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Home My WebLink About6990-zTOWN OF $OUTHOLD B~m.~ING DEPARTSf~T Town Clerk's O~iee Southold, N. Y. Certificate Of Occupancy ~To..Z6~6~? ..... Date ........... May...$9 ........,19..?~ THIS CERTI~INS that the building located at . .wige~s. La~e ............ Street Map No.. F~I.Ae .....Block No..~II ....... Lot No, ~1.~12~2~ ....Ore~npor. t ........ conforms substantially to the Application for Buildln~ Permit heretofore filed in tbfs office dated ............N~V....t~, 19.7~ pursuant to which Building Permit No. '&~)OZ' dated ........Igor .... ~ ....., 197.~., was issued, and conforms to an of the require- ments of the applicable provisions of the law. The occupancy for which t_b~s certificate is issued is .. P~$¥~te. ~l~t~g. poo~.v~tk xeeo~sory~ .&. ~.enc ~u~ ............. The certificate is issued to .Jolm .&. Sa~a. Gent.tie. - · O~ner~ .................... (owner, lessee or tenant) of the aforesaid builrli-g. Suffolk County Department of Health Approval -N',i~ .............................. UNDERWEIT-EES CERTIFICATE No. Il..1.?.~80. Aug. ~.. 1 i).Tb~ .................... HOUSE NUMBER ..... .~.%~ ..... Street .. l~lgglms. La~e ......................... ' Building Fnspector FOYer NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT M~ST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6990 Z pursuant to application dated ............ J~. ............................... , 1 ., and approved by the Building Inspector. Fee ..... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southeld, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcation must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building inspector with the fo~lowing; for new buildings or new use: 1. Final survey of property w~th accurate Iocahon of all buildings, property hnes, 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 buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code comphance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te plan requirements where applicable. B For existing buildings (prior to April 1957), Non-conforming uses, or buddings and "pre-ex~st~ng" land uses. 1 Accurate survey of property showing all property hnes, streets, buildings and unusual natural or topographic features. 2 Sworn statement of owner or previous owner as to use, occupancy and condmon of bu,ldmgs. 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 dwelhng or land use $5.00 3 Copy of certificate of occupancy $1.00 r~,.~ ..... c.~ ~::~ o1,~_ Date ~'~ /6- ~ ~ New Building ................ Addition ....~ .......Old or Pre-existing Building ................ Vacant Land .............. Locot,on Of Property ..... ~..~....~..........x~.....t..~.~..l...~.~,. ....... .~...~....~....~.....t....~....~.?.~..~-~..~..~....~....~..¢.~...-~.. ....... Owner Or Owners Of Property .....~....o..?M.~........~...:---- ....~.......~.....~.. :.~.....~........~... .......... ..~....?..~..,~Z...~....~....~...~°.... Subdivision ..~. .............................................. ; ............ Lot No ............ Block No ............. House No ............. Permit No ~...t./..~.~....'..~.... Date Of Permit 6./.Z.~..3.~./.~...~...Applicant ........ ..~....~...?.....'~.. ....... ...~....:.....~"..?..~...?~.~.e 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 per,it meets oil applicoble~codes and regulations. Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County ~' '~*. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~- 85 JOHN STREET, NEIN YORK. NEW-yORK 10038 N 175580 ~1~ C;;IFIE$ THAT in the following location; [] Basement [] l#t FI. ~i~o. August RXTU~ ~ FIXTURES [] 2nd Fl. outEide Section Block and found to be in compliance with the requirements of th~ Board. RANGES OVENS DISH WASHERS RIRNACE MOTORS FUTURS AI~UAN~ ~RS TI~E CLOCgS UNIT HEATERS Lot DIMMERS OT ER AUTUS: ~-~ranmformer for light, Panelboal, ds: 1-1Stir 125amp (Swimming 7ool) ~hls cert/ficate covers compliance-et the date of Inspect/on only. Because of unusual environment~ it is advisable to have f~equent test and/or ~epa~.rs made by .a qualified pe~eono OF NEUTRAL JohDI N. Lademann 1200 Herbo~ La, Cutohogue, L.~. 11935 CGFY FOR BUILDING DEPARTME~. THIS COPY OF CERTIFICATE MUST BE Date ............................... 