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Home My WebLink About6794-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No..2~62.62 ..... Date ............. Dee.. 30 ....... , 19..~.. (l~a~, I~ke Pk P~l) THIS CERTIFIES that the building located at . .Tgo~mn- P~th ............. Street Map No..XXXXX ..... Block No...3~. ..... Lot No. x~r~., l~&st, ~l&r~n_~_.. !I.o¥o ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ................ A~lg...1(19.73 pursuant to which Building Permit No.. dated .......... AUg...ll, ..... , 197~., 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. rivate, one. f~lly. ~wel;I,iag .~[.t~ .$~1..&d.d.i.t. io..n ................. The certificate is issued to .. A~.b,r~; .Vog.~ ...... 0v~R ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... ~ °R., ............................ UNDERWRITERS CERTIFICATE No. I~.i~1~98.~ ....... ~I~me... 13 .... 19.~ .......... HOUSE NUMBER . .. 970 ....... Street ...Tl'tm~ll. P~t.~. ......... .... ........... Building InspectOr TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 679 Z Permission is hereby granted to: H,,R~.....&/C.....,t,~be~,t..Ve&,t ............... ...... 39oo.....s~mz,t ,e ..~. ................................ ............. · eaf~'ll ...... 31..~.~ ................................ ~o · Jl~a,l~..-~..~l~t~.. e~..ex~$~., d~.l.l ~ ............................................................... at premises located at ...W~/~.,TF~ii~II..J~ili~.....(,~r~..~.~....J~r..~..~I; ....................................... ~a~t~ .~a~.~u.....l~.,Z.. ................................................................................ pursuant to application dated .......................... Ati~ ....... .1~- .......... , 19..7~., and approved by the Building Inspector. FORM NO. 6 TOWN OF SOUTHOLD Building Deportment 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, 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: i. 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 $5.00 3. Copy of certificate of occupancy $1.00 New Building ................ Addition .....'~..~ ........ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..~..~..~...'~...../~...-..~.i...~../.'~.../'../.. ...... .~......~,~.~'.~..'~...,¢~'~2~2,¢~xi~Z.~.....q~.....~_ Owner Or Owners Of Property .~..~.-~.~...~./.~.....~/~..~..i ....................................................................... Subdivision ................................................................ Lot No ............. Block No.....~... ..... House No...~...~..(.) Permit No..~..7...~...<'~....~,,. Date Of Permit ~../../...~..-.~..Applicant ~..,~...~'...4~....~..~...~.,,~.C/f./. ......... Hearth Dept. Approval ...... .~¢/./..~_..... ..................... Labor Dept. Approval .... ~./~.. ............................. Underwriters Approval ..,Z/.~...~.....~'.~..~.'..~. ............. Planning Board Approval ...,,~../~. ....................... Request For Temporary Certificate ........................................ Final Certificate ....~'. ................................ Fee Submitted $ .~....~ ................... Construction on above described building and~r/~i/~ me~d~opp~fble codes and regulations. .......................................................... Sworn to before me this /~ . ~ 7~ ~~f~ .... ~ dayof ~~ / /~ (stomp or seal)~>~ ...................... ........... - THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY [~ ~}~ 8.5 JOHN STREET, NEW YORK, NEW YORK 10038 ..,e :~e ~.~. :t~7~, ~..,cotlo. No.../.~ ~7o~ N 164985 THI~ Vo~;t~ 970 ~ay Lake Park ?(d. ~n~side~ East Marion, L.I. ~. the following location; ~ B~ement ~ Ist FL ~ 2nd FL outside Section Bilk w~examln~on Ju~3 10~ 19711 and found to be in compliance ~ith the requlreme.ts of this B~rd. FIXTURE OUTLETS INCANDesCENT ~ vEAI~Cp~RR¥ II 2 DRYERS FURNACE MOTORS / FUTURE APPLIANCE FEEDERS AMT. K,W, OL H.P GAS H.P. AMT, NO. A, W. G. RANGES ~PECIAL REC'PT ICOOKING DECKS OVENS I DISH WASHERS , AMT. K.W. IlAMT. K.W, b'RT K.W. TIME CLOCKSAM~, AMPS'. , TRAN.BELL S ~UNIT HEATERS., MULTI-OUTLETNoSYSTEMS. OF FEET SERVICE DISCONNECT NO. OF S OTHER APPARATUS: R I C EXHAUST FANS DIMMERS A, W.G. NO. OF HI-LEG A.W.G. NO, OF NEUTRALS OF CC. COND. OF HI-LEG OF NEUTRAL G~NERAL MANAGER COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. t Examine~ Approved ~- APPLICATIOH FOR' ~UILDINe PIP, MIT Da' August; ,.~ 10 te ..... .............................. :.., INSTRUCTIONS s a. This application must be completely filled in _by typewriter or iri 'ink and submitted in triplicate to the Building Inli)ector, witlt 3 sets of talans, accurate plot plan to scale. Fee according tO a~le. .b. Plot pi.e? shdw~,ng location of lot and of buddings on premises, relationship to adlolmng premises or pt~bhc StT~ ~r ereas, an gwtng a detailed bescnption of I~out of property must he drawn on diagram witich s part of th s appl eat on. J. c. The work coVered by.this aPl~cation may not be commenced before issuance of Building Permit. d. Upon apl~oval of this application, the Building Inspector will i~sue a Buildin~Permit to the klJplicant. Such permit Iltell be kepton the ~arem[~es eva, liable f~r inspectio~ threu~hout the worlc e. N~ beildi~g sheff I~e' o~¢upi~d 'o~ ~cl ~:wh~le ~r i~ p~ four bn¥ purpme~hatever ~.til a Gerfificate of C~permy Ifml! have bee~ granted by the Building Inspector. - .A,P~LICA~ION I$ HER_rEBrY~ I~IA~,~Eto the., Buil,di~,:el~ ~. pa}-tq?e~,t for t,h~issuance ~),f ~, Bujl~d.i~g__~e~[m)t pursuant to ur.d.l_n~,, ~f .t .h~, To ~.,gf SO?hORt, ~J~f<[Ik Ceu~ty~ ~.