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Home My WebLink About7516-zl~O~t~ NO. 4 TOWN OF $OUTHOLD BUrl.DING DEPARTMENT Town Clerk'~ Office Southold, N. Y. Certificete Of Occupnncy No.Z.~.~. ....... Date ..........~ .3,..1~)7~...., 19 .... THIS CERTIFIES that the building located at..l~elt4tha].La .lt~a~d. ........ Street Map No..~l~ ........ Block No..xx ....... Lot No.. sr~r.. ~fatt&~t~ek...N,~., ....... conforms substantially to the Application for Building Permit heretofore filed in tl~i.~ office dated .............~.e~t.. ~, 19.~. pursuant to which Building Permit No...?~.~ dated ............Sept-3 ...., 19. ~t~, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is ~ issued is .Private..one. f. aK~l~..dl~2.Zl~g. ~tth. ~n .&dd~tioa .................. ~'~ T~ie certificate is issued to .RObe~.t. ~. 2arb~a .l/aaeke ..... .t~me~.l ................. of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant ) UNDERWRITERS CERTIFICATE No...~1~).~ ...... ]).ee.. ~... l~ ............ HOUSE NUMBER ..... ~8.~ .... Street .... ........ FORM' NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF 't'HE WORK AUTHORIZED) 7516 Z Date .......................... .S.?.~.~.....~. .............. 19....7~.... Permission is hereby granted to: ..... R~b~t...Ramok~ ..................... i ...................... ....Mat:t~t t~c~ .... 1~, X, ....................................... to ~.ulld. an .~d~t~m~..o~..ex~t:tu~.~l~ol]_tn~ ................................................................ at premises located at ...-~&tp~l~,:l,&..]~l~ ............................. ? ..................................................... .................................................. ..~..t.~$..t;.~ ....... ~.,~...: ....................................................................... pursuant to cpplicatJon dated .......................... ~.~ ...... .~ ....... ~.., 19~.~..., and approved by the Building Inspector. Fee $.$.~.~0 ........... Building Inspector APIfLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building~ Inspector, with 3 sets of plans, acc,,rate plat plan to ~ale. Fee according to schedule. ,b. , Pl~t plan showing lOCation of lot andof buildings on premises relationship to adjoining, prem ses or pub c streets or areas, and giving a detailed description of layout ofprpperty must be drown on the diagram which is part 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 iss,',e 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 Department 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, Ordtnancel m 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 laws, ordinances, building code, housing code, and rag~atlons, and to admit authorized inspectors on premises and in buildings for necessary inspections. Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. (Address of applicant) State whether applicant is owner, lessee, agent, a~_ hitect, engineer, general contractor, eleCtrician, plumber or builder. ......... T_ ............................................................................................................... Name Of owner of premises ...~(~.~,~..~.~. ...... ..~.......~/l~,,~l~ ........ ..'~..~.....~....~....,~,...~... .............................. If applicant is a corporate, signature of duly authorized officer. Other Tmde's License No ............................................... 1. Location of land on which proposed work will be done. Mop No.: ........................................ Lot No ......................... Street and Number ......... :....~.~'~.~.[::~,~.~...~.~:~.....L~.O.~). ........................ .~,~..~..-~...~.:'~....~..~,~1.~.:..%/. Municipality 2. 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 Repair .................. Removal .................. Demolition ...... ~ ............ Other Work ..... iption) 4. Estimated cost ..... [.~..~....~...i~ ................................. Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ .~ .................. Number of dwelling units on each floor ........ J. .................. 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 ........~.J ................ Rear ........ ..-7...J~ ................. Depth ..~ ........... Height ..I......~..?.1~,.~.... Number of Stories ....... J ........................ .