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Home My WebLink About7668-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. g6830 ...... Date .../leceraber.. 29 .......... , 1975.. THIS CERTIFIES that the building located at N/f~ .Oregon. R~I ............ Street Cutchogue Map No..ii .......... Block No...X ....... Lot No ...... X ........................... conforms substantially to the Application for Building Permit heretofore filed in this office dated Dec. ember..21i. 2.6 .... , 19..74 pursuant to which Building Permit No...7.6..6.8.~. dated .December..26 ......... , 19.7t., 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 .. Storage..BuiLding...Addition..(Agrlc.ultur.A1 ] ..................... The certificate is issued to ...Jennie. Bokina ..................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... N..R ............................. UNDERWRITERS CERTIFICATE No ............................................. HOUSE NUMBER ...151.0.5 ..... Street ....Qrego~l.. R.o.~4..C.u.t.q .h.o.~tu..e,..1,h..Y., .... Buik~ing Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT,MUST BE KEPT ON THE PREMISES UNTIL FULL CO~MPLETION OF THE WORK AUTHORIZED) N°. 7668 Z Permission is hereby granted to: wm,..~el~aa~....~Z~..~.~.,....Z...~...~.~..~.. ~.o.~:na ........... E,,.Aqa~io.n ............................................... ~o~..~.t.ld ~..~.i~!~..~n..~l~.~Z..f~ .~g . . ~ .re~e~ ~o=o~.d o~...~i~[~..~...~...~rt'S~..~ ............................................................... ............................................... ~m~.he~....~...~.. .............................................................................. pursuant tOr oppliCUHOn dated .................. D~ ............ ~ ............. , ~.,.., and opprowed by the Building inspector. Fee ,~.~.....o...o. ............ FOP~M NO. 6 TOWN OF SOUTHOLD ~ Building Depo~tment 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 in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 3.2' CopyCe rtificateof certificate°f acc UpaofneyoccupancyOn pre-exi$1.00sting dwelling or la nd useDateS§'00/9/~ .... ~ .~.~.'i'...Z.~..'~.?....~. New B~ilding ................ ,~lition ......~..~..ii. Old or~r?-exjstingiBuilding ..... ,~. ...... Vocant Lond .............. ,oco,.o . o, , · ............................ Owner Or ~ners Of Prope~y ..... z~.~...-~~:..~z~~ Health Dept. Approval ............................................ Labor ~pt. Approval ................................................ Underwriters Approval .............................................. Planning BOard Approval ........................................ Request For Temporary Certificate ........................................ Finctl Certificate .......................................... Fee Submitted $ ....~...:.('~ ....................... Construction on above described building and permit meets all applicable codes and regulations. Applicant .............................................. ~.~ ....~/~,..., ....................... Sworn to before me this ...... day of (stamp ol~$e-al) / , ...................................................... Notary Public .................................... County TOWN OF SOUTHOL~ BUILDING DE,P,.AItTMINT "' , TOWN CLINKS OmCE SOUTHOLD, N.Y. '-'' / '~/,~/~ ........................................ . .p.cotion ........... Approved ~ ~ * l .................................. ........................................ . Pe..it .o. 7~/6:Z Disapproved o/~ ....... ~ .... .... i ..................... ....................... APPI.ICATION FOR BUILDING ~EI~IT I ~$TRH~IO~$ o. This opplicotion mu*t ~ compl~t*ty {ill~ in by ~*writer ~. ~lot plon shoWin~ I~atio~ of lot ond o{ buildino~ on premi~, rel~tionsh p to ~d~oinin~ pmmi~or public ~tre*~ oroos, ~nd ~ivi~ a d*t~il~ d~rlption of layout o~pro~ must be dr~n on th~ di~mm which c. ~e work c0wmd b~ this opplication m~ n~ b~ comm~d b~for* i~u~ of 8uildin~ ~e~it. d. Hpon ~pprovol o{ thi~ applicotion, ~ Buildino In~or will i~u~ sholl be k~pt on th~ pr~mis~ avoll~bl~ {or i~p~ction throughout th~ work. e. ~o buildin~ ~h~ll b~ ~cupi~d or u~d in whole or in p,~ sholl h~v~ been omnt~ b~ th~ Buildino Inspector. A~klCATIO~ IS H~R~BY ~Dfi to the Buildin~ D~p~r~m~nt ~or th~ issuonc~ of o Buildin~ ~*rmit pu~u~nt to tho Buildin~ Zon~ Ordin~nc~ o{ th~ l~n o~ ~uthold, Suffolk Count, ~w York, ~nd other ~pplic~bl. ~w*, Ordln~nc~ or Reoulotion~, {or th~ con~tru~ion o{ buildin~ ~ddltion* or oltemtion,, or Ihe opplicont ~r~ to comply with ~11 ~ppllc~bl~ Io~, ordinance, buildin~ odmit ~uthori~d insp~cto~ ~ pr~mi~ ~d i~ ~ildln~ {or n~e~ i~tion~. (Signotur~6f applicant, or name, if a corpom~i~i " · ~...