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Home My WebLink About7238-zFOR~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerlificnte Of Occupnncy THIS CERTIFIES that the building located at .~9 .mid....?!e¥..ROad. ......... Street Map No...OF.~.e.i~..t.b.~. Block No..t'h.~...~..&..Lot No. ~ ..... .O~.~#.l~.t. ,..!1...~... ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. &p.~..1..~.., 19 ..~.. pursuant to which Building Permit No..?.~.8.Z..' dated ........... .]~.~ .... ? ...., 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 .p~.l..*(.a..t.e...~..~..ff..~..l.l.y...d.~.~.]:l..~n. $..~.~.~.h.a.d.d~.t.t.°..~...(a..p.p.r.o.~.e.d..b..y. The certificate is issued to .[d.~..r.d.. &..F!a..~..a...G.r.e.b..~a. r ..... . .0~..e.r.e ............... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .N,.R.; .............................. UNDERWRITERS CERTIFICATE No..Pg.n~...i~.g ................................... HOUSE NUMBER .... ~...0~.. ..... Street .8.o..m,_?...V.i. ew...R~..a.d ........................ ................................................ ............. ............ ........ TOWN OF SOUTHOLD BUILDING DEPARTMINT TOWN CLERK'S OFFk~ SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE pREMIsES UNTIL FULL COJ~PLETION OF THE WORK AUTHORIZED) No. 7238 Z Permission is hereby granted to: G,,...R~el,I..... J~.g....~l.ua,z~ ,&..,.~,t, au..~.....O,rebtnar ............... ..q~.e...e.p. ~..o., ,r.~ ........................................... to .~.9~ ~.~....e~.. ~ .~ ~,.~1 ~.. ~ ..e z,l ~.~ ~.. ~e~L1. ~ '~ I~ ............................................................... ........................... f,~.g.~.~...~Y...~ ..~p.e 1~ a ~ ............................................... : ............................ at premises located at ..,L~t,..~,~.....O~.e~...~..t~e..~ee ............................................................. ......................................... S,cun~,...V.~Lew...~oa, d ............ ~m~ ........................................................ pursuant to application dated ................... ~.....~ ..................... , 19.~..., and approved by the Building Inspector. Fee $..~.~...~. ........... ouildmg ~nspector / / FORM NO. 6 TOWN OF $OUTHOLD , B. ildlng 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: ]. 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 ]057), 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: ]. Certiflcote of occupancy $.5.00 :2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3, Copy of certificate of occupancy $l.00 De,e New B~lilding ................ Addition.../ .... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ....... ~...~..~,~..,,t~.~?..~./...-~.....~........../~,~;3,,,~. .............. ~C~./~/..,~.~.~./. ........................ Owner Or Owners Of Property ........... ~.-.~.~'~..~Z.~./~....~......~.~.,,~.~./..~'....~.~'~.'~'~.~"~/'"'~"..~. ............................. · ~- ........................... ! ......................... i-louse ina../.(.~.~.~.-~ Parrot No 7Z£~ Da, f Per ' ..~-.Z7 ~('-~ ' !~'~'./~ - - /~ .................... e O mit ......... ~ ......Applicant .~ ...... /...'.~.....~..~-....~.. ............ Health Dept. Approval ....... ~....../~.....:..x...~.. ......... Labor Dept. Approval .......... ,;~/.......~....L./..~...~ ........... - Underwriters Approval .............................................. Planning Board Approval ............................ x .......... Request For Temporary Certificate ........................................ Final Certificate ...... ~ ........................... Fee Submitted $ ....~.........-~.. ................... Construction on above described building anti, permit meets al) appl)cj3blei code.[,and regulations. Sworn to befkgte .m.e~his · .~.. ........... day of ~".~.~. ........ .......... Coun ~ ~lo~ ~-~L ~., ~]~rcb 3~ 19.~~ (stamp or seal) FO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 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 scale. Fee according to schedule. b. Plot plan showing location of lot ~nd of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofprpperty must be drawn on the diagram which is port 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 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 'Depar~ment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk 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 Iaws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or frame, if a corporation) ........... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~i~dez Name of owner of premises ..~J.~..lr.~..:~.d. ~ ..F..~.a~i~ ~zebinar . . If applicant is a corporate, sigqatuYe of duly authorized officer. (Name and title of corporate officer) Builder's Licet~se 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 So~d T:J.e~ Road O~len%, ti, /'. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..... ..~...e..s.~..8:.e..n..~.~[...~..e.~.~...'.:~...~.. .......................................................................... b. Intended use and occupancy ..... ..~...e.~.~...8...e~....~.~'...e:.]:......D~..,e.]'..]:..~..~..~. .......................................................................... 3. Nature of work (check which ap ,le): New Building. ................. Addi ~ ........... Alteration ........ ~ ........ Repair .................. Removal .................. Demolition .................. ',. Other Work ...................................................... ' (Description) $ 20o0. 4. Estimated Cost ............................................................ tee .................................................................... (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 ..... ,e,~,,e, ................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ..,~.,0,~.I. ................... Rear ......t~.,Q.?. ................... Depth ......~...~, .......... Height ........................ Number of Stories .,..o,.~,e., ...................................................................................................... Dimensions of same structure with alterations or additions: Front ~r Rear Depth 56~' Height ............................ Number of Stories 8, Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front lOOt Rear ]'O2r Depth 125~ 10. Date of Purchase ........................................................ Name of Former Owner .~.e.?......,.H..,a..b..e.r..1.~.....~..s..,~. ................ 11. Zone or use'district in which premises ore situated ........ ~,~..,~,~.,~,~ ........................................................................ 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ,~,,e.~ ................................................ 13. Will lot be regraded' ..n,0. ...................... Will excess fill be removed from premises: ( ) Yes (X) No · ~dv~rd 1~. Nome of Owner of prem,ses .................................................... ^~ress ...0.~..eA~ ................ Phone No.~.~....2....4~..4. .... Nome of Architect .............................................................. Address ................................ Phone No ....................... ............................................................ ~, 477 Name of Contractor C.I.. l~vell Address ..?..~..?...e~...~..o...z~,. ......... Phone mo ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck dimensions from property lines. Give street ond block number or description according to deed, and show street names ond indicate ;ehether interior or corner lot. ~ G L//~D ~/i EIA/ I~ e ~ O lee ' STATE OF NEW ¥~1~,/,/// couN ~~ ~ ........................... b*in~ duly sworn, deposes ~nd soys t~t ho i~ tho applicam {~omo o{ i~ivid~l ~ionino contrec~ above nam~; He is the ............ ~~ ............................................................................................................................................... (Contractor, agent,' co,orate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke ~nd file this application; that all statements contained in this application are true to the best of his ~owledge and belief; and t~at the WOrk will be performed in the manner set fo~h in the application filed therewith. Sworn to be~m me this · ...... ....... ~ (Si~noture o{ *pplicant) ~o.52-0344963 Suffolk Ceunt~~