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Home My WebLink About7502-zTOWN OF SOUTHOLD BUff.DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificete Of Occupancy THIS CERTIFIES that the building located at . ltoun~ .Are ....... ......... Street Map No. l~ecc~La. ~aaW~k No ........... Lot No .... t? .... P. ee~n~.c~. I~,Y, .... conforms substantially to the Application for Building Permit heretofore ~fled in this office dated ............~a¥...-~.., 19.71+. pursuant to which Building Pe .rmit No..?~)p~. dated .........Aug.. 27 ....., 1971~.., was issued, and conforms to all of the require- ments of the applicable provisions Of the law. The occupancy for which th~s certificate is issued is .. Pr~Lvat;~ .one..£~L~.~-. ~l~.e],~ ~ug..~Lth .a44~t.t.~o~...(&l~p.r. qye.~ .b~,~ .~. The certificate is issued to .h'~lL~a~. J...ilkalttz ..... .bwne~ ........................ (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval 1~ eR, ................................ UNDERWRITERS CERTIFICATE No. · .~.187~0 .... ~ 0~t.. ~0.. $9.~ ............. HOUSE NUMBER ...~ 1 ~ ........ Street ... ~oung..Ave ............................ Building Inspector' FOR, M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7502 Z Permission is hereby granted to: . ~;t,..l,.~ ,.,,T.... ,.J, JJlm,,~.t,,n ................................... ................ ILSmlJLta ....... Ii,Z,, .............................. ot premises located at ...~.~.~....~. ....... ~.~IIlI~L~..~O~.II.I ................................................................. ................................................. 3.1.~.....~..A.~e .............. ~.,aaed~... ........................................... pursuant to application dated .......................~ ....... ~ ................ , 19.~'.., and apProved by the Building Inspector. Fee $..1.1.~.*.~. .......... TOWN OF SOUTHOLD ~/,?/~-~ BUILDING DEPARTMENT '~"//~ - TOWN CLERK'S OFFICE ~r~"--"~--'--~/~/'~~-O' SOUTHOLD, N. Y. D ~pproved a/c''.~ ..................................... ' .................................... Date~. ~ INSTRU~I~S a. This application m~t be completely fill~ in by ~ewHter ~ in i~ a~ s~miff~ in triplicate to ~e Buildi~ Inspector, with 3 ~ts of pl~s, accurate pl~ plan ~ ~ale. F~ acceding to ~h~ule. b. Plot plan shying l~ation of lot and of buildings ~ premises relationship to adjoining prem ~s or public streets o~ areas, and givi~ a detailed de~rJption of I~out ofpr~e~ must be drawn on the d agrqm wh ch s ~ of this applicati~.~ c. ~e work covered by this application may n~ be comme~ed before issuance of Building Permit. d. Upon appr~al of this application, ~e Building Insurer will issue a Building Permit to the applicant· Such permit shall be kept on the premises available for insp~tion thr~gh~t the work. ' e. No building shall be ~cupi~ or u~d in whole or in pa~ for any pu~ose whoever until a Ce~ifica~ of ~cu~ncy shall have been granted ~ t~ Building In~tor. APPLI~TION IS HEREBY ~DE to the Building De~ment for the i~uance of a Building Permit pumuant to the Building Z~e Ordinance of the Town of ~uthold, Suffolk Count, New York, and other applicable La~, O~inanc~ or Regul~ions, for the co~tru~ion of buildings, a~itions or alterations, or for removal or demoliti~, as heroin descri~. ~e applicant ogres to comply with all applicable I~s, ordinances, building c~, h~sJ~ c~e, a~ ~Ulati~s, and ~ admit authorized insp~tom ~ premiss and in ~lldings ~r ~es~w i~tions. '~ ~ (Address of applicant) State whether applicant is o~wner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... .~ ~r~ ~- If applicant is a corporate, signature of duly authorized officer· (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will bedone. Map No.: ..... /, .~..~... ....................... Lot No.. ,/,,Z. ............. Street and Number ~,2~.~....