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Home My WebLink About7554-zTOWN OF $OIJTHOLD BU~.DING DEPARTMF, NT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No..Z?.6~..~. ..... Date ................ . .!~.... ~...., 19.~?. THIS CERTIFIES that the building located at ........... lc~l~. 2tl*e&t ... Street Map No.. IIX ........ Block No..z~l; ...... Lot No~....Q~Le~ .... ]Je~, .......... conforms substantially to the Application for Building Permit heretofore filed in ~1~i.~ office dated ............. . .l~.]~.t...2.~ 19. ~.. pursuant to which Building Permit No. -7~'~ - dated ............ I~t.. ~., 19~..., was issued, and conforms to all of the require- manta of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to . .}~..~..F..1.o .~.. (.B~..t~;y)....]~ .... .~..e.~. .................. (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval ]J,R.~ ............................... UNDERWRITERS CERTIFICATE No. 1~2~92~ ..... &~lg .6...~.97~.... ? ............ HOUSE NUMBER .... ~2~ ......Street .. ~g. St,'eat... O~eat ............... IPO'nM NO. TOWN O~ EUILDING 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? 7554 Z Permission is hereby granted to: at premises located at ....... r;~l~..~l;~e&t, .......................................................................................... ..................................................... 0~ ...... ~1.~., ............................................................................ pursuant to application dated ........................~Op~ .......~.~ ......... , 19.~114,.., and approved by the Building Inspector. Fee $..1.~,q.~1~ ........... Building Inspector -- APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or, in ink ond submitted in triplicate to the Building Inspector, with 3 sot~ of Plans, accurate plot pian to scale. Fee according to schedule. b. Plot plon showing location of lot ond of buildings on premises, re ationship to odjoining premises or Ix~lic streets or oreas, end giving o detoiled description of layout ofproperty must be drawn on the diagram which is part Of this application. c. The work cOVered by this opplication may not be commenced before issuonce of Building Permit. d. ~ approval of this opplication, the Building Inspector will issue o Building Permit to the epplicont. Such permit shall t 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 bythe Building Inspector. ~ APPLICATION IS HEREB. Y MADE to the Building Department for the issuance of a Building Permit pursuant to the ~u~/lud;;tgio~ZsO~. ~orO~ienca~nC~trOJct~h~e.' ' ' T,o _S_u olk ,.C~u.n. ty, New ,York, and ..other,appl!cable Laws, Ordinances or -. , ...... ,~. ~,.i,~,,../a, u~,d~ns or a,mraT~ons, or for removal or aemolitlan, as herein descHbed. 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. Orient trucking & Constr. (Signature of applicant, or name, if a corporation) Orient (Addres~licant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............................................. ......................................................................................................................... : ......... Name of owner of premises .~3:S..~O~'~..T~l]3~ .......................................................................................................... , ....... 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 .... ~,,,,,,,G,~..~.,e,,l,~,.o., ................ Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: .............. ~ ..................... Lot No ...... ~ .............. Street and Number Kin~ Street Orient : Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy dwellin~ b. Intended use and occupancy ........ .s..~.m..e with Private swi~in£ pool, fence, patio accessory$ 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................. Repair .................. Removal ................ ;. Demolition .................... Other Work .~.,o..o..~.....~.....~..e..~.~.e....~.~..c. ............. (Description) 4. Estimated Cost .................... ~...~..0...O~.......+..i .................. Fee ..I[~.~..0..Q ............................................................................ (to be paid on filing this application) · 5. If dwelling, number of dwelling units ..... ..o..~..e. ................ 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 .. .......................... 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ....: ............................................................................................................ Dimensions of same structure with alterations or additions: Front .~ ..................................Rear ............................ Depth ................................ Height ............................ Number of S. tories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ........ : ................... Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ~ ....................................................... Name of Former Owner ....................................................... Zone or use district in which premises are situated ...r.I..~..~..~..s...~. ................................................... ~ ........................... Does proposed construction violate any zoning law, ordinance or regulation: ...~0 ................................................ Will lot be 'regraded ...... ~rl~.S ............... Will excess fill be removed from premises: ( :~ Yes ( ) No Name of Owner of premis~$-~..~-..]~l~ ........................ Address ..~.~..~.e.~.~.; ............ Phone No ....................... Name Of Architect .............................................................. Address ................................ .Phone No ....................... Name of ¢on~'r~ctor ,;.J).~LeT~t..T..&..C ...........................Address ................................ Phone No ....................... ~. _m-Tnc~ ~-. ,~'ii PLOT DIAGRAM 11. 12~ 13. 14. t Wheth~i i!teri°r °! c°r. ni~; STATE OF NEW Y..OR~.,. ~,.~- ......................... I~Ob.~..~O~.,~,S ........................................ being duly sworn, deposes and says that he is the applicam ' (Name of individual signing cantract~ above named. He is the contractor . . (Contractor, ogeat, 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 alt statements contoined in this application are true to the best of his knowledge end belief; and t6a~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ~.~~ Notary Public, '"C/ ~-- '" ' "~ ' ~ //(Sig~ature of oPl~cant) JUDITH T. BOKEN itinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from and block number or description according to deed, and show strc~' names and indica!e FO~M NO. 6 TOWN OF $OUTHOLD , 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 submittedi.~~he 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: 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: 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 ..................................................................................................................................... Owner Or Owners Of Property ....................................................................................................................... Subdivision ................................................... > ............ Lot No ...... ~ BIo~. k No....~ ...... Hou,~ No...,~ ...... Permit No. 7.~.v.~..~.~-.~......~.. Date Of Permit .~4..~.~.~..~.,Applicant~/~~.~.....~ - 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. Applicant ......................................................................................................... Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) 7HE NEW YORK BOARD OF FIRE b ,D2~:;WRITERS ~.u~t ~, t97~,,,,,,..,,o.,o.o.~,,~ 80~06 N 239257 King, King St., Orient, L.I. ~.a r~. outside s~o. mo~ ~t ,,-.***.,,,~,,o.o. August 4, 1975 FIXTURE:!RECEPTACLES! SWITCHES r FIXTURES DRYERS RANGES OVENS DISH WASHERS EXHAUST FANS SYSTEMS NO. OF FEET ! I SERVICE DISCONNECT i NO. OF i S E R V ! C (Sw~r~,ing Pool) This certificate covers compliance at the date of