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Home My WebLink About6914-z FOR~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTI~OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6914 Z Date ....................... ~e-~ ......... .$~ ........... 19~-3 .... Permission is hereby granted to: · .-~ ..... ~e s-~e~,~..~ ...................................... ....... &m~.%h%~'n ....... ~?-~ .................................. to ~i3~--e~.- ad~, ~.~le~.-&-.~-.e~.l-t~e-~,a% ~on~.. o~-. e~i.~%~ng..~e.~ ................. at premises located at Lo.t,..~...$~.....C~p:t.J~Lc~..l~t4~teal ......................................................... ............................ C, en.ta, e~!..ti~i-$ve ......... Ka%-t~i-~u~tk.....ti-~.~. ...................... ~. ................................ pursuant to application dated ........................O~%......'J~i ................ , 19~.~..., and approved by the Building Inspector. Fee $.~.~t~JO ............ FORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy No..Z60~t .... Date ...... &UI~... 9. ......... , 19..~.~ THIS CERTIFIES that the building located at ... Ce~tr~:L DrZv. e ....... Street Map No. C~p¢ ~dd. ~ No ......... Lot No..~37 .... ~~.. ~'~r ...... confoms subst~ti~ly to the App~cation for Building Permit heretofore filed ~ t~ office dated ....... Q¢~ . .]0, 19. ~ pursuant to which Building Permit No.. dated ...... 0eg IQ.., 19..~3, was issued, ~d confoms to ~1 of ~e req~r~ ments of the applicable provisions of the law. The occup~cy for which this ee~ificate is issued b ...~r~v~. 9n~. $~$~..a~9~g .v$~h. ~n .~.~o~. ................ The certificate is issued to . ~the~e. ~g~dg~ ....... ~e~ .................. (o~er, lessee or ten,t) of the aforesaid building. Suffolk County Department of He~th Approval . ~ ? ......................... UNDERWRITERS CERTIFICATE No .... p~g ................................. HOUSE NUMBER . J 1~ .... Street .... ~~..~ ...................... Building Inspector FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. Th~s apphcation must be filled in typewriter OR ink, and submitted ~n DUPLICATE to the Budding Inspector w~th the following, for new buddings or new use' 1. F~nal 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 d~sposal (S-9 form or equal). 3. Approval of electrical installation from Board of F~re Underwriters. 4. Commercial buddings, Industrial buddings, Multiple Residences and s~milar buildings and installations, a cerhficate of Code compliance from the Architect or Engineer responsible for the budding 5 Submit Planning Board approval of compleled s~te plan requirements where apphcable. B For ex~sting buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-ex~sting" land uses' 1 Accurate survey of property show)ng omi property lines, streets, buildings and unusual natural or topographic features. 2 Sworn statement of owner or previous owner os to use, occupancy and condition of buildings 3 Date of any housing code or safety inspection of buildings or premises, or other pert)nent in- formation required to prepare a certificate C Fees: 1 Cerhficate 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 ....~.~.]-.X..3..q~..h.~ ..,~97..~. ........ New Building ................ Addition ,..~ ......... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...... .].l-?.~..C. entz~l..Z)rJ.~r~,..~.ti~J, bu.e,~,...~ew..,~ ..... ~.~..~.. ............. Owner Or Owners Of Property ....... ~a.~b~z,~z~e..~zb.].ed~e .................................................................... Subdivision ......C.~.p.l~,..~.(:l.c~ ................................ Lot No..13.'~ ....Block No .....-..~ .... House Perm,t No .... ~.c).~, ....Date Of Permit .~.0.~.],0~.?.]Applicant ...~.:~3~1.e.~,...1~.~1,~, ............................... Health Dept. Approval ........ .~...o.~....~..e..Cl_.U..J...C.e..~ ....... Labor Dept. Approval ...... ~t..Re~u.~.e~ .......... Underwriters Approval ........................ i .................... Planning Board Approval ~t Request For Temporary Cerhficate ........................................ Final Certificate ......~ ................................ Fee Submitted $ ~.~.O.~ .......................... Construction on above described budding a~ me~s all~o~j~lic/aaaa~/e c)3des and regular,ans. ........................................ Sworn to before me this HO~.u,~ Nn 24-19021~ .. / t,~m~S~ion EXDit'~' Ma <---.-... 3/ ! 2,y~ IUILDIN~ DEFARTMENT ?*~/- .~' ~prov~ ........................................ , 19....~. -e~it NO. Di~ a/c ...... ........................ ~ ................. ~..,...~..~ ~,~ .................... Dot . ....... .......................... , 19~... a. This a~licati~ must ~ completely f, ill~ in by ~writer o~ in i~ a~ s~' in tripl~ate ~ ~ Bui~i~ In~tqr, with 3 b. Plat plan ~mg I~otmnof lot a~=f bm~s ar~s, and givi~ a detoil~ de~ription of I~ut ofp~ must ~ c.~ ~e~k c~ by~is ~li~n.'m~ n~ d. U~ ~p~al of thisa~i~ the.~uildi~ In~0~ ~llXiss~"~ Bu~d~R~ ~r~t ~ the applicant. S~h permit shall be k~t on the premis~ ~oHable for in~ti~ ~g~t t~ ~rk. e. No buildi~ shall be ~cupi~ or u~ in ~ole or in pa ~ ~r any pu~se ~at~er until a Ce~ifica~ of ~cu~y shall have ~ gmnt~ by the Buildi~ In~or. APPLI_CATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to the ,, Buildir~.. ~on.e Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances.or .