~. ~...~.~.~. ~.~..~..~....~...~.~..CO,~./.'C, -~/~j~..~-.~.~ Municipality 2. 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 ~--~,~'~.~. ~.....~~i~ '''~ ............. ................... .................. V Repair .................. Removal .................. Demo ition...:.,..L,...,.. Other Work ...................................................... (Description) o o ,, Fee 4. Estimated Cost ...,-.. .......................................................................... (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 ........ .~.7. .............. Rear ......... ~.Z. ................. Depth ......~.,.~. ........ Height .....~.l~.~. ......... L. Number of Stories ...J.. .......................................................................................................... Dimensions of some structure with alterations or additions: Front .......... ~..7.../. .................. Rear ........ ~....~..'. ...... : ..... Depth ........ .(.~.. .................. Height ......... /~..: ............ Number of Stories ........ / ...................... 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ 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 promises are situated ....... ~.1'.~ ................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will 10t be recjraded' .....~.~2 .......; ....... Will excess fill be removed from pr.ernLsqs: ( ) Yes C~ No 14. Name of Owner of premises ..~/~'..~....~ ..... Add re~/.~.~',~ad.~,.~..~..~.-.[ ..'?~Phone No... g.Y~..-'..~'..9'. ~..,'~ 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 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 contracf) " above named. 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 end file this application; that oil statements ~cantoined in this application are true to the best of his knowledge aria belief; and that the work will be performed in the manner set forth in the application filed therewith. .S..w,.o...m.~r.; dmaeytho~S?..7~..~L..~....,19''~'/~' ~,,/~ ~- ~-. ~ ~, ,~ ..... ~' JUDITH T. BOKEN (Signature of applicant) FORM ~qO. 6 TOWN OF SOUTHOLD 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 New Building ..... !.~ ......... Addition ......... ;~... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .,~.../....~. ....... ;~...(,,J..¢(.~..~./..~ ........ Owner Or Owners Of Property J:'~ z'~. '~.. ~ Subdivision ................................................................ Lot No. Z/..7.... Block No......~...... House No..~..-./...5...-~ Permit No. ,Z....~...~....~.....~.. Date Of Permit ~./..~.7/..~..~.Applicant ~./~,'./~...~//../..~ .~....~...~.....~..,....~.....~.....~../.~./.~. Health Dept. Approval ....... ~J........~.. ........... Labor Dept. Approval .................~.....l..~... ....... Underwriters Approval .... ..~..../..~...7.....~,.....~...~..~ ......... Planning Board Approval .......... L.~....~... ................... Request For Temporary ~.~ficate ........................................ Final Certificate .......... ~ ................... Fee Submitted $ ...~......~. ................... Construction on above described building ~p. ermit meets a(~t ap,~c~ab~.~ ~,~cc~_ regulations. Sworn to before me this ~ ~ ~/~ THE NEW YORK BOARD OF FIRE UNDERWRITERS lin BUREAU OF ELECTRIC(TY ; · [-- 85 JOHN STREET, NEW YORK, NEW Y~RK 1OO]38 THIS CE~IPIES THAT ~ ~.~o. October 7,197~ a~f°undt°beln~m~i~ewitht~r~ui~men~ofth~rd. RXTU~ RXTURE$ ~ bVENS ~ W~IR$ EXHAUST FANS DRYER~ FURNACE MOTORS FUTURE APFUANCE FE~DERS TI/~ CLOCK~ MULTI-OUR-"T DIMMERS SYSTEMS NO, OF I~ET SERVICE DISCONNECT OTHER AI~ARATU~ 3/0 Eleo. Heatel-a ] 2-1.5kw, 3-1.25k~, ~-1.0k~, 2-. 7 ~kw, 1-. ~kw B.J. EleG, CO. 5tillwate~ Ave. CutohoKue.N.Y.L.Z. 11 Per COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIF!C~.TE MUST HQ1'_ BE A~.~_~Rm .m ANY MA~NER. '' 1'7'