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Home My WebLink About6786-zNO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, 1~. Y. Certificate Of Occupancy No. 7~327 ...... Date ............ .P.~b...~.0 ....... , lg .7.~.. THIS CERTIFIES that the building located at ~0~ ..... Map No. ~ ......... Block No.~ ....... Lot No.. ~ .... 8.o~. ~0~.5... [...Y.,. ....... conforms substantially to the Application for Building Permit heretofore, filed in this office dated ........... &u[ .... 10.., 1~3.. pursuant to which Building Permit No. ~?~ .. dated ......... .I..~ .... ~..0 .... , 19~.., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is . Private..tvo. ~a~t~l,y .~e~l~. ~l~..a44~..( .$PP.~d..~..~. appeals) The ce~icate is ~sued to .~a....~,~Or~$ ...... ~./ ....................... (o~er, lessee or ten~t) of ~e Mores~d b~d~g. S~olk Co~ty Dep~tment of He~ Approv~ .. N.*~ ~..,?. ......................... UNDERWRITERS CERT~ICA~ No. ]. ~3 .... J~".~0...~9~. ................ HOUSE NUMBER . .1~ ....... S~eet ~t .~ad ~..~.1 ~.. ~$ra~. a~ ........ FOB~ NO. ~ TOWN OF SOUTHOLD iBUILDING DEPARTMENT :TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE;KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 6786 Z Date ........................... A~l~'tl~, ....... 1~", 19"~13. Permission is hereby granted to: H ~e~v®..&...6estt..~...A/e..Na'~. ....... (ez~'e~..~..~-.A~,~s) ............................................................................................... at premises located at -.~;...]14~...e$~'..-Jl/~:-~l~h-.~&,z,l~rz,...~o~t~ ........................................ pursuant to application dated ..........................~1~ ........ ~4~ ......... , 19.~..., and approved by the Building Inspector. Fee $.~.~ ........... THE NEW YORK BOARD OF FIRE UNDERWRITERS ak BUREAU OF ELECTRICITY · [~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 140983 ~.te Jamuary 30, 19 [ AppIicationNo. o.file 709003 N THIS CERTIFIES THAT only tl~ ~l~ctrlcol equipment as described ~low and introduced by tIw applicant warned on the above application number in th~ premises of Southold, L.I. inthefollowlnglocation; [] B~sement [] lstFI. [] 2nd Ft. outside Section Block Lot tvasexarnlnedon JaIltlal~y 28, 1~74 andfoundtobeincompliancewiththerequirernentsofthisBoard. DRYERS FURNACE MOTORS FUTURE APPUANCE FEEDERS AMT. K.W. OIL H.P. GAS H.P. A~T. NO. A.W.G. RANGES ;PECIAL EEC'PT "'I,"WA%"S SERVICE DISCONNECT NO. OF S METER ? 150 CB x OTHER APPARATUS: EXHAUST FANS AMT. H.P. DIMMERS R V I C E NO. OF CC. COND. A.W.G. HO. OF HktEG A.W.G. AW.G. PER .~ OF CC. COl*ID. OF HI-LEG OF NEUTRAL 1 300mcm 4/O COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FORM NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office Sou~hold, 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: ]. 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. 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: J. 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 Building .....~.. ..... Addition ................ Old or Pre-existing Building ...~ .........Vacant Land .............. New Location Of Property .......... I.~!l..~.......'~lll~..~'.,~.....~rl~cj~f~....~.~..i,..~.~'.~.~t~.~';)__ -- -- ........ Owner Or Owners Of Property ..... .~...,......'~..,....~.~...........~.~i~'A,~ ............................................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No ..................... Dote Of Permit .................... Applicant .~.~. i~.{~...l.~.~.~...~...~..~..~....~!~.f..~. ~,, Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FinaJ Certificate .......................................... Fee Submitted $ ~...~.1~1.^ .................... Construction on above described building and ~r~,tit, me_et.s al_~pplic~'~ codes and regulations. App leant ~. ~ ~ . Sworn to before me this ................ day of ............................................ (stamp or seal) Notan/ Public .................................... County ~ TOWN OF SOUTHOLD · - /-/-' ; ' · - '~- BUILDING DEPARTMENT O #~1~ ~ TO~N CLERK'S OFFICE ~ed ....... ~}. ~ ~? ,/ ~ ~ ~on ~o...~..~...~....~. ............ ~pro~ed ........... :.~ .......................... ~ ........ ~..~~:~. Disepproved ~/c ............................................................................................ ................................................ ...................... INSTRUCTIONS --~ a. This application must be completely filled in by typewriter o~ Jn ink and submitted in triplicats 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, reloti,onship to adjoining premises Or public streets o~ areas, and giving a detailed description of layout ofproperty must be drawn on the 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 by 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 a~terations, 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 inspections. (Signature of applicant, or name, if a corporation) ..... ~....