7 ............. ' . INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building~ 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 an premises, relationship to adjoinina premises or public streets areas, and giving a detailed descrlphon of layout ofpraperty must be drawn on the diagram wh-ic'h is part of~is 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 Certmficate 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 pumsuant 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 lows, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessmy inspections. ~Si~nature of app icant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ............. .-~.~:~:W,r~'~. ........ &.& ........~......~...~..~.....~..~ ........C~~ ............ '~ If applicant is a ~°,,,,r,,P~,.,.rat~:..~ignature of duly auth°rized °fficer' ~ .................. ......... BuildeHs Lic~ No ............... > ..................................... i Plum~r's Licen~ No ................................................. Electrician's License 1. Other Trade's License No ................ ..-.'~--',;~ ..................... Location of land on which proposed wo~k will be done. Map NO.: ~.~.~...~.. Lot No...~.~.,..2'....~..~...~.. ........ ......... Street and Number ........... ~ ............................. .~... ............. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use Ond occupancy ................. ~ .~...'"~dl~..t~.,.~ ...... b. Intended use and occupancy ......................................... / ._ 3. Nature of work (check which applicable): New Building ............ ~ ..... Addition .................. Alteration ' 4. Estimated Cost ............~.....~..~...¢~......<~.. ....................... Fee ........... ,.'~.....~..~...~.....~....o.. ............................................... .~.. (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 type of use ....... ~ .......... 7. Dimensions of existing structures, if an~: Front .........~....~.......~ .......... Rear .;.......~.~.. ............... Depth ..;..~.'...~/....~... Height ..~...2..(~..~ ....... Number of Stories ..............~ ....................................................................................... Dimensions of same structure with alterations or additions: Front L Rear ......... .q...; ............. 8. Dimensions of entire new construction: Front ............ .~...~L.t. ............ Rear .......... .~....~....!. ..... Depth Z..~...~...~....: Hmght ..... ~ ..........Number of Stories .............:..~... ....... ,~...?.....'~.....~: ....... ~...; .................................................. ~). Size of lot: Froot ..............~..~_...:....)..~.......I. ......... Rear ........ ;~.~ ..J~j..~..,.....~..-.~../... Depth ..~'.~.....~..:..~.....~...../.. ~ % 10. Date of Purchase ........ ~L.,~....":~...~. ...... !..~......~.~....~.. ...... Name of Former Owner ];~,~..~..~,...~..:..~3:~J~-~..~..'..l~. 11. Zone or use district in which premises are situated ................. ~..~..~.!~,~...~'..!.~ ....................................... 12. Does proposed construction violate any zoning law, ordir~nce or regulation: ......... ~...~.. ...................................... 13. Will lot be' regraded ...... ~..~.. ......... Will excess fill be removed from premises: ( ) Ye~ (~ No 14. Name of Owner of premises ..... .~..~.~'"'....~-~. Address ...~.~.~t...~-~hone Name of Contractor ............ ...~T7.........~..~..?~-~....-?7.. .......... Address .......... ~ ............. Phone No ......... :'....~. ........ PLOT DIAGRAM Locate clearly and distinctly all buildings/whether existing or proposed, ~and indicate all set-back dimensions fram property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW T. COUNTY (?'~ ' - ............................................................................................... being duly sworn, d~oses and says f~t he is the applicam (Name of individual signing contract) ~ove nde. He is the ..................................................... L ........................................................................................................................ (Contractor, agent, co~grat~ o{ficer, etc.) o~ said owner or owners, and is duly authorized to perform or h~e ,preformed the said work and to ~ke and file this application; that all state~?s ~6ntained in this appliCation are tree to the best of. his knowledge and belief; and t~a~ the'worE'Will ~ performed ~n the ~anner set fo~h in the application fil~ there~th. S*om to ~re,me this -- . _ ~ ' _ . i Nota~ Publ ~.....~...¢..~~ ....~....~ ......... ~.~~ ............... . ~ _-~ ~ _ ' . ~ (Signature of applicant) ..... ~9o~T~n ~9~~ - No. 52'UO=x ~ ~a~Ch 3u, ~ ~ . A 7 ~ /! ,@ MAP OF ~ECTIO/V TWO (~' RFEN POR l TOWN OFSOUTHOID OEV[L OPED BY 12 No, ~, OVv'N£D tClND R u T'/.q FF. f:'~,$'~oN ~ OR,5. (~reenlOorl~ N.