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Home My WebLink About6605-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ~ ................ ~ 5 0/~,<, 'l~e/~ ~ ~ Map No ....... Block No ......... Lot No ............................... conforms substantially to the Application for Building Permit heretofore filed in this office dated . .......... ~/3 't' ~ B , 1Z.~. pursuant to which Building Permit No. ~' ...... [' ~ 7 dated p~Jl ....... '{ i~ 5 , 10.-~.. ...., was issued, and conforms to ali of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ~... 0 N ~'~ F ~ r ~ I L ¥ ~ ~1 E k L ~/~ ~-~ The certificate is issued to ........................................ (owner, lessee or ten.t) of the ~ores~d building. ~u~o]~ ~ou~ ~eDa~e~ o~ ~ealth ~D~o~a] ...................... UNDERWRITERS CERTIFICATE No ............................................. ~OUSE N~BER ........... Street .......................................... Bffild~g I~spee~or ~0~ NO. ~ TO~VN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CI-HIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby gronted to: ~-''~ ~ ~"~'~ '~J~,/g~--~ ~ ~ ~ ~ ~' ~'~ C . ............. ...... ,o ........... .~..~..~.~..¢..~..~..,.~..~~......~2,~.~.~..~...~.....-.. ....... .................. ...~...~...~..~..~. ........ .~.. ........ ~.~.~.~.z~ ....... wZ..~.~..~-~_ ..... L .............. o, premises Iocoted at ..... ..-~.......~...~.~....~~-..../-.~../~...~..: .............................. ...................................................... ...~...~..~... ~.~.~,....--....~...~ ................... Building Inspector. Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Somhold, N. Y. 11971 APPLICATION FOE CERTIFICATE OF OCCUPANCY Instructions A Th~s 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 w~th accurate location of all buildings, property hnes, streets, and unusual natural or topographic features. 2.Final approval of Health Dept of water supply and sewerage disposol--(S-9 form or equal). 3Approval of electrical installation fram Board of Fire Underwriters. 4 Commercial buddings, Industrial buildings, Multiple Res,dences and similar buddings and ~nstallations, a certificate of Code comphance from the Architect or Engineer responsible for the building. 5.Submit Planning Board approval of compleled s~te plan requ!rements where apphcobIe B. For existing buildings (prior to April 1957), Non-conforming uses, or buddings and "pre-ex~stmg" land uses Accurate survey of property showing all property hnes, streets, buddings 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 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 $1 00 Date ....,z}.~.~..~...'~...~..( ~.7.~ ............ New Building ................ Addition ..../.. .......... Old or Pre-existing Building ................ Vacant Land .............. b~cat,on Of Property ...... 2..~....~.ft~...k~.~P..,,....~...~.V,'.....~.fJ ~.~..~3..~..<. ..... ~/'.:.~/.~ .................................. Owner Or Owners Of Property ....V.~//~,',/.....,9../V..o.....~..~..E~.,d~6.T.....-,~.:....~.~,5.E.~/. .................................. Subdivision ............................................................... Lot No ...... ~ ..... Block Ng: ........... House No...R-..Z..~.~. Heolth Dept, Approval ............................................ Labor Dept. Approval .............................................. Underwriters Approval .3/...-r....LL..~..$.5. D. .................. planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ..... ..<~. ........................... Fee Submitted $ ...'$...~ .......................... Construction on above described budding and permit meets all applicable codes and regulahons. Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County THE NEW YORK BOARD OF FIRE UNDERWRITERS [--~r~( BUREAU OF ELECTRICITY ; 85 JOHN STREET. NEW YORK, NEW YORK 10038 ,.re ~,~,~,~,,,- ~. 1~?~ .,pp,,.tion~,o.o.,,,. ~.~, N 112930 THIS CB~IFIES THAT in the following location; [] Baaement [] 1st Fl. teoaeramlne~on* August 31, 1973 [] 2nd I~. Section Block and found to be in compliance with the requirements of thi~ Board. V I C FIXTURE LKEPTACSISI SWIT HE I RXTURES ~T. K.W O~ITLETS ~ C S INCANDESCEm FLUC~ESCENT ~ RANGES 6 13 ~ 6 DRYERS I FURNACE MOTORS FUTURE APPLIANCE F~D~R$ ;PECIALREC'I OTHER APPARATUS~ Vaughan Ramsey, 225 Oak Road, New Suf£olk, L.I. 11956 EXHAUST FANS ' COPY FOR BUILDING DEPARTMENT. THIS COPY OF ¢IKTIFtCATt MUST NOT BE AKTE~iN,, , ,~ ANY, MANNER.~ --': Examined ............. ..e~... ~../....~......'~........, Approved ............... ~..-'/~..~.