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Home My WebLink About7090-zTOWN OF SOUTHOLD BUN,DING DEPAR'I~tr. NT Town Clerk's O~ice $outhold, N. Y. Certificate Of Occupancy No.. Z~920 ..... Date ..............~a~.. THIS CERTIFIES that the building located at .. c~e~al~ .B<)ad ............ Street Map No.~x .......... Block No. xx .......Lot No. ,xX...F~tt$~llek.. ~][, ........ conforms subst~ti~y to ~e Ap~cafion for B~ng Pemit h~eWfore ffl~ ~ ~ office dat~ ........... ~eb.. ~.., 19.~. p~su~t W whi~ B~g Pe~it No. 7.~.. dat~ ........... Feb.. '2~.-., 19.~., was ~u~, ~d co,ores men~ of the applicable pro~io~ of ~e law. ~e occup~cy for wM~ issu~ ~ .... PzA~ .~ .f~. ~!l~g..vi~ .ad~ltl~ ................. ~e ce~ificate ~ ~u~ W ...J~ .~~ .... ~e~. ........................ (o~er, lessee or ten,t) of ~e ~ores~d b~d~g. S~o~ Co~ty Dep~ment of He~ Approv~ ...... ~.B, ......................... UNDER~I~RS CERT~ICA~ No..~ ................................... HOUSE NU~ER ...%0~ ....... S~et ... ~ege~ .~ ......................... B~ding ~r FO~IM NO. ~ 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) N.o 709O Z Permission is hereby granted to: .'ohn l~tht~o~kt ..~.,~ ~r,....39,~ ................................................ ..... liat. t~mek....~..Z. ....................................... to ~a~d an addition on ®xto~l~g ~,v~ll~ at premises located at ....... ~.{~ltgD,..~, .......................................................................................... Natt~tuek N,Yo pursuant to application dated ...................... .F..IR~. ......... ~[~ ............ , 19..~'f....., and approved by the Building Fee ~.~.9...(~... ............. u rang nspec~orI FOKM NO. $ TOWN OF $OUTHOLD Building Depmtment 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 end 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 Si.00 New Building ................ Addition ..... ~f ......... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ........... .0.?...e..~...o..n.....~..o.?..cl;.~.....H.~.~.t,..~..~..u...c..~.. ..................................................................... Owner Or Owners Of Property ....~.o...h..n.....~..u...C..b.~..n..o...s..k..z.'. ............................................................................... Subdivision ..... ~ ................................................... Lot No. ~;~3;.... Block No ............. House No...~.2...2.,0.. Permit No..?.09D..~ ..... Date Of Permit ..2/2,~..,Z.7.4..Applicant -.-Jo~n..~u.~b~:~as.Y,i. ........................... Health Dept. Approval ....... .~...'..~...'. ........................... Labor Dept. Approval ...... .~...'..~...'. ................................ Underwriters Approval .... l~..e.~..c]:..J:.~.g. ......................... Planning Board Approval ..... .~.'..~..'. ......................... Request For Temporary Certificate ........................................ Final Certificate ........ ~ ........................... Fee Submitted $ ......+...(~ .................... Construction on above described building ~and permit meets all .o.~!le codes ~1. regulations. Sworn to before me this ......... .2...~... day of ....... .}~'[.~.Ir......1.~..~..~. ............... (stamp or seal) Notary Public .................................... County FORM NO. 6 TOWN OF SOUTHOLD Buildiug Depar~ment 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, anci 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 o certificate. C. Fees: 1. Certificate of occupancy $§.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ............. .~.~,~... ~], ~...~, g.?...4 ...... New Building ................ Addition .....X.. ......... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property Oregon i~o&dt Ma%t:[%uck Owner Or Owners Of Property ...~.?..~.~...~..~..~..~...~.~.~...I...1~... ................................................................................ Subdivision .....~ .................................................... Lot No. Z-~¢~.... Block No ............. House No..~[2~.O. Permit No. '/..I~I~I.(L~. ...... Date Of Permit .2/~l~.'~.~...Applicant ..~ol~n..~/,~r, htl. t~o~lr~ ............................ Health Dept. Approval ............................................ Labor Dept. Approval ..... ~.e.~.t ................................. ,~ f- ' . ~; .ii · Underwriters Approval .... ~[:..~.~[~...../..~: ......................... Plann,ng Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ........ ::::,: ........................... Fee Submitted $ ..... .~,,00 ..................... Construction on above described building and I~rmj4~ meet$~l ap~jllc~ble codes a~'d regulations. Applicant ..//...%~. ................................................. ~ ............................................ Sworn to before me this ........ ..~..1.... day of ...... .~.......~.~..~/. ................ (stamp or seal) Notary Public .................................... County THE NEW YORK BOARD OF UNDERWRITERS I~ BUREAU OF' ELECTRIcfl"Y ES JOHN STREET, NEW YORK, ~w'YORK ~0038 THIg CE~IFIES THAT doRfl ~uth~nosk~, s/mX~ O~n Rd.j 1500' w/o ~v~*n L~om Nattit uok, L.I. in the/oiling ~ation; ~ B~ement ~ Ist FI. ~ 2~ FI. 0 B2B ~ de ~tion Bilk ~...~i~ o. Aught ~. 19 7~ ~d you~ ~ be in com~ia~e with the r~ulreme.~ of thh ~. DRYERS I mwNAa~ ~TORS SERVICE DISCONNECT NO. OF ' ~.,,T. ,,.