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Home My WebLink About7568-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerfi icnte Occupnncy No. Z~.10 ...... Date ............. .~.a.r. qh.. 3 ..... , 19.?.6. THIS CERTIFIES that the building located at. 1~/.1~ .~l.dAle..R.q~..(.C..P~..7.). Street Map No...XXX ...... Block No. XI( ....... Lot No, . XY~.. ~.c~h.o,~d....~.,.~: ......... conforms substantially to the Application for Building Permit heietofore filed in this office dated ............... ~.e.!~t. ~019..~ pursuant to which Building Permit No.. dated ............ Sept;...30.., 19.7.~., was issued, and conforms ~o all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ... Business. bu~ldlr~g .~i.~h .acldi2~.ol~ ................................ The certificate is issued to . .~ha~..F,..V. ar~. ~:r ..... .~l,m. e~. ........................ of the aforesaid building. Suffolk Co~unty Department of Health Approval (owner, lessee or tenant) · ............................. UNDERWRITERS CERTIFICATE No...Pe2cl. i2g .................................. HOUSE NUMBER .... 1~62.~ .... Street ... l~$cld~ha .~a~l. ]Building Inspector FOElV[ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7568 Z Permission is hereby granted to: . ~..h.p...~...?. ,....V..~ .n..'f~ .U,~ ~. ~......(.y.a..~. ~.,$.e..~...g& ~1. Scl"ir ~.ee ) to ....h~t,,'Ld,,.aa..a.dcL'Lt,,.t.on.,.an.,ex,:L~t,,.~g,.,b~,&~,~ ............................................................ at premises located at .~./..~....~.~..~...~..]:.e....~.o..q..~.....(...~.~.. ........................................................................ ...................................................... ~outh~;l~ ...................................................................................... pursuant to application dated .......................... ~0~.~'.-..'~ .......... , ]9...~ZF., and approved by the Building Inspector. Fee $.~ 5n~J~)J~ ............ ~ ' - Building Inspector FORM NO. 6 TOWN OF $OUTHOLD , Building Depmtment 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 oil 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 fram 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 end "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 B~lilding ................ Addition ....~.. Old or Pre-existing B~ilding ................ Vacant Land .............. Location Of Property .,~.P...~..~../~ ......... Zt~..f~..~..3..~.L.cL ................................................................ Owner Or Owners Of Property ..................................................... ~ ...... Subdivision ................................................................ lot No ............. Block No ............. House No.~..~....~..~f Permit ,o. Z~.~..~.Z,~. Date Of Permit ~.hg//.~..~....Applicant .~.:.../~.,../~/.../~kAJ...~....~...~..~.~..~....~..1~..[....~.~.-~/~. Health Dept. Approval ............................................ Labor Dept. Approval ..: ............................................. Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ......... ~ ...................... Fee Submitted $ ....~..~.~?.. ................. Construction on above described building a~p~t, ~ts all ~a,.p,pli~fq~e, c~odes and regulations. Applicant ..... ~..~.~.~..~x.....~~~ ............................................ Sworn to before me this ....... ...... (stamp or seal) IUILDII~ DIFMLq'MINT ~ INSTRUCTIONS ,n~Trhis...~al~?~c_at_ i~on_~m_u,_st_~be comp!etel, y.fil!ed !n by .typ~.writer o~ .in ink and s~bmitted in triplicate to the Building -r ...., w,m ~ ama or pa~., accurate pm plan to scale, rea according to schedule. b. Ptot plan showing Iocatien of.Jot'and of buildings on prim ses,-,relatlonsh p to adjoining premises or public streets or'~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of thi~ application. c. The wad< covered by this application may rtat be commenced before issuance of Building Permit. d. , U,l~n app .ro. val of this application0 the Building Ir~pector will issue a Building Permit to the applicant. Such permit shall oe 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. .A.P..PLICATION IS HEREBY MADE to the Building Department for the issuance of a Building P"rmlt nt to the i~eU~ud;(~?LrO~nca~nCsetr~L~ho~ oT~bu.O~_~S~x~_~o~:, Suffolk ,.C_ou.n. ty, New .York, and ?her.applicable ~(/s.