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Home My WebLink About6890-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z6..~ 2.2. ...... Date .......... .8.e.p.~;....20. ........ , 19..7~.. THIS CERTIFIES that the building located at .N../8...0r.e.l~..rd..s.t. .......... Street Map No;r~; ......... Block No.. ~ ...... Lot No..x~z.....0.r..i.e.n.t... !,...k~ .. ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... Sep.t... 2.0..., 1973.. pursuant to which Building Permit No.. 6.8.~..0Z. dated .......... .~gp.i~ ...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 Private one family dwelling The certificate is issued to L .2~d..& J' Tal~o~. (Mrs Roger) (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval } ..%~, ............................... UNDERWRITERS CERTIFICATE No...E..1.?793.~ ..... 4.ug...2.~. .... ~.~.. ........... HOUSE NUMBER .~..~.2.~ ........ Street . .~..r.c~x.~.~.~..~.t. ............................ ....... .......... I~ORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PEPJ~IT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6890 Z Permission is hereby granted to: Gol~ami~.h_.~.~..Cans.t~.. A/C.. Ro~e~...T&bor ....... ~o~h~.l~ ................................................... Fo ~..u. ~!~....a..n.....a..~.a...X.~.°..n....4...~.e.....a.!~.ca. ~ ~.~.n..~.....on...~.~..~ ~.~..~..&.~.~. ~.~ ~i~ ................ at premises located at .... ,~,./..S.....O...~,~.a.r..~....,~..~. ..................................................................................... ............................ ..0.~..~.~rd~ ............ ~..,.~.,. ............................................................................................ pursuant to ~pplication dated ...................... ~.~ ...... ~l~ ............. ]9-~-3..., ~nd approved by the Building Inspector. Fee $ J. ~.e.~)~. ........... l~O~ NO. ~ TOWN OF $OUTHOLD Building Delm~tment Town Clerks Office So,thold, 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 buddings or new use: 1. Final survey of property with accurate location of oil buildings, property lines, streets, and unusual natural or topographic features. 2 Final approval of Health Dept. of water supply and sewerage dispcsa! (5-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Mulhple 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 buddings 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 inspechon 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-ex~stJng dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 ........... ..................... New Building .................... Old or Pre-existing Budding ....... ~:...~...~. ............ Vacant Land ' Location Of Property ......... ~..'~.C/./.~;Lc~). ......... ~./.?/~.~'./.~.. ........... .~.~,~../..~.~...L.~.. .......... ~....~.-~.~.. ................ Owner Or Owners Of Property/~,~....~..c..~,:.f~ ..... ./...~ ....... ~/.2.~....~ .................................................... Subdiwsion ............................... ~ .......................... Lot No......~7.~.... Block No ........ ";.. House No ............. Permit No...~..',.~/./.~...'.~. Date Of Permit ...ZZ2.....] ...... Applicant ..~:':.~z...¢).2, l,~.~'.ZT.-Z. ..... .~..~.~..~.~...~...~.~.,~/..?..~.~. Health Dept. Approval ............................................ Labor Dept. Approval .... .~. ..... ~ ..... ~.L,.~.. .................. Underwriters Approval ....... ,./...~...~....~..3...~. .............. Planning Board Approval ............. ..~...!..~ ................. Request For Temporary Certificate ........................................ Final Certificate .....~'i ............................ Fee Submitted $ .~...~.~.:..~.~. ................... Construction on above described building and permit meets all applicable codes and regulations. Appli ca nt .... ~.~..~.~ .~.....~. ~. ...... ~..~.1~.~...~...~.L ................................................. / Sworn to before me this Notary Public .......~/~.~nty FORM NO. 6 TOWN OF SOUTHOLD Building Depo~tmont Town Glerk~ Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY I nstructions A. This application must be filled in typewriter OR :nk, and submitted in triphcate 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 hnes, streets, aha unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage dispcsal--(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 s~te plan requirements where applicable. B. For ex~sting 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. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3 Date of any housing code or safety inspechon 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-ex~stmg dwelling or land use 3. Copy of certificate of occupancy :$1.00 $5.00 ........... .................... New Building .................... Old or Pre-existing Building ......... ~ ......... Vacant Land ............................ Location Of Property ........... ~.,'~,c,/~.4~. ............. ,.~...'/~.(,~.-7C~... .......... ..~.....~..../...~..~..~. ....... .?...~.:...~... ............ Owner Or Owners Of Property ..... ~;r~.~..~.. .......... /(~,.~..,~ ......... ..~.,. ....... .~.~,~.~.....~ ....................... Subdivision .................................... ~ ........................... Lot No ........ ~ ....Block No .......'-,T.. .... House No...~.., Perm,t No ..................... Date Of Permit .................... Applicant .~...~...~....~..~.....~.....~..~. ..... ~-&~.,~........(~...~....~7-' Health Dept. 