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Home My WebLink About6928-zFORM NO. 4 TOWN OF SOUTHOLD BUrg,DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ....I~...h...I~..ne....(.~.~..). ...... Street Map No..x~. .......... Block No. ~ ....... Lot No....x~......S.o.u..t.h.o.l.d..(.R. :F. :.D.~....N.o.Y. ° conforms substantially to the Application for Building Permit heretofore filed in th!.~ office dated ......... .0.c.t....1 ?. .... , 19.7.3. pursuant to which Building permit No.6~.2.8..Z... dated ......... .0!:.t....1.7. ..... , 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 The certificate is issued to .E.i.~..z.a.b.e.t..h..T.h.~.~.a.u.l~ ..... . .0~l. gT ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ~ ,R., .............................. UNDERWRITERS CERTIFICATE No...N...139.~? ..... ~r~.. ~...1~.~ ............ HOUSE NUMBER .. ~.0. ........ Street .... . .i~.gb..I~s~... ' ' Building Inspector I FOE]if NO. ~ TO~'N OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6928 Z Permission is hereby granted to: ar. em.,.. ~,~,~ob....,kYc..)~t~,. -~u.~ ....... ....... ~ou~h~t~ ..... '...'N~"I.~ ................................. to .. ~J,~,3.d,..~_n__.. ~t ~aehe d... g~:ee,8~.. ( ~t ~ .~ ~:~:~.. el3.. ex-i-s ~t-n~.-dwe.tt-$ng. ................ at premises located at .... ]~/.J~...~J;~]3...~l~ ........................................................................................ ............................................... ~o~t~o:l~ ............ F.,~T.o ........................................................................ pursuant to application dated ........................O~f~ ......... .~.~. ........... 19~.~..., and approved by the Building Inspector. Fee $...'J.~*,O0, .......... FOK~ NO, $ TOWN OF $OUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE 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 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 compleled 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 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 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 M, rch ¥ 197t+ New Building ................ Addition .~ ...... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ~U,~ ,1~i~,D.~t..(~.y.~.)......~..o.l.~.~.o..~.~....~..D..)....~..~.. ..................... Owner Or Owners Of Property ....J~.]:.~..~.~.l?..e..~...~.,..~,~..~.,b..e:~,lj;.. .............. .0.,..w~..,e.z,. ............................................... Subdivision ................................................................ Lot No...,~,, ....... Block No. ~ ..... House No......br...6,.O.. Permit No..~.c~.~.~ ........Dote Of Permit .1.0./..].7 ./.7..,~..Applicant ..... .,T....o..s..t...~.a:~.J....o..~.. .................................. Health Dept. Approval .... .}.~..?..~..*. .............................. Labor Dept. Approval ........... .~..;.~..'. ........................... Underwriters Approval ..~.1~).~.8..~......]]/..~,R./.~..~..... Planning Board Approval ..... ..~..;..~..', ......................... Request For Temporary Certificate ........................................ Final Certificate X](]~ Fee Submitted $ ~'o00 Construction on above described building and permit meets all applicable codes and regulations. Applicant ./.... ~..,,~.._. ~.~,n,-n.. .......... ~... ~.~ ........................ Sworn to before me this ...... .~ ....... day of .............. .~.....].~.~... (stamp or seal) Notary Public .................................... County THE NEW YORK BOARD OF FIRE UNDERWRITERS 8.k BUREAU OF ELECTRICi'FY ', ~ ' ~ 85 JOHN STREET, NEW YORK, NEW yORK 10038 THIS CE~IFIES THAT ~lSS ~llzaDevn 'rnxDaut~ ~cn ~ne, s/o ~o~th Roaa~ ~ou~hold~ ~.A. in the follotvlng location; [] Basement [] 1st FI. [] $nd Fl. gax~ag e Section Block Lot~ ._.,.,.i,~do. January 21, 1971~ and/oundtobei, comPlian~ewiththerequlre=entsofthls~oard. RXTURE OUTLETS 1 DRYERS RXTURES RANGES COOKIN~ DECKS OVENS DISH WASHERS EXHAUST FANS FURNACE MOTOI~ UNIT HEATERS MULTI-OUTLET SYSTEMS NO. O$ FEET DIMMERS SERVIC~ DISCONNECT S E R V I C OTHER AI~ARATUS: Peter Bogovle, Main Road, Southold, L.I. 11971 ..~COPY FOR BUILDING_ DEPARTMENT. THIS COpY OF CERTIFICATE M~J~ ST NOT BE ALTERED IN ANY MANNER. - ZzO.O n [ · - ' FOI~M NO. J. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .~.../...7. ............ 19.?.....~.. Approved '~ f '~ 197..?.. Pemit No. ~..~. ~-' ~ ~ Disapproved a/c ...~ ....... ~ .......... (Butldmg Inspector) APPLICATION FOR BUILDING PERMIT Date ...... ..~.~'...~....~... ....... (.~.. .................. 19....?...~....~ INSTRUCTIONS t~ a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wi 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. PIct plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, a,q,d giving a detailed description of layout of property must be drawn on diagram which is part of this application. ~X~ 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 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 beJm 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 of the Town of Southold, Suffoll~ 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, If applicant is a corporate, signature of duly authorized officer. 1. Location of land on which proposed work will be done. Map No.: ~.O..;.-~.....~..~¥e~"No .............. ~ ..................... ..~..' ~'~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ ~ ........................... · .......... u ..................................................... b. Intended use and occupancy ...... ~.~...~ .......... ?,~.~...~ ............ .~...~ ....................... 3. york (check which applicable): New Building ....................... Addition ...... ...~... ......... Alteration."....'.:... ~ .. Repair ......................... Removal ......................... Demolition ........................ Other Work ...,f.~./~;[~r~.~.~. ....... (Descript~'n) 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 .................... ..~.....J~....~.. ......................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of usa ..................................... 7: Dimensions of existing structures, if any: Front .....-~..~...'. ........ Rear ...~.~... ............... Depth ...~..~.!. ..................... Height ......... ~....J. ......................................... Number of Stories ........... .~......-~...~.~...'. ................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ....... ~../'~...~ ........... Rear ...!..~.. ................... Depth ....~....~ ...................... Height ........... ~.~..~ ............................... Number of Stories ................ ..~....~'..~.. ............................................................ 9. Size of lot: Front .....~..O.Z~jt.... ......................... Rear ...... ~....l~..,J.~..~. .................. Depth ......~...~....~..f. ............................ Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ....... L~...7....~?. ................ Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................................................ 13. Will lot be regraded ..........~...?.. ................ Will excess fill be removed from premises: [ ] Yes [X No 14. Name of Owner of premises .~...~..J.~,ZIJ~ ..{~... ~/~/~j~~~~~ (Address) (Phone No.) Name of Architect ..................................................................................................................................................... · (Address) . (Phone No.) Name of Contractor ...~.~.~....~.~.. I.~../[..~..~.,~.~.~'1~. ........ ,~...~..~..~..~.. ~,~. ~.~...t2~,...~......~,.'..0...?...~...~.?..~....7..~.~..-.~.~ (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-back 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. ~ ~ ~' STATE OF NEW YORK, x-~ ~ ~ ~[ ~ __ ~ J ' I// --------.66L~'~/ej ...................................................................................................... ~ duly sworn, depo~ that he is the applicant above named. ' (Nameofindividualsigning~.ontract)t,g~ ~ is the {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 all :~tatements contained in this application are true to the best of his knowledge and belief; and/~at the work will be performed in the manner set forth in the application filed therew;th . ~'/~. ~_ ~)~ , ~ lq'