~P. r~, ~q-'~m. ~.e'2w ~..3w 3.'~ 3]~w ~. ~C~CO.D. OF CC. COH~. I 150 CB x 1/0 OTHER ~A~TUS: EXHAUST FANS DIMMERS l/0 Per~'~ COPY FOR BUILDING DEPARTM~T. ~IS COPY OF CERTIFI~T~ MU~ NOT BE ALTER~ IN ~ ~N~ TOWN OF SOUTHOLD BUlL.DING DEPARTMNNT TOWN ci.r~.K~$ OFFICE ~O~JTHOLD, N. Y. Application No ...........&.. ................. Disapproved a/c ...... ~..._..~ ........ ~. ~ (Building Inspector) APPLICATION FOR BUILDING PERMIT ~ Date ............. ~.tt~..... 2.11. ................. , 19...2.~. ..... INSTRUCTIONS ~ a. This application must be completely filled in by typewriter ac, in ink and submitted in triplicate to the Buildin~ 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 adjoin ng prem ses or pub c streets or areas, and giving a detailed description of layout ofpraperty must be drawn 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 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 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, Ordinances or .RFhegeeUlati.0ns, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. 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 inspections. t,/ (Signature of applicant, or name, if a corporation) ....... ....... . tlt eJ ............................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................................. .............................................................................................. Name of owner of premises ...~..e..h.~..~ll,.~;~RggK.~, ...................................................................... If applicant is a corporate, signature of duly authorized officer. /~ ~v,~ '1'~ f~ ar'T, T~- ~ (Name and title of corporate officer) /uoo - c~ ~ _ "~ _ c~ Builder's Liceqse No ..................................................... ~~---~-~"--- ~ ~_ · ~ P umber's License No ..................................... .../ U~~ ~ ~ 1. Location of land on which proposed work will be done. /v% ) No.: '..~'......:~........~... .............Lot No...::~. ................. Street and Number ....... .l~.~.gg~..,~,f~J~4 ......... ,~[a.~;:l;,Lt i~k....N,,T. ................................................................... Municipality 2. State existing use and occupancy of premises and intende, use and occupancy of proposed construction: a. Exisiting use and occupancy dve[l:Lttg b. Intended use and occupancy ....~.~I, eL..1R;L~L.J~..~,I:[cl.~,.t~[10~ ......................................................................... 3. Nature of work (check which applicable): New Building .................. Addition .......~... Alteration .................. Repair .................. Removal .................. Demolition ................ ;... Other Work ................................................... (Description) 4. Estimated Cost ........... ~.~....(~...0...+,~ ............................... Fee ...~.~0~ ........................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... .1. ................ 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, Jf 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 ....... .~...L~ .................... Rear ..... .1.8 .................. Depth~.l.-..8/.~.8. ....... Height .................... Number of Stories ....e...~... ............................................................................................................ Size of lot: Front ........................................................ Rear .......................................... Depth ................................ Date of Purchase ........................................................ Name of Former Owner ........................................................ Zone or use district in which premises are situated ...~.?...l~L~t ................................................................................ Does proposed construction violate any zoning law, ordinance or regulation: .......... ~,~1 ......................................... Will lot be regraded ....~. .................. Will excess fill be removed from premises: ( ) Yes ( ) No Name of Owner of premises Johll [~tth:~l:tOWSk:l. A --- ~[attitaek .................................................... cid ................................... Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor same 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 corner lot. 10. 11. 13. tOO' STATE OF NEW~. Icc COUNTY OF .....~...~...~.~....~.. ............ .......... ; ................ ~1}~..~I1.tl3__4~11~..] ............................ being duly sworn, deposes and says that he is the opplicanl (Name of individual signing contra¢O above named. He is the .......................................... ~.e...~..-...~.~.~.e.~. ..................................................................................................... (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 in this oppliqation are true to the best of his knowledge and belief; and tha~ the work will be.performed in the manner set forth in the application filed therewith. this ~..1... ~ayme o.f 19..~..~... ~ /~ ~ ~, /Swomtobefore ................. · ........ i ........... , r Notary Public~.~~o~nty ...... .~.~......~..~ ...................... (Signature of applicant) JUDITH T. BOKEN Notary Public, State of New Yodt No. 52-0344963 Suffolk Count~~'' Commission Expire~ March 30, 19.~