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Home My WebLink About8610-zFORM TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's O~ice Southold, N. Y. Certi~icnte O~ Occupnncy No. g.~J:6.8 ....... Date ............ AUg ..... 9 ...... , 19. THIS CERTIFIES that the building located at .. ,Bay.shore..Bloacl ......... Street Ba Est Map No. 4~?.*...P.e.c. qn. ~loek ~o ........... Lot No...L~. ~...(~l'~t~0r.t.....N.,::(: ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... May.... 25. ,, 19.76. pursuant to which Building Permit No..8.5.1.0.g.. dated ............ t)~.ay... ~.6..., 19. ?.6., 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 . .P~.i.v.~.tg..9.n.e..f,a..~y.. ,dv.e.1..1.t.n.g ....................................... The certificate is issued to ,~..~..e.~ .t~ ~.h.e..1.by, ....................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~.~Y..~..1...].97.6....by..R. ;..V~.~.~ .a ..... UNDERWRITERS CERTIFICATE No.. .p.e.n.d..[.~.g. ................................ HOUSE NUMBER ..... .6.Q~. .....Street . .~.~..s.hp,~.e., .Rp.a.d' ......................... FOI~M NO. 2 TOWN OF $OUT~OLD BUILDING~ DEPARTJ~ENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 8610 Z Permission is hereby granted t°:, 'r ..... ~ ~ ................. ~,~.~i~,,~ ......................................... pursuant to applicohon dated ......... ;., ................... ...:.,. ,..,. ....... ~,: .~,: :.~rgved by, the Uuilding Insl:)ector_ ' - ~ :. ' ' , ' ' Fee ' Budding InsPector~ ~ [ r FOEM NO, ~ TOWN OF $OUTHOLD , Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Insfrucflons 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: h Final survey of property with accurate location of oil buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage dispasal--(S-0 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installatlons, a certificate of Code compJiance 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 ail 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 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 D te ..... ......... New Building ...X..~.X.. ....... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..... Greenport Owner Or Owners Of Property ..~.~.D...e..q.t......~.:,...S...~..e..~.b.~ .............................................................................. Subdivision ................................................................ Lot No...~....D.....SBlock No ............. House No ............. Permit No...8..6..~.0.....Z. ..... Date Of Permit ..6../,?,.~./.,Z,6.,..Applicant ..~..~.~..a:.~..d....~...°..m,.?.~.t...Z...~..c..: ....................... Health Dept. Approval ..../'/~(~././../.,.~.. .................. Lobor Dept. Approvo, .... .N.../..r. ..................................... Request For Temporary Certificate ........................................ Final Certificate ....y...e..s......~., ...................... Fee Submitted $ .5..:..0..0.. .......................... Construction on above described building and permit meet~es~ns. Applicant .............................. ~..~~ INLAND HC~4~S, INC. Sworn to. before m.~ /~' ~z/thi~ ~ __ ........... ..... Nato, Pubhc Coun~ ____ o.'i BUREAU OF ELECTRICITY 85 JOHN STREET NEW YORK, ~,EW YORK 10038 THIS CE~tFIES THAT ~y ~he e~c~rica~ equipme~ ~ ~sc~bed be~w ~ ~"c~ by z~ app~i~ ~med ~ z~ a~ app~ ~m~r in ~ p~mi~e" ~J ,, Earnest ~eZby, ~ay~o~e ~oad Ke~Zn ~Zv~. ~ Zs~an~ ~ew Lane, I CE MOTORS ~TURE APPUANCE ~EOERS ~SPEC AL REC'PT TIME CLOCKS ~tZ UNIT HEATERS I MUtT ~UT~T ~GRVICE DISCONNECT I I~0. OF I ' S E R V I E 1 -: / C Walter Finger Box 991 Mattituck, L.I. 11952 Lic 1845 GF.~ERAL This certificate must not be altered in any manner; return to the office of the Board if incorrect, Inspectors may be identified by t~eir c~,~ /: BUILDING DEPARTMEN_*r/~_~/~. ~ /~,d ~ ~/~ TOWN CLERK'S OFFICE ~**' 61¥~ ¢.~ ~ ~ ~ Examined .............. ~ , :~ ( Application N~!,,-~,,,,~,../.2 ................ TOWN OF SOUTHOLD APPLICATION FOR BUILDING PERMIT '~ ~ay 25 76 Date ................................................ , 19 ............ INSTRUCTIONS a. 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, 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 o~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this applico, ion. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this opp[icotlon, the Building Inspector Will issue o 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. IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the APPLICATION Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or 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 regulations, and to admit authorized inspectors on premises and in, buildings for necessary inspections. ...... ................................................ (Signature of applicant, or name, if a corporation) ~ ~.~i'cuck, N.Y. 11952 ...... ......................................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. General Contractor Name of owner of premises .....~..~...~.?...~.~....~-.t...-~-.,~-~.A.b..~.. ......................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... 517-P Plumber's License No ................................................. 273-E Electrician's License No ............................................. Other Trade's License No ............................................... ::o: ............................. .............. ..................................................................... ii:C .................... ........ State existing use and occupancy of premises and intended use and occupancy of proposed construction: Vacen"~ ' XXX - 3. ' Nature of work (check which applicable): New Building~. ................. Addition .................. Alteration ............... Repair .................. ' Removal .................. Demolitior ..................... Other Work ................................................ .._ ~ c ~-- (Description) 4. Estimated Cost $30,000.00 F ~...C.'}..~ (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, if 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 ....... ~8, ........................ Rear ........~P~ ................ Depth ....... 2,.~ ............. Height .................... Number of Stories ..................................................................................................................... 9, Size of lot: Front ............... .1..O..0.. .................................. Rear ...... ,1.0..Q ............................. Depth .......... ~.~.f) ............... 10. Date of Purchase ........................................................Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... [2. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regroded, ...... ¥,,e..s,. .............. Will excess fill be removed from premises: ( ) Yes ( ) No 14, Narne of Owner of premises ..~..z-..~...e..s...t...~:.:.....S..~..e...J:.b.~.. ........... Address ................................Phone No ....................... Name of Architect .............................................................. Address ................................Phone No ....................... Name of Contractor ...~.~...L'..A...N..D...,.~...O.,~.,~.S.~....~.C..:¥. ............ Address ....B..?..c...1.1..~!...N..a...l:..t. JP~fi~ No. .2:. .9. .8. .-..?.~6.?..6. .. . 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 STATE OF NEW YORK, COUNTY OF ................................ ............................................................................................ z....being duly sworn, deposes and says that he is the applicanl (Name of individual signing contract) above named. Fie 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 and file this application; that all stateraents contained in this application are true to the best of his knowledge and belief; and thor the work wilt be performed in the manner set forth in the application filed therewith. Sworn to bef,o, re me this ................. day of ......... , Notary Public,. .................. -~,,~'~:: ' ~'~u n~' ....... ,.~ ................. ~/~ 7//' , (Signature of applicant)