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Home My WebLink About6672-zNO. 4 TOWN OF $OUTHOLD BU~r.I~ING DEPART~FRNT Town Clerk's O~ce $outhold, N. Y. Certificsle Of Occupancy THIS CERTIFIES that the building located et ,.~../$..~.~t~..l~... !$~.~).. Street conforms substantially to the Application for Building Permit heretofore filed in th~ office dated ...........J..u~....~.., 19. ~ pursuant to which Building Permit No... ~.~.~ dated ............. .~..~.....~.9, 19. ?,~, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which thi.~ certificate is issued is . p..~.?.~.t~., .u..t$.l.~..t~'..(.I..tg..~.~. )' .b..~..1..~..~.[ ............... , ............... The certificate is issued to .Dr..0~f~ed. ~z~l~allr~ ..... (h~- .......... ~ ......... (owner, lessee or tenant) of the aforesaid building. , Suffolk County Department of Health Approval ].,.R.,. ......... .. ..................... UNDERWRITERS CERTIFICATE .......................... ! ..................... HOUSE NUMBER .............. Street ..................... ..................... ( ' BujJding ~ctor~ FO~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) N? 6672 Z Permission is hereby granted to: · · ..l'a'-, .* ~ ¢.~£~.~,¢t. -.. · (~, -~',~ ~t~ ....................... ......... 4.....i]~a¢.h~od:....D~ ................................ ................ ]~'~'~Z~o ....... ~l.~ ............................. to ...b~3,.q...~.,.¢...~.~..J,~,.~r...b.~Lu~ ........................................................................................... at premises located at ..... ~/Z.,,..~o~X...,q,ot,..J;....._h'Or(~tr~..~¢st, e~..l; ....................................... .............................................. S/.~..~.~'.t.?~.~¢1 ..~2~2..Y.) ........ G~e eapo~t, .................................. pursuant to opplication dated .................... .~ .......... 1~) ........... , 19..~.~.., and approved by the Building Inspector. Fee $ ..'J[..~.~..r,~). .......... Building t-Inspector ~ t THE NEW YORK BOARD OF FIRE UNDERWRITERS , ,.I~,, BUREAU OF ELECTRICITY ~ 85 JOHN STREET. NEW YORK. NEW YORK 10038 .., 7,- 153301 THIS CERTIFIES THAT Dr. U. Oermansky, Route 25, s/side, 100' e/Gull Pond Rd., Greenport~ L.I. in Ehe followi~g location; ~ l Basement [] 1st FI. [] 2nd FI. O~t~ td~ Section Block Lot tvas examined on A~l ~ ~0711 and found to be ln compliance tvlth the requirements of this Board. FIXTURE JECEPTA LEI W T I FIXTURES I DRYERS FURNACE MOTORS FUTURE APPUANCE FEEDERS AN~T, K, W. OIL H. P, ~A$ H, P. A.MT. NO. A.W.G. SERVICE DISCC)HNECT I NO. OF [ S T METER AM. ~.wp. TYPE EqUiP. 1,,~'2W 1.e'3w 3~3w 3~4W ~ 150 C~ X OTHER A~ARATUS: RANGES E TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET SYSTEMS AMT, A)4PS. TRANS: NO. OF F~ET V I OF CC. CO~4D. 2/O NO. OF HI*LEG OF HI-LEG EXHAUST FANS DIMMERS E NO. OF NEUTRALS A' w' G' OF NEUTRAL 1 2/(; Photo LiMht Cell SoutholdE L.I. 11!)71 GiNERAL MANAGIR COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FOKM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. ¥. 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 similar 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 3. Copy of certificate of occupancy $1.00 , .00 Date .......................... New Building .................... Old or Pre-existing I~uilding ............. ~z ............. Vacant Land ............................ Location Of Property ..............~..~...~...!..~ .......... '~....~ ................................................ Owner Or Owners.~f P.,'~,',ert,,' ~")~ ~i ~ .... . ...................................... Z'"'_' ......... .......................................... Permit No..~... Date Of Permit .f~?/..~.~...Applicant ..... .~.....~..:..~ Health Dept. Approval ...... /..v.....J..~w~...: ..................... Labor Dept. Approval .......... ,~........~TT... ........................ Underwriters Approval .......... ~....(....~.....*: .................... Planning Board Approval ....~....~.....~... ....................... Request For Temporary Certificate ........................................ Final Certificate .......... v~' ........................... Fee Submitted $ .~................¢~'~'/~. ....... Construction on above described building and permit meets oJ~applicgble codes and regulations. Applicant .." ..................... Sworn to before me this ........... Notary Public (stamp or seal) (..~, ~ O BUILDING DIPAICrMI~T,~_ i. ?~ TOWN CLERK'S OPlrlCl~ Examined ............... .~......, 19..7~.. / . Application No...u,.........,. .................... ' ,t ~k ..................................... Approved ....... ~........i ...... ' ................ , 19...~.~... Pemit No i~ ~ (Building Inspector)~ ~ APPLICATION FOR BUILDING PERMIT L.