~ or Th .... '--'- ...... ¥. ~,,;u,,~,~,: ,~. ,.~ons or a~mmTLons, or Tar removm or aemolitlon, al herein dea:rlbed. , u~p,,~u., ugrees Fo comply w~tn a. app.came ~aws, ordinances, building code, housing code, and regulatkml, and to admit authorized inspectors on premises and in buildings for necessary Inspections. , ..: ........................ .~.~ .....<,~-. ......... ~... (Signature of applicant, or name, if a corparatlon) . ...... (Address of appllc6nt) ' · ' ..... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. / ...... j_. ~...~..~: ..................................... Name of owner of premisesC~..,~.~,.....~..- ~.*~.'./~....~. ::Z C,./~,. If applicant is a co?/~ate, signature of duly author!zed officer. ....... ........ (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No. /./. / Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which,l~ .reposed work will.~e dorje, h49P/No.: ............................ Lo; hJo ...... ......................................... /.j... ......... State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. ,sit, ngus, andoccupan C ./. ...... ...... ................ intended use and occupancy .~.~.~: ~. ~ ~. . .~;~a~. ~ .C. ~ ~ ~ ~ .~ . ~ ~.~.~:~.~ ~ ~.~.~. ~ ~ ~ ~ ~ ~. . ~. ~ ~ ~ ; ~ ./~ k~ ~.[ ~ ~ ~ ....... ~ ......... b. 3. Nature of work (check which applicable): New Buildihg' · ................. Addition ...::.~. ......... Alteration ................. Repair .................. Removal .................. DemOlition .................... Other Work ..................................................... (Description) 4. Estimated Cost ........ /..~..~....Q .................................... Fee .../..~..~..~ ............................................................... (to be paid on filing this appl!catJon) .5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ........ / ........ .~./~.~.~,...i ................... i ............................................................................... 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 Stories ................................ 8. Dimensions of entire new construction: Front ./.~.Z~.~..~./~.d ...... Rear ...... .~....~.....~ .......... Depth .~..~'~ .............. Height .../...~/ ........... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ Date of Purchase ~. ....................................................... Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............ ..~...q; .................................... 13. Will lot be regraded ............................ Will excess fill be removed from oremises: ( ) Yes ( ) No 14. Name of Owner of premises ~.~A?' ..~...~.,~.~.. ~...~/-Z~.~~ Address ..~.~&.~./~..e..~/Z ...... Phone No .~..~..~..:~..~...~.2 Name of ~rchitect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all sat-back dimensions from .property lineS. Give' street and block number or description according to deed, and show street names and indicate whether interior or corner Iot~ STATE OF NEW,~V/J~ I,S S ........ /~~..~.~ ....... . .............. ~-...be~g du!y swom;,deposes al~d soys t~t h~ is th~ applicam (Na~ividual signing c~t~ ' ' ' above nam~. t ' He is the ..... ~O.~.~.~..~ ....... ~.~.d.~...... ............................... ~ ....... . ................... '.' ....................................... / ~ (Contractor, ag~t, co~r~e officer, etc.) of said owner or owners, and is duly aut~rized to ~rform or have performed th& said work and to ~ke and file this application; ~t ~all stateme~s ..c0ntoin~'ih this- application are tree,. ~ the ~st of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application fil~ ther~ith. ~fom me this S~..~..t.~ .... of ....... ~~.--, 1~/ ~,~ ~ ~~ Not°~ Public ~.~ ............. ~~ ~n~ ...'~....~4..-t~;.Z.~...-~:~.~.~.~ .................. JUDITH T. BOKEN ;~lO~ Publi~, 5tale ~ N~ Y~ NO. 82-0344963 Suffolk ~un~ ~ ~mmi~n ~pi~ Mamh 80, I~