~.~...+..~.T..~.3.~.U~.~ ..................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................... .~.E.~.~.~ ...... .~,.~.'~..~..T.~ .................................................................................................... Nome of owner of pr~mlses ..................... ~ ............................................................................................. If oppJicant is a corporate, signature of duly authorized officer. (Name and tit[e 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.: ~.~...~}..~..~...1~../~. Lot No ......................... Street and Number ..... ~..~-.......1~ ............... ~-~....~T:{~'~]~::~:~....~/~. ......... ~.LI..':~'~L~ ..................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ........ .~..).~.~.J,,~;......~../l~l.~,'~.......~,~.]~.~..~.~..~-~ ....................................... b. I ntended use a nd occuponcy ....~-~ ....~./~ ~ .L,~.......~.~,,~].(~.~'~....~ ..~. ~ .~.~':~....~ ........ 3. Nature of work (check which applicable): New Building .... ~.. ......... Addition .................. Alteration ...~. ......... Repair .................. Removal .................. Demolition .................... Other Work ..................................................... ~ ~ (Description) 4. Estimated Cost ...~,,~.~.{gl~C~.; .................................... F, t...~....~ ...................... ............... (to be paid on filing this application) 5. If dwelling; number of dwelling units ............................ Number of dwelling units on each fi.oar ............................ If garage, number of cars .............~'..~ .............................. 6. If business, commercial or mixed occupancy, spec fy nature and extent of each type of use ....... · -x :~ ,~-Z~.'~ ' ';~;;'; ........... 7. Dimensions of/e, xistJng structures, if any: Front ...... ~ ................ Rear ...... ~...~. .................... Depth ..:'[~,.~ ....... Height ....~.L/. .............. Number of Stories ........ .'~..~) ..................... ; ................ Dimensions of same structure with alterations or additions: Front ~..~.......~,....~ Rear ............. Depth ................................ Height ............................ Number of Stories ............................. i.. , ,~ ~..~, ~,, ~.' 8. Dimensions of entire new construction: Front ........ ~..~.7.~. ............... Rear ....~,~..'! ............... Depth. ...~. ............ Height ....).~.~..~.~.... Number of Stories ........~f~ ................................. ' ~i.i ;', ..' ............ 9. Size of lot: Front ........................................................ Rear .......................................... Depth ...................... 10. Date of Purchase ........................................................ Name of Former Owner ! 1. Zone or use district in which premises are situated ....... .~;~xl~.~.'~L ................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ............ ~(~ ...................................... :13. Will lot be regradec~ .......~ .............. Will excess fill be removed frOm premises: ( ) Yes 14. Name of Owner of premises ..)~.,.~)~]~....~{~'~}~ ........... Address ~¥~J~J~'.~'o.'~ ,.i. ii~ ............... Name of Architect ~'~,~....~.~ ......... ~J~...bJ.~... Address .~.~..~..~....~.../~/~Phone No ....................... Name of Contractor ~L~)....~..~..~/.I~.~.,. Address ~.~F...~. ~.T~d~;)hone 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 indicate whether interior or comer lot. STATE OF NEW .YORK. J¢ ¢ ~,~ COUNTY OF ....,~1~]~.,~.~ ~,-~-~ ~,-. -'$~"~ . I ........ ~J~ ...... ~,.".~..'..' ............ ..................... bei~y sworn, d~oses and says t~t he is the opplican, (N~e of i~ivJdual signing contrac~ above name. He is the .............................. .~E.~.....~~ ..................................................... (Contractor, agar, c0~orate officer, etc.) of said owner or owners, and is duly aUthorized to'perform or h~e performed the said work and to ~ke end file this application; that all statements Contained ~,~is application am tree t0 the best of his knowledge and belief; an~ tha~ the Work'will be performed ih the manh~t ~o~h in the application fil~ thereWith. Sworn to before me this '. ....... o, ................... . Nota~ Public, ~~~...i Coun~ ............... ~..~..~., ................................. (Signature of applicant) ~RRI ~E E~ NOT~ PUBLIC, Sta~ of New No. 52-6168295 ~ualified in Suffolk County Commission Expires March 30, 19