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Home My WebLink About6378-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte OJ Occupnncy No..Z. ~J..~. ..... Date ............ .J..~.....13 ...... ,19F3. THIS CERTIFIES that the building located at !~,0~1~..]~1 ,g~h ~t ....... Street Map No.. ~x ....... Block No.. ~ ..... Lot No. ~...al'e~t~ol'~;...i .¥.~ ........ conforms substantially to the Application roy Building Permit hereiofore filed in this office dated ........... I~!~....¶..., 1973. pursuant to which Building Permit No..6378Z. dated ........... ]~a~....1 .... , 19 73., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy forwhich this certificate is issued is .... Private. ~ne. £~mil.~ .dwell~ .................................... The certificate is issued to . ~'.~ .~£ ....... [~mel· ........ ./ ..................... (owner, l~ssee or tenant) of the aforesaid building. Suffolk County Department of Health Approvall,R~ ....... ~" ' 'I ...................... UNDERWRITERS CERTIFICATE No .... l~. 9.R.*.. ..............i. · .?. ..................... HOUSE NUMBER...t6~[ ..... Street.. ~.'~:!. ~ I]1; ................. : ...................... · 0~,~ NO. ~ 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) N9 6378 Z Permission is hereby granted to: · ....... ~; .......... .; ........ ~:..:-: ...................... ...... : ......... i~. ................... ~ ....................... ................................. ;~ .......... .~..L.;.....;..~ ......... ;.;.,.,.; ........................................................... at premises located at .......... ..~.'..?.:..{~..'. ....... ..~...(./......~.. ...... ..~.../...~....~....~,.....~..7. ......................................... ~ ~Z- L- ~' ~ ~' ~, ~/ '/ pursuant to application dated ................................... L....~.~..~, 19.Z: and approved by the Building Ink,tar. /~ Fee $ ........................ Building Inspector FOB~ NO. I TO. bi OF $OUTHOLD Building Depmtment T~m Cle~J O~ice Southold, bi. Y. 11971 APPLIGATION FOR CERTIFICATE OF OC:GUPANCY 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. Swam statement of owner or previous owner as to use, occupancy and condition of building~ 3. Date of any h.ousing code or safety Jnspectlon of buildings or premises, or other pertinent in- formation reqmred to prepare a certificate. ¢. Fees: 1. Certificete of occupancy $§.00 2. Certificate of occupancy on pre-existing dwelling or land use $§.00 3. Copy of certificate of occupancy $1.00 Date ...... ,3 U rjr..~,~, e.. ~.~.2 ~ ............. New Building .................... Old or Pre-existing Building ...... ..X.~ .................. Vacant Land ............................ Location Of Property ........ ~.r.i~I.~...I~J~..n....F....N..~.~..T..H...~.T.e.~R..E..E..N..P.P...fi.T. ........... H.O..U.~..E...~....Z...6..h..q ............... Owner Or Owners Of Property ..... ............................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No ......632~ ......Date Of Permit ..,~./.[/.g~.....Applicant .I~I.T.I~R..~I.I~J~..~I~.~..~.~.E..H...E..N..T....~...O.~. .... H~alth Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ...~.~Q[J ........................ Construction on above described building a~ t~m~eet~ble,/~ s~ ~d~~s, Applicant .....~<.~~....~ ....... ~...: ......... ~..~..~.~........~...7~ ................ Erneet F. Richter Sworn to before me this .... ........ TERRI LE£ El. AK NOTARY PUBLIC, State o~ New York No. b2-616c~295 Quahfled m Sutlol~ County Commission ~xpires March 30, (stamp or seal) · OBM NO. 1 TOWN OF SOUTHOLD BUILDING OEPAItTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ................... Z...~.., 19.7.~.. p.oved .................. ,.m,, Disapproved a/c .............~........~ ........... (Building Inspector) APPLIGATION FOR BUILDING PEP. MIT Date / /~/4 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink end submitted in triplicate to the Building Inspector, wit 3 sets of plans, 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 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 granted b? 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 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 ell applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors o~n premi~es~nd in bui)~fings for nec~s~a,ly~s~ectioni. / ~ l/T-,, ~ /~' , ~ ~,~/~' / ' ........ :..:,..L...;;;:..: .................. ;.~.;~::,.; ....... ~......~.. ............ (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · .......................... ~.~..../.'~.~.z;. .............................................................................................................................................. Name of owner of premises ................................................................................................................................................ 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 .............................................. Lot No ......................... Street and Number /"' / ~' '/' ~/ / ' ~r 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 .................................................................. ?...;~,. ..................................................... 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration~..~......~.....- Repair ........ Removal ......................... Demolitio,~,j.~y .................. Other Work ................ . .................... · ................ ~~ (Description) 4. Estimated Cost ........................................... .y~- Fee ................................................................................................. f?/I, ~ (to be paid on filing this application) 5. If dwelling~umber of dwelling units ................. Number of dwelling units on each floor ......................................... If garage, number of cars ........................................... , ............................................... 6. If business, commercial or mixed occuoancy, specify ~]~_re and extent of each tvpe of use. .......... ~../; .................. 7. Dimensions of existipg~tructures, if any: Front .......... , .......... Rear ................... e~.~/. ~lbth ................................... Height ........................................................... Number of Stories ...........~..~,~ ......................................................... Dimensions of same~ktrpcture with alterations or ad/dit~ns: Front .......................... Rear .............. ~c ........................ Depth ............................................. Height ................ v-~. ................... Number of Stories ................. ..~p~ ............. 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................. Height ................................................. Number of Stories ....................................................................................... 9. Size of lot: Front ...................................... Rear .......................................... Depth ................................ ~... / 10. Date of Purchase ..................................... Name of Former Owner ...................................................................... /..!. 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zOning law, ordinance or regulation: ...................... . ............................. '. ....... 13. Will lot be reoraded ........................... ~.)Nil4~e~o~sfcfill be removed from premises: [ ]' Yes [ ] No 14. Name of Owner of premises : . .................................................... ' (Address) (Phone No.) Name of Architect ................ .~i.~.~.~.~.~...~.....tT;,.,,.t?~.....l?.4.~:...~.~,~,~7 ......... ?~'~'::'~':;"'"'~/~"l~'~'~'~;'~'~"~'" Name of Contractor "i ................................................................. i'/~'~{'d';;'s's')''~'''';'''I`' ....................... i'l~l~'(~'n';"l~'(~:i ......... ' ..... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block..q~mber or description according to deed, and show street names and indicate wheth- er interior or corner lot. ~"----~ C I ~ i STATE OF NEW YORK, ~ ~'l' ~: (;~ ~'~ SS COUNTY OF ...................................................... ....................................................................................\ ; ..................... being duly sworn, deposes and says that he is the applicant above named, {Name q~e ird~id~sil~t~ngTectntr4tct ) He is tha ................................................................................................................................................................................................................. {Contractor, agent, corporate officer, etc.} of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the-best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. ..~ te of New Yo~l · Notary Public ........ G~IkQ~i,t ti .0.q. ,E.x. ~,l.r.e,s.. ,~.a.[ .c ~, ~u. :,.,.,, .~,7. ............. County .... ~.~i ................................................................................ .x .................. (Signature of applicant)