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Home My WebLink About5754-zFOB~ NO, · TOWN OF $OUTHOLD BUH.BING DEPARTMENT Town Clerk's Office Southold, BI. Y. Certificate Of Occupancy No. Z6.1~.t~ ...... Date ............ Apr;L]... 1~[ ..... ,19.7~. THIS CERTIFIES that the building located at .lake .l)l~e ............... Street Map No.. ;r~ ........ Block No... ~;X ..... Lot No, . .xx ...S~uthold.. R,Y, ........ conforms substantially to the Application for Building Permit heretofore fried in ~hi~ office dated ....... M~, .... 20' 1572'° .... pursuant to which Building Permit No.. dated 6/.2~/7.$ .&. ~.21/~.2.., 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 .Pr$.v..a.t.e...o~...f.a~..~.3:~r. ~.~.~..~...~.X..~.h..& .d.d.~.t.~..o.n.I. ..................... The certificate is issued to . Je. role..S$1b, ers~;a~n ....... 0w~er .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . N.,B, .............................. UNDERWRITERS CERTIFICATE No. ]/..919892 .... J~C..1.(~...19.~.1 ............... HOUSE NUMBER ...... ~ 20.~... Street..Lake. .Dr~.v~ ............................ ................. Building I~spector , FORM NO. 2 TOWN OF ~OUTSOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 575z] Z Dote ............................ ~,~.O,....?J. ...... , ~9....~... Permission is hereby granted to: ...... ~.em..~-J~... J~...;t'~z~...~ J.l~e~'.~.~e f~a to . ~ .~ ~. ~ ~g ~e~ ........................................... ~, -~,.. ( G~eet ~o~) at premises I~ed at .......... ~..~.~ ........................................................................................ Z ................................................... ~[~....~,~.* .......................................................................... pursu~ to application dated ........................... ~....~ .......... , 19..~., and approv~ by the Building Inspector. Building Inspector l~Ol~M NO. $ TOWN OF SOUTHOLD , Building Deportment Town Clerks Office Southold, N. Y. 11971 '~ ! APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and st4bmitted in DUPLICATE to the Building Inspector with the following; for new buildings or new u~e: 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 sewbrage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire U(~derwriters. 4. Commercial buildings, Industrial buildings, Multiple I~esidences 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 bses, 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 buildir~gs or premises, or other pertinent 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 ....... ................. New Building ................ Addition ..... Id or Pre-existing Bu}lding ................ Vecant Land .............. Location Of Property .......................................~. ................ '" ............ ~"'~'""~'~'";X' ........................... Owner Or Owners Of Property ....~J.~-~'i.~..~._c~.~...~. ....... ...~..:...~...r....L.;.~./~ .~...~'..~.....~.~.'..r.~..,~/;. .................................. Subdivision ................................................................ Lot No ......... ,,.. Block No ............. House No ............. Permit No...~...~.~...~.~Dafe Of Permit ~,~/~!~:~,~Applicant ...~..,~j~/, ............................ Health Dept. Approval ..._._~ ............................. Labor Dept. Approval ................................................ Underwriters Approval .............................................. ~ Planning BOard Approval ....................................... Request For Temporary Certificate ........................................ Fin(~tl Certificate Fee Submitted $4~,,~f"'e ..................... :: Construction on above described building~""~m_it meets ~fl~ll ai PP .............. 'r-" Sworn to before me this , // ~licable codes and regulations. (stomp or seol) ~/~'~'/~'~) L/ DRYERS- ,=Elec. ORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ?,~,85 JOHN STREET. NEW YORK, NEW YORK 10038 lberstein, Lake Drive, off Kenny Rd., Southold, L.I. ~.~,,~:. ~ ~.d r~. outside .~: RJRNACE~MOTORS FEEDERS TIME CLOCKS MULTI.OUTLET SYSTEMS NO. OF FEET DIMMERS ., 1~ 4/0 j'!* 1 4/0 Oaklawn Ave., not be altered in any mannerl return to the office of the Board ;f incorrect. Insoectors moy be MANAGER D credentials. -TOWN OF SOUTHOLD TOWN CLERK*S OFFICE SOUTHOLD, N. ~'. Approved ~ ........................................ , 19 ........ Pemi~ No ..................................... Application No.....~......~.,..~....~., ........... ~ Disapproved a/c ......................................................................................... ~.. ......................... '(' ' '~'i '~l'i';'~' I n s p e/Ct o ;i ...... . ....................... APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. This application must be completely filled in by typewriter or in iok and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relati6, nship to adjoining premises or public streets areas, and giving a detailed description of layout ofproperty must be drawn ~n the diagram which is part of this application.~k/~ c. The work covered by this application may not be commenced befor~ issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue ~ Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any pur~)ose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building D~portment for the iJssuanc~ of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New ~ork, 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 ail applicable laws, ordinances, buildihg code, housing code, and regulations. (S~gnaturb or app~licont, or name, if a corporation) (Address Of applicant) - State whether applicant is owner, lessee, agent, architect, engineer, generbl contractor, electrician, plumber or builder. ....... z'....~L/../...~%z..z...T. ........................................................................................................................................................ Name of owner of premises ..~./~..~J.~.~.~..~ ....... ~..~/..~).'.~J..7.~./.~.~..~.~ ...... If applicant is a corporate, signature of duly authorized officer. ' ............................................. ~ (Name and title of corporate officer) t. Location of land on which proposed work will be done. Map No.: ..~ ............. u.. ........ ., ........ Lot No ......................... .............. ..... ................. ............ ................................ Municlp~lity 2. Stere existing use and occupe~cy o~ premises end in~ended use ~nd occupency o~ proposed construction: o. ................ ....... ' .......................................................................... b. Intended use ~nd occupancy ......... ~X~.~-; .... ...................... 3. Nature of work (check which applicable): New Building .................. Addition .....'~'~.Z~........... Alteration '. ............... ~.~ Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .......... ~..~....~..~:..~ ......................... 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, ifany: Front ......... i~..~. .............. Rear ........ ./..3 ................... Depth .....~..~.: .......... Height ....... .~..~.. .......... Number of Stories ............../. .................................................................................................. Dimensions of same structure with alterations or additions: Front ............. ~.~.. ................ Rear ........ ..~T..~ ............ Depth .......... .~.~ ................ Height .......... ./.~.. ............. Number of Stories .........../. .................... \ 8. Dimensions of entire new construction: Front .............. ~ .................. Rear ............. .././. .......... Depth .....~¢....~.. ............ Height ...... ~...~ ........ Number of Stories ................ ./ ..................................................................................................... 9. Size of lot: Front ............... ~ ........Rear ........... ,~ ...................... Depth ........ .~....~..~..~.?Z... ....... 10. Date of Purchase .......... Z.~Z..~... ................................ Name of Former Owner ........................................................ ] 1~ Zone or use district in which premises are situated .......... ~...'.'. .................................... .? ........................................... 12. Does proposed construction wolate any zogjng law, ordinance or regulation .......... ~...~.. ................................. /n~./l ~,'. ' ,£~ ~ ~1.. ~fV~_, ;4/~- '"' 13. Name of Owner of premisesl/..,~,.~.//~..~..t.'f;.J.?./.f, ............ Address ~/.~..~..~.~/,./.~.J.,../,',~'./'/~,mr¢~t'Phone No. Nome of Architect ...................................................... Address ............................. .~ ........... Phone No ..................... ame of Contractor ..............Address ........ .............. Phone 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 whether interior or corner lot. .......................... ...~.~.:.~...~...~. ...... being duly sworn, deposes and says that he is the applicant (Name of above named. He is the ........................... ~.~.':.~_~...~ ......................................................................................... (Contractor, ~ent, corporate officer, etc.) of said owner or owners, end is duly authorized to perform or have per{armed the s~id work ~nd to m. ke end file this application; that oil statements contained in this application ore true to tho best of his knowledge end belio{~ that the work will be performed in the manner set forth in the application filed therewith. Sw°rn t° Z[e me thiSday of ~..~ 19~ ~ .~' ~~~ Nota~ Public, . ........................................................... Covnty (Signature of t)