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Home My WebLink About6621-zFOItM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. No.. Z57..2~ ..... Certificate Of Occupancy Date ............ January .... 7..-, 19.7~+. THIS CERTIFIES that the building located at Source} · Ave .&. ;-iatnut..PlaceStreet Map No. x'x ......... Block No.. xX ...... Lot No. xxx ..... ¥,al:tltuak .... Il ,¥-. ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... June .... l"" 197~. pursuant to which Building Permit No. 662tZ'- dated ............ Jmae..1 .... , 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 P.r. iva.te, one. family, c[~e ~ ling ....................................... The certificate is issued to ...P,,tt~ .... au-gust ..... 0~nel, ........................... (owner, lessee or tenant) of the aforesaid building. ~uffolk County Department of Health Approval .... i~ ~t~, ........................... UNDERWRITERS CERTIFICATE No. N~ 29~ ~? ...... I~o~,..26...%973 ............... HOUSE NUMBER ...i.l. 080 ...... Street ... ~oun~..bYe ............................ ~0 Walnut Place ' ' - Building InspectOr FOEi~ NO. 2 TO~VN OF SOUTHOLD BUILDING 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) N? 6621 Z Permission is hereby granted to: ...~lgar...C~e -~3~..&..W1f~ ........................... .......... Y~a.'J;t,4.t,u.~k, .............................................. ~o...~.'~.~.a.....~..m.~.J,.~,$,ol~..o~...~.~;1..~.t,.~g..~.~.e~;l*.~.g ........................................................... at.premises located at ....... .~g..t~T~....~.~,.q....&;.....~..a..~,.~..~..~...?..Z..~ ........................................................... ................................................ ]~t~tuck ...... ~.~ ......................................................................... pursuant td application doted ........................... ~t.~_e' ......... '1 ....... , ]9..~.3.., and approved by the Building Inspector. Fee $..Ji~a,Ol~ .......... TOWN OF SOUTHOLD Building D4pmtment TMm Cledm Offlee Soathold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF O~CUPAN~' In.tmctio~ ^. 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 disposel--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildin~ 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. Swam 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. ¢. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of nccupancy $1.00 ~.00 New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Owner Or Owners Of rropeny .......... a:.~,~r~,.....~c./,~.~,~. .......... ;.;. .......................... ,~. .......... Subdivis on ................. ~ .................................. Lot No.....-~...:.... Block No.......-~.... House No [/.~..,~..~ p, ,t Oat, Of eermit ........ Health Dept. Approval ............... .~..~..T...~......: ............ Labor Dept. Approval Underwriters Approval ................................... r ann ng Board Approval .......................... a ............ Request For Temporary Certificate ........................................ Final Certificate .................................. ~,~.. F~ Submitted $ ................................... Construction on above described building and permit meets all appllcable~codes and regulations. Sworn to before me this ........... .................................. ....... JODITH T. BOKEN Notary Public, State of New York No. $2-0344963 Suffolk County'_ __ Commission Explre~ March 30, 19~ THE NEW YORK BOARD OF FIRE. UNDERWRITERS BUREAU OF ELECTRICI~ ~ E5 JOHN STREET, NEW YORK, NEW YORK 10038! , 1291.. THI~ CE~IFIE~ THAT Joseph Lovlz~o, s/e/oo~. Walnut ~tace & Sound Ave., Matt/tuck, ~.I. (~00' e/o~acto~y ~e.) in the yollowlng ~at~n; ~ ~ement ~ 1st FL ~ 2~ FI. ~tlon B~k ~t 2 , ! 2 2 2 DRYERS FURNACE MOTORS FUTURE APPUANCE FEEDERS / SERVICE DISCONNECT NO. OF S OTHER ~ARATUS: RANGES iPECIAL EEC'ET R ICOOKING DECKS I OVENS ]D4SH WASNERS AMT. K, W. il AMT. K.W, ~T, K.W. TIME CLOCKS B~L[UNITHEATERSUNIT HEATERS MUtT~OUTLET , ' i 'TEAN . ,~ SYSTrSAS I I V I C E EXHAUST FANS AMT. H.P. DIMMERS AMT.' WA~S A. W, G. NO, OF HI-LEG OF CC. CC)ND. W.B. Ruland, Mmttltuck, L.I. 11 COPY FOR THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. / / Examined ................. , · ~proved ........................................ , Disapproved a/c ............................................................................................ FOBBf NO, 1 TOWN OF BUILDING DEPARTMENT TO~N CLERIC'S OFFIGE ~TH~D, N. Y. _ Date ~Tune I 19 73 INSTRUCTIONS a. This application must be completely filled in by typewriter ~ in ink and submitted in triplicate to the Buii Inspector, with 3 sets of plans, accurate plat plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or publ c stre~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this applic~ 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 ermit 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 Occt ~ancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Perm t pursuant o the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinan, :es or Regulations, for the construction of buildings, additions or alterations, 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) Matl~ttuel~ N.Y. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. builder Nome of owner of premises ....E...d..~..a.?.....C..o...~..D...e...l:~... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's Lic~se No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work w~ll be done. Map No.: .~ ............................... Lot No. ~ Street and Number 8ou.~.d Ave & Walnut Plaice .......................................... ............................................................... ........ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..... ~.~'..e.l.l. iD.~. ..... b. Intended use and occupancy ........... ,~B, gta..~i.t~l...a.~...&dfL~.~,,1,0~ ............................................................ Nature 13f 'wbrl~ (check which applicable): New Building .................. Addition ........ ~... Alteration .~..i~'. .... Repair .................. Removal .................. Demolition .................... Other Work ...................................................... (Description) 4. Estimated Cost ..........1-~2.0.Q.jG ................................. Fee ...... .~..~.0...0. ........................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... .Q]A~. ........... Number of dwelling units on each floor ............................ If garage, number oficars ............................................................................................................................................. 6. If business, comme~ial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same I structure with alterations or additions: Front .................................... Rear ............................ Depth ............................... Height .......... ; ................. Number of Stories ................................ 8. Dimensions of entir.' new construction: Front ...... 3.~'...6 ..................... Rear ...... ~.0..-...6. ............ Depth ....8...-..0.. ............. Height ................... Number of Stories ......... .O.~.~. ..................................................................................................... 10. Date of Purchase; ....................................................... Nome of Former Owner ........................................................ 11. Zone or use districi in which premises ate s, ituated ..... ~.....G.l.-q.~. .............................................................................. 12. Does proposed ConStruction violate any zoning law, ordinance or regulation: .... ~Q ............................................... 13~ Will lot be regrade~? ....~Q ................... Will excess fill be removed from premises: ( ) Yes ( ) No Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ...~.O.S~,...~.Q.~.~.Q. ............................ Address ................................ Phone No. ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NL:W Y_ORI~, .. Ice COUNTY OF ...... ~I~T..:~ .O..J,~. ......... ~ '~"~ ....................... ~I'~IS~IDI:L..T.QIEJ~,~.O ....................................... ~being duly sworn, deposes and says that he is the opplicam (Name of individual signing controcf) ~bove named. builder 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 file this application; that all statements contained in this application are true to the best of his knowledge and belief; end that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ..................... of: .................. ................ , ,¢...7..!. £ ' ' ........................ TERRI LEE ELAK #GIARy pUBLIC, Sta'.e at New York ion Expires March 30, t9