~ ................... ~ ................................... ~ ....... .j ............. Dimensions of same structure with alterations or additions: Front; ....... ..'/..! ...................... Rear .......~....0. ................ Depth ....... ~(~../. .............. Height ..~....~'~.~. .......Number of Stories ........ ). ...................... 8. Dimensions of entire new construction: Front ........ ..O1..~. ..................... Rear ......... ..~...I. ............. Depth .....~...'~.../. ........... Height L..~.~.~.~l'~.~... Number of Stories ...I .......................................... : ............................................................ .· ......... 9. Size of lot: Front ............. L~..O.. .................................. Rear ...~?o.~ .............................. Depth ...~...~..~...:.'/..~.. ............ 10; Date of Purchase ....J~.~.....'....~ .~....~.~l~.Name of Former Owner .~.~.~.,...B.~?~.~.~',.~... ...... .~'-~.l~ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ._!~. ............................................... 13. Wi!l Iat be r. egraded ...... ..~.~'-~ ............ Will excess fill be removed frompremises: ( ) Yes (~) No 14. Name of Owner of premises .~c~.~......~,~ ............. Address .J~.~.~'.~.'~'~'~e.~.~:me No. '~..~.~..%~L~...~ N6me of Ar~:hitect ............ .~l...O...~...~.. .................................... Address ......... ~ ................... Phone No. ...................... Name of Contractor ........ .~....:.....~..~..~...~...~. .................... Address .....~...~.....'~...~' ............. Phone No.~....~.~'..-.~..~..'7 PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from propeYty lines. Give 'street and block number or description according to deed, and show street names and indicate whether interior or corner lot. sTATE OF NE'~-~:)~,~/,~ COUNTY ~.. ........ ...... ; .......... ~ ............................................................................... being duly sworn, d~oses and says t~t he is the applicanl (No~ of i~ividual signing c~tmc~ o~ve nam~. He is the ................................................................................................................................................................................. (Contractor, agent, co~orate officer, ~c.) of said owner or owners, and is duly aut~rized to perform or have .performed the said work and to ~ke and file this agp!i~etion;.t~t all statements contained in this application are tme to the best of his knowledge and belief; and tha~ the ~ork will ~ performed in the manner ~t fo~h in the application fil~ therewith. Swom~m me this ........................ ....................... FORM NO. 6 TOWN OF SOUTHOLD Building Department 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 II Date ..... I/....~-...~./.~....~.. ................... New Building ................ Addition ~/ Old or Pre-existing Building Vacant Land Location Of Property .......... J/~..~-_~..~.~.}j.~....~...~.~ ......... .~......~....~..~... .......................................................... Owner Or Owners Of Property ....... ~-~.......~.......~.....~....~..~.'~... ....... ..~..:~ ........... Subdivision ................................................................ Lot No ............. Block No ............. House No ........ ~.. Permit No..'~,~..[/~.~Date Of Permit ..~./..~.).~.~.Applicant ..... L"~. (~.~.~.. ....... ..?..~.~..~.. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .... ..~... .................................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ ~. Sworn to before me this · .~......~ ....... day of ~....!~.~.) APPR...OVED AS NOlrED~ ",IFY BUILDING DEPA~,TM~NT- L~ iNSPECTIONS: BEFORE BACKFILLING F~UN~A 'ION OR START FRAMING BEPOKE COVERING PIPELINE FINAL WHEN JOB COMPLETED THE NEW YORK BOARD OF FIRE UNDERWRITERS ~-- 1'11~ BUREAU OF ELECTRICITY ~ JOHN STREET. NEW YORK, NEW YORK 10038 oe~ ~aeke~ s/s Westphalla~Rd.~'~1~U~st~Pli~num~imt~P~m~es°f in the followi~ location; [] Baserat~t ~ Ist FI. ,~,~.~.-,i.~o. De~ember 19, 197#' 6 i 5 6 L~ 2nd FI. ,~ctian B/~wk /~ol and found to be in compliance e~ith th~ requirements ~f this Baard. DIMMERS S~I~VICE V C OTHER AI~AIIATUS: Elee. ~om Hea~;e~s: 1-1~0km. W.B. Rul and Ele err! clan Matt t~uck, L.I. This certiflcote must not be ~ D