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Home My WebLink About7464-zFORM TOWN OF SOUTHOLD BUILDING DEPARTMENT Off'me of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z.I. 14. 7.4 .......... Date ...... F.e.b.v. 9OFY..1.4 ........ 19~3. THIS CERTIFIES that the building ................................................ Location of Property ............. Soundvie.w. Ave.hue, Pe.cpnic... Ho~e No. S~ee~ County T,x Map No. ! 000 S~ctinn .. 0 6lB ....... Block . .04. ........... Lot .q 15. A. 0 ] b ...... $~on ..... .X ......................... Filed Map No..~. ...... Lot No..X ............ Conforms substantially to thc Applic~fi°n for Building P~rmit ho~tot'o~ ~ed in this ~co dated ~u~u~.~ 8 ................... , l ~ .7. 4. dated ...A.u.g.u. $..~.· · ·. ·. · ...........8 19 .7.4., was issued, and conforms to all of the requirements of the applicable provisiom of the law. The occupallcy for which this certificate is issued is ......... an accessory bavn build:Lng: The certificate is issued to ......... .D~ .................................... ]~ARiR¥ ~AV~.T~ ......... {owner , de~ er. cer,~ of the aforesaid building. Suffolk County Department of Health Approval ...~ [ ~. ................................... UNDERWRITERS CERTIFICATE NO ........... ~J. 5.,qC} 5 .4.4 .............................. Rw.l~l TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT ('THIS PEPJ~IT MUST BE KEPI' ON THE PT~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7~6~ Z Date ........................ '~U'g ......... '8" .......... ' 19'~F'" Permission is hereby granted to: · ..W,~I,-~ r,~...4~.ek.e~ ............................................... ............. ~.~.~n~..Y.~w..A~ ................................. ................. k~e, ............................................. to .~ ~:.~ c.t .. £.=~.n~...£e~¢~ ~.....b.u$~,~t..~am ..a~t $.~.. eh.. e~ .~..~.... ~.. ~ at premises located at ...~/f.~...~.~13D.~....~'~.eW..J~.F~ .............................................................................. .......................................................... ?.~oa~, ...... ~.~.. ..................................................................... pursuant to application dated ................................ &~g ....... $~ ....... , 19r~.., and approved by the Building Inspector. ........ SOUTHOLD, N. Y. Exomined .......... .~ ....... , ~ ~ *-*' ¢, Xp~oti~k~.2~.~......~ ........................................ ~ ~e~Jt ~0..l.,.,.f....,.l...~ ............ ................................................................... .................. APPLI~TION FOR BU~ING PE~IT / .................. 19.~.~L.. INTRUSIONS o. Thi~ opplic~tion mint be compl.~l~ fill~d in b~ ~writ~r o~ in In~or, ~ith 3 ~ o~ pl~ ~ccumt~ pl~ plan ~ ~. ~ ~co~i~ to ~h~ul~. b. P~ot plan ~howin~ }~otion of lot ~nd o{ buildin~ on pr~mise~, relationship to ~dloinin~ oreos, ond ~ivi~ ~ d~t~il~ d~ription o{ I~out o{pr~ mu~t be drown on th~ di*~r~m which i~ ~ o{ thi~ opplicotion. c. Th~ work cov~r*d b~ thi~ o~lic~tion m~y not b~ comm~med before issuance d. ~pon ~ppmwl o{ ~i~ ~plic~tion, ~ Buildin~ In~p~tor wil~ issu~ ~ Buildino ~rmit to th~ opplic~nt. Such parmit shall be ~pt on the premises ~ailable for inspection thmugh~t the ~rk. e. No building shall be ~cupied or used in whole or in pa~ for any pu~ose whoever until a Ce~ificaM of ~cu~ncy~ shall have been granted by the Building Inspector. ~PPLI~TION IS HEREBY ~DE to the Building Depa~ment for ~e issuance of a Building Perm t pu~uont to the~ Building Zone Ordinance of the Town of ~thold, Suffolk County, New York, and other applicable ~, O~inances or.~ Regulations, for the construction of buildings, a~itions or alterations, or for removal or demol t ~, as hem n descr bed. I ~e applicant agrees to comply with all applicable I~s, o~inanc~, building c~, housing c~e, and ~ulati~s, and t~ admit outhoriz~ in~to~ ~ premises and i~ buildings ~r n~es~ ~ti~s. (Signature of applicant, or ~me, if a co~omtion) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .......................... ...~..(~...~...~.1~.........~...-......~.~...~¢.~.. .................................................................. If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's. License No ............................................. Other Trade's License No ............................................... Locat on of and on which osed work w be do~e~ Mop No · ' OCtet, ~ ~-d Lot Nn Street and Number ............................................ ~/~...~..~ ........................................................................ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................ b. Intended use and occupancy ....~...~....~/.~....~)~ ~ ........ ~2~..~.....~..~7......_......__ 3. Nature of work (check which applicable): New Building ........~ ...... Addition ........... ....... Alteration' ..~.~....". ........ Repair .................. Removal .................. Demolition .................... Other Work ...................................................... . / _ ~ . ~ ~' ~ (Description) 4. Estimated Cost . ~ ~ 0 . Fee J-~ ........ (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 ~ . ........ 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 ........................ ;...Number of Stories ................................ 8. Dimensions of entire new construction: Front .............. ~..~ ................ Rear ...... .~....kj ............... Depth ..... .~...~... .......... I Height ......... ]..~. ...... Number of Stories ........................................... · ......... ;.; ............................................................... 9: Size of lot: Front .................... !.~ ...... .~...c...y~....~. ........ Rear .......................................... Depth: ....... ~ ....................... 10. Date of Purchase ..................~...J..?..~ .......................... Name of Former Owner .;..*..l~J.,.C...~.J:l.f~. ........................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ~.t~ ................. : .......................... 13. Will lot be regraded ...... .~f/~.X ......... :.. Will excess fill be removed from premises: ( ) Yes ()(,) No 14. Name of Owner of premises .~L~ ' Address o N dc No. Name of Architect .............................................................. Address ............................. ,. Phone No ....................... Name of Contractor.. ........................................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate c early and distinct y al' bu~ d~ngs, Whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according' to deed, and show strect name~ and indicate whether interior or camel at. ' 1 / / / / / . / STATE OF NEW ¥OPd(. COUNTY OF~.....~'a'=' ................... ~ ...................~...-~... .......................... ' g duly sworn, deposes and says that he is the applicant (Name of individual signing ~ntract0 above named; He is the ............................ .¢.....~.....'f.....~.....~.. ............................................................................................................................. (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 all statements contained Jn 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. Swam to before me this ........ day of ..... ............ , Notary Public, . .............................. (Signature of applicant) NO?ARY PUBLIC, Sta~e of New York No, S2-4S22~26 ' Suffolk Count~ FORM NO. 6 TOWN OF SOUTHOLD . Building Depar'~men~ Town Hell ,~P,,- C~i O~, FOR CERTIF~CATE OF OCCUPANCY Instructions This rppHcat~on mus~ be filled in ~yp~,¢rk~r OR ink, ~nd sub~i~ed in duplicate ~o the Building lnso~ tor,.vi:h [ne foHo,,vjn¢; for new buS,dings or new usa: 1. Final sup/ey o¢ prcperW wi;h accurate toc~don o[ afl buildings, proper~y lines, s~ree[s, and unu% 2. Fin~ 8a~rovai o[ He~h Dept. of wa~er supply and sev/era~e disposal--(S-9 form or equal). 3. ACprovai of electrical installation from Bo~d of F~re Unden.vrk~rs. 4. Commercial ' '~ ' . *-N' guhdm~s, Indus,,:~ buiid]ngs, Multiple Residences and s~miiar buildings and ~ns~aF tions, a cerdf[c~ of Code compHanc~ from ~he Architec~ or Engineer responsible for ~he buHd~n 5.2ubmkPlanninegosrdaoprovalofcomple[ed '-: ' ~ - s~,~ plan requirements whet8 applicable. Fcr ex~sdng buildings (prior ~o April 1957), Non-conforming uses, or buildings a~d pre-ex[sUns 1. Accurate ~¢~ey of p~o~er~,/ show'ha all properly H~es, %r~e~s, buildings and unusual natural c ~opmgr~phic features. - 2. Sworn s(a~ement of o',vnet or previous owner a~ to usa, occuoanc,t and condition of buildings. 