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Home My WebLink About6718-zFORM NO. 4 TOWN OF $OUTHOLD BUII.I~ING DEPARTMI~.NT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No ............. Date November 16 ~ THIS CERTIFIES that the building located at ...~..~.t.. ? .I~.1.~..Rg.~.d' ......... Street Map No. XX ......... Block No... X~ ..... Lot No..Y~. .... ~.a.t.t.~t..u.c.k. ............... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... Feb.,..2~ ..... , 19. F3 pursuant to which Building Permit No...~].~.~.~. dated ......... Ju~..].0~ ..... , 19.~.3., 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 Pr~.vate one fa~.ly dwell~.ng(addition) The certificate is issued to ...~ .r.J.o.r.~..e..D.,...~..~.~.~..~.p.s. ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...... .N.:t~.: ......................... UNDERWRITERS CERTIFICATE No. N ].238{~2 I~,8~ 0~t, 30! 1973 HOUSE NBIMBER ...~.0.0. ........ Street East l~:[ll Road ........................................... . .................. Building Inspector FO]~tM 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) N°. 6718 Z Dote ................. f/~...-~..-:..~ ............ , 19....:.,~ granted : Permission is hereby ~/ ~ ~), ~ · ........ '-'" ": .......................................... 12'7,":' ,~ ,o.g~..k....~...~~....~~ ........ .~.~......,z...~....~.~_ ....... ., ............ ~.~.,~,~ ~,~, .~/~ ~..,~. ,~ /.. ............. ~'"'? .......~' ..... '~'~"\~'"?/'Jq'"-/q"~ ........ 22Z ......... ,~'" Fz~'~-~I ~ ~ ,~ .............................. ................ ............................................... pursuant to application dated ................... ..~...'~....~... ................ , 19~..., and approved by the Building Inspector. Fee $./../)·~ .. THE NEW YORK BOARD OF FIRE UNDERWRITERS C 5 BUREAU OF ELECTRICITY [-- ~CtOb(~-~ ¥) · l()7E~., JOHN STREET. NEW YORK. N~W YO~K 10038 THIS CE~IFIES THAT o~y t~ el~t~ ~ui~ment ~ ~b~ an~ ~ ~ ~t ~ o~ the a~ appl~at~n numar in t~ p~m~s of in the following location: ~ BaseFjent ~ ~] ]st FI. OCtober 2~, [] 2nd FI. 0 tl'~ ~ ~. (.~E~ Section Block and found to be in compliance with the requirements of this Board. Lot FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS SERVICE DI~NN~T OTHER APPARATUS: ~at, er h~ater/s: 1-~.5kw ;~.*ctr!c room heat;er/s: 1~2.5k~;', 1-1.Skw, 1-!.25kw~ 2-.,., kw, l-.75kw Grdql~AL MANAGER Per COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Clerks Office Southold, N. Y. 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, tv~ultiple 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 $5.00 Date .....~O.:.L~..-)..."~ ....................... New Building .................... Old or Pre-existing Building ........ ~ ................ Vacant Land ............................ Location Of Prope. ................... !...0....0. ............ ........... ........ ............................ Owner Or ~ners Of Prope~y ~~.~,..~.~.~ Su~ivision ................................................................ Lot No ............. Block No ............. House No ............. Perm t No ~.~ Date Of Perm t )~.~ App cant ~.~....~.,~:D..~ ....... Health ~p,. Approval J~...~,~.~...)......Lobor ~p,. Approva~..~.~...2~;~.~.~ ..... Underwrtem A rova .............................................. ~ I~ ~ ~ &~ .~.~'~ ~' pp Planning Board Approval ~.~...~.~ Request For ~empora~ Ce~ificate ........................................ Final Ce~ificate .........~ ........................... Fee Submitted $ ...~..~.Q ....................... ...~p~cable codes and regulations. Construction on above described building and permit meets all a Sworn to before me this G0 .... ~.~,i,,- day of ...~..e_~ ..... .~..~....~..~ ........... ... t _. __.__.__ · ...%.~,~-~.~",~ ..... County V~.L W. - Notary Pubfic Notary Pubhc'. Sta,'~- ~f New Yor~ No. 52.3889685 qualified in Suffolk County Commission Expires March 30, l~,J ......................................................................................................... .......................... m (Building rnspector) [ ~ TOWN OFSOUTNOLD ~ -~ /~ ~~ ~ BUILDING DEPARTM~T ~/ / ~ ' ~~/ ~, TOWN CLERK'S OFFICE /'~/~ ~ ~' ~U~.~D, ,. Y. ~ ~ ~, ~ ~ ............... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS -,~ a. This application must be completely filled in by typewriter or in ink and submitted in tl'Jplicate tO the Building Inspector, with 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 pert of this application. c. The wo~ 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 one' the premise~ 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 thall 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 Zon~ Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, fer the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all aPl~feable ordinancel, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building~or rme#sm~/inspectiona~ ............... (Signat~ 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. If applicant is a corporate, signature of duly authorized officer. ~Name and title of corporate officer) Builder's license No .......................................................... Plumber's License No ......................................................... filectri¢ian's License No ..................................................... Other Trade's License No ................................................... 1. Location of ~and on which proposed work will be done. Map No .............................................. tot No ......................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: 3. Nature of work (check which applicable): New Building ....................... Addition ..~ ................ Altera~t~on~= ' ........ ' - :,,... '~ Repair........,................ Removal... ........ ....... . ...... Demolition ........................ Other Work ...................... ; .......... (Description) 4. Estimated Cost ..~,.~.~.~.~..~ .......................... 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, commemial or mixed occuoancy, specify nature and extent of each type of use ~.~7~,T.~,..~.~.~,..~.~.\~., 7. D mansions of ex~st~ng structures, f any: Front ....~.o ............ Rear ....~..~. ................. Depth ....~ .......................... Height ...... ~.:~ ................................................ Number of Stories ........ o ~'~' ..................................... c~i ............................. Dimensions of same structure with alterations or additions: Front ~l~,s,.~-~,~.~ Rear ..~...x~.....~.~,,.~ ............... Depth ............................................. Height ......................................... Number of Stories ......... 4 .............................. 8. Dimensions of entire new construction: Front ....~..~.~. ............. Rear ...~..~. .................. Depth ~ rt~ Height .~t. .................................... Number of Stories ~ ............ 9. Size of lot: Front~.e-.~t~.%.%..~.'~.. Rear .......................................... Depth ~ ................. ~ ............................... 10. Date of Purchase ......%.~.~t. ...................... Name of Former Owner ..~.~5:~,~L....~n~..~..%.~.~'~q~3 ................... 11. Zone or use district in which premises are situated ....~ ............................................................. i ............................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....~3 .................... i ............................... 13. Will )ot be re(jraded -~.~-.? ....................... Will exc,~ss fill be removed from promises: [ ] Yesi ~ No 14. Name of Owner of premises~ -- '"'" ~'~ --' ~`~~L~-~"~\~-~t~`~`~`~`~~ ..... ~ (~ (Address) ~{Phone Noj Name of Architect .................................................................................................................... (Address) ;~hone No.) Name of Contractor ..-~.. ........................ (Address) ~(Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-[ ack dimensions from property lines. Give street and block number or description according to deed, and show street name; and indicate wheth- er interior or corner lot. STATE OF NE~NYORK, ) COUNTY OF ...~.~.~ ...................... ) ~ ..... · ..'~..~L..'-~...~ .~,. .~ .............. being duly sworn, deposes and says that he is th~ applicant above named. ~arne of individual signing contract/~ .~ ' He is the (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 fil~ 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. 'R 76S-~660 9AM TO 4P ED INSPECTIONS: 1. BEFORE BACKFILEtNG FOUNDA TION OR START FRAMING 1. BEFORE COVERING PIP~LIN~ 3~ FINAL WHEN JO~ i 1 trY,4 7'"ri 1"u¢ ~<