~.~.~...../~....~.~ .......... ~' (Address o~ppl~nt) ' State whether applicant is owner, les~e, agent, a~hitect, engineer, general c~tractor, electrician, plumber or builder. Name of owner of premises .................................................................................... If applicant is a co~omte, signature of du~authorized officer. ......... ~....~~~.~.~~~'~'~.~~~~~~~~.'~'~~~.~.~~~'.~''.~~~~'''~'~~..~~~'~~.~~..~~~~~~'.'(Name and title of co~orate officer) Builder', kic~ ~o ..................................................... [l~ctricion's kic~n*o ~o ............................................. Other Tr~de's License No ............................................... .~...~.. Location of Iond on wh cJ~roposed wo,d~ b*J done.~p No' . Lot I~ ~./,~ )~'~.~ Street ond .umber ..~..~/~....Z~.~.(~.~......~/.,~(~.....~.~ ....................... c/ U Munici~ 5tote existing use Grid ~cu~ncy of ~ ~d inter,se Gnd ~cu~ncy of pr~e~ const~ction: ~. ~,,i,,~,e~=u~,~ ..... ~~....~~ ...................................................................... b. lntend~ use and ~cu~ncy .......... ~ ................................................................................................ 3. Nature of work (check which applicable): New Building .................. Addition //"' Alteration .................. Repair .................. R~noval ............... ... Demolition .................... Other Work ..................... .~ ........... : .................. ,~ ~.. (~escription) 4. Estimated Cost ....... /.~./..~J; .................................. Fee ..... ~.....:.....: .......... : .................. : ........... i ........... ~ .................. [to be paia 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~eac, h type of us~' ~,~-~. ~- ~7~~.~..~,.~ 7. Dimensions of existing structures, if any: Front ...... .~.....~......'. ....... Rear ..... ~..f.~.~..~. .............. Depth .....~..~... Height ........................ Number of Stories ................................................................................................ .~....~ ......... Dimensions o~.structure with alterations or additions: Fron~t ............................ Rear .................. Depth ......... ~..~ ................ Height ............................ Number .of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ DePth ........................ Height .................... Nu~be~of Stories .............. . ....................................................................................................... 9. Size of lot: Front ...................................... ~:....r,.(. ..... Rear .......................................... Depth ................................ 10. Date of Purchase ....... i ................... : ............................ No, r~f/,j. ~r~/e~! Owner ........................................................ 11. Zone or use district in which premises are situated ........ -- ~ ' "~'~...:~,~.~..~ ......................... ~ .............................. 12. Does proposed construction violate any zoning law, ordinance--/~"or re~l~/'ation: ..... ~ ................... ~ .............................. 13. V~Jll lot be regraded .~ .............. Will excess fill be removed from premises: ( ) Yes : (~No 14. Name of Owner of prer~lses ,~..: ......... :.~....~/~..~ .................... AddreSS ,e~.....~.....~....:;....~Pllone No ............... ~, ..... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ~xisting or propqsed, and indicate all set-bock dimensio~ from property lines. Give street and block number or description according' to deed, and shew street mames and indicate whether interior or comer lot. --' STATE OF NEW Y~K./ / , I/ [cc COUNTY OF (N(~me of individual signing contracf) above named. eing duly sworn, deposes and says that he is the applicam He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, end is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application ore 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. Swam b3 ,_be~j~re me this .... .......... , ................................ ~/~- / (Signature of applicant) ]dbitH T. BOKt~N No SZ-034A968 Suffolk CouI~