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Home My WebLink About5955-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMF, NT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy Date ...............~.p.t....2.~ ..... , 19..~.. THIS CERTIFIES that the build~ocated at ...C.a..l~..~. g.t..c~.. R..oad ....... Street Map No~..a.s.s.:..P.t..! .Rildin Minor ) . .~.a..s.s.a.u.. P.o.i. nt.~. Cutchogu* ~: Block No ...........Lot No ................... conforms substantially to the Application for Building Permit heretofore filed in this office ............ ....... dated ..........S.e.p.t .... .2.1+..., 1973.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to . .~..n..u~..l..&..~.a.r.b.r.a...~.i.e.$.e.1. .... . .O~n..e.r..s ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N. :.R.: ............................... UNDERWRITERS CERTIFICATE No... ~..1.~.9..~.3.6. ..... 0.c..t..i.1.,, .~.77.~. ............. bUild!'~- HOUSE NUMBER .... 3.6.1.~. ..... Street...V.a.n..s.t.o.r.~. ilp. a.d. ......................... · Ol~V[ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5955 Z Permission is hereby granted to: ........ l~....J~.]:ovooA..&vo ............................ ............. li~mpm,l~ml,...- tl.,r} s ............................... to at premises located at .......... Ve41~el~..~o~lJ ............ IltllS~ll...~:l:l:~ ............................................ ............................................................ C~f,~l~e ...... .~.,.~ .............................................................. pursuant to application dated .............................. ~..ll~.ql...~l....,~9.~r~.., and approved by the Building Inspector. Fee $..~.~*O0 ........... Building Inspector FORM NO. 6 TOWN OF ~OUTHOLD Building Depn~ment Town Glerks Office Southold, N. Y. 11971 APPLIGATION FOR GERTIFICATE OF OGGUPANGY 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), No~-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 o 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 ce ,f,cate o, occu ncy $,.00 D blew Building ................ Addition ..... Old or Pre-existing Building ................ Vacant land .............. · ocot~on Of Property .... ..J~.~:~:...~T./.~.~...../~:~.~.~. ...... .~ ....... ~ ..................................................... Owner Or Owners Of Property ..~..~.~-Y.~..~'~;..~C........~.~.~..~.~= .~... ......................................... ........... B,oc -- ............. .ouse Health D~pt. Approval ....... ~....~. ............................. labor I~pt. Approval ................................................ Underwriters Approva ....................................... arming Bo~rd Approval ........................................ Request For Temporary Certificate ......... i...~. .......................... Final Certlfi¢ote .......................................... ..... o, ..... Examined ..... ~..:.[....c[ .......... ApproYed ........................................, FORM NO. 1 TOWN OF SOUTSOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ]9 ........Pemit No ............................. Disapproved a/c ............................................................................................ .................... i'"'""'"'""(Building I~spector) APPLICATION FOR BUILDING PERMIT ................ /..(..? ..................... , INSTRUCTIONS a This a lication must be eom letel filled tn b t ewr ter or n ........ PP p y ' y yp ' ' 'nK ana suDmittea in triplicate to the ~suilding inspector, with~ 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'~?emises or public streets or areas, and~,~ giving a detailed description of layout of property must be drawn on diagram which is part of this,,app,~jcation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this applic~tj,o% the Building Inspector will issue a Building Permit to the applicant. Such permi~shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or ~;~,,v~ol~ or i~l~[' ~r~nl~J3urpose ~n~q~ersu~i!,~ Cet~l~ate of (~l~ahe~sl'~ll~l~ave been 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 South, ~_u~fo~ke~Cj~J~tyJ~ev/~J~ a~t;her app.Ji~fe !~.i~O/~[J~3q~;~J~r .~Je4~ations, ~or/tl~ eer~tfue'tJ~ of bu dns ' r' g, add t~ons o alterations, or Tror removal or demolition, as herein described. The ~f~plicant agr~s to, compty with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors,~p~ef~J',et*a/~'~dings for necessary inspections. ..... ....... (Signature of applicant, or name, if a corporation) _ , .......... '~l~dress of applicant~ ~.~..,~ State wheth~ applicant is owner, les~e, a~nt, architect, engineer, general contractor, electrician, plumber or broider, Name of owner of premises ~.