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Home My WebLink About8222-zNO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. ¥. Certificate Of Occupancy No. ~.7.0.8.8 ....... Date ............. .~.u.n.,...17 ....., 197.6.. THIS CERTIFIES that the building located at .. ~/S. lqaiI~..Road .......... Street Map No.. x,'c ........ Block No..xx ....... Lot No .... xX ....Sou,:hold. · .}I ,Y., ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. 0.e.g... 2.., 19..?[ pursuant to which Building Pemit No. B.222g.. dated .......... 0q.g ....2 ..... , 19. ?~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .Pr.l.v. 0 .~.o..~qq.e.s.~o. ~'y..s.$gr.~g0. &.. u.t. ilitY..b~ildl~g ................... The certificate is issued to . .l~t.dge.. ¢.o~p ........ .0l~ler ............................ (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval ...I~:.R.': ............................ UNDERWRITERS CERTIFICATE No...Iff. 28~.210 ................................. HOUSE NUMBER ..... 50.8.Q0... Street ... t.t~In. Ko. ad.. ~outl~Qld ................ FOI~I~ 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? 8222 Z bate ........................ ~e .t, ......... 2 ............ , 197.-~..- Permission s hereby granted to: l~w],ge...~L~, .............................................. : .......... at premises located at ~.~J...~ltl..~.~t.E:~ ....... (.f.o~lltez'~..;~(]~,.~...i~..:.~ggta~ ............... ................................................... ~o~thnl~ o~ ~ .... . .................................................. pursuant to application dated ........................... ~e~.....~ .......... 19.~.~.., end aPl?oved by the Building Inspector. .: ,,. Fee $.~.~..~...C~. ........... [, v- Building TnSPector '~, . TOWN OF $OUTHOLD ~ Building Deportment 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 buildit~gs 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 o certificate· C. Fees: l. 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 Dote ..... .................. New Building .~.~.J/. .....Addition ...'~,. ........... Old or Pre-existing Building .....,-~., ........ Vacant Land / Location Of Property ~.,~..~,...'., .~..e..~...O.~......~..~/..~....,.~.*.....~..l~./~...,~'x'~.~.~ ..................................... Owner Or Owners Of Property ....................................................................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Dote of Perm t . . .App,,cont''-- ....... ............................ N~.~.~.~.~...... Permit Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval ~..~..~,~.~.~,/...~. .................... Planning Board Approval ........................................ Request For Temporary Ce,~ificate ........................................ Final Certificate .......................................... Fee Submitted $ ............................ ~ .... Construction on above described building and I;~it meets ell applicable codes and regulations. · · l~, THE NEW YORK BOARD Of FIRE UNDERWRITERS ~3~,5 JOHN ~TREE'f, NEW YORK, NEW YORK 10038 I~ ~,,.,.June 8. 1976 i,,,.~,.,,,~,,,, ~ ....... f~,. 859317. N ~udge Corp., 50800 Main Road, Southold, b.I. 10 ' 10 i 3 i 10 ~ ~ ~ I i 2 , F Panelboard/s: 1-10cir. 125amps. 1-1.65kw Hot water heater Gray Electric Inc., 29 Seabro Avenue, No. Amityville, L.I. 11701 D Per~ This cerhf,cate must not be altered in a~y manner; return to the office of the Board if incorrect. Inspectors may be ,dentified by their credentials. FOJLM NO. 1 TOW. OF sou,. L. BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~~ ~UTHOLD, N. Y. ~i~ed ................ , ~. Appl~c~tlen ~o~ ........................................ , ~O, ~..~.....~ ....................... ~~ ~_~.Z APPLICATION FOR BUILDING PERMIT INSTRU~ION$ 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. Plat plan showing location of lot and of buildings on premises, relationship to adjoining 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 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 o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to th~ Build ng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances Regulations, for the construction of buildings, additions or alteratiOnS, ~r for remoYal or demolition, as herein described7 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. (Signa]'~j'/brof applicant/or no~, if a cg.~poratio?) (Addres~ of applicant) State whether oppl~ !s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. / (~'/4J -r.c~ ..... If applic~s a corporate, signature of duly ~uthorized officer. ~ (Name and title of corporat~,~fi?r) . Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No....~ .................... 1. Location of land on which prgl~osed work will be done., Map No.: ................. ~......~....~//Lot Nor' ....... ~ ........... Street and Number '. :...'~...~...~...~ff..~r~r.......~... ......................................... ~~~ii~___' ' ........ 2. State existing use and occupancy of premises and in~,ended use and occupancy of proposed construction: ' b. ~ntended use and occupancy ........................*/.. ......................................... ~ ......................................................... 3. Nature of work (check which applicable): New Building.. ............... ,. Addition ..... ./f'.-..'....... Alteration Repair .................. Removal .................. Demolition .................... Other Work .................................................... "' C~, d~T] ~;~,, ,~?~.? (Description) 4. Co , ................ .............. ........................................................................... (to be p~id 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 ............................ 7. Dimensions of existing structures, if any: Front ........~.Q .............. Rear ...... .~ ................... Depth ..~ ........... Height ....... ~.~.~ .......Number of Stories ....... ~ ....................................................................................................... Dimensions of some structure with alterdtions or additions: Front ......... .............. Rear ...~ .................. Depth ....... ~.~. ................. Height ........... ] ................ Number of Stories ....... .~ ...................... 8. Dimensions of entire new construction: Front ......... :./.~ .................. Rear ....... '¢.~ ............ Depth ................. Height .....~ ....... Number of Stories .......... ~ ........................................................................................................ ~ 9. Size of ~ot: Front .......... ~. ........ , ........................ Rear ......... ~.~.,~ ....... ¢ ....... Depth .v~.~.~......~.. ]]. Zola or use d str ct n wh ch pre' m se' s ares tuated ~ ~..: ..~..~...~..,... .................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ ~.~ .................................... ~3. Will lot be regraded ......... ~ ..... Will excess fill be removed fr~ p~mises: ( ~ Yes ,,. .......... Name of Architect ............................ ; ................ ~ .............. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and indicate all set-~ck dimensions from property lines. Give street and block number or description according to deed, and show street names a~d indicate whether interior or corner lot. ST^T~ OF NEW Y~t<,Z/~//; ~ S COUNTY OF ,:.~.~-~r~¢~. /V{ ~ i/¥ 7~ ~ .............. ; ................................................................................. being duly sworn, deposes ~nd says that he is the applicanl (Name of individual signing contract) above name. * He 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 statements contained in this application ore true to the best of his knowledge and Belief; and that the work will be performed in the manner set forth in the Sworn to befo~ me this ,~'~ ........ ....... Notary Publ~~ ..J....'~unty .... JUDITH T, BOKE~ arian filed therewith. '// I / ..... ........................... LAND PLJDGE ~ /Tq.g~3