~l~Ulat,ons, tar the construction of buildings, additions or alterations, or for removal or demolition, as ~erain described e applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and r~ulations; and to admit authorized inspectors on premiseS and in buildings for necessary inspections~e , ¢ // ~"~ , . (S'g at o~licont, o,r name, if a corporation) .............. ............................... (Address of applicant) 7-6' 7-0 'f/-~ ,~ 7': /( 7Y'/ State whether applicant is owner, lessee, agent, architect, engi.~eer, general contractor, electrician, plumber or builder~ ................................................. ...................... ................................................... Name of owner of premises ........... ~.~..' ............... R('..~..,~ ............ ~.~....~.....~...~... ~.. ~ ~:; ....... If apJ2Jicant is a~ corpgflate, signature of duly authorize;I officer. ......... (Name~(d title of corporate officer) Builder's Licm~se No ..................................................... -7;,~...~- ~ ~ ./~-7.~--- ...... n, ,,o ~ ~0~ ~-/'/~-~,~ ~ ~ ~ ~ rlum~rs Lice s ~ ................................................. r .~ .~ , ~ ~ ~l , ~ ~ ~ ~ ' -- . .... Z ~ ~ ~- ~ ~ ~ El~tr,c,ans L, cense No ......... ~.~ .............. ~ . . ~ .... ~her Tmde's Licen~ No ............................................... / 1. L~atim of la~ on ~ich~p~~ will be done. M~ ~o.:~ .)~ ~ ~''~' ........ ':~,- .............. ,~ ~.~ ...... s~reet on~ ..m~r ~.~ ..... .......... ~..~.~.~.~.......~.~.~..~' ...................... ~ MuniciNli~ 2. State existing use and ~cu~ncy of promises and intend~ ~l,~d ~ c~mcti~: ~. ~,,,,ng u,~ ~u,n~ ............. ,...~.~ .................. ~.~..~ ................ ~. ,.tend~ ..~n~ ~u..~ ................. E~.~ ............ ~.~../~ ...................... -Nature of work (check which applicable): New Building .................. Addition .. . Alteration ................ ?.' Repair .................. Removal .................. Demolition .................... Other Work ............................................. 4~ .... 4. Estimated Cost .....~.......~.~.~ ................................. Fee ~/~ ~ (Description) (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 natgre and extent of each type of use ..................... 7. Dimensions of ex.sting structures, if any: Front ...........~ ....... Rear ....... ~...~... .............. Depth ..~..c~.. ........ Height ............. ~. ........ Number of Stories ............................ ~.. ......................................... Dimensions of same structure with alterations or additions: Front ......... .~...~.. .................. Rear ....~...y .............. Depth ........ .~....O. ................. Height ......... /. ................. Nu/nber of Stories ........~. ...................... 8. Dimensions of entire new construction: Front ........... /..~.... ................ Rear ....... ./..~.. .............. Depth ...~.....~.. .............. Height ........ /. ......... Number of, Stories ...... /.. ............................................. .; ............................................... .~ ............ 9. Size of lot: Front .......... /; .~......~. ................................. Rear .......... /..~.....'. ......... ~ ...... Depth ..../..~.....~.....'. ............ 10. Date of Purchase ....... ../.~...~..c~. .................................... Name of Former Owner ..~...~..~t~...~.. ........ ~...~../~...~... ........... 11. Zone or use district in which premises are situated ....... ~...~...~.(...~...~..~....'/~..I.~1~..~, .................................................. 12.Does proposed construction violate any zoning law, ordinance or regulation: . ..~'..~. ............................................. 13. Will lot be regraded ....x~..~. .............. Will excess fill be removed from premises; ( ) Yes ( ) No 14. Name of Owner of prem ses ~.~._~..~....~...~-Z.~....~.. ~TL~EJ~Addreo ....~.~-~ ~' ~. - r'~ ........................ ', ................ ~ ' · · "~' '~- ~. '~ ;~' .~" &~' ...... I~nOftO Name of Architect ................................................ ; .......... Address ~"'i~:~'j~"~'~: P~.ne No ....................... Name of Contractor~.~.~....,'~...~.....~.........~.'... ........ .o.....~...... Address ,~f.~..~.~i~,~.~.%~... Phone No...~..~.~....7...~'' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil 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. STATE OF NEW'/~O~,..,~.a .,~ ~ . J. S S COUNTy .J;)F ~. f~:~ (Na~' o~ i~dividual signing contr~cO above named. ~ ~ He is the ~ -~ , (Co~tractor, ag~t~ ~rporate ~ficer etc of said owner or owners, and is duly a~orized to perform' or ha~e~ ~erformed the said work and to ~ke and file this application; fhat ~11. statements cen~ned in th s,app'~ca~i~e true to the best of h s know edge and belief; and tha~ the work will be performed in the manner set fo~h in the application filed therewith. Sworn to~e this ~ ~ ........... ~ot*~ Pu~:~...~.~ty ............ x ........... ~ .......... ~x...~.~.~ ....................... ($i~not~ o~ opplicont) JUDITH T. BOKEN Notow PubJic, State of New No. 52-0344963 SuJ~k C~g~J~ ~emml~ioH ~pi~i March 80,