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Home My WebLink About7597-zNO. · TOWN OF SOUTHOLD BUII.r~ING DEPARTa~.NT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at..~)~-~c~..~.., t~0.~.1~1 .... Street Map No ..... .~ ..... Block No .... ~ ..... Lot No..)(, .... ~./( .'~..-ff./.~.~. ~..~..../..L/./// conforms substantially to the Application for Building Permit heretofore ~ed in this office dated ........~..~...'[..../..~'.., 19. ?. ~( pursuant to which Building Permit No. 7.~.~. ~--~ ........... ? ....... l!..., 19.-!.[/, was issued, and conforms to all of the require- dated ments of the applicable provisions of the law. The occupancy for which thl, certificate is issued is....~.~..~..~.A..."~..~.--... ~a .~..~. C.'.g..~.o..,.~..~)...~'.&.a A ~L~...~,~, ~-.D.~..~.. The certificate is issued to .~. ~l.~I~/... ~.~..T../9.1. AJ.O.$/.<, ~' ..... .C9 i.~J..~.~,~._ .... (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval . ...~..~/.~.. ......................... UNDERWRITERS CERTIFICATE No ......... ~..,..~..: .......................... HOUSE NUZ~BER ...~0. aa... s~et..O.~ ~. 6.o..~....~. o. a ..~. ............. Building In-~pector~ FOp-M* NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN a. ERK'S~OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7597 Z Date ........................................ ..... Permission is hereby granted to: ...... ~.~ .......... ,?.~.~..~.~t~../. .... Building Inspector. Fe, ..... Building Inspector .... ,~Y7 Application No~ Z ...................... APPLICATION FOR BUILDING PERMIT .................... ,,ZX..... INSTRUCTIONS a. This application must be completely filled in by typewriter or.in ink and submitted in triplicate to the Building Inspector, with 3 sete of plans, accurate plat plan to scale. Fee according to,schedule. b. Plot plan showing Iocatior~ bfJof ?nhd of buildings on premises, relationship'to adjoining premises or public streets of areas, and giving a detailed description of layout.ofproperb/must be drawn on the diagram which is part of this application. c. The work covered by this application may nat 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 permit shall be 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. B .A,P..PLICATION IS HEREB. Y MADE to the Building Department for the issuance of a Bul d ng Permit ursuant to the u,mng Zone Ordinance at the Town of Southold, Suffolk County, New York, and other applicable ~sp, Ordinances or Regulations, for the construction of bud nas, additions or alterations or f~r The applicant agrees to comply with all applicable laws, ordinances, J~ildi~ removal or demolition, aS herei.n described. code, housing code, and regulahons, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ............................ · 1.;....; ........... ; ......... ...~... : ............................... · . ~aaress ot applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .. ~...~.../~-.. Name af owner of premises ................. ~ ................. ~,~.. .N.L.~.~.q. KL ........................................................... If ~pplieant is a carporate, signature of duly outhori~ed officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No. Electrician's License No. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: .................... '-. ................... Lot No ......................... Street and Number O/~'~-- ............................................................. ............ .,.... ....... .............. Municipality 2. State existing use and occupancy of premises and intended use an.d occupancy of proposed construction: ~. . . .~. . ./=.'.-. a. Exisiting use and occupancy ..................................... ~.~,......; ....... ~',. ....... ~),.,,~... .................................... b. Intended use and occupancy ...................................................................... .~.; .......... 3. Nature of work (check which applicable): New Building.· ................. Addition.................. Alteration ........... ,,· .... ,;_.~ Demolition ...,.; ............... Other Work ................................................ Repair .................. Removal ................... .... 4. ~timated Cost ............................................................ tee ......... ~ ................................................................................ (to be paid on filing this application) 5.~ If dwelling, nu~er of dwelling units ............................Number of dwelling units on ~ch floor ............................ If garage, number of ~ ............................................................................................................................................. 6. If business, commercial or mixed ~cupancy, speci~ nature and extent of ~ch ~pe of u~ ............................ 7. Dimensions of existing st~ctures, if any: Front ............................ Rear ................................ Depth ....... ............. Height ........................ Nu~er of Stori~ ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... R~r ............................ Depth ................................ Height ............................ Numbe~ of Stories ................................. 8. Dimensions of entire new construction: Front .............. .~. ........... Rear ........ [..~ ....... D~th .....~.~ ....... Height ....~ ......... Number of ,Stories .................. ~ .................................................................................................. Does proposed construction vlolote any zoning Iow, ordinonce or reg~loti~: ........................... /~. .................. ~11 lot be regroded. ......... ~ ................. Will excess fill be rem~ed~ ~fr~ ~mises: ( ) Y~ ( ~ Nome of ~rc~itect ................................. ' ............................. A~re~ .............. .................. Ph~e No. ~ ..................... ~om~ of Contractor A~re~ ................................ ~o~ No ....................... PLOT DI~G~ L~ote Cleorly ~nd distinctly ~ll buildings, whether existing or pr~o~d, ~nd indicate ~11 ~t~k dimensions from prope~ lines. Give street ond bilk n~mber or description occording to de~, ond show street n~mes ond indicote ~hether interior or corner lot. 11. 12. 13. STATE OF NEW/YO, RI~. ~Z ~ ¢ c COUNTY OF~: ...... ~ "'"' ................ ~ ........ ..~..(/...7~../~.../....'~.....~....~....~..~...~..../. 15e~'ng duly sworn, deposes and says that he is the opplicanl (Name of individual signing contracf) above named. He is the .: ................................ ..~...,~/V",~~"1....~. ............................................................................................... (Contractor, agent, corpordte 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 thls applicoti0n are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this /. 8' day of ...,. .... / Nota ....... ............................ ~7' JUDITH T. -- -. York (Stgnarure o1' appJlcanrl No. 52-0344963 5uifoJk Couni~q C~ commission1 Expires Ma~¢b 30, THE NEW YORK BOARD OF FIRE-UNDERWRITERS tl~ BUREAU OF ELECTRICITY ~ 85 JOHN STREET. NEW YORK, NEW YORK t0038 THIS CE~IFIES THAT ~ly t~ e~t~ ~u~p~nt ~ ~.~ ~ ~ tnt~ by t~ ~t ~ on t~ a~ ~pl~a~ ~m~r in t~ p~mise8 of oonn~u~n~nos~l~ sis Oregon Rd. ~ 1500' w~o ~lvahs inthefol~wlngl~at~n; ~ s~.t ~ ~stFt. ~ ~ rt. Garage G 0utsLde w~ examin~ on ~e CO~ · ~ 9 ~ 19 74 a~ fou~ to be in comptia~e ~ith the requiremen 4/ 2 5 4 ~YEEKSw,' OP- ~J~8"pAI'~ I~o~O$~OES H.~, RANGES IcooxtNG DECKS OVENS l DISH WASHERS WT. K.W. AMT. K.W. I AMT. K,W. kMT. K.W. $1~CIA[IIEC'FI TIMECLOCKS/ lUNITHEATERSBELL UNIT HEATERS MULTi-OUTLET A36T' ~p, r A~4ps ] TRANS ~ SYSTEMS .-~p~ ~'2w ~.~ 3~'3w 3~,w .o~c~cc~cc.o. ^.w.~. .o. oF H~-L~G ^.W.O. SERVIC~ DISCONNECT OTHER APPARATUS** EXHAUST FANS DIMMERS OF NEUTRAL W.B.Ruland Hattituck, L.I. P#£ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANN~.~. FORM ~qO. $ TOWN OF SOUTHOLD Building Department 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: i. 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 O- ? Date ......... / ................................ .?.. New Building ..... ~ ..... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property (~J ~ ~'q ~) '~ ,~ O. /'~ d Owner Or Owners Of Property .......... ..~...~...~...q'.. ....... .~.~....~.,...~.....(....~....0....S../~..i .................................................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No.....~..~.~.~'..... Date Of Permit ./..°...L..?..~..LJ..Applicont .... ..~....~..~..hjT........,/9.....c~...~.~....!....~...,c!.S.,.~.l' Health Dept. Approval ......... .~..../...'_'~ ...................... Labor Dept. Approval .... ...~.......~.... ............... Underwriters Approval .. .......... ..~....!...'_'~.. ...................... Planning Board Approval ........ !..~.,.r.~. .......... Request For Temp°raryc,)C.,c~rtificate~. ........................................ Final Certificate .......... .~. ......................... Fee Submitted $ .....'~...............--'"~. ............... Construction on above described building and permit meets .all applicable codes and regulations. Applicant~......~....~]/~' ..................................... Sworn to before me this Notary Public ...... ~ ~/~_County (stamp or seal) t