--......, TOWN OF SOUTHOLD TOWN CLEItK'$ OFFICE / ~ ~ ~ -'~'~*ce'~ ~ SOUTHOLD, N.Y. -'~,'~- 19 ............ lu APPLICATION FOR BUILDING PEIUGIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing locationr of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram Which is part 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 available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part 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 i~uild n.g. Zone. Or.dinance of the Town of Southold, Suffolk County, New York, and other appli~c~;~ble Laws,. ~lnances or egu at~ons, tar the construct on of build ngs, additions or a terations, or for removal or demolition, as herein The applicant agrees to comply with all applicable laws, ordi nonces, building code, housing code, and regulations. (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................. Name of owner of pl'"'4~~em~ses ...~..~..."....~.~~ ........................................................................................... .............................................................................. ,f~.ant is a c].~t~~f~uly authorized officer. Location of land on which pro~sed w.~rk will be done. Map No.: .o.l .................... i~,~ ...... L~t No ........ Street and Number ..~.....~~ .......................... ~.~...'~...~.~ ......... [[[ii[,.i[;;[[[i'" ~ ~, ~. ~" Municij)atity "' State existing use and occupancy of premises a~;J inten, ded~'~ - ~, /'~' ' ,' ' ,use and occupancy of proposed construction: a. Exisitlng use and occupancy ..~{~e~.....~~.....~ .................................. b. Intended use and occupancy *" Repair .................. Removal .................. Demolition ........ .~,....._.O~her Work (Describe) .......~-- ................................ Est mated Cost ~. ~2. t~. Fee ../~..L.~. ~.. . · (to be paid on filing this application) If dwelling, number of dwelling units .......... ~. ............... Number of dwelling units on each floor ............................ If garage,'number of cars ....... ~. ............................................................................................................................ If business, commercial or mixed OCcuponcy~~ure and e)ct~l~t of each type of use ............................ Dimensions of existing structures, if any: Front ............... ~,~~ ~~--.~D_,~ ................................ Depth ....... · Height ........................ Number of Stories .................. : .................................................................. / Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ new constructioh: 8. Dimensions of entire Front ....... ~.~.. ..................... Rear ....... ~.¢ .............. Depth .. ~,.~. ............. Height ....... ~/~.~ ...... Number of Stories ...... ,~ .......................................................................................................... 9. Size of lot: Front ......~..l~.../....'T~....... Rear ..... :.....7~1..'......-~.. ....... .Depth ...... ~.~m~..~.....~....-~..... 10. Dote of Purchase ......... :...2 ..................................... Nome, e~,.of Former Owner ........~ ......................................... 1 1. Zone or use district in which premises are situated . ~..:.:.... .................... ~... 12. Does proposed construction violate any zoning law, ordinance or regulation? ......... .~...~......"" ............... ' .................... 13. Name of Owner of premises ..... ~ ........................... Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .4~.,....~O~/~.' ...+...~,,~'43~. ......... Address ....... A~;~....~4~.~.~.~..~4u¢,.... Phone No...~..~;.¢~...~1~_ PLOT DIAGRAM Locate clearty and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from proper~y lines. Giv~ street and black number or description according to deed, and show street names and Indicate Whether interior or comer lot. IG ' 'f r,~,e ,' I IV/ 111~ , /' , t ' / /1 / / / ,, ,,,, ,. COUN~ 0~....~~'~ , ................. ~.~e.e~T.2L, ....... ~.~..~...[, ..................... ~,~. ~y ,.om,'~, on~ ,~y, t~ ~, ~, th. ~pp,ca.t (Name of inSividual signing applicotion) above named. He is the ~ .... (~t~to;, ag~;, co&rate ;~ic,;['~;;i ....... of said owner or ~ne~, and is duly authorized to perform or h~e ~ the ~id ~rk and to ~ke and file thi~ qppljcat ~n; ~at all statements cont~n~ in this applic~ are t~ ~ .the ~ of his ~owl~ge and belief; and that the work will be performed in the manner ~t fo~h in the ~pllc~lm ...... Nola~ Public, State of New Yo~ . No. 52-0344963 Suffol~ ~emmls~ien Expires March 30~ '1' I II ~ ~,L. OWF-P-. LF-VEL J T I g iT"/ Roo~ [