The URL can be used to link to this page

Home My WebLink About7222-zFO~M NO. · TOWN OF SOUTHOLD BI. nI.BINC. DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. g6[0¢ ....... Date ..........J~.. ~ ......... , 19.7.5. THIS CERTIFIES that the building located at . .lt/~;. l/,ain..Road ........... Street Map No..xx ........ Block No. xx ........ Lot NoJ~x.. ~uthald.. I~,Yo ........... conforms substantially to the Application for Building Permit heretofore filed in thi.q office April ..0 ~ l:'e .....71 '}'1Z 1.19.~.. pursuant to which Building rnu~ ao.722~.. dated ...........Iqay'" ' I' ' dated .......... A.l?.r.~i~ay..1.0.3, 19~., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which thl.q certificate is issued is ~r~t.vate..one. family..dwe~.l~Jag, with. additian. &&lter. at Ions. AI~. ho,p~tal The certificate is issued to .Dr,..14~i;[.$am. Z,$tek ..... f&~ne~ ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. l~.dt, ............................. UNDERWRITERS CERTIFICATE No..~ ~ ~70+9-..~/~ -1/-7~- &- '~ 1 ?~3~. -'7/~'1'/~ HOUSE NUMBER .... ~Sf>O~ .... Street .. l/~.]a. ~oa~l. · .Szu.~hold ................. ....... ..... ........ FOB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT frillS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7222 Z Date ........................... Ee:y~ ...... .jJ ............ , 19r~... Permission is hereby granted to: ~r...~£~la~..Zl~lc .......................................... ............. 8~u~ch~d· ............................................... fo .]~.B;~...a~..~L6£t ;~u...o~..e ~ ~t ~n~...dw~l:Lln~ ..~®a~.) ............................................... at premises located at ...N~.~..~...~rt...]~o~d. ......................................................................................... .......................................................... ~OU. tb..o~d ........ ~l~:Z, ................................................................ pursuant to application dated ...................... $1~-y.....~, ................... 19..~)+.., and approved by the Building Inspector. Building Inspector FOP,~[ NO. 6 TOWN OF $OUTHOLD , Building Deportment 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 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date .....~.' .//..~..'~/?}..~. .......................... New 8clildin9 ................ Addition ..... ....~,,,.... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property jdj¢ /$1g-,g /~ ~)! ..l~./g ~p~D~pr/14~:~Vl.~...[ }~'d~ Owner Or Owners Of Property ..'1~...~. ,....~.O.j..C....g....~..~..~. ~',TI~,. ................................................................. Subdivision ..... ..~_.~...5:...C~...}..~.~.0. ................................. Lot No ............. Block No ............. House No....~...~..,~...5'- Permit No. ............. 7~,~_~. Date Of Permit ...~'..l.~. l"7~., Applicant .................................................................. Health Dept. Approval ......... .~....J~ ....................... Labor Dept. Approval ........ ~.....'..~ ......................... Underwriters Approval ./J/r~.Z.~..~..!.~...~ ................ ~...~.//.~. Planning Board Approval ..... .~... ....................... '/L Request For Temporary Certificate ........................................ Final Certificate / Fee Subm tted $ ....-:-~.....~....~'~. ................... Construction on above described building and permit meets all applicable codes and regulations. Applicant Sworn to before me t ' ~'-'day of ... 2 Notary Public ....~County / (stomp or seol, THE NEW YORK BOARD OF FIRE UNDERWRITERS ~I,W BUREAU OF ELECTRICITY- ~- 85 JOHN STREET, NEW YORK. NEW YORK 10038 THIS CE;IFIES THAT Nortn~o~k Animal Hospital. n/s ~Aln Rd.. 3~0~ w/o Btexed~ 3outhold. L.I. in t~ f~ing I~ation; ~ ~ement ~ Ist Fl. ~ 2~ Fl. OUtS ~ de ~tion B~k ~t ~ exami~d ~ Ju~y 2 5, 19 7 ~ a~found to be in ~mplla~e .ith the ~qulre~n. of th~ DRYERS FURNACE MOTORS FUTURE APFUANCE IEEE)ElIS OTH..ER ~ARATUS~ Un i t ~ I2 3 1/2 Ton AC RANGES R COOglN~ DECKS I OVENS DISH WASHERS TIME CLOCKS E~LL UNIT H~AT~R$ MULTI-OUTLET V I C E EXHAUST FANS DIMMERS A, W.G. NO, Cf Hr-LEG OF CC. COhlD, OF NEUTRAL W.B.Ruland(Eleet~toLan) Mattltuck, L.I. 0 ..... 11 Per 'x ~__. · · COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNII~ (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No. ~/~i.L."~"A~"b ....................... IUI~ING DEPARTMENT ~_ Z ~ ~ . /' ~./ Examined .............. · ....~. .................. , ~plication No ................................. APPLICATI~ FOR BUILDING PE~IT ........ INTRUSIONS ~n~p~toG ~i~ 3 ~ o{ pl~, oceumt, pl~ plan ~ ~l~. ~ ~cco~ino to ~h~ul~. b. ~l~Pl0n~h~in~ I~fion of lot ond of b~ildin~, on pr~mi,~s, relationship to ~d~o n no premise~ or public *tre~t~ o~ · r~s, ~nd ~ivi~ ~ d*tail~ d~ription o{ I~o~ o{p~ mu~t b~ drown on th~ dio~rem which i~ ~ o{ thi~ ~pplicati~. c. ~ work c~r~ by th~ ~lication moy n~ b~ commenced before i~,u~me o{ ~uildinfl ~,rmit. d. Hpon ~pp~l o{ ~hi~ ~pplic~tion, ~ Build,nfl In,~or will i~ue o Buildin~ P~rmit to th~ oppllc~nt Such p~rmit ~h~ll ~ kopt on ~ pmmi~ amilab~ {or in~tlon thm~hout t~ ~ork. e. ~o buildi~ ~h~ll b~ ~cupi~ or u~ in whol~ or in po~ {or an~ pu~ose whoever until ~ ~holl h~* b~en ~mnt~ ~ th~ ~ildin~ In~tor. ~ AP~LICATIO~ IS HfiR[BY ~fi to th~ 8uildin~ ~pa~ment {or the ~u~nce o{ ~ 8u Id nfl ~it pumuont to tho ~uild~n~ Zon~ O~in~nc* o{ th~ To~ o{ ~thold, suffolk Count, ~w York, nnd other opp c~b ~ ~,, O~inonc~ or ~e ..... applicant agr~s to comply with all applicable I~s, o~inanc~, building c~, h~s ~ c~e, ~m t authonz~ m~tom ~ prom ~s ~d ~n ~lldi~s ~r ~e~ ,~t,~s. ......... ........ ............ ........ State whe~er applicant is owner, les~e, ~gent, a~hitect, engineer, general contractor, electrician, plumber or builder. Nome of ~ner of premiss ........................................ ~.~..:~ ...................................................................... If applicant is a co~orate, signore of duly authoriz~ officer. Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ............ ~.?...~/...~..,.'~. ....... Lot No ......................... Street and Number ...... ~ .........~.~.g~' .~'.~:.... ~1..~ ~ ................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ......... ~..~...~/.~.../...,~..'..C.~ ............................................................................................ b. Intended use and occupancy ...... 3. Nature of work (check which applicable): New Building i..L. ............ Addition ....... Alteration Repair .................. Removal .................. DemOlition,........ ........ :. Other Work ...................................................... (Description) (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 c~rs ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify4l[ J~_~a~llure and extent~,lof ~ach type of use ............................ 7. Dimensions of eXisting structures, if any: Front .........~..-I/.Z~ ....... Rear ...... R'..I.:,~..~. .............. Depth -;mlr,~:....J..?.I Stories ~ Height ........................ Numberwithof alterations ............................................ additions: Front ...~'.--~ '~'''~'- ................................... l~LI; ~]'"'~' ......... ~ .... Dimensions of same structure or .............................. Rear ...~..v...~r.,. ............ Depth .......... ..~.."~ ............../ Height ............................ Number of Stories ....... ~ ..................... 8. Dimensions of pntire new construction: Front .................................... Rear ....~'.~.." ............... Depth ..J'.~. ................ Height ..~...~ ...... Number of Stories ............ ~. ...................................................................................................... 9,. Size of lot: Front ..................................................... Rear .......................................... Depth ................................ 1CL Date of Purchase ........... ~Z~.'.'7~i~ .............................. Name of Former Owner ..~..!..~.~....~...~...r'.?m ............................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ,AAI~. ............................................ 13. Will lot be regraded ..~:~-,~ .............. Will excess fill be removed from premises: ( ) Yes {~"~ No 14. Name of Owner of premises ....~./...L...~.~..~..~.)......E...-....~..T'.~/(Address ....~1~..~ ....... Phone No. ~%~.I~..... Name of Architect .............................................................. Address ................................ Phone No ...................... . Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all bui~ings, whether existing or proposed, and indicate all set-back dimensions fram property lines. Give street and block I'~mber or ..c[eScription nccording to deed, and show. street names and indicate whether interior or. corn_~er..Iot2 ~ .~- -- -- ~ ~ ,~' ' Ur-ll OF ............... ...... ? (Name of i~ividual signin~c~n~mc~ D~ ' He is the ............. ~.~....." .................. ~ ........ :J ........................................................................................................ (Contractor, agent, corporate officer, etc.) of sa d owner or owners, and Js duly authorized to ~erform or have performed the said work and to ~ke and file this application; that all statements contained in this :~Pplication are t~to the best of his knowledge and belief; and that the work will be performed n the manner set f6~hm the application 'fi~ed therewith. Swam to ~fom ~ this ~ ' ~ ~ NOTIFY BUILDING DEPM~TMENT ~7 ~. FINAL WHEN JOB COMPLETED .¥ o-'o ';