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Home My WebLink About5786-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z%992 ...... Date ........... ~Te2mar~ · '3q .... , 19. q3 THIS CERTIFIES that the building located at Booth .&. Jenl~$ngs .Bd ..... Street Map No.O~k.~.!dg.e..H. ~,~lllck No ........... Lot No...2 ..... 6outhold.. ~,¥, ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... Apr~,l. 3 .... , 19.72 pursuant to which Building Permit No...5'7~6Z dated ....... kBril...3 ...... , 19. ~, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...P.r.$ .v.a.t.e...o.n.e.. f...a~..1Jr..d.w.e..1.1.~, g ..................................... The certificate is issued to ... Tholla-~ .0?BI,~.I~I. & .lgife .... (hr~er.s ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...N.,.l~: ............................. UNDERWRITERS CERTIFICATE No.. P~r~d~.n~ ....................................... HOUSE NUMBER ..... .~00 .... Street.. Jerminge .P,4 .................................. Building Inspector FO~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5786 Z Date &.~r~. 3 19~ Permission is hereby granted to: ...~,~...2.~.~......*..~.~?.....°..'.,~?.*.?~ ...... ............. ile~the:4. ............................................... pursuant to application dated ~.~'~-'~ ~, 19..r.~...., and approved by the Building Inspector. Fee $..~.~.~...~.. ......... TOWN OF SOUTHOLD Building I)q,adrment Town Cle~.s 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 fram 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 o~ 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 Date ..... ~.....~......2...~.. .............. New Building ~..~..~.:..~.~...... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ...~. ........................... i .................................. , ........................ i ..................................... Owner Or Owners Of Property ......~7.~,:~..~.S.......(~.~J~..~./.~ .................................................................... Subdivision .~..~.~/:.d~......(~ ...................... Lot No.....~..~ ..... Block No ............ House No ............. Permit No..~.~...~.~..~.... Dote Of Permit ~..~..2--...Appticant .... ..~.~.~..~......r~...~..~...~ ......... Health Dapt. Approval ............................................ Labor Dept. Approval .................. ;;; ........................... Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .,,~ ............................... Fee Submitted $ ..... ~.:..~... ................... Construction on above described building and permit meets all a..p~licable codes and regulations. Applicant . ' ........... Swor/~,~ efore~____~/~nto.~b me ~,~/~ ~, ~this / .~ day of Notary Public .....;~~ou. gty Suffolk Count~ (stamp or seal) TOWN OF SOUTHOLD ~:,/ ~¥'~ ' ,UILDING D'EPARTMENT TOW~ C~aK'S omc~ ~ ~. ~ ~1( - Examin~ ~..~'~ ........... , 19.27 ~4] ~"'¢ * ...~.~.f~ .... ...... ~plicati~. ,0 ........... ........................................ , 19 ........ Pemit No ........................ /~/ D~ppr~ ~ "' 'j~"7 , ~'"' ~ 0 APPLIC;ATI?N FOR INSTRUCTIONS a. This application must be completely filled n by typewr ter or n ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee ~6Cerdir~g~o schedule. 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 laYe~t of Property must be drawn on diagram which is part of this application, c. The work covered by t~is application may not be commenced before issuance of Building Perm[t~ d. Upon approval of this applicetion, the Building Inspector will issue a Building Permit to the al~plicant. Such permit shall be kept on the premises available for inspection throughout the wo~rk. . . e. No building shall be occupied or used in ~vhole 0¥ in part fo~r'hn~; p~rp6se Wkateverbfitil a Certificate of Occupancy shall have been grented by the Building Inspector. API~LJCATION. ~ , S . HEREBY MADE to the, ,~,Bu d ng, Department~ ,f°r, ti}e, s~uence of a Bud ng Permit pursuant to the Bud ng Zone Ordnanca of (he 'To~ of Southo d, Suffotl~ Cdunty,New York, a~ld O'thet applicable Laies, Ord nantes, or Regu at ohs, 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. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..........-- --..~-~.~....4~l~ll~d~. ....... C~:...~J~.~.~.~. .................................................... If applicant is a corporate, signature of duly authorized officer. ..................... ii~'~;~;':.;,'~/'~i'~i;'~'i'~;:;~-~'r'&i~'~;:~i~';5 ..................... % ~. ,ecation o, lend on which propo~ work wi. be done.' Uap ,o.: .~.¢..~...: ~ot,o....,..