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Home My WebLink About6945-zNO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Tow~ Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z~83 ...... . Date ............. ~.eb ..... 6 ....., 19..~. THIS CERTIFIES that the building located at .. ~l/li..~,eZ~ .La~e ........ Street Map No.. J, 0~erto~ Bieek No ........... Lot ~...~.. 8onthold.. ]1.o~ · ............ conforms substantially t~ the Application for Building Permit heretofore filed in this office dated ........... 0~t. '.;i .2.~., 19.73. pursuant to whieh Building Permit No...6~.~Z dated ....... 0e.t..2.~ ...... , 19.73, was issued, and confoms to all of the require- ments of the applicable/provisions of the law. The occupancy for which this certificate is issued is .Pr:~&te, .one. ~a!a;[l~-,d~[~.~g ....................................... The certificate is issued to ... II~]~l~ .l~13,],en. t~ ..... l~ez. .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .N,R, .......... . .................... UNDERWRITERS CERTIFICATE No... ~ .]1. :~32861~../Dea .. 13. · 19~3 .... HOUSE NUMBER .... ?~0 ...... Street ..... Telt~l. I~ .... ~ ..................... ........ ..... "' FO~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPAItTMENT TOWN CLERK'~ OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6945 Z Permission is hereby granted to:. ............ ~d ......... l.Z. ............................. et premises located at ~;.d~...J[l[~...t~.-:.~l~.~a~.~[~lt .................................................................. B'aT~ .................. ................................... ~ .... .e. ~....~...~ ......... .~ut,~.:[~t ...... .W.,.1[, .............................. pursuant to application dated ............................. ...~....2~ ......... , 19~..., and approved by the Building Imq~:tor. Fee $.Lqi~ ........... · · Bu[ldrhg Insl~Etor ~, THE NEW YORK BOARD OF FIRE UNDERWRITERS 08 BUREAU OF ELECTRICITY * I~ 85 JOHN STREET. NEW YORK, NEW YORK 10038 THiS CE~IFIE$ THAT Rloha~d M~le~ n/8 're~y ~8ne quu e/o noo~v nu.~ in the ~ollowin~ Ioc~tion; [] B~ement [] l ~t Fl. ~.,.~a.~i~ao. Deoembel, 10, 1973 FIXTURES ~n~ FI. Section Block =nd~ound to ~e in compliance with the requirements of this Board. RANGES COOKING D~CKS OVENS DISH Lot FANS F~CTU~E SWITCHES OUTLETS DRYERS OTHER AFfARATUS: E V I C E W.B. Ruland Matt It uck, L. I. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MA~Gi;P.. I~OR~[ NO. 6 TOWN OF $OUTHOLD Building Depo~tment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This opplioation 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 disposel--(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 site plan requirements where applicable. B. For existing buildings (prior to April ]957), Non-conforming uses, or buildings and "pre-existing" land uses: ]. 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 certifioate. C. Fees: ]. Certifioate 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 De,e .......... New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Locot,on of Prape 0w,n. ers~Of Pra~p,,erty ....... ~/..t,,~ .~....w~, ~.....~......~.... ............................... Owner Or Subdivision d.;~.l..:.....~...~ .................. ?...LateNcY. ~..~...5,.:,. Block No ............. House No..,~...~...~... Permit No. ~.,~.~.~..~.... Date Of Permit .~,.~:..~..2~2.Applicant ..~..,.~.'.....~.~....~.,.....~w:., ....... Health Dept. Approval ...~....~. ....... Labor Dept. Apprava ........ ..~...v.......~... ....................... Underwriters Approval.../~--./.~.,~-..~..~-..~......./~/.~¢f-~.....Planning Board Approval ...~...' Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ ...~......~........ ................ Construction on above described building and/~.~=eets all applica~.~~ulations. Applicant ....~...~/.~ .............................. Sworn to before me this ~ ............ ~?"~'~'//"? ~''"'"" '" "" -- 6 7 ............... day of ..~ ............. ~....~ ........ (,,a~ or seal) / Nota~ Public .................................... Coun~ NO. 1 TOWN OF SOUTHOLD BUILDIHG DEPARTMENT ~ TQV~I ~a. ERK'S OFFICE ~SotJTHOLD, N. Y. Examined ..~..c;;~.....~. ........ , ........................................ , ....... Permit No ...... Disapproved a~ ...... ~ ;' '" ' '" ' ; PPLICATION LDING PERMIT INSTRUCTIONS ~ a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to'the Bul ding~ Inspector, with 3 ~ of plans, accurate plot plan to s~le..