The URL can be used to link to this page

Home My WebLink About6321-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z .~03fl ..... Date ............ ~1~..l~. ....... , 19~ THIS CERTIFIES that the building located at 1~ .l~m~ .off. ,rang..at .... Street Map No..~ ........ Block No .... ~ ..... Lot No... ~... ~zn~..~. .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... Doe.. 29..., 19.72. pursuant to which Building Permit No. ~.. dated ............ Da¢...29..., 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 .~rX~ata..a~e f~$ly..awe5X~g ....................................... The certificate is issued to ~. C., .~re~ ...... ~er .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ~.R, .............................. UNDERWRITERS C~RTIFICATE No... p~ ...................................... HOUS~ NUMBFR.. ~.0 ....... Street...~. ~r~OO..~O ........................ ";" '?": '7'" Building Inspector FOF, M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMEHT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 632! Date .................. ~1~ ........... ~ ............. , 19.~.. Permission is hereby granted to: ~o~..Jl~k.l.m~....~.CLl~ s ~ t~..~1~ ............... ..... ..~J..~. ............................................................. at premises located at .~.t,..]~ad..~f...S~.8..~[:Lr'..~,..-q~f,z'.ea'l; ....................................................... .......................................... .gZ~,e.~ ......... ~.~.~ .................................................................................... pursuant to application dated ............................... D~e, ...... ~....., 19...~., and approved by the Building Inspector. Fee $~. ~..~. ............ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY' ' ' ~; ~, 85 JOHN STREET, NEW YORK. NEW YORK 10038 THIS CE~IFIES THAT : P,bi]]ip Frey, Pearl August 13, 1973 RXTUIll; ' RXTURES OUTUtTS SWITCHES FLUOrESCEnt* ?d., off Willow Terrace, Orient, L.I. [] 2~ Ft. OUtside ~t~ mock ~t and fou~ ~ ~ in compl~ce with ~he requi~ments of th~ ~. ~NGES C~KINO ~ ~NS ~ W~S EXHAUST FA~ RJRHACE MOTORS ~JTUIEE AP~UANCE IEEE)ERS TIME CLOCKS DIMMERS S E R V I C I 4/0 2/U Peter BOgovlc, Mai~] Road, Southold, L.I. 11971 m MANAm I1 Per COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FOltM 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 in triplicate 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. Swam 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 Date New Building .................... Old or Pre-existing Building ~' Vacant Land Location Of Property ....................................... :. '~ ~'-~__ ....~-.-: ............................................ Owner Or Owners Of Property ..~~. ./~...~__ .................................................. Subdivision ................................................................ Lot No ............. Block No .............~-H°use No ............. /*~.... ,/.'..~Z.....Apphcant'Z 7z~- · 7'~ Permit No..~,*~.~*/.*.*'~*... Date Of Permit ....... .....~.. ............................................... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ..J~../...'~.~f.~.,~,. .................. Construction on above described building and permit meets all applica,bJe codes and regulations. Sworn to before me this ~'~-~/~ [~; FLOYD F, KING, JR, Notary Publie, le~..publ~. 5tare. oF New ,~Fo?L~nty No. 52-7267800 Suffolk County Term Expires M~rch 30, ~97~/ (stamp or seal) TOWN OF SOUTHOLD ~.~,~ ~ BUILDING DEPARTMENT / . /TOWN CLERK'S OFFICE · I ~) '//~, ~ SOUTHOLD, N. Y. ........................... , 19 ........ ........................................ , 19 ........ Pemit No ..... ~.~ .............. Di~pproved a/c .............................. .................................. :..~: .................. ~ Application No...~....~......'~../. ............. 1. Location of land on whic~ proposed work will be ~zne. Map No.: .................... Lot No .............................................. Street and Nu m be r. ~~... ~....... ~....~....~... .......................... ~~'r~ i'~ i '1~ 'a'ii' 't~ .......... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..~: ............. ~1 b. Intended use and occu anc P Y ..................... ~J/~ ~or) ' APPLICATION FOR BUILDING PERMIT Date .