3. Date of ~n,t hcus~ng code or s~fety ~nspacdon of buiid~ncs or premises, or other partJnem inform: don required to prepare a ce~fic3;= / ' ' ' 1. C~mif~cate of occupsncy S5,00 2. Cardfics:a of oc,u~,n~, on 2ra-exis:in~ d',vellin~ or land usa 3 Ccsyof ~-*:~ --~ - - SS.C0 - c ......c¢,_ of occupancy SI.C0 ............ r .... s, ,,~ ~u~ cmgL.;) .. ....... : /Vacant Lend Loc~don of O,ooer.,. /,-~/,r' J~ v-~.., ¢:, v' f t~-~.~ '": ....... Ho, ,Vo. ' ....... ................... ,-.. ....... Owner or Owners of Prop,rty ~-~.~ ~ ~ ' i~OC County Tax Mao No..1000 Section . ~ 6~ ~'*-k O~N . Sub=k, is~on ~ ............................ LOt... ................................. Filed Map No. -.: ....... Lot No. . Perm[[ No ........... Date of °=,mit ......... A~I-___..... %1 ................ Hea/th Dept. Approval ~ ' .................... Labor DepL Approval ...................... ,.. Request for Temporary Certificate · .................... Final Certificate ........ - ......... Fee Submitted S ........... Cans~rucdon on above described ' r; '~,, )~ h,L , 3nd permiFmeets all aool~cab~odes and regulations. ....-..~.~ ....... ~ / ............. 'G .............. I;~ORM NO. 6 TOWH OF $OUTHOLD Building Delm~tment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR GERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OP, 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 19§7), Non-canto[ming 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: l. Certificate of occupancy SE,.00 2. Certificate of occupancy on pre-existing dwelling or land use $.5.00 3. Copy of certificate of occupancy ~ew Building ................ Additi ................ Old or Pre-existing Budd~ ~ ............. Vacant land .............. Location Of Property .................. !....~,.. r-. ', ............ Owner Or Owners Of Property ....... ..~!.~./. ........ Subd vis an ................................................................ 'at ............. Date ....................... ~ ........................ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ .equest For Temt C f,oate ........................................ F,n Cert,f,ca.e ............ .................... Fee Submitted $ ..... ~..t. ........................ Construction on above described building and permit mee~codes and regulations. App cant Sworn to before me this ................ day of ............................................ Notory Public .................................... County (stamp or reel) FORM NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLIGATION FOR CERTIFIC:ATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DLIPLICATE 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 $1.00 Date .. .~. ../.. /.' ./.......~...~..p.....]...~..?....~. ...... New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ....... ........ .,~'.~....~...~./..~.....c~...,~..'~.~..~.~..~?.~..~.../.~.t..~...: .............. Owner Or Owners Of Property ................. ~.6~../~..~....~... ....... ~.C~...~.....~... ............................................... Subdivision ............................................ '~' .............. Lot No ............. Block bio ............. House No ............. Permit No..~7...'//~.~....~-.... Date Of PermitZ~..g.?.~..Applicant ..~,~.;.~...~.....~....~...~.~...~... ................... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval ...................... : ....................... Planning Board Approval ......... ~ .................. Request For Temporary Certificate ....................................... FinoJ Certificate Construction on above described building and permit m~e codes and regulations. Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seol) THE NEW YORK BOARD OF FIRE UNDERWRITERS ]-00].07]. BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 =0, N 590544 THIS CE~IFIES THAT ~. ~tt, ~ A~, ~8, ~ N.Y. (~) w~exami~don J~ ~7~ ~ a~foundwbeincompllancewiththerequirementsofth~B~. fiXTURE OUTLETS DRYERS AMT. K.W. ~ ] ~J FIXTURES ,~TRANG?W. FURNACE MOTORS FUTURE APPMANCE FEEDERS SPECIAL COO~K~!NGD~.ECw~$ ,Mt0VEN~.L. Dl~tSH W,AK.SHw!$ OTHER Pa=e~: 1-7exit. ,125~. 1-1.~v. hot w~l~r heater. EXHAUST FANS DM~MERS R V I C E A.W.O. NO. OF HI-LEG A.W. Gl ~l OF NEUT~AL~ A.W.G. G&~I~l~c 11~?1 L.tc~l~78 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be redentials. COPY IK)R BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY