The URL can be used to link to this page

Home My WebLink About6656-zFORM NO. 4 TOWN OF SOUTHOLD BUILI~ING DEPARTMENT Town Clerk'* Office $outhold, N. Y. Certificate Of Occupancy No.Z.~.9. ? ? ....... Date ............l~..y. .... ~6 19 7~ THIS CERTIFIES that the building located at ll/.S..~ain. Road..' .......... Street Map No. ~ ......... Block No...¥~ .... Lot No. ,..x~IAKx..,..E..a.s.t...~.r.~ .o~.,..}! :.~.o.,, conforms substantially to the Application for Building Permit heretofore filed in this office dated ...........~... ~..2.., 1~3.. pursuant to which Building Permit No..~..6[.~.Z.. dated ............. .J.~e.. J.2, 19. ?[t, 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..~c.c.~.~ ~.o..~., .b.u.~.~..d.~..g, {. ~r.~ .e.~..o.u.s.e. ) ................................. The certificate is issued to . .l~.ty~J;].e..G.:. ~q~;~; ..... .0~.e~ ......................... (owner, lessee or tenant) of the aforesaid bui]dlng. Suffolk County Department of Health Approval .... ]',. ,~.. ........................... UNDERWRITERS CERTIFICATE No. , .N:.R.o ....................................... HOUSE NUMBER . .8.?.8~. ....... Street . .g.a..~...R.o.a.d...(.R.T..2~.). ..................... BuiMing Inspector ]FORM 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? 6656 Z Permission is hereby granted to: · .~a~le ..... ~...4~ot~ .................................... ............ ~a~.t~..~arJ,.~ ......................................... to ...]~.ui l& .. n~..,~.me. ~ ~.~y... h~kl ~.~g...(.q~.~.e.~thq~a~.). .................................................. at premises located at ..~/,&....}:~,trt...~O~ ....................................................................................... ........................................ .~.~...~f~x!~a ...... ~.J.,. ............................................................................ \ pursuant to application dated ......................J.t~te ..... .~.~ ............. , 19.~.~.., and approved by the Building Inspecto,r. ' ' Buildin~t~ispect°r FORM NO. $ TOWN OF SOUTHOLD Building Department Town Clerks Office Soutbold, 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 w~th the following; for new buildings ar new use: 1. Final survey of property with accurate location of all buildings, property hnes, streets, and unusual natural or topographic features. 2 F~nal approval of Health Dept of water supply and sewerage d~sposal--(S-9 farm or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buddings, Industrial buildings, Mulbple Residences and similar buildings and installations, a certificate of Code compliance from the Archztect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where apphcable. 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 topographmc 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 bumlclings 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 ............ ~-././..5..?Z~..~. · .............. New Building ~'...,e'.B~.N..~S~ld or Pre-existing Building ............................ Vacant Land ........................... Location Of Property ....~/~....¢6.(~.l.I}L..~.9.1~D.....:..~/~.[.../}t~.6.~,g..~..~.H..~: ................................................... Owner Dr Owners Of Property .lVk~.~..'T.~,~..~..l~.r~i.~...~:~.~.D.?'..?. ................................................................. Subdivision ................................................................ Lot No ............. Block No ............. House No..r~.~.. Permit No. ~.~,.~.~...~... Date Of Permit .,~/./~;../'Z~ ..... Applicant ..~..~.~.~..l~...,~m.~t.G.(~.,..~fk.q.~..T. ........... Health Dept. Approval ................. ..~ ....................... Labor Dept. Approval .............~ ................................ Underwriters Approval ..................~ ......................... Planning Board Approval ...... ~ ............................... Request For Temporary Certificate ........................................ Final Certificate ......~ .......................... Fee Submitted $ .......... ~ .............. Construction on above described building and permit meets all applicable codes and regulations. Sworn to before roe.this //~ (stamp or seal) LO~ ~. )'. DUVAL I~OTA2Y YUBLI , ~tcte of ~ r Yo~k Na. ~-185C725 ~uallfled in Na~au County Cezt. fried iu Suffo~ County Te~ ~p~ ~;ch 30, 1975 ~{ ' BUILDING qIPAITMINT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ....... :... .- Disa~rovecl a/c ...................................................... APPLICATION FOR BUILDING PERMIT ,~) .......... , INSTRUCTIONS ; a. This application must be completely filled in by typewriter or in ink and submitted in tripliCate to the Building Inspector, wi 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 street~ orames, giving a detailed description of layout of flroper~ must be drlwn on diagram which is pert of this application. ¢. The work covered by this application may n(it ~mrnancad before issuance of Building Permit. d. Upon approval of this application, the Building Ih~t~re~tor will i~ue a Bud ng Perm t to the app cant Such permit.shall be kept the premises available for inspection throughout the work. e. No building shell be occupied or used in whole or in pert for any purpose whatever until a Ce.rtificate of Occupancy shell have granted by the Building Inspector. .A. PPLICATION 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, Suffotk County, New York, and other applicable I.~ws, Ordinances or Reguletionl, for the COnltructlen of buildings, additions or alterations, or for removal or demolition, as herell~ de~ribed. The appliCant agrees to comply with &Il applicable lawl, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building~ for naceselry inlpantionl. State ~ether a~licant is o~er, Ira, a~nt, amhi~, e~in~r, ~eral con~K~, el~ician, plu~m ~i~er. If a~liflnt is a cb~rm, signature of dulY auffioriz~ offi~r. ..................... ..................... Builder's Li~n~ No .......................................................... Plum~'s Li~n~ No ......................................................... El~rician's Li~n~ No ............................................... ~her Tr~'s Li~n~ No ....................... ........................... : 1. L~tion of land on ~ich propo~ ~rk w~ll ~ do~. M~ No .............................................. ~ Lot No ........ ~: ........... ~ St~t ~ ~m~r ,~ ................................ N~_- ~~e~~ ew K~,~. kss, . ~.'~;~'~"~,~L -- KOR~e~K~I ....................................................................................... Mun~i~li~ 2. S~m exi~ing u~ and ~u~ncy of p~mi~ and inm~ ~ and ~ncy of pm~ ~n~i~: a. Exi~ing u~ and ~u~ncy ....... ~~. ............................................................................................. b. Inmn~ u~ and ~u~ncy ........ ~E~,~ ............................................................................................. Z Nature of work (check which applicable): New Building / Addition .....................Alteration ............... Repair ....................... Removal ........................ ~ RI'rAc~"G ~- G~.~o~ ~'~ ~' ~'~-'"-a.,O ...... i'~'~;i~'~'~'~;;i .......... '- 4. ....... ...... .............................................. , ' ~' . ~* '~ ([~'~'~id on fili~ this a~li~tion) 5. If d~l~, ~r bf'd~lhng uni~ .......... ~ ...... Numar of d~ll'ng un'~ on e~h fl~r .......... ~ .......... ~ ................. ,. If ~, numar of ~ ............................................................................................................................................ 6. If ~.'~mial or mix~ ~m~n~, ~ify n~m and ex~nt of e~h W~ of um ........ ..~ .......................... 7. Dl~ons ~ exi~ing ~, if any: Front ..................... Rear ........................... Dep~ .................................. He~t ........................................................... Num~ of Stor~ ............................................................................. Di~nsions of m~ ~u~re with al~ati~, or ~itions: Fret .......................... R~r ......................................... Dep~ ........................................ ;.... HeiSt ..................... ~ ................... Numar of Stmi, .................... ~ .................. . · . 8, Dl~.mion~ of ~i~ ~ co.~i~. ~ront ......................... ~..r ............................ D.~ ................................. ~t ................ .~ .............. ~.~ .......... Numar of S~ri~ ........................................................ ~ ................. __ .... ~IZ8 ~ lOT: ProR[ ............... ,.~ .................... ,~.m .......................................... ~. ........................... .. ................. .. Da~of~mh~ ~t~. ~-!~ Na~ofF~merO~er Z~e or um di~i~ ~ich p~ am s~ ...................................................................................................... D~ m~ ~i°. vl~y z~in. law, mdi~ ~ ~ion: ........ :.....~.~. o, o, ........ ......... (~) (Pho~ No.) Na~ of A~i~t .................................................................................................................................... ~':~ (~r~) (~one No.) N.~ ~ ~.~or ..................................................... : ...... ,......~.~A~. ................................... i~g~.~g:i ............... PLOT DIAGRAM Lot=~ oicorly ~nd di~lnctly MI bulldlnge, whether exim~g or propoaed, and Indicate all ~et-baok dlmen~tom from L,.properW Hnm. Give ~t and block number or clem'lptlon according to deed, and show street neme~ end indicate wheth. er interior or (turner lot. STATE OF NE~:Yqfl[(,, (, ) C~U,~ ~ · ~r ............ ;.;....., .................................. ) He is the ................................ (~tor, ~, ~ o~, e~, ) of .id ow~r ~m~n~ con.i~-i. ~ ~i~t~ are true to ~ ~t of hi. k~ ~-~ t~t t~ w~k will ~r~ in ~ ~r ................................. ~ ~ ........ ~:..~ .......... ~ .~ ..... ,