~, ........... , ....... ., ............. ,, . - ~ , ~' , St~tand ~umher....C~.:~.*.....:...r~.~....S&~.....~a'~U~,...~...l~ ......... ,...~ ~ .............. 2. State existing use and occupancy of premise%~nd intended_ use and occupancy of proposed constructIOm a. Existing use and occupancy ............... ~.~ ........ ,...~ ...................................................... ~ .................... b. Intanded use and occupancy ................. .?......~ ........ i ....... ~., .~.~..,~.....~.. ........................................ .: .......... L:(check which applicable): New Building .......................Addition .............. Alteration....~..., ....... Repair .............. ~ .......... Removal ......................... Demolition ........................ Other Work .................................... . . (Description) 4. Estimated Cost ........................ Fee .~...~:,:; ....................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... i .......... 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 usa ..................................... 7. Dimensions of existing structures, if any: Front ...~J~.~ ......... Rear ...~..O..: ............ ,.;. Depth ...~....~:..~. ......................... .F Helgh..t ....... ............................................... Number of Stories ........ /.. .................................................................. Dimensions of same structure with alterations or additions: Front...~ .............. Rear .....~.~.. ............................ / Depth ....... .~.~.. ............................... He ght ........ m., ............................ Number of Stories ..... :. ................................. 8. Dimensions of en;cire new construction: Front ....i.t..~,.~. ............. Rear .......I...~.~. .............. Depth ..~...~.~ ........... i ........... Height .......... ~.~,~. .............................. Number of Stories 9. Size of lot: Front ...... ll..~...~..:....'., .............. Rear I -'.~..~.' Depth .,.../.~....?........~..~...{~.~... Height Number of Stories 10. Date of Purchase ...... ; .............................. Name of Former Owner ............................................................................ _ 11. Zone or usa.district In which premises are situated ................,~.~[~M',~.~I[~./..~., ....................................................... 1Z Do~s propo~d construction ¥iolate any zoning law, ordinenca or re~letion: ....... ~ .......... ................................... 13. Will Iotbere~'eded t. ......................... Willexca~flllb~renlO~lfrompremi~: ~,-~ Yes [ ] No 14. Name of Owner of prem,sas .,..'~.hJl~%l~.~.e..,.?~r.~..,..',.~J~,/.~l¥..' ...................... ' ................ , ...... , ........ ~;.;, ...... {Address) (Phone No.) Name of Archimct .................................................... ;...,.:; ........................................................... ~ ..................... _ ~ . (Addre~) ~ (Phone No.) Name of Contractor ..~.~.~.{~t~...~..'...'.~....!.t.l...I;a...J~....~. .......... ;~&.,...~:. ........................ ~...~...~...'.'..~..~ ....... (Address)' (Phone No.) PLOT DIAGRAM ,L0cate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-back dimensions from property lines. Give streak'and blOCk nun~ber'or description according to deed, and show street names and Indicate wheth- er interior or corner lot. be perfor~ in the n~nner- r statements contained in this application ere true to the best of his k~ewledge and belief; and tl3at the work set.forth in the application filed therewith. JUDITH T. ~OKEN ~ ~ .,~ **~ Notary public;~State of New Yore ~ ................................ ,...d,y of ...................... [ Notary Pub,,c,~..~:..~~.' ' ~ ~n ,,on =xp,m~County ................. 7'~ ~'.,; .... ;.d.~' (. ~/~e~ ~...~. ~ .~m"'.., , j.?...,. JaliSCo/. STATE OF NEW ~ORK, ~ ~.~ COUNTY OF ....2 .......... ...................................... ) t ~~,. ..................... ~-.~U~I~I~.I~....J~.' .*...~ll~.{..~.l~.}"~t~. ........................... being duly sworn, deposes an.d. says tl~at'h, is the epl~licant above named. (Name of Individual $1g#lng contract) ., ,, .......................... : .................. .................................................................................................. ....................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly auth~orized to perform or have performed the said work and to make ~d file this. application; that ell . T½OMAg t'vl. O'EEtEN CAT,',-qE;~tNE C. O'BrZIE. N ~T