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Home My WebLink About7642-zNO. 4 TOWN OF SOUTIIOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupency No. ~.6~.~.~. ...... Date .............. ;h~.],y... 1~ ...., 19.7.~. THIS CERTIFIES that the building located at . .Ma.x':ii~..e..Lame ............ Street Map No. ~; ........ Block No. xxx ...... Lot No,~...l'~t.~-~ t~ack..N .~.~ ......... conforms substantially to the Application for Building Pemit heretofore filed in this office dated .......... l~vv. · .. ~ .., 19~. pursuant to whi~ Building Permit No. 7~2 ' · dated .......... Nu~.... 2.~...., 19~., was issued, and conforms to all of the req~ ments of ~e applicable provisions of the law. The occup~cy for which this ce~ificate issued is . P~$va~e. one .f'a~llE. ~e~lLug..w~th..an. ~dd~tl. on .................. The certificate is issued to .. A~. ~k~,e ....... 0~.,~ .............................. (owner, lessee or ten~t) of the aforesaid building. Suffolk County Department of He~fh Approval ~ ,~ ................................. UNDERWRITERS CERTIFICATE No...~2372k9 ..... ~u~.. 29... 19.7.~' ............ HOUSE NUMBER ... l¢9.O ...... Street .... l,~arZiz~e. ~ ........................ NOTE: This e~rtiflcate covers the orlgir~a~ dwelli~,~g- built before April 23 1957 - as well ~.~he addition ....... :::... ~mming In~ector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHO£D, Nm. Y. BUILDING prERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 7642 Z Permission is hereby granted to: a g)a(:...~....,~;~..~;~..~,.~. ............................................ ........... ~:-~.~z~e...La ........................ ~ .................... .................... · }~.~-~;.~: ~ek. ..................................... to ~;L~c.)... 4~z~ ..a~1;;~...o~...o~t;&~..~. :~.~- ~t~ ................................................................. at premises located at ...~.'.~ff~...L;.~ ............................................................................................ .............................................. i~t ~;£t~k....ll,~, ............................. , ................................................ pursuant to application dated ........ ; .............. l~.o.~. ....... ~.~.~ ........... , 19~/),...., and approved by the Building Inspector. Fee $'J:.~.,.O ~. ............ t Vu Bu~dit~r'lnspecto~ ~UN~_AU OF ELECTR~C:iTY .... 2 8!,9 D~ July 29~ 1975 z~,.~,~.~o,~,~.o,~f::~ 898358 COOK;N~ 3 '~' !0.-, 4 3 "' - D~U~NACE, MOTORS t ,, ; ~r $~PS ~ -~ ~ ' ~T, T ,o j ~,.wg. ~,~=, ~, ' J SERVICE OlscoN N]CT ~ N~,~F ~ , S E ..... ~T-~ : t NOO CC COND A, W, G- J NO, OF Hr-LEG A-WG $~1 AWG Charles M. Hall Box all FORM NO. $ TO~H OF $OUTHOLD Building Depoffment 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; 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: 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 $!.00 New Building ................ Addition ...... .~....'.. Old or Pre-existing Building ................ Vocont Land .............. Location Of Property ........ /.L~..0..........~..~..~../.~(.r-......~,..~-~{.~ ....................................................................... Owner Or Owners Of Property .................. A~.~.....'~.~.~.9, .................................................................... Subdivision ......................................................... .,.....Lot No ....... ...... Block No ............. House No.../...~..~..d. Permit No....~...~...~...~'...Z Date Of Permit ..././l~.~..~...Applicant ......... A../~.FL..~..~.?...~...o.. .............................. Health Dept. Approval ......... ~,l..',,~.. ......................... Labor Dept. Approval .......... ~.:."/~. ............................ Underwriters Approval .............................................. Planning Board Approval ..... ~J.:.~. .......................... Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ Construction on above described building and permit m.eets all appli~ble codes and regulations. Applicant .................... ~.:.. ~.~...f'...I-~..~..',..~,~:~.;'~..(.~...~..,r,;} ...................................... Sworn to b~fore me this ............... -~ ......................... (stamp or seal) No~ .......... ~ .... County FORM NO, $ 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 unusuo~ natural or topogrophlc 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 oil 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 / Date '~' '?;" ~'~"y' ...... .Z.~....../...~....Z New Building ................ Addition ................ Old or Pre-existing B,uilding ................ Yacant Land .............. Location Of Property ........ L ...... ~ ..~..~ ............ ****~...A..**I~...{.F...~!~ ....... ...~.~ ......................................................... Owner Or Owners Of Property ................. /..~ ................................................................................................ Subdivision ................................................................ Lot No. -- Block No. House No. z D .................. ..................... Permit No ................ : ....ate Of Hea,th Dept. Approval .......... .[.~....'~.: ................. Labor Dept. ApproVal ................... ~1:..