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Home My WebLink About7663-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z63.~.0. ...... Date ............ H, .er..!8 ........ , 19. ,~. THIS CERTIFIES that the building located at .. l~&~rv[e~ .Ave ............. Street Map No..~n~h~lock No ........... Lot No. ?8. ~! .... q~9~P~... ~.~ ~ .... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... De.e .. ~ 8 ..., 19..~ p~suant to which Building Permit No. ~663Z.. dated .......... D~q .. ~ .... , 19.~., was issued, and conforms to all of the req~re- ments of the applicable provisions of the law. The occup~cy for which this certificate is issued is ...aeg.~pr~ .~.%~:~8g .. {p~y~. g~r~gQ. ) ......................... The certificate is issued to . ~ .~'. ~!~F. ~}~ ....... ~ ............. (owner, lessee or ten~t) of the aforesaid building. Suffolk County Department of Health Approval N.~, ............................... UNDERWRITERS CERTIFICATE No. ~,~, ....................................... HOUSE NUMBER .............. Street .......................................... Building Inspector ~ TOWN OF SOUTHOLD BUILDING I~EPARTMI~NT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ~N THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 7663 Z Permission is hereby granted to: C~at ~...Or~ski.....AZC.. ~e~a~.4..&..~ SeMmierer ..... .g..g.~..~9. ~t.e. ..................................................... to .~..~!~..~.e.x..~.~.....~.~:~.e. ............................................................................................... at premises located at ...~t~..~.J~..&..~]......J~~lL..; ................ ; ....................................... · ~g.S. B~...'.~ew Ave .6..~e~n err : pursuant to application dated ......................... ~.e...e....~..l..~. ........ ~...., 19...~..,, and approved by the Building Inspector. Fee $....~Q~.~.O ........ FOP,~ NO. fl 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 fallowing; 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 .............. Of Property J..~.(.~I.L/,.~,....~/~..,......~.~,~./..'~L~..~/..., ................................. Location / -- Subdivision .~..~::...~..-- / ~Lot No. 7.~/~'j Block No ............. House No ............. Perm t No'~.7. ~.~ Date Of Perm t~...r~ / ~ .'.~' '/.'" .~ pp cant C.~...-~?.__'.~'~l~ --r 2. Health Dept. Approval .... .~..I..~...~...~ ......................... Labor Dept. Approval .......... ~,.'..~, ........................ Underwr,e Apprava, ...... ......................... P,onn ng B rd Approvo, .... ...................... Request For Temporary Certificate ............-~ ........................... FinaJ Certificate .......~.~.~..~.~ ...................... Fee Submitted $ ....:~.m..,.,..~..q~,. ............... Sworn to before me this , ///~/~ / .:...~.....~... day of ..... ~~.~..~.~ (stOmp or seal) // TOWN Of MX~rNM~ lUlU)IN~ W~ITMINT ~OWN Ci~UCl MIFICl ,~ravedExamined i ............................. '~ '~'~ ' Permit No..~.~.. ~ ~ Disapproved a~.:; ....................................... ~. / APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or. in ink and submitted in triplicate to the Building-~ Inspector, with 3 set~ of plans, accurate plot plan to.Kale. Fee according to schedule. b. Plot plan shawiag location of lot and of buildings on premises, relationship to odjoini .rig. premises or public streets o~ areas, and giving a detailed deSCription of layout ofprc~erty must be drawn on the diagram wh ch is port of this application. c. The work covered by this apl) ication may not be commenced before issuance of Building Permit. cl. ~,_U~l~_~a_p~:)_ ~r~vL_al of t~.is appl!.cat. !on; t~. Build.!ng I.m~.tor will issue o Building Permit to the applicant. Such permit shall ,,~ ~,~, ~, me prem=ses avallaDm mr inspocrmn mroughout 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. Bu~PU~T~O_N .!S HEREB. Y_.~_DE to the Building D*portment for tho issuance of a Bui~ing Permit pur~nt to the a ng Lone ~)ramance aT me ~own of SouthoId, Suffolk County, New York, and other applicable Laws, Ordinances or RThe~eual~l~cnS~°argtr~e~:~(~Sct~nw~:h~alldai~ng~i,c_~C~._iti_or~.- or a~!terations., o..r ..for m ,~.al' or. demol, ition, as herein described. admit authorized inspectors on premises and In I:)ullcllngs for nec~ons. ......... i,, .............. . .......... ...... ....... ~'~i;;~';~'h;i;ii~g;;;i ............................... State whether applicant is owner, I~se~? agent, om_hit~-~-, engineer, ~enerol contractor, el~:trician, plumber or builcler. o, o, -- '-'""---------- I{ applicant is a corporate, signature of clul¥ authori?ed o~icer. " ' ' I '"'"""'"' Builder s License No .................................... Plumbers L,cense No .................... ................ ............. Other Trade's License No ............................................... 1. Location of land on whicb~Drapo~d work will be dorm Mo~ No · f T * ~ -,.~'~r' r- "'~-'",~,~ .......... .~...~ ......... Lot I~10..,e.~J~......~...~. ..... Street and Number ...~,~..~.;U...,,.~q,e,~..../~,_,Q,....~. ............. / M4mlclpplily \ 2. State existing use and occupancy of premises and 'intended use and occupancy of propased construction: o. Exisiting use and occupancy b. Intended use and occupancy .,../....~..~~) ~ ......... iI ................................................. 3. 1~lature of work (check which applicable): New Building.. ........... Addition .................. Alteration .............. ¥., Repair .................. Removal .................. Demolition .................... Other Work ..................................................... ~ (Description) ') . ..... ................................................................ 4. Estimated ~,ost ....~....1. ................................. ; ........ (to be paid on filing this application) ,5.If dwelling, 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 .....~..~..;f., ....... 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 ....... ~...(~...; ................ Rear ...... ~.C .............. Depth .....~...~ ............. Height ......L....~. ..... Number of Stories .......... ~ ............................................................................................. Size of lot: Front ...... .._. ....... /..~. ............................. Rear ........ ~ ..................... ;~.....~..~D,eptJ~;...L,~. ............... 10; Date of Purchase .~...r/.~.~-.~....3~,, ................ ,.~Name o,,f Form~er Owner ']'~'i~~/)' ..... 11. Zone or use district/in w~ich premises are situated .~.~,~i.~.,I....~...(M~,...w ....... 12. Does proposed construction violate any zoning law, ordinance' or reg~ulation: ...~<3~..........-t......~......~. ..................... 13'. Will lot be regraded ....~ ................. Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .~1~...~. Address ~;,~,,~,,.,~,,.~.~,.. Phone No..,,-,. ................. Name of Architect ............................................................ Address ............................... ,Phone No ....................... Name of Contractor ~.~: .................. Address f_~ ~3, ~ __~~...~one NoT.~... ,~....~.~. ~. 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. I STATE OF NEW Y~,.,/'. /~ ~S 5 COg N'r~F,,/~-;3~~X . . .......... ~~,..,.~.~ ................... being duly sworn, d~es an~ says t~t he is the applicant (Name of ihdividual signing c~tmc~ above name. ~ ~, , · He is the ......................................... ~..=.~1 ........................................................................................ (Cont~ctor, agent, co~orote officer, etc.) of said owner or owners, and is duly authorized to perform or h~e performed the said work and to ~ke and file this application; t~t all statements contained in this application are t~e t~ the best of his kn~dge and belief; and tha~ the work will be performed in the manner set fo~ in the application filed t~ith. ................ o, .............. , .............. ....... ............................ No, 52-0344963 Suffolk Cou.~ ~ ~pi~ March 30, 19~~