~rj~ bi~j ot .hat ~[~ La~,(~rdki~k~ Or Regutatl~ f~ bull?lngs, addl. t.~..ons or alteratg.ons,, or for removal .or demolition, a.s herren des.?ibed. The aPl:flicant agrees to comlaty ~ ordinances, budding code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for neeeta~/~l~Qeet[ .~..h.. '(Signature of applicant, or name, if .a ~r~tio~) I~ddr~ of applicant} 'State whether applic~ant is owner, lessee, agent, architect, engineer, ger~eral contractor, electrician, plumber or builder. ......................................................... ,.A.&.e. nt.. ................... ~ ............................. Name of owner of premises ..~...]:.b....e..~.}....V.'.?..~..~. ..................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) . b 1. Location of land on which proposed work will be done. Map No.: .......... _..._....~.~ Lot No. :-c-, ....................................... Streetand Nu--~'r ~..T..0 B&vlmke P~k R~.. Eas~ M~lon.L.I. ~c ,~, ~.c Municipality: 2. Stete existing use and occupancy of pra~qises and intended use and occupancy Of proposed construction: ' · . Existing use and occupancy .......... L.,:.~,...~...~..~Y....~..w...e..~.]:.:~,.~..~.. ................................................................................ b. Intended use and occupancy ........ .1..~..,3~:L.~.....IIt,~,T~J~.'RJ;.~.;. ............. ; ........ 1 .......................................... ' .... '~ ~ .... ~ 3. Nature of work (check which applicable): New Building ....................... Addition ...Z~I!. ........... Alteration ........... ~.:~ · Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... ~ ,. ( ~, esari ption ) 4. Cost ........ ............................. Foe'..,Z ...................................................................................... (to be ~aid 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 bu$ine~, commercial or mixed occupancy, specify nature and extent of each type of uss ..................................... 7. Dimensions of existing structures, if any: Front .....aqJl[ ........... Rear ....... .~. .............. Depth ..... ~...2. .................. ~ ...... Height ............ .]=...~. .......................................... Number of Stories :....:~ ................... : ................................................ Dimensions,of same structure with alterations or additions: Front ,..i...~ ............. Rear ....... ~. ....................... :.~.. Depth _.,.y......,~T,..2 ....................... Height ...........~.~., .............. Number of Stories ......... ~' ............................ 8. Dimensions of entin~ew construction:'Front ....... ..~ .............. Rear ........... .~ ........... Depth ......... ..]...t.. .................. Height .~ ......... : ............ [.~.. .................... Number of Steries ............... ..~. ....................................................................... 9: Size of lot: Front~......~......]~[ ................ Rear ...... ~. ....... ..~,~.~.. ................... Depth ....... .2.~. .................................... .................................... ........................................................................... 0:.~ Date of P0rchese .................................... Name of Former Owner ............................................................................ 11; Zone or use district in which premises are situated ....~ ...... ~, ................... ~ 12. ...l:~)i~ propoesd oonstruction violate any'zoning law, o~dinance or l~J.' Wl!l,k~t be mgreded -_JILl .................. .: ....... Will [ ] yes 14, "Name of Owner of premises ...A...]...b..?...z~....~.e...i~ (Phone Ne.) PLOT DI'AGRAM ~ .~ . ~ c!~rly~and distinctly all,buildings, whether existing.or proposed, and indicate al!.let4)eck dimlrlsiorm from. erproPertYinteftorltr~i'or cornerG~e ~eetlot. and block number or description according to deed, and show. street names an~ indlclt~ ,STATE OF NEW YORK, ) :: ~'~' ~ ~, COUNTY OF .............. .~. ..................................... i ............................................. .}[-.A~.....Z?.....C....I~.B.?..~.'~..]'.. ...................... being duly sworn, deposes a~d says that he is the apph~cant ~bove named. /Name o/Individual signing ~ontracI~ He is the , ' Oeat~&ct~ {Contractor, agent, corporate ofl~cer, etc.~ ~ of ~id owner m' owners, aolilLis ~.ul¥ authorized ~o'perform or h~ve ~l~erformed the saidrwork and to make and f e thil appl cat on that Stlltlmel~ col~lned m thl$.~ to the best o~ his k~o~tedgtl ~ betiefTand that the work will be perfornmcl in the ~t forth in the appllcation,Oled~tlt~re'~l~;l~J~Jl'.~ ' ~ J/I ...... ........................................... . ............................ ,/~i! ri APPROVED A5 I :765-2~60 ~^M TO ~RM FOl~ ,R~Q!~ll~ BEFORE B~CK~IC~ING ' F~UNDP, ,