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Home My WebLink About7092-zFO~,M NO. 4 TOWN OF SOUTHOLD BUT[,BING DEPARTM~,NT Town Clerk's Of[ice Southold, N. Y. Certificate Of Occupancy No..~.6.203 ...... Date ............. Nov .... 20 ..... ,197.1+.. THIS CERTIFIES that the building located at E/~ .Nassau. P. oin*-. J~d ..... Street Map No. Eas~ .Pt ....Block No ...........Lot No. ~.~ .... gmtchogu~ ................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ Feb ..... 2~ !9 .?1~. pursuant to which Building Permit No. dated .........F.~b.. 26 ..... , 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 i.~ .Aacassory..but I in~ .wltll .&dditi~. &. alt,~r.a%io~, ................. The certificate is issued to Alfrad. Blaikia .... flwner ............................ (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Heslth Approval .... N..Ro ........................... UNDERWRITERS CERTIFICATE No..Pend.i~g ................................... HOUSE NUMBER ...692~. ...... Street .. NAssal~ .P. olr~t .RO~ ................... Building Inspector lrO~l NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7092 Z Permission is hereby granted to: i~m./ ~et~ea~e~. ................... A/.e...L~. J3ASJr~ ............. ...... gmt~hot~a .................................................... at premises located at ~l~.t,..~....~&ll~tt.~l~A~t,..~.~ ............................................................... ............................. ~./..s....~.q,.s..e.u ~otnt ~..cm.~l ~.t;~.h~m . pursuant to application dated .... ; .................... ~'J~ ......... ~ ......... , 19J~.k.., and approved by the Building Inspector. FOP,~ NO, 6 TOWN OF $OUTHOLD 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 Date ~ /~ 19~/ New Building ................ Addition ................ Old or Pre-existing Building ..... .~.....i Vacant Land .............. Location Of Property ~.~..~...~.~.-s~..4.~.~.~.~..~...~.~Z..~...~.~...~...~.~...~..~.6.~...~..~?(~.~.~.~..~.~.~.~ ................. Owner Or Owners Of Property ..~.~ ~..~-...~.:?...../..~_ ~-/¢ / ~ M ,~-~ ~o,'~ ......................................................................................... Subdivision ......... .~C...~.~. .......... ./........~...~....../...~....... Lot No...~./.. Block No ............. House No ............. Permit No....?.6,~...~....~?.. Date Of Permit ..~.~..~..~i...~.Applicant ...... ..~...~...~...~.......~.../....~.~.~./5.~.~ ........ Health Dept. Approval ............... ~ .................... Labor Dept. Approval ............... .../k/.Z./~.. ...................... Underwriters Approval ............................................. PIonning Boord Approval ........................................ Request For Temporary Certificate ........................................ Finol Certifi¢ote .......... ~i .................... Fee Submitted $ ~ ~ ¥~ ~ z~t~ ~ ~ FO~M NO. I /~z~! ~ /~ TOWN OF SOUTHOLD' ' TOWN CLERKS OFFICE ~ - ~ . .~ ~ /. SOUTHOLD N.Y. ' c~*,~,~-c-. ~ · ? .............................. ~_, pp 'cation No ................................. Approved ....... :~ ......... :.t. ................... , 19.7..~.. Pemit No..?.....~...?...~....?......' ........... .5,,,,,~ Disapproved a/c ........................................... i ......... .................... '~Build~ ............. APPLICATION FOR BUILDING PERMIT ...... Date ........... , ...... ~...~1~/ INSTRUCTIONS a, This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with~ 3 sets 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 adjoining premises or public streets or areas, an~R, giving a detailed description of layout of property must be drawn on 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 bee~;~ 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 ,._.,A'Signature of applicant, or name, if a corporation) (Address of applicant} State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................ .......................................................................................................................... .......................... Name of owner of premises .... ,,.:. ................................................................................................................................ if applicant is a corporate, signature of duly authorized officer. · .............. .................. ....... .... n /'r~d t '-~ ... 1. Loeetion of land on which propo~:l work will tl~do e. Map No.: ~ .~... Lo No ~...,...: MunJcipeliW ; 2. State existing use and occupancy of premises and intended use and oc~pancy of proposed construction: a. Existing use and occupancy ........ .~'....~....~..~-.~.'...~...."~.........~.~...~..!.~/...~.~'~ ' .............................................................. b. Intended use and occupancy ...... A..~.~.~....~..?.~...~ ......... ~....u../...~..~./..~..S ................................................... ...' ......... ':. ~3., -~jatUre of work (check which applicable): New Building ....................... Addition. .......... Repair ................. Removal ......................... Demolition ........................ Other Work ............................. a ..... ........ , (Description) 4. Estimated Cost '. ...... ~.....p ............................... ~ee ............ z ................................................................................... (to be paid on filing this application) 5. If dl~ifl~,'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 eachtypa of use .................................... 7. Dimansions of existing struc'tl~r~s, if any: Front ..... Z~.. ......... Rear .....::.'/.~.. ............ Del~th ........ ..~.. ...................... He,ght ....................... /.. ................................. Number of Stories .................. /.. ........................................................ Dimensions of same structure with alterations or ~ld~tions Front ..... . .~.....(~.. ........... Rear ......... ,~....o.. ........................ Depth ............. ~ ........................... Height ............. ~ ......................... Number of Stories ....... ~. .............................. 8. Dimensions of entire new construction: Front .......~....o.. ......... Rear ....... ....~....o.. ............ Depth ...... ~..~. ................... / .~ / Height ................. ./../.. .......................... Number of Stories ........................................................... '1 ............................ 9. Size of lot: Front ...................................... Rear Height Number of Stories ........................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ , ~ ,.~.?....: ........................................................ 11. Zone or use district in which premises are situated ...:~ .......... .~.. .......... / 12. Does proposed constructionviolate any zoning law, ordinance or regulation: ......... .~......o. ........ ':~:' ............ 14. Name of Owner of premises ~,~'~,e,~ ~'~/.ffrg~. ......................................................................... ......................................{Address) (Phone No.) --p.. ............ ...... Name of Architect ................................................ ~'- ' - " 'Ph No ~Address) ~ one Name of Contractor ...................... .~.~2~/...~. ............................................................................................................... (Address) (Phone No.) PLOT DIAGRAM ~l~_ocate clearly and d_i~tinctly,{l~I buildings, whether existing or proposed, and indicate all set-back dimensions.from property lines. Give street and bl'ock nui~ber or description according to deed, and show street names and Indicate when- er interior or corner lot. I -t ' / ~ATE O E O~K, ) ~ ~0 * COUNTY ~/...,.~....~.......~ ................... ) .......... ~.~ .......................... ~in~ duly ~n, ~* l~d ~ ~t t . [Na~ of tnd~ ~ ~n~O " ' ' He ' *~- ~ of ~id owner or owner&, and is ~ly ~thorized to ~m~or h~ ~rfor~ t~ ~Wo~ ~ to ~e ~n~ ~n~ m ~i~ a~t~.~ ~ ~ h~s k~e~ ~ ~l~f,. ~ that ~ ~oo II