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Home My WebLink About5976-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No... Z9~'~5 ......... Date ..... F.e.I~L"U~Lr~.. 'J. 9 ............... 19 ~.0. THIS CERTIFIES that the building ................................................ Location of Property .... 865...Second. S.t~'.e el; ................... ~le~. ~uffoLk.. N...Y. House No. Street Hamlet County Tax Map No. 1000 Section ...1.~? ...... Block ....8. .......... Lot ...... ']0 ......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... O'llrte .20 ......... ,1972. pursuant to which Building Permit No .... 597fi~ ............ dated .. ~Ilal;le. 29 ................. 197.2., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .................... One. F. amil.y..l~eiL_l±n~ .w/Addition ........................ The certificate is issued to ............ 0'0hi'l .I~{~-J,1'10¥/~:i, ............................. of the aforesaid building. Suffolk County Department of Health Approval ......... ~T~.R. ............................. UNDERWRITERS CERTIFICATE NO ................. ~ .~/p. ~./5~./~ /~/{/,~ 5 ~. Building Inspector Re~ 4/7~ · 0~,,.~ NO. ~ 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) N? 5976 Z Permission is hereby granted to: / · ......... ~..~.~.....~...~..~..,...~..~.~..~.~..~. .......... ............. ~.~..~....~.~.~..~..~.~.~. ...................... ........ ...................................................... ~t premises Io~oted ot ............................................................................................................................ pursuant to application dated .............................. ~......~......, 19.?...'~.., end approved by the Building Inspector. Fee ,../..~...o.__...o. ......... Building Inspector Examined ...... ~.....~.....~_......, Approved ........................................ , I~OB~ NO. 1 TOWN OF SOUTHOLD BUILDIN$ DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19 ........ Pemit No ..................................... Disapproved a/c ....... ~.. .......................................... Application No ............................... .'~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS June 20 L~ Oate ................................................ , ..... a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building 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 premises or public streets or areas, ana~) 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. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on 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 bee 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 o;~ 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. (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. Owner Name of owner of premises ...... ~;o~;m..~3..3.d~r~gs~iL ...................................................................................................... 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.......3;~..., Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: · - Store & other buildin s a. Ex,sting use and occupancy ....................................................... J~...a ...................................................................... b. Intended an addition on ~he;,~pma~g~uilding. 3. Natbre of work (check which applicable): New Building ....................... Addition .....~ ........... Alteration.....~..~....'... ° Repair ......................... Removal ........ ~ ............ Demolition ......... ~ ........... Other Work .................................... 1i { Description} 4. Estimated Cost ............................................. ;. Fee .......~..e.Q(~ ................................................................................. (to be paid on filing this application} 5. If dwelling, number of dwelling units ...Q$.~ ........ 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 ..... .1.8 ........... Rear ........ .1.8 .............. Depth .....~.~ ......................... Height ........................................................... Number of Stories ......o.~.,e. ................................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front .......... ~ .......... Rear ......... ~ .............. Depth 22-6" Height ...................................... Number of Stories .....o...~..e. ............................. 9. Size of lot: Front ........... ~),0 .................... Rear ........... 9.~..%'...~..1..0~.,'!r..... Depth ............ .~.1.8..I,...&..8.~.+. .............. 10. Date of Purchase ..................................... Name of Former Owner., ......................................................................... 11. Zone or use district in which premises are situated ....... ~.'..~.~....~...i..s..~. ........................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .......... ~7;~.~ ............................................. 13. Will lot be regraded ........... ~ .................. Will excess fill be removed from premises: [ ] Yes [x.] No 14. Name of Owner of premises ...... ~o_~ ~,,,~.].';~.OW,,~;;[. ....... ,,~f~..~.U~,.f'.O~, ...................................... (Address) (Phone No.) Name of Architect ....................................................................... (Address) (Phone No.} Name of Contractor ..................................................................................... (Address} (Phone No.) PLOT DIAG RAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck 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. See plan attached STATE OF NEW YORK, COUNTY OF ...... . .~..~...~.Q,~ ............................ ) ........................................ .U-....O.~...~. ,e:.~.~..~,.O.E.S..~.~. ......................... being duly sworn, deposes and says that he is the applicant above nabbed. (Name of individual signing contract} Ha is the .......................................................... ..Q~....~...~...~. ......................................................................................................................................... {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 ell 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. ~ ANNA W. JACOB~ ,~- · . ....... :....~.~..~;::......dav of .~/~C~E~/.eUbl~.in. Stete~f~le~lglf~.. ...... ~_ ~ n t~ /_ ~ .......... 7__ o THE NEW YORK BOARD OF FIRE. UNDERWRITERS BUREAU OF ELECTRICI'~'.. . --" r~c 85 JOHN STREET, NEW YORK, NEW~YORK 10038 John Halin~ski, w/s 2nd St., ~00' $/o King St., New SuffOlk, L.I ~exami~on J~O ZU~ a~foundtobei~mplia~eWiththe~ui~mentsofthisB~' flXTU~ flXTUR~ RANGES mc~Ka~ O~KS 1 OVENS I~SH W~HERS ~Z 34 x 200 CB WoB, Ruland Electrtc~l; n Hattituck. N.Y. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.