The URL can be used to link to this page

Home My WebLink About6560-zFORM ~OWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z .~.6~' ....... Date ............ ~..~p~e.~..b.er..'1..9,., 19.73. THIS CERTIFIES that the building located at ...~e. ne..R.o.a.d .............. Street Map No...~..~. ....... Block No....X~. ...... Lot No....X~.....g~..~.~..1~..g~.~. ............... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... .t~...r~.h. ~.!..., 19.7.3. pursuant to which Building Permit No...~.0g. dated ......... . .~... 9.~ ...... , 19.73., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is Fax~ Start8 The certificate is issued to .... ~.~.e.h.a.e.1..~.hg]P.~..~. .................................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval UNDERWRIT£RS CERTIFICATE No .... .N.,.~. ? ......................................... HOUSE NUMBER... 6.~.6.O. ..... Street ....... .~. ~..I1.$ .~..~. ............................. ................................................... Cuteho~t~ ................... Building Inspector FORM NO. 2 TOV~N OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~REMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6560 Z Permission is hereby granted to: .... F~.e....{~..$.~.~. ............................................. ................ ...~..~.e.~ .[~... .............. : ........................... at premises located at ...... ~..~ead..~..I,tt.tle..~aek..]k~a{l ............................................ ............................................... ~..h...o.~. ......... ..~.,.~., ......................................................................... pursuant to application dated ..................... ..~.~ ......... 9 ............... , 19~.3 ....and approved by the Building Inspector. Fee $-.-1-0~ ......... , , Building Inspector(k` THE NEW YORK BOARD OF FIRE UNDERWRITERS -II: BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK, NEW YORK 10038 T~l~ CERTIFIES THAT . - L ..h~o~;n~ r~urrrber i~ the premises of FIXTURE OUTLETS FURNACE MOTORS TURES 1 - FUTURE APPLIANCE FEEDERS DRYERS SERVICE DISCONNECT OTHER APPARATUS and found to be in comphance w~th the requiremant~ of this Board RANGES S E E~U ST FANS DIMMERS Approved FOBM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. Pem,t ........ Application No...~.....,~..~..,0. ............. Disapproved a/~ ........... ~Z ............................................................ ~ ~ INSTRUCTIONS a. Th~s apphcat~on must be completely filled in by typewriter or m ink and submitted in triplicate to the Budding Inspector, w 3 sets of plans, accurate plot plan to scale Fee according to schedule. b. Plot plan showing location of tot and of buddings on premises, relationship to adlolnlng premises or pubhc streets or areas,; glwng a detaded description of layout of property must be drawn on d~agram which is part of th~s apphcat~on. c. The work covered by this apphcatlon may not be commenced before issuance of Building Permit d. Upon approval of this application, the Budding Inspector wdl ~ssue a Budding Permit to the applicant. Such permit ,shall be kept the premises available for inspection throughout the work. e. No budding shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have b granted by t~he Budding Inspector APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuance of a Budding Permit pursuant to the Building Z Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances or Regulations, for the construct~o buddings, addtt~ons or alterations, or for removal or demoht~on, as here~n described The apphcant agrees to comply with all apphcable In ordinances, budding code, housing code, and regulations, and to admit authorized inspectors on premises and m buddings for necessary mspect~c (S~gnature of applicant, or name, ~f a corporation) G ~-I~ I ' (Addre~ of apphcant) State whether applicant is owner, lessee, agent, archi~ct, engineer, general contractor, electrician, plumber or bui~ / Name of owner of premiss ................. ~.~..~.~.~.~ .......... ~.~.~.~.~.~ ................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Budder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Olher Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No ....................... Z.; .................... Lot No ...................... Street and Number ............................................................................... ~ ......................................... ' Zi'Ai2i 'ii } ....... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a, Existing use and occupancy ....... ,O,,,,N,[ ..... ~.R,;.,~,!.!..L,.¥, ........ .~.,,,~,,,.~...L,,L,.!.,~,,..,G.. ...... ..~,. ..... E..~..~.,../~,. ...... .,,-~,,b.,~.. .......... b. Ir, tended use and occupancy ....... ...~....~...M....E. ........... .~..'.!.T...N.. ......... ..L.?,..T~....~..~.,.~. ..... .¥...E...~...;.....~..T...~...~..I....I~. ................. t).,', 4, . ~. ' ' Nbture of work (check which applicable): New Building .... ~ ............. Addition ..................... Alteration ......... ~ ..... Repai~ ......................... Removal ......................... Demolition ........................ Other Work .................................... 4. Estimated Cost //~- O 1'- Fee /~ ~ (Description) (to be pa~d on hhng this apphcatlon) 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 occuoancy, 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 additions: Front "-'--- Rear Depth ............................................. Height ..................... ~. ............... Number of Stories ........................................ 8. Dimensions of entire new construction: Front .......... ~...~.J~... Rear ............................ Depth ..../...~. ..................... Height .............. ~ ............................. Number of Stones .......................................................... ., ............................. 9. Size of lot: Front .............. ...c~...../...~. .......... Rear .................. ..-~.....~...C.. ............ Depth ....~..~.. ..... .~'....../...~..?..:..~.~.. ...... 10. Date of Purchase ....... ./.?.....~...?. ............... Name of Former Owner .... ...~.~...~.......~.........~..~..~..7....._...~X~?.~...~:z~ ............ 11. Zone or use district in which premises are situated ............... ~..~.../.~....[..~....~.~..~..c~.~.~-. ....... ~...~..?.~;~./...O....~...N~...T.!.~ 12. Does proposed construction violate any zoning law, ordinance or regulation: ............. ..~...,o.. ..................................... 13. Will lot be regraded ........... ~ ....................Will excess fill be removed from premises: [ ] Yes 14. NameofOwnerofpremises ~,,I~Hzgtr c "~'~ E ~'I~ ~"~ .....................................................,. /i~'~l~ ;~';;i ........................................................... (Phone No.) Name of Architect .................................................................................................................................................... _ (Address) (Phone No.) Name of Contractor .................................................................................................................................................. (Address) (Phone No.) PLOT DIAGRAM Locate clearly and dmtinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro property lines. Give street and block number or description according to deed, and show street names and indicate whet er interior or corner lot. STATE OF NEW YORK_ ) COUNTY OF.....~, ~-~.~ (Name of mdz~zdual ~nmg contract) · . being duly sworn, deposes and says that he ~s the apphcant above nam.- He ,s the ....... .~..t,J'~.N'~?,,, .~.. ..................................................................................................................................... (Contractor, agent, corporate officer, etc,) of sa~d owner or owners, and ~s duly authorized to perform or have performed the sad work and to make and hie th~s apphcation; tha, statements contained m th~s apphcatmn are true to the best of h~s knowledge and behef, and that the work wdl be performed m the mar set forth m the apphcat~on filed therewith ~u~c. st~'~ ~L~~ ............... day of ...... ~u '~ZCt~¢.s~ ...... ......................... (St~ature o[ a~phcant)