~ l 0 fill INSTRUCTIONS a. This application must be completely ' ed in by typewriter or in ink end submitted in triplicate to the Building Inspector, ~th' 3 sets of plans, accurate plot pl,n to scnle. Fee ,ccording to schedule. b. Pict plnn showing Iocntion of lot nnd of buildings on premises, relntionship to ,dioining premises or public streets or nre~s, ~nd giving n detniled description of In, out of pro~rW must be dr~wn on dingr,m which is pert of this npplia,tion. c. The work covered by this nDplicntion mny not be commenmd before issunnce of Building Permit. d. U~n ,pprovnl of t~is npplic~tion, the ~uilding Inspector w ssue n Building Perm t to the the premises available for ins~ction throughout the work. e. No building shall ~ occupied or u~d in whole or in part for any purpose whatever until a ~rtificate of Occupancy shall have gran~ by the Building Ins~ctor. APPLICATION IS HEREBY MADE to the Building Department for the issuan~ of a Building Permit pursuant to the Building Z~e Ordinance of the Town of ~uthold, Suffolk County, New York, and other appli~ble Laws, Ordinances or Regulations, for the ~nstruction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comp y w th all applicable laws, ordinan~ building code, housing code~an~[e~ula~p,. =nd t~ ad~t a~pectors on premises and in buildings for ne~ssary ins~ctions ................................ ~ ~ ' / ~ ~ ' (Signature of app cant, or name, if a corporal on) -/ ~._ / '~ ' ~ [ P~ ~ ,/.~ /~ 1~ '/ ' ................................................. {Address of apphcant)~'"; ........................... , / S~t~~nt I~ o~er, Ieee, a~nt, architect, engln~r, general contractor, electrician, p um~r or builderL Name of owner of premi.s ~ ' ' ~ ~ ..................................................................................... ......... ............................................................................ ~ g ' o o fleer. ..................... ..................... 3. N;,ture o~ work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ......................... Removal . Demolition ........................ Other Work .................................... ........................ (Description) 4. Estimated Cos ...... .'...~...~... ,~...'...~....~. .................. Fee ........................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....2. ........ 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 ......~T...~./... Height ./. ......................................... Number of Stories ........ /.. .................................................................. Dimensions of same structure with alterations or additions: Front .....~....~/....( .......... Rear .....~%..z(....~ .......................... - Depth ........ ~..~...~.~ ..................... Height........................................./;¢ ' Number of Stor,es ........................................ ~ .....~..../~.. ................ Depth .../.. ........................... 8. Dimensions of entire new construction: Front ........ .~.. ............. Rear / / / Height .......... ~ .................................... Number of Stories ......................................................................................... - ~ t 9. Size of lot: Front ........5...~..../. ...................... - Rear .......................................... Dap h .................................................. Height ........................................ Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Form~ Owner ............................................................................ 11. Zone or use district in which premises are situated ...~...;:...7~--'~-- ..................................... .......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .~ ................................................ 13. Will lot be regraded ~ .................... Will excessfill be removed from premises: [ ] Yes ? [ ] No 14. Name of Owner of premises ,,.~,.,~ ~,,..,.~ .. (Address) (Phone No.) Name of Architect ..................................................................................................................................................... .~ _ (Addcess) (Phone No.) ................... ............... Name of Contractor ...... ff. .......................... ,.,~,,,~' ti'none ~o. 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 wheth- erinteriororcornerlot. ~ ~iN6 57' J~,,t/~,'^TI2 ~12 STATE OF NEW YORK, ) SS COUNTY OF .,,.*~.~...~,.,F.,~-Z.~. ............................ ................... .T,~,..,/U..~.........~..~..~,,.~.~.~..,~. ....................................... being duly sworn, deposes and says that he is the applicant above named. (Name of individual si~ing con~act ) He is the ........................... ~/~.~-~ ............................................................................................................................................................... (Contractor. a~nt, co.orate of~cer, etc.) of said owner or owners, and is duly authorized to ~rform or have parformad the said work and to mak~ and fil~ this application; that all statements contained in this application are true to the best o~ his knowledge and belief; and that the work will be ~fform~ in the set forth in the application filed therewith. ... 2 ......... o, ............. ............ om~ ~u~dc 5folo of No~ York ............................ Notary Public ~..¢ ..~.~.~ .... ~:-.....~ ...................... ~ ......................................... ~ ~ .erin e :p[rc.~ L}.Trc~l 0% 197~ ~ t~t~m~ ofapphc~t}