~e~according to schedule. ~ b. Plant,plan shOwing location of lot ~a~d o~ butldings]~n 15~n~isas, relationship to adjbining premises or public streets or areas, and ~w~ng a detailed description of layout ofproperty must be drawn on the diagram which is part of this application· c. * _Th. ?~ covered by thi~ app~i~;ation cnay not be Comrn~r~ced before issuance of Building Permit. ~. d. ~ U~roval of this ai~ll>fic~tJ~n; th&Building Inspec't~' 'will issue a Building Permit to the aPp cant. 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 pa rt for any purpose whatever until a Certificate of Occupancy shall have been 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, 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. ................... ....... .......................... iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii Name of owner of premises .......... ...~::......~... ................... .?.. .................................. If ap~iegnt is a corporate, signature of duly authorized officer. ~ame and title (,Iq o~/e'//efpora te offi~er) Builders License No...,~'. ............................................ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed~work w II be done Mop No ............................... Lot No ............ Street and Number ......... ~..'~'..."~...~ ........ ~r../~'....~... ................................ ~.~.~/~,~...[i~ ,. Municipality State existing use and occupancy of_premises and intended use and occupancy of propase~corlatrecflon: a. Exisiting use and occupa~nCy . ~ ....~... ~...~:-...../~... ~ ~ . .. b. Intended use and occupancy i ....... ...~......t~.......~..~.(....~....~... ................................. ' .ii ..iiii ' ~'" Alteration ~ ....... 3. Nature of work (check which applicable): New Budding .- ............... Addition Repair .............. ~... Removal .................. Demolition ...... '~..~.,.~.. Other Work ...................................................... . ~ ~ ~' ' (Description) 4. Estimated Cost~'..'.~.~.~-~O' ~O Fee~.....~.,~...~.?.. (to be paid on filing this application) 5. If dwelling, number of dwelling units ....................... Number of dwelling units on ~ch floor ............................ If garage, number of cor~ .......................... . ................................................................................................................. 6. If business, commercial or mixed occupancy, speCify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or ndditions: Front .................................... Rear ............................ Depth ................ ~;.,-, .......... Height ............................ Number of Stories ................................ 8. Dimensions of entire new const, ruction:~ ~,~ ~-~..,-~.~L ,, ~ o,cc~- ..~ __ ~_____F~r°nt .................................... Rear ............. ~ ............ Dept~ ........................ Height .................... Numl~er of St~rie~/~`~?..~..~..~.~(.~..~...~....~..~G~.......~...~....:.~....../.~./..~....~..i~..~ ........ 9. Size of lot: Fror~ .~. .............. .~iL.~, ............................... Rear .......................................... Depth ................................ 10. Date of PurchaSe ...:.'. ......... ;.;....../. .............................. 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 ( ) No 14. Name of Owner of premises .~../..~..~?.....~....~...~..~^ddress .~'...°..~..~.. .......... Phone No ....................... Name of ArchiteCt .............................................................. Address ................................ Phone No ................. Name of Contractor ~...O...~....~L~.....~-....~..Y.e..T~.....L~....C-.:. ....... Addresse~'-I:~.-~..~e'.../~,~I ....... Phone No.7.~...~?..~.~..;~,'O 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. STATE OF NEW' YORK, ~ CQUNTY OF , ............................... ~'~"; ~.,~ .................. ~..~....r.~beiLng duly sworn, deposes and says that he is th~'applicom - (NaFn~ 6f i,~'~/.~du~Psigning'contrec0 above named: ~ ~ He is the ....~.......~....~...~..~. ......... ~ ....................................................................................................................... (~C~ntrocto;t ~t, ~:gJ~Pg~,at~offJcer, 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 statements contained in this application are true to the best of his knowledge and belief; and that the Work will be performe~d in the man,q~' set forth in the application filed therewith. Swam to befoze me this ~ ............. .......... . // _ (Signat~fof applicant) JUDITH T. I~O~N ~glg~/PuBlic, State of New ¥0d¢ ~ ' i~: ~:0~44963 Suffolk Count~