~., l~ If appl~t is a corporate, ~ignat~re of duIv author~ officer. ....... ....... ~ [{~amo and title of corporate officer} 1. Location of land on which proposed work will be done. Map No.: ...~,..O,,,.~, ........ Lot No .............................................. Street and Number ............... ,.~,,,,~ ,.'~,.,?..,.~,,,,,,,~'~, ......... ~.,,,~.,,,'~,, .................. : ...... .,,~,,,.,.t~,,~,,,~,,,O.,.l~-,...~1',..~ .............. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of. proposed construction: a. Existi ng u se a n d occu pa n c¥ ......'./....., ../..~.~-....'~.~../... ?...~'~.. ....... ... ,~,, ..~;~'... :...~.......~, .~..~..., .............................................. b. Intended use and occupancy ....... ...~..~.~ ................... Z, ~'~ 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alter,ati?.n.,.. Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost .~.....?/..?..e...D. ........................... 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 ......~...~....~. ............. Depth .....%~..~..~ ...................... Height ........... ..'~....~...~..-~.....~..'("~".~.. ................. Number of Stories ......~T.~7~....~......./....~..~..~ .................... Dimensions of same structure with alterations or additions: Front ........ ~...~..... ....... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ 8. Dimensions of entire,~ew construction: Front ....... ..r... ............. Rear ...... ..~... ................. Depth .....~ ......................... Height ................ ..~.....~ ......................... Number of Stories ............ ./....~..../...~.....~T.....~ ..................................................... / 9. Size of lot: Front ...................................... Rear .......................................... Depth .................................................. Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ............. ...~.....¢~.....~....~-....~....~.....~....(~....~... ............................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................................................ 13. Will lot be regraded ...... ~....?. ..................... Will excess fill be removed from premises: [ ] Yes ,~ No 14. Name of Owner of premises .....~..~...~....~.. ...... ...~..~.~...~.. ........ ..~..~,..~.~..,~........../~...~ ....... ?...~...~..~....3~_ ( Ad d r e ss )~/.~,.~ ~,~,~__ (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor .......~..(~.'~.....~....'~'...'~.....~/...,~.....~. ~-. ~...~...~......~...~..~---~'-~.. .................................. ........ 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 o~r description according to deed, and show street names and indicate wheth- er interior or corner lot. C~/~.(-~(~,~C,-T,,--~ ~.~ ~r~. STATE OF NEW YO~K,.~/,,, ,/~,/~;, ) SS COUNTY OF ...... ~'"".~'"'L ~ ............... ~/.~.~... being duly sworn, deposes and says that he is the applicant above named. He is the .......... I.~.~~I ....................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~;~t~t)o[~!~o perform or have performed the said work and to make and file this application; that ell statements contained in this ~i?a~i~n, a~,~t[ue te~t/n~ct~st of his knowledge and belief; and that the work will be performed in the manner set forth in the application fi~ ~bet~Wi~3 ~uffolk County~Z~ ................... · /.Z... ayof ............... i .......... , otary u ic, .~.~......":2=-t:~/Z~..~...~..,~...,~..~ty .................. ,-........',......~. ........... :..,~...~.~....: ...... '" (Signature of applicant'- - ' --- '"---- ') ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS ~.k BUREAU OF ELECTRICITY ~ 85 JOHN BTREET. NEW YORK. NEW YORK 10038 o~October 1~, 1973 ~.t~on~Vo.o. li~ 5.53108 N 119536 THIS CERTIFIEB THAT only the electr;c~ equipment e.s de~¢rihed ~ ~md introduced by the .pplic~mt n~med on the ebm~e epplie~t;o~ numher in the premises of Manuel Siegel· e/side Vanston Rd., Cor.o£ Carrlng~on Rd., Cut ehogue~L. I. in the following loc=tion; ~ Bosement ~ Xlst Fl. -- 2nd FI. outside Section Block Lot was examined on 0 S t 0 D e r ~ · 19 7 ~ and found to be in compliance with the r~quiremen ts of this Board. RANC~$ K.W. COOKING DECKS [ OVENS [DISH WASHERS AMT. K.w. [ ~T. K.W. MT. K, W, 19,31 I TIME CLOCKS BEU.IUNITHEATERSUNIT HEATERS MULTI-OUTLET A~, '/~PS, TRANS.~ N~.Y~)TFE~T II R V I EXHAUST FANS 1 F EI~ER$ 1 60 A. W.G. NO. OF HI-LEG A.W.G. NO. OF NEUTRALS A. W, O. OF CC. COND, OF HI-LEG OF NEUTRAL 3/0 1 1/0 SERV~ mS/CONNECT I HO. OF I S METER 1 200 CB x 1 1-10 amp. Compactor John M. Lademann Box 123, Cutcho~ue· L.I. m MANA~ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.