,~.....~jg~.elL ......... 7. Dimensions of existing structures, if any: Front 20 t. Rear 20t Depth .5...2...~. 9s Height ........................................................... Number of Stories ...... .o...~..e. ................................................................ ..... 20s 20t Dimensmns of ~me struc~ture with alterations or addtttons: Front .......................... Rear ......................................... Depth ............ ;.', ............................. Height ......................................... Number of Storms ........................................ eS. Dimensions of ent~r~ new construction: Front ...2...0..s. ................ Rear 20 s Depth ~ t · o~e Hei ht .....................................Number of Stories ................................. .... 50°22 ~'1:. _ 53.°88 ~ _~ 95.52 lg 110.82 9. ~ize or lot front ...................................... ~ear .......................................... uep[n .....~ ......................... , .................. 10. Date of Purchase ................................ .. .. . Name of Former Owner ........................... · ................................................. 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does 10roposed construction violate any zoning law, ordinance or regulation: ............................................................ 13. Will lot be mgraded ....... ~.?:.o. ....................... Will e_xcess fill be removed from premises:~[ ] Yes , [1[] No · ,James [(z-eh ~,~.~ ~w..///~// ~ ~/-/,-~ 2~ 14, Name of Owner of promises ................................................................ .T.j~..:x~..~.:....;~:: ............... ........ ......... (Address) (Phone No.) Name of Architect ............~ ........................................................................................................................................ (Address) (Phone No.) Name of Contractor ............~ ...................................................................................................................................... (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly al! 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 wheth- er interior or corner lot. STATE OF NEW YORK, COUNTY OF ....... : ...................... ............................ ~'~JLJ'I'~JYJ'"'":~.~ ....... ~"A'~"~" ................. b luly sworn, ~s and says that he is the appli~nt above named. (Name o/individual st~ing con~act] . He is the ............... ;~.~E~ ....................................................................................................................................................................... {Contractor, a~nt, co.rate of~cer, etc. of said owner or owners, and is duly authorized to ~rform or have ~rfor~d the said work and to make and file this application; that all statements contained in this application are true to t~ b~ ~ed~ and bel'ief; and that the work will ~ ~ormed in the ~n~r ~t fo~h in the application filed therewith. Norm Public, State of New Nn ,5~-0344~63 Suffolk C~ .................... ....................