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Home My WebLink About8762-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z11640 Date ...... A$.r.$/J-..2.7. 1983 THIS CERTIFIES that the building alteration Location of Property 54280 Main Road Southold County Tax Map No. 1000 Section . .0 .6.1 ........ Block 04 .Lot 22 Subdivision... ~C ........................... Filed Map No....X ..... Lot Ho...X. .......... conforms substantially to the Application for Building Permit heretofore fried in this office dated ..... .~.u.l.X 28 8762 Z ............ 197. 6.. pursuant to which Building Permit No ...................... dated ..... ~..u.l.y..2..8 ............... 19.7..6, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... a retail store. The certificate is issued to THERESA FROHNHOEFFER ........... ...................... of the aforesaid building. Suffolk County Department of Health Approval n / r UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector ........... Rev. 1/81 FOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8762 Z Date ......................... ~T~t~,~: ....... ~ ..........19.~.. Permission is hereby granted to: ,T. Qs.,..E~.q~g~.I:£.~...~. ................................ ~ ............. ~4aJ~.~o~d,..Scmt~o~l, ....................... AExcavate cellar under existin~ old p,a~t o~' bu~.~..~.D~ .~..~ addition ..... ~..~ee-amt..f~l~...o~..e~et~g...b~m .iae s.s.. bu~.~.d..$ng .. ~...no..a~d~ti~mj~...m~le s area) at premises located at .R~/,q..t,,aJ~..~o~J ............................................................................................ ................................................... .$.~u,t,h.o.l~, ....... N,Y.,, ............. :;, ......................................................... pursuant to application dated .......................~TLL~.....:)~ ............. , 19'/~...., and approved by the Building Inspector. Fee ~.'.~...*....(~.. ............. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Ha~l Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and subr~itted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Final surYey 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 installa- tions, 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-conforrning uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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 informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Cop,/of certificate of occupancy $1.00 ot land New Building .. ,0.-~-~,0.~ Old or Pre-existing Building(X) ......... ~ 'Vacant Land ............ Hou~ No. Street Hamlet Subdivision ...... ~ .......................... Filed Map No .... ~ ...... Lot No... ~ ........ Health Dept. Approval ........................ Labor Dept, Approval ....... ~ ....... ,.. Unde~riters ~pproval ........................ Planning Board Approval .... ..~ ..... ~ ,., Request for Temporary Certificate .................. Final Certificate ........ - ......... - Fee Submitted $ ............................. Construction on above described building and,permit~9~pets all app~.caJ~le.,cpdesand regulations, Applicant.; ~"..~. -. ' ,~,/..a~. -~.~.- .~.-~. ~.~i. ,L:,Z_~, .... . ..... - .It O TOWN OF :SOUTHOLD~ TOWN CLERK'S OFFICE~.,~ omined ...... r: :- Approved ....~:/... /.... ~._.. ~ermit ~o. ¢~.....~ ....................... Disapproved o/c ............................................................................. APPLICATION FOR BUILDING INSTRUCTIONS o. This application must be completely filled in by typewriter orr in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, acqUrate 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 o detailed description of layout ofproperty 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 Deportment 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 Regulations for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with o opp icab eows, ordinances, building code, hous ng code, and regular ons, and to admit authorized inspectors on premises and in buildings for necessary inspections. (nt,oTome~ ilar:~''' '~''''''~ ......... oration) ........ (Address ;f ?';. "7-' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder, ......... ................................................... Name of owner of premises ...~...~...~.~..~lM.,t~r.,.:.....~'..~....O...~...~,...~.O.~..~..~.~.......~....~..t. ..................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ............ ~ ............................... Plumber's License No. Electrician's License No. Other Trade's License No. Mo No , ' /'~ Lot No Location of land on which proposed work will be done. p ~.:~. ....................................... ~ ...... .~..~ .... Street and Number .~.~.~..~.. ....................................................... .~ ....................... Municipality State existing use and occupancy of premises and ntended use and occupancy of proposed construction: a. Exisiting use and occupancy ~...~..~.~.. ....................................................... :. .................................................. Intended and ' . .............................. ~.... ~ '41J~.~ b. use occupancy .......... ~ ..................... ~ .................................. / 3. Nature of work (check which applicable): New Building~· ................. Addition .................. Alteratioa ............... '. Repair .................. Removal .................. Demolition .................... Other Work ................................................ .... (Description) 4. Estimated Cast ,~.~..~...~ ...... /..¢~.~.~.~'.-.. ............... ~ee "~ ~..~ ........................................ (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, specify nature and extent of each type of use ...c~.~l~... .......... 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 ................... , ................ Rear ............................ Depth ........................ Height ...J.~../..~. ...... Number of Stories ...... c~....~.~'~.~.l.'~;~'. ................................................................................ 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises qre situated ..................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ........................................................ 13. Will lot be regraded . ........................... Will/excess fill be rerr~v..ed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .~..~..~.~..,/./..J..'-'~...~,.O.../~...~..~'c~r'ess-- '"~ A'~ Ic~.~..~ .~..../'~fl.~.~J ....... Phone Klome of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor .~ ........................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorn property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~RI~-~ lb /'SS COUNTY OF ....~.'.~.c?..Lk......~' ' ~, .'~[~..~..~....~.,....~....~..~...,~....~...~...~./~...~..~..~L..~../~.: ...................... being duly sworn, deposes and says that he is the applicanl (Nome of individual signing controci) above nome& He is the .~.~.~.t...~.~,~-~,~.~..~ .................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this application; that all statements contained in this application ore true to the best of his knowledge and belief;, and tho~ the work will be performed i~ the manner set fo~h in the application filed therewith. Sworn to before me this ..... ..... ................................. ........ , ....... _ . ............. .......... .............. ~g O, bM c, J, b ,I L d' ? '" :' JAN, 74; /I