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Home My WebLink About7258-zTOWN OF SO~HOLD BU1T.nING DEPARTMk'~T Town Clerk's O~iee $outhold, N. Y. Certificste Of Occupsncy THIS CERTIFIES that the building located at /¥~ 0 ~? ~:~0~J~: ~/~ ~ Map No ~- Block No Lot No "' conforms substantially to the Application for Building Permit heretofore ~ed in thi~ office dated ...............f.~...~..~,'719.7?. ;ursuant to which Buildin~ Permit No..'~.Z. ?..~. dated /~ ~ ~197~, was issued, and conforms to all of the requi~ ments of the applicable provisions of the law. The occupancy for which ~.hi~ certificate is The certificate is issued to ........................................ :.. (owner, I, :_ ' ') of the aforesaid building. Suffolk County Depa~-~ent of Health Approval ~/. UNDERWRITERS C]~TIFICATE No ......................................... ~oos~. mn~Fa ../.Y.~ .0. .... s~t ...~'..~?.....~. ~¢~t.~.....~ ~.~....~.h f. '...O · .... ..... FOB,~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPAItTMENT TOWN CLERK'~ OFFICE SOUTHOLD, N~ ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL | COMPLETION OF THE wORK AUTHORIZED) No. 7258 Z Date ........................ ...]~. .......... t.~. ......... , 19~... Permission is hereby granted to: at premises located at .~.~..~.~.(II~C..~I~...T~3T~ ........................................................................... ............................................................. Lm~z~Z ...... ~i~'~ ..................................................................... pursuant to application dated .........................~ ....... 16' ........... , 19~....., and approved by the Building Inspector. Fee ~.~6~0 ............. Disapproved a~ ............................................. APPLICATION FOR BUILDING 'PERMIT ItlL7 16 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 and of buildings on premises, relationship to adjoining premises or p~u~. lic streets or ~, areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of thss 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 hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department .for the issuance of a Building Permit pursuant to the~ ~uildln.g' Zon,e Ordinance of t. he T,o,wn ,of. Southo. l,d., Suffolk Cou.n. ty, New York, and other applicable Laws, Ordinances or egu at,ons, Tar the construction at DUUalngS, add,tions or alterahons, or for removal or demolition, 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 in buildings for necessary Iosp~-t. i~s. xq (Address of applicant) (Name and title of corporate officer) Builder's Lic~se No ..................................................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of prem ses ~.O...b~ ~ .............................. i ........................................................................... If applicant is a corporate, signature of duly authorized officer. 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 Pe~ol~l.¢~ MUnicipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .... .~...~t.~.~....~ ~ .............................. b. Intended use and occupancy 3. Nature of work (check which applicable): New :Building. ................. Addition ....31:2~ ......Alteration ..,23~ ....... Repair .................. Removal .................. Demolition.:..· ................ Other Work ...................................................... (Description) 4. Estimated Cost .................~.~0O...d~$..~i.:~.i...:.....?:..qee. -.--~ :.~.e0.~ ............................................................................ (to be paid on filing this application) 5. If dwelling, number of dwell)rig units .......... .'~ ............... Number of dwelling units on each floor .................. : ....... ~. If garage, number of cars ...................................................................................................................... 6. If business, commercial or mixed occupancyj 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: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ............... t~ ................ Rear ........... ~l.~ ............ Depth ..... .1..~ .............. Height .................... Number of Stories ...... ~ .......................... : ............................................................................. 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises ore situated ........ ~A.g...d.~,lB~ .......................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...ll~. ............................................... 13. Will lot .be regrdded' ...~ .................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ..... ~..~ ........................... Address ....~13~e~.. ............. Phorm No .........., ............ Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil 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 Iot.,~[ STATE OF NEW YORK, IS S COUNTY' OF ....... ~1~.£~¥- ....... ~' " ................................. ~JJJJJlJJ..~ ....................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing controcf) above homed. He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that oil statements contained in this application are 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. · y ...,,'. ; ....................... , 19...~ ' ~ -- // (Si'~nature o app ican~ ............................. JUDITH T. BOKEN Nota~ Public, State of New Yo~ No~ 52-0344963 Suffolk Cou~ FORM 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 os 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 $1.00 Date ~ ~''/ 7~ ~ New Building .......~... ...... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Property ....... ./.....~....~....~......~'..~...7.......?...~...~.~..~. !..~. ...... ..~...~..~ ....... ./.~....Z...~. ~. ~.y ....... Location Of Owner Or Owners Of Property x//J/4 ~-/ ~:~(~/~/~1__~ Subdivision .................... .mz..:;.'T: ...................... , ............ Lot No ....... .~...B ack No .......'~..... House No / L/¢ & ---- ............. Permit No....7~.~,~.~. Date Of Permit ..... ~/'.r~.?~...Applicant ............. .~...~L: ............ .J.~.'~:.?.2..~ ......... Health Dept. Approval ................. .,,~'........~. ............... Labor Dept. Approval ................... f..~...../..~. ................. Underwriters Approval .......... ..~...../.../..../....?....'~./. ............ Planning Board Approval ........... ,/'~,,....!...~... .............. Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ ... ~...~i .......... Construction on above described building and permit meets all applicgt~e codes and regulations. Applicen, ............... Sworn to before me this/'~ .................. .............................. P z_ 6. V7 THE NEW YORK BOARD OF FIRE UNDERWRITERS nr BUREAU OF ELECTRICITY F~; 85 JOHN NEW YORK. NEW YORK 10038 STREET, 2(; 785161 t975 THI~ CERTIFIES THAT John J. Burns, s/s Peconic Bay Blvd. So. Oakwood Dr. & Laurel Lane, m thefotl~i~l,,cet~o~ ~ ~..,~,,,.,,~ ~', ~ r't. ~J ~,,,~ n. Laurel. L.I. - out sid~ ,~,~.~...i,,,,a.. February 24, 1975 .,,,~/,,~,,a,o~i,,,.o.u,~.,,~..~,~, I 9 6 ~ v , ...... ~ .... ~ ~ . 9 ORYER$ O~HER APPARATUS: Dettner E!ec. Co. P.O. Box 482 Riverhead, L.I. 11901 i