~ Dote ................................................ , 19. '! a. This application must be completely filled in by typewriter or in ink and submi~ed in triplicate to the Building Inspector, wi 3 sets 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 or areas, and(Y_ giving a detailed description of layout of property must be drawn on 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 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 granl~¢l 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 Tow~ 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 ~l~fllicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections, ............... ..... (Signature of applicant, or name, if a corporation) State wheth~' applicant i, o~ner, I~, a~nt, at, hitter, engineer, ~nerel contrector, el~trician, plumber or builder. If applicant is a c.orporata, signature of duly authorized officer· (Name and title of corporate officer) 1. I.ocation of land on which proposed work will I~ don... Map No.: ...... ~..i~...Z .,~... .................... : ..... Lot No....~....... Street end Number .......... ~......~.: ................................................................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... ,..~~.....~, ................................................................................... b. Intended use and occupancy .......... / {'J'~'~' ~"~-'~fr .......... ~,'~ ................................................................................................. 3. Nature of work (check which applicable): New Buildin4] .................... Addition ..................... Alteration ............. Repair ......................... Removal ............... ,..~;:.~.~:Demolition ..: ............ Other Work .................................. ~ -.~ r~-f).. ~ -,' : ,~t ~ ~ {Description) 4. Estimated Cost ................ :..~..~....~..,:...v........ Fee'.,;;.L.../......;.;...'. ......................................................................... - · :(to be paid on filing this applicatiqn) 5. If dwelling, number of dwelling units .................NUmber of dwelling units on each floor ......................................... If garage, number of cars ................................................................... 6. If busip.ess, comm6mial or mixed occupancy, 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 ....................... ~7~ ............ 8. Dimensions of entire new construction: Front .......... ~......~....~. Rear .............. L ........... Depth .......... J/.....~.... ..... / Height .................... ~ ...................... ~. Number of Stories ............ ~..~. S;ze of lot. F o ...... 'i . .................... ._..~. --..~/~_..[,,t~,.? ...,...:..])Z~Z.;.~. 9. ' ' r nt . .~ 'l*.~,..:. Rear ......... ~.' ..... Depth ...... ~. ................ 10. Date of Purchase .......... ~ ~.~.:..~am. of Former Owner .....~ ....................................... 11. Zone or usa district in ~d~ch premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................................................ 13. ~Will lot be re~aded ..................... ~-~..~r.-.. Will exces~i!l be~e~f~oved from premises: [ ] Yes [ ] No 14. Name of Owner of prem~sas .................... i~;~'~"~'~i Name of Architect 1Address) (Phone No.) Name of Contractor ....................................................................... (Address)'~ (Phone No.) PLOT DIAGRAM Loc. am clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions from number ~r_d _e~cription according to dee_d, and show street names and indicate wbeth- STATE OF NEW YORK, COUNTY OF ....~.....~..~..~d~..~. ......................... ....... ~..~..C~.~. ?~..~. ........ ...~:...;...(~'..~.~;~,.~...~ ........................ being duly s~rn, ~.s and .ys that be is the a,pli~nt abo, na~. (Na~ of i~tv~ si~ing eo~ct) He is the ............ ~..:..~.~ ........................................................................................................................................................................ ; : (~n~ct~, ~nt, ~mte o~, eta ~ of ~id ow~r or owners, and ia duly authorized to ~Horm or be~ ~rfor~d t~ ~id ~rk and to make and file thia a~i~tion; ~at all -- a~n~ ~ntain~ in thi~ a~li~tion a~ true to t~ ~at of hia k~wle~ and ~li~; a~ ~at t~ work will ~ ~Ho~ in t~ w~r ~t forth in tbe ap~i~tion fil~ ~e~ith. ~ q~ ~ ,~Y PUBLIC. S~ ~ ~ , ~ ............. .L....~ ................. day of ............... ~.~L......'~ ...-.He...~,e~ '"'"'-"-~" ~/ ~ ~// ' ' ~n bpi~ ~, 19~ ~ ;- .............. ~ta~. Public, ~.~.~-~-...~ ............. ~ ............... ~"~"~~J'"""~ .... N oT /oo. o ~ ~.EE NPOI~T . 7'0~'~1 Of 6Ou~'NOLD, Al. Y.