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Home My WebLink About6970-zTOWN OF SOUTHOLD Bu~.r~ING DEPARTM~T Town Clerk's Of[ice $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES.that the building located at .~/~..~.9~e. ~/~ ......... Street Map No.. Xxx ....... Block No. X~X ......Lot No, 21~1~...01';l,e~$...l~e~.,. .......... conforms substantially to the Application for Building Permit heretofore filed in thle office dated ............Nov.. 2.., 197~. pursuant to which BuiMin~ Permit No.. dated ............~..o~. .... .~.., 19 ~., was issued, and conforms to all of the require. ments of the applicable provisions of the law. The occupnn_ey for which this certificate is ~uea ~, ...~ri.v. at~..o~e, f~l~..~ve.~ l~.s..w~..th. ~ .q.d.d~t.$.o.n. ................ The certificate is issued to . G~tl'ud.e. ~el' .......... 0amel,. ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .N...R..e .............................. m~WaZTE~S CE~T~ZCATE No. ~..~36~..-.. 1/7/.~.. ~..~..S.~..-... HOUSE mn~Ea ...... ~..~.... Street ..... .~.o..~. I.e. ?..o.e.d. ....................... FOB,M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6970 Z Permission is hereby granted to: -~ob e~.~..~ ~......~,~ ..G~t r.t :,u~t ~..~,e~ ........... ........ ,S o~t,~O ;].~ .................................................... to i~lJ.~d...aZ~.&d~.f,~rm..,~., za~r~..~],.te r~ ~; ~ e..m~..e~.~ ~..~e~ ~ ~ ................... at premises located at ..... ~//~.......~.~:~t~i..~l;~.....~....~-.:..~.-'...~-0...~.~. ................................................ ......................................... ~£ez~t ......... ~.?Zo ..................................................................................... pursuant to opplicotion dated .........................~ ....... ~. ............. , 1~;~...., and approved by the Building Inspector. Fee ~.~ e ~.L~.~ ............. t *- BuiJding Ins~ctor Examined ........................................ , Ii t' ....... ~' App ca ,on No ...................... ~ .......... Approved I9..?..~. Permit ,o. ~ f 7' ~ ~ .............. ...... Disapproved ........................... ........................ (EluJlding In~l~ector) ~ ~,e ~ APPLIP.,ATION F BUILDING PER/~IT , ote .................. INSTRUCTIONS ~Ln~ a. This application must be completely filled in by typewriter ~ in ink and submitted in triplicate to the Bui Inspector, with 3 set~ 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 areas, and givlng a detailed description of layout ofpmpe~ty must be drawn on the diagram which is port 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 avai ab · for inspectia~ ~hout the work. e. No building shall be occupied or used'in whole 0r in part for any purpose whatever until a Certificate of Occupancy~ shall hove 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, os here,n described. The applicant agrees to comply with all applicable laws, ordinances, building code, hbusing code, and regulations, ~ to admit authorized inspectors on premises and in buildings for necessary inspections. State whether applic.,p~ is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .........................../ ................................................ : ..................................... Name of owner of premises ...................~Z.~.~..~. --~.~..~ ..................... , ............................. If appl, (~a~;~nd~; ' ' ttle of 4'o!~doU;;iie~hOrized officer. Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on whiCh pjiefpjlsed work w bej~/Map I~ ............ ~ ...... Lot No......~... .......... Street and Number .............. ~...~... ............... ./..~: ........~~... .................................... , ..................... Munlcil:~llty 2. State existing use and occupancy of premise.~a/r)~ intended use and occupancy of proposed construction: a. Exisiting use and occupancy .............. ~ ....................... ' ................................................... b. Intended use and occupancy .............. ~ .............................. 7--!ix ............................................. '4 3. Nature of work (check which applicable): New 'Buil~ling Addition ..................1/' Alteratiom .................. Repair ................ ..~emoval ..................Dern~li{;i~.. .................. Other Work~ ....: ............................................... ~',~ ~'1 : ,, ~ (Description) ~ 4. Est, mated 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, sp~ifY/nature and extent of,each type of use ................ ~ ....... .. 7. D,mens,o~s pfextstmg struct~, res, ff any: Front .......~ ................. Rear ................................ Depth .....'~....~... ........ Hmght~i! .~ ...................... Nt~mberlUr of Storms'ia ................................................... ,,~ ...................................... ;_~./ ........... D mensons of same structure wth aterat ons or add t ohs: Front ...... ..~....z~Z.. ..................... Rear ......~.....~...~...~ ......... Depth ................................ Height .......................... Number of Stories .................... · ............. -' 8. Dimensions of 9ntire new construction: Front ....~....~...i./..~.~ .............. Rear ........~.....~... ............ Depth .......~...~'- ......... Height ...... ../..~...~ .... Number of Stories ........ ~ ........ ../~ ............................................................................................... 9. S~ze of lot: rant ....................................................... Rear ...... ,~ ............................ Depth ................................ 10. Date of Purchase ........................................................ Name °f~m~/ner',*Ow~er-~'~'-"'~;~ 11. Zone or use district in which premises are situated ...... ~ ......... ~.~~...'~T...~....; ...................................... ]2. Does proposed construction violate any zoning law, ordinance or regulation: ....... .~.....~... .............. ._.~ .................. 13. V~_ lot beci~adec~ ~/..~.~....~ill e.xce.~_ttl, be remOVed from 'Prembes: ( ) Ye~ ( '/)No 14.~ Narne~o, Owner of oremises ./..~...~---./---./~---~r~ '~:~l~one ld,,~ ' * - ".,i~ .......................... : ............ y. ..... '~ "7'"':'~: ........................................... . Name :of Arch tact .~4'.~'. .......... ..~...:.~.'_....~-.~. ...... i....../, ...... Acldres/s:.~':: ..~.:...~...i,., .... ,/Phone No.' .............. . N~ne of C°nt~ctor~.~ ........ Add[~i~~Phane NOT~..~...~..~..../..?.~.'.~ · '~ ~'~' ' ~' - '~LOT DIAGRAM ' 1.~ ~.te cffear!y 'o~,~ distinc~fly all builaings, whether existir~g or proP~~'~a~e/~'''~'''"'~; ~ all set-hack dimensions from ~O~her~r in~el~ri~r Go~0~of.and block-number 'or description according f0 de~.~r{d'.'s!L~..ow ~street nc~me~ a~ indlcote , OF .................... E....'~7....~..~h....'~.. ......... ~./..; ........ ..~;: .............. ....being duly sworn, deposes and says that he is the applicant · :' !Name of iD~vidual signil~ contract~ ~ t /- -' He s he ....................................................................................................... ~ ........................................................................ (Contractor, agent, corporate officer, etc.) of said owner 6r owners, and is duly authorized to perform or have I~erformed the said work and to make and file this application; that all statements contained in this al~plication are true to the best of his ~,nowledge and belief; and that the work will be performed in the manner set forth in the application filed fherewith. Notary P~(~...~:~l~1'-~4~ty '" (SFgr~ure of ap~icant) JUDITH T. BOKEN t~olary Public. Stale of Ne~ hl~, ~2-0344963 Suffolk Counl,/~ ~mml#lan Expires M~rch FOKM NO. 6 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 simibr 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 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 /~ ./ ! ~,,~_ .,..._ D t VlI/I - , New Building ................ Addition ........ ,"---- ~ /~ _~, t'")L' ....... QId ~ Pre-existing Building ................ Vaccj~t Land .............. Property ......... . .~...r..~ ..~~..~...~..~1.../...(...~....~..c.L~ ............................................... Location Of Owner Or Owners Of Property ......... .~L~.~~ ........ ~....~. ~ .......... ~ ................................... Subdivision· ,~.~,..--" ............ ~ ....... .~...:....,~....L~ot No..,~ock No~-~ House N~.....~....~...~.~' __~).~..~.J~te Of Parrot r L ~ A cant Permit No ....... .... .................................................................. Health Dept. Approval ................... --'~"'L~'":; ....... Labor Dept. Approval ........... ~x/~;..[.~...~ ........................ Underwr tars Approva .... .&/.. ........ ~./......~ .............. !....Planning Board Approval ..... . .~.~. ~.... ..................... Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ ...~. ::i~ ................. Construction on above described building and pej~it meets all applicable codes and regulations. Applicant . ....~.....~...~....~.../~.,.......~... ~....~.~ .................................... Notary Public ..... ~~County (stamp °r se''~l~, ~C~¥ THE THIS CERTIFIES THAT NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY '* 85 JOHN STREBTo NEW YORK, NEW YORK 136546 Peter 5oporr! Main Rd, Southold, L.I. 11971 11 BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT THE NEW YORK BOARD OF FIRE UNDERWRITERS 6 n~ BUREAU OF ELECTRIC~ (~O~-~ZO~ 01111.3654 /'i ]'/7~"~1 EE JOHN STREET, NEW YORK, NEW Y0~K 1OO3~ ~t. Ja~ary THIS CE~IFIEs THAT . - - l ~y t~ ~t~ ~u~t ~ ~ ~ a~ int~ by t~ ap~t ~ on the a~ ~pl~ numar in t~ p~mM of ~..o.,i~a o. Jamm r),3 ) 197/* ~,,,d ;o,,,~ ~o ~ i. co~p.,,,~, with the requirernen~ of this J~oard. fiXTURE LECRETACLBSI WIT I RXTURES I DRYERS I FURNACE MoToRS FUTURE APftJANCE FEEDERs. RANGES K.w. (:00ICING "'CKS OVENS DiSH WASHERS RRVlce DISCONNKT ] NO. Of I S OTHER APPARATUS: Loc EXHAUST FANS DIMMERS 2 600 R V I C E NO, OF CC. COND. A~W.G. hO. Of HI-LE~ A.W.G. A.W.G. ~eter CCIPY FOR BUILDING DEPARTMENT., ~THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN.AJiY ~