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Home My WebLink About6717-zFORi~ NO, 4 TOWN OF SOUTHOED BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .. O'Y~f:&O N ....... ~:1)~\'~ .... Street Map No .... 7~ ....... Block No .... ;77 .... Lot No ....... ~ ......................... conforms substantially to the Application for Building Pe~rmit heretofore filed in this office dated ........... ~.0..q.q!';(.., 1~.. pursuant to which Building Permit No.~.q ! Y..;L-.~ dated ........... t. ?, ~.O. ~i.., 1~.-~.., was issued, 'arid conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .]~ ....~./~ ?{ .~ ? .... ~ 'Y~ q ~.~..~.'..k= .... -.~ .~d ~ ,L. ;1~ .L ~.q ..~. ...................... The certificate is issued to .... (dwner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .......... N).: ~ .: .................. UNDERWRITERS CERTIFICATE No .... h! ....~..ff..V:: .O.. ~ .~ ...................... HOUSE NUMBER .............. Street... ~}~..~. ?..~i~.~ ..... ]'.~. ~ .~. ~ .............. .... : . . : ........ Building Inspector FORM NO. ~ TOWN ,OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N~ Y. N°. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ' ~' ~ ~7J7 z ........ d:u ...... / ........... /..o ........ Permission is hereby granted to: at premises located at .~ .~..~ ~'~ ~'~ O/~J.~ i-i-:-'~'-'~ .......... ~..~ ...................... ~. ............. .~ .................... ~ ............................................................... Building Inspector, Fee .... ; .............. ........... ' B~ilding in'spector '( TOWN OF SOUTHOLD:~ Built, lng Department Town Clerks Office Southold, iq. Y. 11971 APPLICATION FOR CERTIFICATE OFr OCCUPANCY Instructions A. This application must be filred in typewriter OR ink, and sdbmitted 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 U~derwriters. 4. Commercial buildings, Industrial buildings, Multiple R;esidences 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, 9ccupancy 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 ....!Vi..~..~.°...h..,..]:. ~ .!....]..~ Z.L~ .......... New Building ....~ .......... Addition ................ Old or Pre-existing Bt~ilding ................ Vacant Land .............. Location Of Proper~y ......... ~.9.~.~.~...~.~]..e.......0..~.C:°.?....~.~.: .......... ./(. ~ .0. .?. .0. ....... ..~.~.~.~.~.~.?. .................... Owner Or Owners Of Property Rober'b L~, i{owehl Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No.....0..~.].?.~ ..... Date Of Permit .?..':.],..0..-..~...Applicant .~.w..~:¥.!....Z.'.~.:....~./..o....!.~..o.~..C.:.....O..:...~.o. we?l]- Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .... ..~..].!.-!,..0.~.~ ........................... Planning Bo0rd Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ............. ~ ........................... Fee Submitted $ ~. 00 Construction on above described building and permit meets all ~pplicable codes and regulations. Applicant ........... ~~..~~... .............................. Sworn to before me this ~(~1 ....Z~ day of ...... .~,.~./E~.:.C.£~: ...... ..//..~/.~-/ (stamp or seal) ~V,,~d~,J ~~ ' Notary Pubhc .........~<L~Z~. ~ .........Zount.v .... ~ ..... r~, Commission Expires ~arcn au, ly~ THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ BUREAU OF ELECTRICITy, .; i F-- 85 JOHN STREET, NEW YORK, NEW YORK lOO3B~ 7. .97" ..,,c..o. N 147069 THIS CE~ FIBS THAT ' Mattltuek, L.I. in thefol~ing~catio.; ~ B~emen( ~ Ist FL ~ 2~ FI. ou:slde ~t~. Bilk ~t ~o ",".i~ 0" Mar eh 5, 197~ ..d /..~ ~ be in co.pllance mith t~ r.quireme, ts of th;" B.rd. FIXTURE DRYERS ?.., sw?., ,.c...;. FUENACE ~OTOES ~t H.P, GAS H.P, FIXTURES : :': ::: - F 2 '/ SERVICE DISCONNECT I NO. OF METER 100 CB RANOES SPECIAL REC'P1 R [COOKINO DECKS OVENS DISH WASHERS TIME cLOCKs l BEU [UNITHEATER$ MULTI-OUTLET C 1 OF CC. COND. EXHAUST FANS AMT. H.P. DIMMERS NO. Of NEUTRAL~i A. W, G, Of NEUTRAL T.H, Cheshire & Son Inc., P.O.Box 2113, River Rd., Calverton, L.I. 11933 J MA~Am COPY FOR BUILDING DEPARTMENT, THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER, BUILDING DEPARTMENT ~ ~/4,z,~ ~ ,~. ~ ..~/'~1,.,,.~. :I~ TOWN ~K~ OFFI~ ~ ~ ~ Z.~.~. ....... ,~..Z~,~]~. ~ - ~ 7 / Z ~ ~,,~ot,on No. ~...~..~..Z ............... ~" Ex~min~ ~proved .................. .., er~it No ....... i ............................ ~ . . ............... ,. · ................. = t ildi~ I~Br[ APPLICATI~ ~E BUILDING PE~IT ~la/X INSTRUCTIONS a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Building~ Inspector, with 3 set~ 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 adj'o n ng premises or pub c streets areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram wh ch 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 o 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 pa rt for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. B .A.P..PLIC,^TIO~N IS HEREB. Y MADE to the Building Department for the issuance of o Bud ng Permit pursuant to the~ u~m,ng Lone urainance at 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, os herein described. The applicant agrees to comply with all applicable la.ws, ordinances~.building code, hous ng code, and regulations, and to admit authorized inspectors on premises and in build,ngs for nece(~l~( inspections. · ",~}~'i'~'l~[l~'l~";f' a'l~ii~ant, or na'"'""L'~" .~ if"l~T"~'~'~'~i~l~i- :- .~.. ~....' '%.~ !L~a~- ...... t..'1.~...~...~-~ Star~lvhether applicant is ow.ner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... ................. . . Nome af owner of ......... If applicant is a corporate, signature of duly authorized officer. (Name and t~tle of corporate officer) ,.t~ j~b ~,3. ~'~ u Iders L~cense No ..................................................... Plumber's license No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on wlgl,ie~l~prop .osed v~,, will be dg~3e. MopNo.: ..... ~ ....... /~ ................ LotNo ................... Street and Number .~....~,.~..~.........~)~.~.....~..~.....~.I?.~...~G'.~.~,....~'RZ'~X:fC/ .......... .../. .................................. ii....iiii ~ Municipality 2. State existing use and occupancy of premises and intended use and occulfancy of proposed construction: b. Intended use and occupancy .......... ~:~.~ .......................................... i~..t..~ .., ................... ,. Repair ........... ;4'" Removal .................. Demolition .................... Other Work .................................................... k~! , -,, ,;~J A (Description) " (to be paid on filing this application) 5. If dwelling, number of dwelling units............................~ Number of dwelling units on each fl~r ............................ If garage, number of ~rs ............................................................................................................................................. 6. If busine~, commercial or mix~ ~cupancy, speci~ nature and extent of each ~pe of use .~ ....... 7. Dimensions of exi~ing structu~, if any: Front ............................ R~r ................................ D~th .................... Height ........................ Numar of Stori~ .................................................................................. j ............................... Dimensions of same structure with alterations or additions: Front .................. ~ ................. ReaF ............................ ~pth ................................ Height ............................ Numar of Stories ................................ 8. Dimension~f~ntire n~ construction: Front ......... ~ ................. ~ ......................... D~th ~...~ Height ..~. ............Number of S~ries ...................................................................................... ; ............................. 9. Size-of Iot~ Front ....... ~.,~.] ...............................Rear ..... ~.~.~ ...................... Depth ................................ 10. Date of Purchase ......... ~ .............................................. Name of F~r ~ner[ [ ..................... ~... ~ ............................. I,. Zone or use district In ~,ch premises am situated ...~ ~ ]~; ..................... ~!.C.~.I~ 12. D~s proposed construction violate any zoning Jaw, ordinance or regulation: ........................................................ Nome o Contractor ........ ~..~ ..................... : ........... Address ................................ Phone No ....................... PLOT DIAG~ L~ate clearly and distinctly all buildings, whether existing or pr~osed, and indicate all set-~k dimensions from pr~e~ lines. Give ~r~t and bilk number or description according to d~, and sh~ street ~ames and indicate whether interior or corner lot. STATE OF NEW, LYQRJ(, . COUNTY OF ...~..~..~:~b.~.~...~ ......... )' ' ...................... .~.c~..~...~...~...~....~..~'.j~.~.....~. .............................. being duly sworn, deposes and sbys that he is the applicam (Name of individual signing contracO above named. He is the .C~a~..~..~,...~...'~...~ ........................................................................................................ (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 ore true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the applicati.ga..filed therewith. : Sworn to before me this Notary Public, .~.....~...~..... ........ County .................... ..~..,[,~,.,~,,?,.,,C~,,.,/,:..~.~.,,~..~.~ .......................... U(Signature of applicant) TERRI NOTAI~Y PUBUC, State of Hew York No. 52-6168295 Qualified irl Suffolk County Commission Expires March 30, 19 "/4 200 99' N. 59 44 O0 E ROBE'RT RowEHf-