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Home My WebLink About6759-zFORM NO. 4 TOWN OF $OUTHOL0 BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.~6~}93 ....... Date ..... .: .... .Feb.. 23 ...... , 19. THIS CERTIFIES that the building located at . I~I/S. P. aoif'~e. 8.~ ......... Street Map No, .. ;z~ ....... Block No..:r,X ....... Lot No, x~r~.., l~at~i'~uok..I~,X, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ~l~:.. 2.~., 19 .?3. pursuant to which Building Permit No..(~?~gZ. dated ........... J.~J,;f.. 27..., 19. ?~, was issued, and conforms to all of the require- ments of the applicable previsions of the law. The occupancy for which this certificate is issued is ...~.e.e.e.z.s.°.~.F.. b.u.~ .1.d.i.n.g. .................. ; ............................. The certificate is issued to .l~tella. 8.,.,..i~aclY. o~d ...... .~l~e~ ....................... (oWner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .t].~ ............................. UNDERWRITERS CERTIFICATE No .... p.e~.~,~[.. · ............................. HOUSE NUMBER ....... .~.~.(~ .6~. Street .., ~.~,~. ;RO~. .~. Pa.~.lfi~..~t: ........... Building Inspector FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL N? 6759 Z Permission is hereby granted to: ..... .~ ~ ~,1,~...~,~,~ £.o.~ ...................... : ................. ....... .~..~ ..................................... ~ ................. ............ .~$~..l~:ton ...................... ~ ................. at premises located at ...~I~..~O~,..~.~.&Q;L~i~3...8~ .................................................................... ................................................ ~.t~.........~..~.,. ....... ~ .......... i ................. i ....................................... pursuant to application dated ..........................~.~..~. ....... ...~.....~...., 19.~.~..., and approved by Building Inspector. Fee $. ~.~.~.{~ ........... Building Inspect TOWN OF SOUTHOLD , Beildiag Depoffm~tf Town Cle~ Office Sou~old, N. Y. 11971 APPLICATION FOR CEItTIFICATE OF OCCUPANCY 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 Cede compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Beard 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: i. Certil!icate 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 . ..~.~..~;. ~.~....Z. ?. ?..6. ............. New Building ................ Addition ................ Old or Pre-existing Building ......~ ........ Vacant Land .............. Location Of Property ~.§~.Z..¥:~§~.T.~!~?..Z..T.`U.~.~.~.~.~`~..~..~.~.~..~Z.~.~.~ ..................................... Owner Or Owners Of Property ...~?.~?.:T.:~..~..~'~..~.~. ........................................................................... Subdivision ..... ~.C..F~...~.~ ......................................... Lot No ............. Block No ............. House No.....~ ....... Permit No..~:~...'~'.~..~-,... Date Of Permit .TL~.~/Z.~...Applicant .................................................................. Health Dept. Approval ......... ~.~ ............................. Labor Dept. Approval ............ ..~/.~ ............................. Underwriters Approval ........... .~./..~. ............................. Planning Board Approval .... .~L~: ............................. Request For Temporary Certificate ........................................ Fin~ Certificate ...........~ ............................. Fee Submitted $ ...~.:.~ ......................... /~ C°nstruction °n ab°ye described building and~.~6--/~.~.~6 ..~rn~eetsf ~li~Z~e'¥~ and regulati°ns' ~ ~ Sworn to before me h.~.' _ ~~"~'~ ~ Notary Publia~/~.~-Z [...~.,~. County/~/ ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS tat) BUREAU OF ELECTRICITY I~ E5 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CE~IFIES THAT in the follcnving location; [] Basement [] 1st FI. [] 2nd FI. 0~ ~ ~, ~ ~ ~ Section Block Lot ~vazexamlnedon Octobe.,- ~r~ ~'~7~ andfoundtobeincornpliancewiththerequirementsofthlsBoard. JT"'T.w. %?EA%'2'Tw'.R:. RANGES ;PE~IAL REC'PT SERVICE DISCONNECT NO. O~ S 0 u~ '~ETE~. x OTHER APPARATUS: EXHAUST FANS AMT. H, P DIMMERS ANAT. WATTS .o. ~ECC. CO.O. ^. w. O. OF CC, COND, NO. OF HI-LEG OF HI-LEG Room Heaters: i-2.0MW 2,1,25KW 2-!.0KW 2-.?SKW johr} M, I,a<~ema~,n COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. r~ome of c0htractor ....................................... . ..................... · Address ............... Phone No ....................... PLOT DIAGRAM Locote clearly and distinctly oil buildings, whether existing or proposed, and indicate oil set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate lot. , (1) F ctet g b mtng. (2) to Dee~on~ ~ING a~ ~ oono~e mOn~en~ ~e~ ~ the no~he~s~ . OO~e~ of Pac~o Steer ~d ~a~ Street; thence ~ N.~7o Og~ oono~te mon~ent; thence ~ N~2o ~0~ ~0" E.~.90 feet to a mon~ent; ~ce ~ S.~5o 57~ ~0" E. ~o~ the ~ o$ Sp~er 202.57 ~eet to a concrete ~on~ent set ~ the no~her~ side ~ a ~ off 6~.~ feet to the ~nt o~ p~oe off beg~n~. Approved .(,/-......~.:...... ..................... -- , Disapproved a/c .......................................................... : ~ .................. I /~_ o, ~, ,~ ............ ........... ................ ,. iNSTRU~IoNS a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Building~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee accCWdin~to sehedule! . b. Ptot~p[an s~owing location of lot and of buildings on prer~'iSeS, relationship to adjotn ng premises or public streets o~ areas, and giving a detailed description of layout ofpreperty must be drawn on the diagram which is port of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upa oppraval of this application, the Budding Inspector wrll 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 pa rt for any purpose whatever until a Certificate of Occu 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 tR& Building Zone Ordinance of the Town of Sot~thol~, Suffolk County, New. York, and other~ applicable Laws, Ordinances dr Regulations, for~theconstruction of buildings;~a~d~iOhs or altetati0ns; or'for re~oval o~ ~Jemolition, as herein described. The applicant agrees tO comply with all applicable laws, ordinances, building code, housing code, and regulations, amir admit authorized inspectors on premises and in buildings for necessary inspections. .: ~; . . --. ~ .~ ~ (Signature of aPl~icant, or name, if a corporation) · - R. l13t. · ~ '~ ~ ..... LA~lclr~ss of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... ~...8..~ ~...R~.. ~..~. ~;.a...~ ........................................................ 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 ............................................... Location of land on which proposed work will be done. /V~op No.: ........................................ Lot No ......................... :~ Street and Number .....~...~ff~lt~l'..~l~R...~...(~l~l~t~.:~.,,~}..Jl~.~,~..~l~,;~l~.~ ...... ~l~.~.~;~'~l~..~..,.;~.r ....... :'~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and oc~cuponcy .~T~..~I~..~...~..II~.{~.~ .................................... ' ....... ~/J;"'; ...................................... i;~=r b. Intended use and°CCupo y ................................... ~ ................................................... ~ ~;' 3. Nature of work (check wh~h applicable): New Building .................. Addition .................. Alteration ................. Repair .................. Remov~g .................. Demolition ................... Other Work ...... ~....1~..TI:'.~.~....q~....~ ...... (Description) " 4. Estimated Cost ~(tA000'00 .Fee ~ l~.o00 (to be paid on filing this application) 5. If dwelling, number of dwelling units ?..O.~..~-.....I~....~....Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .~..e.l~..~...~....z~../ 7. Dimensions of existing-structures, if any: Front ...,.1.~....~.f~. .......... Rear ..... ~....~..e..e.~. ............. Depth ..~.~...~..e~..-.~. .... Height ..~....&....~......e~r.. ..... Number of Stories ....~..~...~:..J~.~*3r. ................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ........................... Depth ................................ Height ............................ Number of Stories ................................ Moved, x'*u**e~'*~ ~A feet, ' ~-*~eet, ..................... 8. Dimensions of entire new con~s:ructton: Front ...... : ............................. P, ear ...................... ~ ..... Depth Height .~....~...~.~ ....... Number of Stories .......... [~.e;~r ............................................................................................. 9. Size of lot: Front' ~....&..]:.....~.....~..e..e~.. ............................... Rear ....6..~..:...9~....~ .................. Depth ....2~...,..~..2....~....e~... ........ 10, Date of Purchase ,...A.~.~....~...~...9. .................................. Name of Former Owner .l~........[~.....g..&...l~....x~.. ............................ 11. Zone or use district in which premises are situated ....~....~ ................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ...!10. .................................................. ~. :~ill lot be regr~d;ed ...1~.....0~.~.. ~,~i,~ess fill be removed from premises: ( ) Yes ' (.Z) No 14. Name of Owner ~premises :~g:i~fl:~...~..j~.~ .......... Address .~,J~ ............... Phone No.2~l~.~.. ........ Name of Architect ............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ..................... ;....; ..... Phone No ....................... 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 number or description according to deed, and show street names and rndicate ('t) ~ELr~uf lmm'~laS-,,. (~) Bu~l~tnf to bo moved em to p].o~. bme~Lp~iout BB3INBI~3 a~ a eone~o~e nouumen% set in ~he nort~eas~ eenlor ef Paeifie ~ee~ and lain ~x. ee~I M~enoo nnmAuf l.~Fo 0~' ~, SOu l.-~m.~2 £ee4 aleug Mle ea~e~l~.~ ~ ef ~&el~le ~ ~e a ee,~off~e mammal t~eaee ~ lle.~ ~0, 20e B.-4~.90 £ee~ ~e a ~ a ctta~msee of 61.97 fee'e f,e ~he pe~,,t, or ~ee ef COUNTY OF ....~.~.~'~.~. .......... ~'~ .............. · ~.."~lT?~\.~'~...~.:.~.~.~.. ~,~. ................................ :...being duly sworn, deposes and says that he is the applicon! ' (Name of t~dividual signing contracf) above named. ~le is the ................... ..C~.~.,~...~...~ ......................................................................................................................................... (Contractor, agent,, co. rporate 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 appl]cation~are tr~m.to'the best of his knowledge and belief; ano that the Work will be performed in the manner set forth in the application filed therewith. ....... of ......................... , Nota, Pub,c, Coun ........ .......... / (Signature of ap~)lic~/ 'I'ERR! LEE ELAK