The URL can be used to link to this page

Home My WebLink About7271-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ZT~(~. ..... Date ............. P~r ..... 114...., lg. g? THIS CERTIFIES that the building located at . ~l~m~m. Pa.gh ............. Street Map No..B~. y..I~a.k.~... Block No .... xx .... Lot No. :1~ ·. go..garb, on ................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. 14ay.. 22., 19.71~. pursuant to which Building Permit No..7.271~- . dated ........ l~la~... 22 ..... , 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~.iva~;.e .a¢.e.~ s $ol~.. ( B.torag®)..~ihed..(l~dg }, ..................... The certificate is issued to . gatlmr~ .Kl'~,b ..... 0~raer .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...N..~ ............................ UNDERWRITERS CERTIFICATE No..]~,R, ....................................... HOUSE NUMBER ..... lb,10 .... Street ... ~ln~az~ .P.&tl~ ......................... Building Inspector FOF, M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7271 Z Date ............... Permission is hereby granted.to: / ..~ ............ ~o..~~../..~..~.~....~.,~...Y~,,~~ '/ 7 ........... 7 ...... et premises located at ......~.........~~...~~ ................. ............... ......................................... ................. ~~~,......~..~.~/' ~'"~7~'m~m~'/ ............ ~. ...... , pp o d by the Building Inspector. ~. ,./...~..~ .... FORM NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLIGATION FOR GERTIFIGATE OF OCCUPANGY 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 featu~s. 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 ? .~7'~,,~r~'~" Date.. ......................................... .. ... New Bqilding ...~...~'...~...~..~... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property . ~ ................................................ Owner Or Owners Of Property ~..~.. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No ..................... Date Of Permit .................... Applicant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ..................................... Request For TemponJr¥ Certificate ........................................ Fin~ Certificate .......................................... Fee S hmit d $ ................... Construction on above described building and per~t/meet,~all applicable codes and//'egula~ns. Applicant ....... 1'~'"'"~ .......... Sworn to.~before me ~is /~ ~'~/ -.~ -. ~ '"~ ........~. ~ ~. ~ ~,~ ~ / I..5' A. INFORMATION - GENERAL C.P.L. 100.15 FORM NO. 256 WILLIAMSON LAW BOOK CO., ROCHESTER. N. Y. t4609 STATE OF NEW YORK : COUNTY OF ...-.~~..-~ cO~,RT__~..~;~~~Z ............... ............... ~l!e ~leople of tl~e ~tate af ~ew ~ark ..~. ............. ~ ........................... ~..~: ........................... , ......... ~.~.....~..?~._ ............................................. , ~y ~,~ ,.,o~.~,o, ma~ written accusation as ~.~_.~~.~ ............................................ o. ~...(.~__ ~ay o,..~...,~...~.~ ..... ~.[~..~.~.L~~__~~~ ................... , ,.~.~~ ............ o~ ...... ~....~_~ .................................... , Coan~y og ............................................................................................. ~ ,New York, did ~o~t~ o,~ o~....~~...~_~_~ ...... ~~.~.~ ...... ....... -5- .......... ~--~ ................................................................................. 'on ~ ~ *0~ /~ ~ I olthe ~(vlolation) in violation of Sect, ..... k~ ......... 1 ............ '.~- ............. ~ o[ the State o[ New York, ia that (s)he did, at the aforesaid time and place* The facts upon whlc~ this in[ormation is based are as ¢ollows: The faregolng factuaJ allegations are based upon personaJ knowledge of the complainant (and upon information and beJlef, the sources of complainants information and belief being, )o Wherefore, Complainant prays that ............................................................................. be dealt with pursuant to law. **Subscribed and Sworn to before me on ........................................................ , 19 ....... Complainant Name Title or Office *set forth statutory language constituting the offense **Verification By Subscription and Notice Pursuant to CPL Section 100.30, subd. 1, par. d False statements made in the foregoing instrument are punishable as a Class A misdemeanor pursuant to section 210.45 of the Penal Law. Accordingly and with notice of the foregoing, I hereby affirm that the foregoing statements of facts are true, under penalty of perjury, this day of 19 Complainant An appearance ticket has been issued herein on ................................................................... by ..................................................................................................... , directing the said ...................................................................................... to appear before this court on the ................ day of ........................................................... , 19 ......... and bail in the amount of ..................................................................................................... has been posted with Complete above only if appearance ticket has been issued) I ; , I : 'i 1 o ~U ul' /~ TOWN. ~ERK'S / . ~TH~D, N. Y. [x~min~ ........... , 1~.. ~ ~t 1 it ~o .... ~proved ........................................ ~ ...... Dimpprov~ ~/c .......................................... ~ .................... ...................... ............... ....... I~$TRH~IO~$ In~tor~ ~ith ~ ~ o{ pl~n~, oceumt~ plot plan to ~1~. F~ ~oco~i~ ~o ~h~ul*. b. Plot pl~ ~h~ino I~ation o{ lot ond o{ buildin~ ~ pr~mise~, rel~ti~ip ~r~s, ~nd oivi~ ~ d~t~il~ d~cripti~ o{ I~o~ o{p~ mu~t be dm~n on the die,mm which Js of applJcati~. c. ~e work covered by this a~lication may n~ be com~ before i~uance of Building Pe~Jt. d. U~n approval of this a~licati~, the Buildi~ Ins~tor will issue o Building Permit to the applicant. Such permit shall be k~t on the premises available for in~ti~ thr~h~t e. No buildi~ shall be ~cupi~ or used in whole or in pa ~ for any pu~ose whatever until a Ce~ifica~ of ~cu~ncy~ shall have ~en grant~ by the Building In~or. APPLI~TION IS HEREBY ~DE to the Buildi~ D~ment for the i~uance of a Building Pe~it ~nt to the Buildi~ Z~e O~inance of the To~ of ~t~ld, ~ffolk Count, New York, and other applicable R~ulati~s, for the constr~ti~ of bui]dings, ~iti~s or alte~i~s, or for mm~al or de~liti~, as hewn d~ri~. The applicant agrees to c~ply with all a~licable I~, o~i~, buildi~ c~, h~sing c~e, a~ ~ulati~s, a~ admit outhoriz~ inspectors ~ promises and in buildl~s for n~sa~ I~tions. (Signature of applicant, or name,i if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ....................... i'~ ........................... 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 ........................... ~...~....-~..~.../.~.J'...C..~.........X~../...~.'.~..~. ,~...,~..~......~..:.:;.,.+~=......~.~.....~..~..~ ............ Municil:mlity State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. ExJsiting use and occupancy .............. .~'....~.......,:~.......x:~......C.//,~...../.~...~.....~..~....C~.. .................................................. b. Intended use and occupancy .................. .~../.....~.....~....~...~...G. ........ ~...~...~...~.. ........................................................ Repair 4. Estimated Cast ............................................................ Fee .......... ,~......~.. ................................... ; ................................. (to be paid on filing this app~icefion) §. If dwelling, number of dwelling units...... ............., ....... Number of ch~elling units on each fl°er ....... 2 ................... If garage, number of cprs · ' 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 ........................ Number of Stories ......... ~.,: .................................... Dimensions of same structure with alterations or additions: Front -- Rear Depth ......... ~ ........... Height ....... ;. ....... ~.~ ........ Num/ber of Stories ................................. .... / ! 8. D,mensmns of ent,re new construct,on: Front ....... ~..~... ................... Rear ....... ~....~... .......... Depth .../..~). ............ oo Height ......~. ........ Number of Stories ......... ~ ............................................................~ ................ 9. Size of lot: rant ......... ~......~..Z. ............. ,~ ................. Rear .......... ~:.'..~...~/. ................. ,.. Depth ..Z./....?~.....~.....~i ........... 10; · Date of Purchase ........................................................ Name of Former Owner ................................................ 1 i. Zone or use district in which premises are situated ...~.~.....,~J~/..'.o...L~....(...c~..k%.C{.~.-.,/.....~g..~...~i~;i.~i 12. Does proposed construction vig~ate any zonir~g~law, ordinance or regulation: '., .......... /.~o ~//~c ¢c~ ~, ~ ................................... 13. V~ill lot be regraded~..?.?.. ......... : ......... ~dl exc'esS~fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premise .s ..~........,.~.......,~-~/..,~f....~'~...G.x~../..w...~x~/..~.~/..~Address ~..~..T../..~...~..~...~.....~d./... Phone N ............ ~ ........ Name of A~chitect .............................................................. Address ............................ ¢... Pho~ No Name of C t, ctor ................ ................... Ph e 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 comer lot. (Name of individual signing controcf) ' · · above named. ..... · He is the ' ~ ' (Contractor, agent, corporate office~, etc.) of said owner or owners, and is duly authorized to perform O~ h~e'Performed the said work end to make and file this application; that all 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 for'/h in the appllc~afion filed therewith. Swam t(~ before~ne this ~ Nata~ ' ~ / ~ignotur~ of ~pplicant) No. 52-0344963 Su~olk Commimien E~pim~ Mmeh :30, 19.-~'~ THE NEW YORK BOARD OF FIRE UNDERWRITERS aX BUREAU OF EI.ECTRICIT~ ---85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only th~ d~ctrlcal equmpment as d~scnbed below and ~ntrodue~d by tbe appl~attt named on th~ abo~ apphcat~on number in th~ premis~ of ^.0. Kre~b, Bay Lake ?ark, ~aln Ra.E V. ast Mar~on, in thefollotving iocation; [] Basement [~ lst FI. [] 2~d FI. ou'csl de Section Block Lot ,~,,...,,.,i,~d o. Novembe z* 8, 1973 ..d /o..d to be in compliance with the requirements of this Board. FIXTURE ~C INCAIqDE~Celq? RXTURES o~,RAl~.w' COOKINO DECKS OVENS DISH WASHERS EXHAUST FANS OUTtETS L~TACLES SWITCHES / TIMECLOCK$ BELL UNIT HEATE[ MULTI-OUTLET SERVICE DISCONNECT NO. OI S R V I C E Mike ~ ...... risE Main ~oad, East Marion, L.I. 11939 COPY FOR BUILDING