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Home My WebLink About6416-zFOP~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Ot~ice Southold, N. Y. Certificate Of Occupancy No..Z~37.9 ..... Date ............ &Xtg...lt~ ........ , 19.73. THIS CERTIFIES that the building located at .tl,.0.,W, ,. ~./S. ~.O~t~d..V. leW. ~i~et Map No...xx ........ Block No... ~X ..... Lot No .... ~... [louth~ld.. I~,Y, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... 1,ia~. ..... ].~.,. 19..~.3 pursuant to which Building Permit No. (~.~.I.6Z.. dated .......... .I,l.a.~....]9. .... , 19.?~.., 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 . .P. rSvate, one. f~lly..dwellin~ ...................................... The certificate is issued to . 1~ .&. M~'s. Hen:~¥. J. aeeb~.. ...... ~r~e~.~ ............... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ~.l~e-. ex/sting ................... UNDERWRITERS CERTIFICATE No .... N. ¢10~.8814,....AU~ .. 8...]9~'~ .............. HOUSE NUMBER ...~.98~ ....... Street .. ~eund. I/$e~. £v.e ....................... 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) 6416 Z Permission is hereby granted to: ~B~tild an additzon & ~.~ake alterations on at premises located at ~.;~'8 ~,O,U', off ~/8 ~ou~d View .......................................... ~.,o.~k~..o.~. ......... ~.,:~: ................................................................................ pursuant to application dated Mar 1~; 7 ......................................................... 19......~.., and approved by the Building Inspector. Fee $ ~ ~..', ~ ............ Building Inspector FOBM NO. $ TOWN OF SOUTHOLD Building Delm~tment Town Clerks Office Southold, N. Yo 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 sewerbge disposaI--(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 ar 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 u~es, or buildings and "pre-existing" land uses: : 1. Accarote 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, oqcupancy 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 $5.00 Date /~..~..~.~..Z ....../...~.., ...,/..~..2 .~... New Building .../~..Q ........... Old or Pre-existing Building ................. : ........... Vacant Land ./~'..O. ..................... Health Dept. Approval ..... ; ...................................... Labor Dept. Approval ~ ......................................... Underwriters Approval ~./..~,.ff....~.ff.;.~.. ....................... Planning Boa~d Approval Request For Temporary Certificate ...;...."~, ............................... Final Certificate ~ .................................... Fee Submitted $ .~.....~. ........................... Construction on above described building ondj?%rmit meets oil appllcoble codes and regulations. o, or Nota~ Public .... ~/~~. County .~ . ~ "' . ,. ' ~'., ~(~F,FH T CK TOWN OF SOUTHOLD BUILDING DEPARTMENT ~ TOWN CLERK'S OFFICE APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, witf~ 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 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 o 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 by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone O~dinance of the Town of Southold, Suffotk 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 applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspecti~ (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. Name of owner of premises ............. .~. ................ ...... .k~....-c.......l'~C..i....~'..~................. ........................................ If applicant is a corporate, signature of duly authorized officer. ~ CName and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......... .(R..~..-....~. ................................ Electrician's License No ....... .~...~..?...-...~.. ............................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No ....................................... ,:......Lot No ......................... e-ia .......... ............ .......... Street and Number ............................ ~ Municipa)ity ~-~, -State e~g Use and occupancy of premises and intended use and occupancy of proposed construction: · b. Intended use and occupancy ..................... .... ti / Alter=rtinn' ' 3. Nature of work (check which applicable): New Building ....................... Aaa) on ........................................ Repair .................... Removal ......................... Demolition ........................ Other Work .................................... ~[ (Description) 4. Estimated Cost ....... !..?..L~:.,~.. ................... Fee ................................................................................................. (to be paid on filing this application) 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 ~' °r Rear ..... .R?. .................. Depth ....~. ............................ I Height ....... ~.. ......... . ........................................ Number of Stories ,.,,,;,....( ................................................................ Dimensions of same structure with alterations or additions:,Front ....~....:. .......................................................... Depth ....... ~.~ ............................... Height ..... L.~..~. ............................ Number of Stories ...,...~. ............................. ;z. 611 o n-~- z~~1o' Depth ~'...~'...~..~ ..................... 8. Dimensions of entire new construction: Front .......................... aa, ..... ~ ..................... Height .......... J~ ................................... Number of Storms ....................................................................................... 9. Size of lot: Front ..... /. ........ , ...................... Hear ......... /. ............................ Depth ..~..~..~. ......................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ....... ............~:~...u...'~...e../~;~ ........ .~ .......................................... , ....... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ~. ................................................ 13. Will lot he regraded - ~.~ ........................ Will excess fill be removed fromoremisas: [ ] Yes Ix] No _ 14. Name of Owner of premises t.~,,k~.~...z~It~.~,.....p~;.....~!...~z~. ....... .~...:~.~[~ .................... ................ ..... (Address) (Phone No.) Name of Architect ..................................................................................................................................................... _-.,, , , (Address) (Phone No.) Name of Contractor ........................ ~_,~..~.'~9.R ...... .~......~f, ........ ~ .......... ~....~....~...,q.~.. .......... .~....2.....~ (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set~oack dimen~ions from property lines. Give street and block number or er interior or corner lot. % · ·f leU description according to deed, and show ~.~t names and Indicate whath- STATE OF NEW YORK, } ~. COUNTY OF ...................................................... ) ..... EC~.U&..(R,~..'I~ ....... .~'.~....~.~.~[.[,..~..~....~. ................................ being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract) (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 ell 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 therew;th. (s~nature o£ K~AP OF L,~ND UACOBI ~ THE NEW YORK BOARD OF FI.R~ UNDERWRITERS ~ ' 85 JOHN STREET. NEW YORK, NEW ~ORK~ iOO~ '~ only the electrical equipment ~ &scribed below and introduced by ~applicant na~d on the able appl~t~a ~mmber in the premises of in the.following location; ~ Basement ~ 1st FI. FIXTURE OUTLETS SWITCHES DRYERS FIXTURES [~ 2nd FI. ;~[~5~ ~C~ Section Block Lot and J'ound to be in~ compliance with the requirements qt' this Board. RANGES OVENS DISH WASHERS EXHAUST FANS E R I NO , NO, OF HI-LEG OTHER APPARATUS: C AW, g, A.W,G OF HI-LEG OF NEUTRAL GENERAL MANAGER cOpY FOR BUILDING DEPAaI/~EN~o THIS COP~ OF:~CI~R~T~,FI¢~iE[~/~U,~]~(~i [I!:~[-Tf[R~.~ IN ANY /YtA~I~ THE NEW YORK BOARD OF FIRE UNDERWRITERS Et~,f BUREAU OF ELECTRICITy. ~ 8.5 JOHN STREET. NEW YORK. NEW YORK 10038 ~ THIS CE~IFIES THAT only t~ e~tHe~ ~uipment ~ ~se~ ~ ~ int~ ~y t~ applier ~med on the eb~ ~pl~tion numar in the p~mlses of H. Jacobi~ Soun~bz~ew Ave.~ w/o Kenny~ Rd., Southold, L.I. in the following location; ~ Boement ~ let FL ~ 2nd FL OUtS ~de S~t~n Bilk ~t w~ examined on A ~I~ ~ ~ ~ ~ ~ ~ ~ and found to be in compliance wi~h the requirements of this Board. RXTURE FIXTURES RANGES C~KING D~KS OVENS DISH WASHERS EXHAUST FANS 12 16 10 2 DRYERS TIME CLOCKS UNIT HEATERS MULTI-OUT~T SYSTEMS NO. OF FEET OTHER APPARATUS: qleC.~'OOln he&tel's: .... . ~kw~ E R V I C NO. C~ CC. COND. PER .8' 1 OF CC, COND. 4/0 NO. OF HI-LEG 4-I. 5L~% 1-1. OkwE 2/o Charles ~'~. ];all, ~ox 417 :.,outho~ds L.I...~qll Per_ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ./ L