The URL can be used to link to this page

Home My WebLink About6603-zFOR~[ ~0. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate O[ Occupancy No. Z~80~ Date .F. 9 .]p. 2~. 197}.+. THIS CERTIFIES that the building located at ..... F..o.x..H?. ~.l.ow.. I~.. ....... Street Map No.~. ........ Block No. ~ ...... Lot No. xXX Iga~?c i'cuck E ,Y · conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... }:'.~.. 2.~..., 197.~. pursuant to which Building Permit No...6.6..0~.Z. ,dated .. . .M.a.y ...2.~ ..... , 19.73., was issued, and conforms to ail of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to .Jp.h.n..~..J. 9.s.eph..i.n.e..~.9.rf~.a.n. ....... . .~n..e.~..s ......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval 1~.,.1~, ....................... UNDERWRITERS CERTIFICATE N~ 3.)+29.8.8. ...... F.~b...~ 2...1.97.1~. .............. I-IOUSE NUMBER .. ?.QQ ....... Street ...F.o;~h(~_.o.W. ~1 ......................... Building Inspector/ FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) -,?~ :~ N? 6603 Z P~rmission is hereby granted to: ........ ~T. ,~. ~l~.~mala .............................................. ............. h,....Ca~i~a..~.'t a~ .............................. ........ ~$,.~...u..,.~.~t~ ...... ~.,~.... ................................ ~o ..r..~.~...~..~:~.~.~,.o.~....o.~..~?..~,~...~.~ ~.~..g. .............................................................. at premises located at ...~.QZ..~D~L~L~q~...~D~CL ...... ~...~-~d~aar~,.y...F,~ ............................................ ..................................................... y~.t...~.~..~.~.~.~ ....... ~.,.~., .................................................................... pursuant to application dated .........................~. ...........~.~ .......... 19..~..3.., and approved by the Building Inspector. Fee $.4..~.,;0(~ .......... Building Inspector FOl~I NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcation must be filled tn typewriter OR ink, and submitted in DUPLICATE to the Building Inspector wtth the fallowing; for new buddings or new use. 1. Final survey of property with accurate location of all buildings, property lines, streets, aha unusual natural or topographic features. 2 F.nal approval of Health Dept of water supply and sewerage disposal--(S~9 form or equal). 3. Approval of electrical ~nstallation from Board of F~re Underwriters 4. Commercial buildings, Industrial buddings, Multiple Residences and similar buildings and installations, a cerhficate of Code compliance from the Architect or Engineer responsible for the building. $. Submit Planning Board approval of completed s~te plan requirements where apphcable B For ex~sting buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-ex~sting" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural er topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buddings 3 Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a cerhficate C. Fees' 1. Certificate of occupancy $5.00~ 2. Certificate of occupancy-on ~re-existing dwelhng or land use $5.00 3. Copy of certificate of occupancy $1.00~/~..~.. Dote ..... New Building ................ Addition ~. ........ Old or Pre-existing Building ................ Vacant Land .............. Local,on of Property ............................................ Of P oper,y ...... ................................... Subdivision ................................................................ Lot No ............. Block No ............House No ........... Permit No..~.~.~.~...~... Date Of Permit .~'./.~'..~.~/.7...~...Applicant ~,/..~..~"~xt.e......../~..~..,:?../.~..zf-?...~.~.. ........................ Health Dept. Approval ............................................ Labor Dept. Approval ~ ... Underwriters Approval ~...~.......~../7~...,.~....~..~....~.. ......... Planning Board Approval -- Request For Temporary Certificate ........................................ Final Certificate ~ .............................. Fee Submitted $ ..... .~...~ ................ ..... ~Sday of .... .~....~.....~....(...?, Z..~f ......... (stamp or sec~,) Notary Public .................................... County /~_~.~ THE ~_ak ~e February THIS CERTIFIES THAT NEW YORK BOARD OF FiRE UNDERWRITERS BUREAU OF ELECTRICrI'Y . ' 8~ JOHN STREET. NEW YORK, NEW YOi~K 10038 12R 1974 ~p~,~o*~.~o.o~f~ 664870 N 142988 only the electrical equipment e~ described belme and introduced by the apldic~nt named on the aboee application number in the premises of 3. B. Mo~an~ ~ox Hollow Rd.R Mat~l~UekR L.Z. FEbruary 7, 19714 HXTURE OUTLETS IEPTACLES SWITCHES RXTURES [] ;.a r~. outside section Block and found to be zn comphance w~th the requirements of th~s Board. 1 SERVICE ~ONN~T I NO. OF I S ~ 1 ~00 ~W METE~ X ~T, ~. 'PE ~p 1~2w 1~3W 3~ 3~4W NO,~ CC. COND, RANGES ~ECI AL ~EC'pT R TIME CLOCKs ~ UNIT HEATERS 2 Lot EXHAUST FAN~ DIMMERS Panelboard/a: 1-15cir. lOOamps. IV Box 300 "'"'""~ ~"'"'"'O., 'NI I~! Mattltuck, z,.z. ii~5~ ~~ ,/ ~l ,,, .i 7'/. COPY FOR BUILDING D~ARTMENT. THIS COPY OF CERTIFIOTI MU~ NOT BE ALT~. !N ~Y ~N~ BUILDING DEPARTMENT ,/__ _ /; .... ~ ._ .. TOWN CLERK'S OFFICE SOUTHOLD, N.Y. ~(~- ~amin~ ............ ~ 19~.. Applicati~ ~ ................................. ~r~ ........... ,~..'........:~ ............. , 1~... Pemit No..~..~.~.~.....~' ~r~ a/c ........................................................................................... - ............................................. ................ APPLICATION FOR BUILDING PERMIT z / ?73 Date .,,/~. ...... ........................ , 19 ............ INSTRUCTIONS th e. This application must be completely filled in by typewriter or in ink end submitted in triplicate to the Building Inspector, wi 3 sets of ptans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot end of buildings on premises, relationship to adjoining premises or public streets or areas, end giving e detailed description of la, out of property must be drawn on diagram which is pert of this application. e. The wo~ covered by this el~plication may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue e Building Permit to the applicant. Such permit.shell be kep the premises available for inspection throughout the work. grantede' NObybUj~in~ ~belllj~ng belnspector.°ccupied or used in whole or in pert for any purpose whatever until APPLIDATI~EBEBY MADE to the Building Department for the issuance of e Building Permit pursuant to the Building Zo~ Ordinance of the Tow~ of ~outhold~ ~uffolk County, New York., end other applicable Laws, Qrdinances or Reguletiop. s0 for the construction buildings, additions or alterations, br for removal or demolition, ns herein described. The applicant agrees to compl9 with ell applicable law~ ordinances, building code, housing oode, end regulations, end to admit authorized inspectors on premises end in buildings for neeessar~/inspections. ...... or ::::::::::::::::::::: .... ' ........... (Address of applicant) //~t--~. ~' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................................................................................... Nem~ofo~iof ~mses ... ~iZ~-. O ~IR,~/" .... : ............... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ............................................ [ ............. Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No../...~...~...~...~....~....~.~./. ........ ./.~...O...-Lot No ......................... Street and Number ...... ...~..~...~........~..~...~....~..o......(~......~....~.. ...... ../~..~..~..~./..~....G/...~...,~.....~....~/.....~,...~.. .......................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ ...~....~...~/m/~/....A~..?m. ......................................................................................... b. Intended use and occupancy ....... ~../,~/..~.~..~../....~....~_~ ........................................................................................ · 'ti 3. Nature of work (check which applicable): New Building ....................... Addt on ..................... Alteration ............... Repair .................. Removal. .................. .. .. .. Demolition ........................ Other Work .................................... ....... (Description) 4. Estimated Cost .~: ............................................................ (to be paid on filing this application) · ! Number of dwellin units on each floor ........... ................... 5. If dwelling, number of dwelling umts ................. g ........... If garage, number of cars ................. r .......................................................................................................................... 6. If business, commercial or mixed °cCUoancy, specify natu. re,nd extent of. e ~a~. ~}:)e of usa ....~..L.....: ........................ Dimensions of existing structures, if any: Front ..... .~.....,...~..... Rear ,.,...~........~.. ........ Depth ..~.~.. .......................... 7. ,~ / ....... / ............ Dimensions of same structure with alterations or additions· Front ....:Lr-.......eT.. ........... Rear ...~'......~.., ....... ~ .................. / .............. ,/....~.. .................... ,,,. Number of Stories / Depth ....~...~. ............................ Height ........................................ Rear ...... ~.. .................. Depth ..-~...,~... ....................... 8. Dimensions of entire new construction: Front ...... ~.. ........ ..... / ~-- ............. Number of Stories ! MelgnT . ... ................................................................................................................... 9. Size of lot: Front ...... ~..0...~-,.~. .................. Rear ...,~ ............................ ep 10. Date of Pumhsae. ............. ~ ~' ~..~.....~....., Name of& Former Owner ....~-~;.~..~..£..~....~.:.. ............................................ 11. Zone or use district ...... tn which prem~sas are sttuated ...... ~../..~..~..~'.....'~:/.- ........... ~ t.. ';~' .................. .................... ~ ..... 12. Does proPOSed construCtio,n vi~late any zoning law, ord~ee~tegU~eLteln:-,.;;_;~...5..-..,.,,;,-..;,, ........................... 14. Name of Owner of premises ...... ~.~..~..:. ~(~P~/~("~~~-~(~ ....... '. ,~.../......~..:/.o.ed' (Address) (Phone No~) Name of Architect ................................................................................... (Address) (phOne No.) Name of Contractor., ........................................ , ............................................ ; ........................................................... (Address) (Phone No.) PLOT DIAG RAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimenaions 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. ............................................................. ~..,~ ............................ ~i~ ~nd ~ys that he is the appli~nt a~ na~d. (Name of individ~ s~tng con,ct) ( Cont~tor. ~nt. co~mte o~r. etc.} of said owner or owners, and is duly authorized to ~rform or have ~rformed the said work ant to make and file this a~li~tion; ~at all statements contained in this application are true to t~ ~st of his knowled~ and ~lief; and that she work will ~ ~o~ in ~r ~t forth in the ap~ation fil~ t~mwith. ~ERRI LEE ~ t / ~ ~T~ PUBLIC, State ~ York - (~m~ of ap~ant) APFIJOVED AS I~O':ED DATE: ~ ~' NOTIFY BUIL~ING DEPARTM:NT 765.2~0 9AM TO 4~ FOR REQuite- ED INSPECTIONS: ~. BEFO~ BACKFILLING FCUNDA- TION OR SIAR1 FRA~ING 2 B~,:L. COVERING PIPLLIN~ 3 ~ll~,L WHEN lOB COMPLETED