[..~***.,. .............. Underwriters Approval .............................................. Plonning Board Approval ........................................ Request For Temporary Certlficote ........................................ Fin~ Certificate .......................................... Fee Submitted $ ....... ~.....'T.~ ................. Construction on above described building and permit meets all opp~cqble codes and regulations. App,,cant ..................... .................................... Sworn to before me this ................ do~ ................ (stamp or seal) Notary Public ~ ..... ~,.. County INSTRUCTIONS a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Building~'~ Inspector, with 3 sets of plans, accurate plot plan to s~,ale. Fee according to schedule. b. Plot plan showing lOCation of lot and of build ngs on premises, relationship.to adjoining premises or lic streets i areas, and giving a detailed descriPtion of layout ofpraperty must be drown on the diagram which is part of ~ applicati~. ~ c. The work covered by this application may not be commenced before issuance of Building Permit. mi d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such parmit 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. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the ~ I~:~udi~t~oZnsOn~orO~hdienca~nCttrOufct~h~e- _T~ow~.n.,o~__S~_ut_h~o~:. Suffolk ~Cou.n. ty, New .York, and .other.aprd!cable Lows, Ord nonces or , a UUllUll u/ UMIlUllrly~bl UK3OITIonSor alterations, or Tar removal or aemolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and irt buildings for necessary inspections. · To~a & A~a Biota (Signature of applicant, or name, if a corporation) Ma~li~e La~e Matti~e~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................ ................................. Name of owner of premises AIB~ S]ElZ~O 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. Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: .......... ~ ................... Lot No ........ ~ .......... Street and Number .......... ~l',l,:[ll..,~J~;.: ..........]~.~.t~.l~.~: ....................... "" ' Municipality State existing use and OCcupancy of premises end intended use and OCcupancy of proposed construction: a, Exisiting use and OCcupancy b. Intended use and OCcuPancy $~ vi~ garage a4~i~io,, 3. N~ature of work (check which applicable): New Building.. ................. Addition ....~1~ ...... Alteration ,. ............ Repair .................. Removal .................. Dernolition".L ................ Other Work ..................................................... (Description) 4. Estimated Cost .............. ] ............................................. Fee ...l...~..e..O...O. ............................................................................ (to be paid on filing this application) 5. If dwellir~g, number of dwelling units ........ ~ ............. 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: Fron~ .................................... Rear ............................ Depth ................................Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ .~.~ ....................... Rear ...... .1~ ................. Depth .~. .................. Height .................... Number of Stories ....~?/NII ........................................................................................................... 9. Size of lot: Front .... .2...2.~ ......................................... Rear ....... 22.~. ........................... Depth ....:~.~.~ ..................... 10] Date of Purchase ........................................................Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..... .~.A~..J~.I$:~ ............................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... ~ ............................................. 13~ Will lot be regraded' . ....... ~1 ...............Will excess fill be removed from premises: ( ) Yes (X) No 14~ -Nameof Owner of premises ...AI~...~O ........................ Address ...... ...J~....~.,~.,l.,t.~..e.~..... Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ......... .S.~ ................................... : ...... Address ................................Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all 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 whether interior or corner lot. ~ee attaehe~ plan STATE OF NEW_Y(iD~_. ~ S S COUNTY OF ....~....'t~...~..o.~1; ............ ~' - ........................ A~J...SJ[lil'~ ................................................... being duly sworn, deposes and says t~t he is the applicam (Name of individual signing c~trac~ above name. He is the ........... ~ .......... J......~.~...~ .................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly aut~rized to perform or have performed the said work and to ~ke and file th s application; t~t all statements contained in this application are true to the best of his kn~ledge and belief; and that the work will be performed in the manner set fo~h in the application filed ther~ith. Sworn to besom me this .................. ~[ day Of ................... ~ ............... , 19...~. Notew Public, ~fo~ C~n~ (Signature of applicant) .¢