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 applicable codes and regulations. ........ ............... Sworn ,o before me this / ~7-//~~ '/,~/~' ~¢'z'://( ................ day of ............................................ (stomp or seal) Notary Public .................................... County THE NEw YORK BOARD OF FIRE UNDERWRITERS aW BUREAU OF EI. ECTRICI;rY ~ ~ JOHN STREET, NEW YORK, NEW YORK 10038 Au..t N 177933 THIS CE~IFIE~ THAT ~y t~ ' t ~ ~t ~ t ~ numar i~ t~ prem~s o~ RXTUIIE RXTURES OUTLETS ~ 2nd Fl. OlltS~4~ Section Block Lot and found to be in compliance with the requirements of this Board. OVENS DISH WASHERS EXHAUST FANS DRYERS FURNACE MOTORS TIME CLOCKS UHIT HEATERS MuL'rI~UT~q' DIMMERS SYSTI4&S S E R V I C Panelboarda: 1-901~ 125amp Theodore Rohloff ~rehard St. O~ient,L.I. 119~? COPY FOR BUILDING DEPARTMENT. THIS COpY OF .~,__~. a. . ~ , MUST NOT BE' ALTERED Examined ............................. ~pproYed ........................................ , FOR,~I NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. 19.~ 197...~... Pemit No.~...~.~....,,~,. ............ Disapproved a/c ........................... ~ '('1~ ~'ii~t'in g I n spec/t~r ) ............................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 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, and 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 been granted bv 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 Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, a(~ditions or alterations, or for removal or demofition, 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 aplSlicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... ..~...~...-~...~. ~.~.z~...~.....-. ................................................................................................................................................. Name of owner of premises ......... '~-----vf~..J~.~.....~'~.~3~. ...................................................................................... If applicant is a corporate, signature of duly authorized officer. ..... ~' (Name and title of corporate offlcer~' 1. Location of land on which proposed work will be done Map No · ..... : .................................................. Lot No ............. Street and Number..~..~..~/Z~....~'~'....~;~E~,.~Y~,4)...~;'~, ' .......... -- ,,~4~...~'~..~.~......,~1~., .......... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~:>~.~./..~..~.~,t..-~... ................................. , .......... ~..~ .................................. b. Intended use and occupancy ....... n,~'~.~.."~... ....... ~~..~..~........~...~.....~....4:~ .............................. 3.' Nature of work (check which applicable): New Building ....................... Addition .....,~'. .......... Alteration ............... Repair ......................... Removal .................. ,....,. Demolition ..., .................... Other Work .................................... m/y-' ~ { Description 4. Estimated Cost ...........~.~..?....c~...;....~... ............... 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 Wpe of use ..................................... 7. Dimensions of existing structures, if any: Front ..~,~ ............ Rear ...... ~ .............. Depth ...~.~'Z .......................... Height ...~ .................................................. Number of Stories .............................................................. .... ....... · ... Dimensions of same structure with alterations or additions: Front ..... ~ ............... Rear ....,.~4) .............................. 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 ..~'~,~O'_...:.;~...: ........................... 10. Date of Purchase ..d/,~,~aIOz~. ............ Name of Former Owner ...,.~J~'~-~'~x'~,~Z3.~. ..........,~/,{30,~,.~ ................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....,0/-~...-. .............................................. 13. Will lot be regraded ....... ~V~ ...................... Will excess fill be removed from premises: [ ] Yes [;K]' No ',~- 14. Name of Owner of premises ..... ~.~t;~i~...~.~...,7'~XSt~/~C- ................. g:3~..../.~., .................. ~..~-~ ....... ~,&~...~'...... (Address) (Phone No.) Name of Architect ........................................... ~ ~ ~, (Address) (Phone e~o,.) _ Name of Contractor ...~.~..~..~.~.~.~ ....... ~:[~./~...~...~.~<~'.....'?....(::~O~/~.'.~.~,~ ............ ~..~.......~..~.~...~....'~. (Address) (Phone No.) PLOT DIAGRAM I,ocate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or de~,cri,13tion accordin er interior Or corner lot. i~' ~'O~ ~ to deed, and show street names and indicate wheth- ............ · ..~'~.,.'~...-.~-.~.....~..'.......~-~...~..'~..~~ .................. being duly sworn, depots and says that he is the appli~nt above named. (Na~ o/ individ~ si~ing con~act) He'IS the ...... --~' ..................... 0~.~ ' .................................................................................................................................................... ~ ~t~ctor, ~nt, co~te o[~cer, etc.] of said owner or owners, and is duly authorized to ~rform or have ~rformed the said work and to make and file this application; that all state~nts contained in this appli~tion are true to t~ ~st of his kn~a~ef;~ that the work will ~ ~ormed in the ~nner set forth n the app i~tion filed themwitk , .t~;~ ~'~ ~ ~"~ ~. -- ...................................... of / ,i