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Home My WebLink About7141-zlpg'bUM NO* · TOWN OF SOUTHOLD BUll.DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No~7~l~? ....... Date ............Ali~t... l~..., 19~.. THIS CERTIFIES that the building located at ~1. of. irl~o~h®ai ~a ..... Street Map No..x~ ......... BlockNo. ~. ' .Lot No..z~..P~l~..ll,l~, ........... conforms substantially to the Appllcati& for Building Permit heretofore ~ed in r~ office dated .........K~. ,..~ ,~.., 19.~:. purs~t to which Building Penm't No, .~.¶I~IZ. · .. . .. ., 1 ., issued, and conforms to all of the require- me~ts of thy applicable pro,as~o/// f the law. The occupancy for which this cert~icate is The certificate is Issued to / p. Hoz't,O~ ...... 0mini,. ........................ / (owner, lessee or tenant) of the aforesaid building. Suffolk Coupty Departmen~ of Health Approval 1[,1[,. ~ .(ell;~t, tz~ .slrstelL ~ ........ UNDER~ITERS CERTIFICATE No..11.1~$98 ...... J~d,%. 31.. 1.9~ ........... INSTRUCTIONS a..This .a.,Pl~cat. ion ;m~st be comp!etel.y fil!ed in by ,t~pewriter or, in ink and submitted in triplicate to the Building inspector, w~,m~a set~ oi' plans, accurate plat plan to scale, tee accoedi~g to schedule. , b~ {~:~e~ showing Ioca'dd~'oftdt ~ri'cl~O~ bbildlngs on prem,~}s, rel~,tl~r~sh,p to a~f~o~n ng premises or public streets areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The.work covered by thLs application may not be com~r~.,nced bef~o.re iss~.a~.~ cOLf~BujLd~g Permit. , d,.,~i ~J,i~.e~ ..r~'al of t.h~j~appH, fc[t, ~,'011.,~? ~ilding I,nspec~,~r ~vill~ i~sL~e 'a~tBu~jC~rmi~ tqo the applicant. Such permit sna. De Kept on me premises ovauame mr inspection mrougnout the work. shalle' haveN° buildingbeen grantedshall bybe the°CCUpiedBuilding°r usedlnspector.Jn whole or in pa rt for any purpose whatever until a Certificate of Occupancy B .A,P, pLI_C~TIO~N ,IS HEREB. Y N~DE to the Buildir~l:)e~a~tment for the issuance of a Building Permit p~ant to the ui~aing ~one urainance at the Town of Southold, Suffolk Count, ~lq,~, ,Yozk- and Other nnnllenhla I ~m~,41 R I ' . .. ~r'.~tr~ ~-~,,~- -r~-..-.---.- ,,,,~,,~a TheegUapplicantat'°ns' fOragreesthe construct,Onto comply with°f bu,ldmgs,all add tons or alt~i~fJ~s, or ~or ramova or demolition, .~s'"~l~;i'n'~ described. laws, ord nantes, building code, housing code, and _r?g.u~lation$, grid to admit authorized ~_~'t,g~_s~n oremise~a _r~d ~,- k..:,~,--~ ~ ~, ................ (Sfnature o~dr~ ~F name, ~orporat,o~ State whether applicant is owner, essee, agent, arch tect, cna ne , ener~l co · ctor~t~l~t~ician umber r ..................................... ~.~.u.,.~.~.~. ...... .c,,.~.~.-T~..~.~.b.,....Li ........ ~.~.~.~I~... ............................................... i .:.- ame o* awDer o* premiss ....... :...2 ........................................................................ L.....i. If ,applicant is a corporate, si~anature of duly authorized officer. .... ....... . ~ {Name and title o1' corporate officer) Buildei.'s klC~'~ iN0 ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. M~ No.: ........................................ Lot No ......................... Street and N^umber ~/U~.~..~.~..~..~/dgt~..-.~.~.~:¢~/..~.~.~.~./m~..~.=~~e~m~`~. I~C.e ~ ~ ¢ N . ~'. Munlciparl~' State existing use and oCcupancy of premises and intended use and oCcupancy of proposed construction: a. Exisiting use and oCcupancy ..... ~....N..~w.....~..~.k~.tL,..¥.......~..~:...~...L..~.~..~.., ....................................................... b. Intended use and oCcupancy .................................................................... i ................... 3.~ Nature of work (check which applicable): New Building ...: .............. 'Addition .................. Alteration C......' ....... · Repair .................. Removal .................. Demolition...;....~ ........... Other Work · ~.~. O0 I~ ' ~T'-~....~.~ (Description) 4. Estimated Cost ....... ~ · · ·. FeeZ .... .............................................................. · (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, specifl/ nature and extent of each type of use ............................ 7. D~mens~ons of,ex~shng structures, if any: Front ...... ~.. .............Rear '~.~ ...................... Depth Height ..../...~.i .............. Number of Stories ...J. ...................................... = ................. .~.~ .......................... Dimensions of ~ame structure w th a terat OhS or add tions: Fron~ ....... ~...~. ........ Rear Depth ........~... ..................... Height ..~/ ..................... Num~l:~.r of Stories .../i ...................... 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number ,of Stories ............................................................................................ 9. Size of lot: Front ....... './~...0. ........................................ Rear ........ /~... .......................... Depth ~'~*'~" · ~ /~ J>'~ Name ........................................................ 10.'`Date of Purchase ..... ~: ................... .............................. of Former Owner 11. Zone or use district in which premises are situated ................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ...~/~. ............................................... 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes (~') No 14, Name of Owner of premises .~.~.LL.!.~...~.......~.~.~...-~.P....~/. ............ Addressl~/~t~/./~...O.:.~.t/...e*..~.i..c:.... Phone No..~.'~.~/...~.~..~.. Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor .~..~..~...,~..~.~ ..i~......~.o...~..~..J;.....~.,I~...C.:.... Address(~lj~f~.u..._.~p.~.'['...l:..~..?. Phone '~:~' PLOT DIAGRAM · ~?' Lo~te clearly and distinctly oil buildings, whether existing or proposed, and ndicate all set-back dimensions ~rom property lin~s. Give street and block number or description according to deed, and show street names and indicate whethej Intll~ or corner lot. m.,~,~/~_~_~ ~-'~' · . [ , . I ,.._ I STATE OF N.E~I~_Y~!~,~ ~ COUNTY ...................., , .................................. . .... *.~-,, ~ ,~"~ ,~""~'.~ .................. .... :-. ,,~.t be. ng duly. ,~ ~.~s~rn~,~d~_~,an~n~s~,~ that he is the a~licanl ., (Name ~f m~lVldUa} Slg~l~g c~trac~ obo~e' n~m~. ¥ He is the ................................................................................................................................................................................. (Contractore ggent, ~qrp~e ~fficE~ ~.) of said owner or owners, g~ is d~y authorize~ ~o perform o[ ~ave perfumed the said work and to ~ke ond file this application; that ~11 statements contained in th s opp cat on are tru~fo the best of his knowledge and belief; and fha~ the work will be performed in the manner set foHh in the ~pplicatio~ fi[~ therewith. Swam to before this ......... ~ota~ Public~...~....~~,.:~ ....... ~~....~~...~...X .............................. JUDITH T. BOKEN (Signature of app~ant) Nota~ Public, Stde of New York Ho. 52-0344963 SuffoJk Coun~ ~mmission ~xpbes March 30~ lrOB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEfARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7141 Z Permission is hereby granted to: ........... &ozzt~. ................................................. ~emodel & add to existing cottage (to Tear around home) at premises located at .~..,~,....,?.~..~.....A.?...P..o..~...h..e.,a.,~.....~.~.e. ...................................................................... ............................................... ~..~..c..o...q;L~. ....... ~....~.: ................................................................................ pursuant to application dated .......................... J,'..~,It ......... 2.{1 ........ , 19..~.~., and approved by the Building Inspector. F-- $.'..Z*.~ ............ Building Inspector 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, end submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: I. 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 .~)/.(Z...~..., ..../..~...~..~...~..~.. ........ / New Building ................ Addition ....'~.......... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ~J~.g~..~...~..~...~......~....~...~.......~...~.......~..4~..~. .............................................................. Owner Or Owners Of Property .~.J:'~..t.~J...~......~......~'~9..l~.-~.~..O..~'~ .................................................................... Subdivision .~./~.....L~..~/4~'~......C~.....u...~.. ................... Lot No ............. Block No ............. House No ............. No..~./..~.//.~.... Date Of Permit~.~,~,~...¥'.Applicant ~...~...~....~..~...~...~..~...~...~..~...~...~..~..~..: ............ Permit Health Dept. Approval ~t_Lc,..~ %.~Z~.. Labor Dept. Approval Underwriters Approval ................................ .~..:..~././..Planning Board Approval .... ~.;...'.:... ......................... Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ .....~'~'.~..~....~. ................... Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me this ........ /. dayof ..%.... (stomp or seal) THE NEW YORK BOARD OF FIRE UNDERWRITERS aW BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK ~0OSE THIS CE~IFIES THAT Ho~tons ~o~ Head La., Pe~onie, 1.l. ~ ,,,~i~ o, July 29, 197 ~ o.a/o.~ ~ be in complia~e with the r~ui~ments o/th~ B~rd. HXTURE RXTUR~ ~$S ~KING D~KS I OVENS DISH W~HE~ EX~UST FANS · ~ 3o 3 600 OTHER A~ARATUS: 1-qton AC unlt~ 1-lOa~ garbage eompacto~ ~-post lights COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE ~UST HOT BE ALTERED IN ANY MANNER. ~. 70' 39 ZO"W. -- ZO U J F- 5CALE~ 50'= I" surv~uad AcQus+ 6. VAN TUN/L % SON ~;~~ ..... // AFFF,..OVED AS NO'TED FEE:~~ NOTIFY BUiLDiNG DEPARTMENT hr