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Home My WebLink About7633-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupency No. ~..63~.~. ...... Date ............ Fa b ....26 ....... , 19.7.~. THIS CERTIFIES that the building located at .~?S..~ ,. ~11. ~oad. ~) ..... Map No..x.x. ......... Block No.. X~ ...... Lot No..×x~ · .l~at. tituck.. }(,..~ ~ ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ................ 0¢.¢..22 1~... pursuant to which Building Permit No. dated ...... ~,~. I~O.V....~.8...., 19 ?.~.., 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 Baaineaa. bu±~tclir~g.. ?..~'cor~ga .&. shop. e.te ......................... The certificate is issued to Cyz~h~a. ~¢aminzky ..... .V~m~ .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N, ~.~ ................................ UNDERWRITERS CERTIFICATE No2/2,1~./.7.~.. by. ~....l~Ubacki ................... HOUSE NUMBER ... 80 ........ Street . JJ, ·. ~4;L~l. lb:md .......................... Building InspectorI FORH 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 CQMPLETION OF THE WORK ^UTHORIZED) N? 7633 Z Permission is hereby granted to: ~,3,.~.:.~.~.:.A~.~...,,.~.~.~t~ ~.,.~l.x~ ........................................... ..... ~u.~ ..................................................... Lu:~J.~L ~ ~ ~tility - ~to?a~e build~.n~ (a~ro~ed b~ Bd AppealS) . . at premises located at "~ttztuck pu~sue~ ~o eppHce~io~ de~ed Oct 29, . ~ ]9.~..~ e~d epp~oved bw~he FORM NO. $ TOWN OF SOUTHOLD , Building Deportment Town Clerks Office Southold, N. Y. 11971 APPMCATION 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 disposol--(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 formation required to prepare a certificate. C, Fees: l, 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 Date ....~...~..,.~.0.r.,,/.~...~....~.'~... ..... New Building ...~...._.../.. Addition ................ Old or Pre-existing Building ..~.. ........... Vacant Land .............. Locetion Of ...... ........ .... Owner Or Owners Of Property ....~.¥..~...~...b..~.~. ........ /~...~.....r~....!.t~...~...I.~./ ............................................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No..:~.~..~"~..~..~-Date Of Permit ...... ././//...~.~.~l/~pplicant ~.yJ:)..'?../?I..;...~,......~I.~..L.CI.~'.)(.. ..... Health Dept. Approval ..... .~.....[..[...~.:...: .................... Labor Dept. Approval ....... .~....:..!..~. ............................ Underwriters Approval ....~.......~...'...~.'/~'...~...-/----'~-- ............... Planning Board Approval ........... ?/..~..~....~.....~.~.~..) .......... Request For Tempora Certificate ........................................ Final Certificate .... ~ .................................. Fee Submitted $ ~ ................................ Construction on above described building and permit meets all applicable codes and regulations. .....~.~.....::... day of ........ ~.~.',.~..:.~.¥~.~:..~.. ...... ~,7Z~ (stamp or seal) Natow Public ...~~(~' Coun~ K~N ~' / / FO~I~I NO. 1 '~'*~*"*~'~ TOWN OF SOUTHOLD BUILDING DEPARTMENT 'rowN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....~ ........................ 19.?..~.. Pemit No....~ ............................ Approved ......... ~..~...../....~.. ........ , 19.?...~.. ~ ~ 3Z~ '~ (Building Inspector) APPLICATION FOR BUILDING PERMIT (~ Dote INSTRUCTIONS a. This application must be completely filled m by typewriter or in ink and submitted ~n triplicate to the Building Inspector, with~ 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 pubhc streets or areas, an giving a detailed description of layout of property must be drawn on diagram which is part of this application. 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 permit shall be kept 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 bee granted by the Building Inspector. APPLICATION 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, Suffoll~ County, New York, and other applicable Laws, Ordinances 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 re§u[ations, and to admit authorized i~spectors on premises and it~ buildings for necessary inspe~ions. (~ignature of apphcant, or name, if a corporation0 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ... ~ ............................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 2. State existing use and occupancy of premises and intended use ~ind occupancy of proposed construction: a. Existing use and occupancy ......... ~..~../....~.~... ~'~r~t,~.....~-~-.~.,~...~..~ b. Intended use and occupancy .............................................................................................................. ; ................... I. Location of land on which proposed work will be done. Map No.: .................... Lot No .............................................. Street and Number ................................ .... ~;...~..~.,(:~.:~,, -- ..................................--~'""'~"~'s/4~d-~ .... 3. Na~ture of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ OtherWor ' ~ (Descrip~onl ~.. Fee ................................................................................................. 4. Estimeted Cost ...... .............. (to be paid on filing this applicafion~ 5. If dwelling, number of dwelIing units ...... ~. ....... Number of dwelling units on each floor ......................................... I~ garage, number of cars ........... ~. ............................................................................................................................ 8. If business, commercial or mixed occupancy, specdv nature and extent of each type of use~~~t~~ 7. Dimensions of existing structures, if any: Front .....................Rear ........................... Dep ................................... Height ........................................................... Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of ~tories ........................................ 8. Dimensions of entire new construction: Front ........ ~ ........ Rear ........... ~..~ ..... Depth ......... ~. ................ Heigh~ ......... ~,~. ...... .~..,~. ................. Number of S~ories ..................... ~. ................................................................. 9. Size of [ut: Front .......... /.2~...:. ............. Rear ........... ~.Z.~...~..~ ........... Depth ....~..:,.,,L~...I,I.~..~. ....... Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... ~ame of Former Owner. ..~.. ~ ~. Zone or uso district in ~bich premisos are situated ..................................................................................................... 12. Does proposed construction violate an~ zonin~ law, ordinance or regulation: ........ ~ .......................................... 13. Will lot be regraded ....... ~ ................. Will excess fill he rem~ed from premises: [ ] Yes [~o 14, Name of Owner of premises ..... ~ ' ' ''~~--~ ~~..,.,~~~~~,,.,.~/ Name of Architect .............. :~ .................................................................................................................. ~ddress) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or L R::::p ' ' STATE OF NEW YO COUNTY OF ) being duly sworn, deposes and says that he is the applicant above named. He is the ................................................................................................................................................................................................................. (Cbntractor, agent, corporate officer, etc.} of said owner or owners, and is duly authorized to perform or have performed_ __-r~, the said work and to make and file this application; that all statements contained in this application are true to the best of ~i~Jl~/~let~q['~.~q~ ~t~f and that the work will bo performod in tho manne~ Notary public, o ~J~ ~t ~ set forth in the application filed therewith .... 63 Suffolk County ~ ~ ~ No, b2-O344y - ...................................... y ............... ~, ............. , .~ ....... , publ~~...~.,.~..f~ ~ No . y ......... County ......... ~ q (Signature df ~plicant) ~ 0o ~ It, d