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Home My WebLink About7715-z~ N~ 4 TOWN OF SOUTHOLD BI~.nING DEPART~r~IT Town Cl~k', O~iee Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the bui]ah~g located at..~.~..~'?~..~?..w....~.~. ~ F... Street MapNo. t~ ~ ~*~'~moe~No. '-- .~otNo. tS~- ~ P^~ conforms substantially to the Application for Building Permit heretofore ~ed in thi~ office dated ..... .~..~..~.V. .... .~. .... , 197/. pursuant to which Buildinff Permit No.V. ?./..~. ..Z- dated ....................... , 19.:.-., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which thi.~ certificate is The certificate is issued to /~N'T~N~ [~ ~1:' Sr)UZ/~ (owner. ~) of-the aforesaid building. s~om cowry ~p,,~m~,,t ot H~,tm Approv~ ?.f?.. ! ,/..~.7.~..~.. ~..~f... ?. :.S.o.: !.S 0 HOUSE NUMBER t~ ~ ~ 0 Street .~. ~ .Y..~. t!~. ?. !~, --~ t~ a ~:~ Building lnsl~ctor FOKM NO. 2 TOWN OF $OU~HOLD 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) N? 7715 z Permission is hereby granted to: .- .C..9.~.ll..g.O.~!a.~l'.~.q.~l.9.1~....q.o..~p....g/~ .~..~.O~io DeSot~a ............ J~.a~ta'tol~....: ........................................... ~o ..~.:l..La.....a.~....o..n..~....f..a.~.i.~....a.~.,..~:~..i.~.~ ................................................................................... ......... .C .apia r.ct~.c!....lair.., al.. &lap.c.a l.a .) ................................. ~ ......................................................... at premises located at ..~Ktt, iL..~..l.~i..~c.l.~[2.....,l_tamelltl~Cl...P.~Oltl[~...~..~3.~&~l ............. ................................. /~.~...~.~a..I4~.~4...~..l.~laa4..Xi.~.w...b~aq~ .......... ~..~.~.~.~..t. ................ pursuant to application dated ................... ~e~.t;....~ ...................... , 19.~..1~..., and approved by the Building Inspector. Building Inspector FORM NO. $ TOWN OF SOUTHOLD ~ Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions ................ day of ............................................ Notary Public .................................... County 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 unusua) 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 featums. 2. Sworn statement of o~'ner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing bode 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 .............. New Building ......~. ......... Addition ................ Old or Pre-existing Bu/ilding ................ Vacant Land .............. Location Of Property ............ ~.~z~er...~£..z~3~.z~...~.~.e~..~e..~L...~...~...e..b.~.~.e....~.~..~...~.~9..e...~.g.9~¢~ Owner Or Owners Of Property .............. Subdivision ~.QD,,~L.¢...~.~,~'...:[~.'.~f~.~..e...~. ................... Lot No.~?..~:~.~..~'~* Block No .......... i House No LI'~.~...O. Permit No..Z~.,~.'.~. ....... Date Of Permit ..~.../.~.../~.~......Applicant .~[~.~.~.~?.~.?...?,,e...,~O..~,.~.. .......................... Health Dept. Approval ...~,~3~,~,*l..~,.t...~.~.~.~. ......... Labor Dept. Approval .... ,L~i/.[.~. .................................... Underwriters Approval .............................................. Planning Boa. rd Approval ........................................ Request For Temporary Certificate ........................................ FinoJ Certificate Fee Submitted ~.......~../~.. ...................... Construction on above described building and per4~it meets all~appl~, hie codes ~'~d regulations. ^ ,. . ......... ............... ppl~cant ~. :~,. ~.x~.....; ........................ Sworn to before me this (stomp or seal) TOWN OF SoU'rHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. NOTICE OF DISAPPROVAL '"~[~P:;:;'::':~:'::::'":':'"i ......... ...:._. :: ...... :: ......... :....~, .......................... , .... ......... Building Inspector ..... / oreos, ano gJw~ a O~t a~Cr pT Oe Of ~ ~ ~ ~ ~ ~ ~ d*~ ~ ~ ~ ~ ~ ~l~t~. c. ~ ~ c~ ~ ~ ~li~t~ ~ ~ b C~ ~m i~ce ~ B~ P~. . ~ .u~.~ ~ ~i~ :~l~ h ~ t~r ~i, ~ o B~t~i~ ~ to h ~t~m. s~ ~,~ e. No ~Mi~ ~1 h ~ m ~ in ~ ~ in ~ ~r ~y ~ ~er u~ll a ~ ~ ~c~ ~all ~ ~ g~ ~ h Bul~i~ I~r. B ~?LI~TI~ .~S ~Y.~DE ~ ~ B~i~'~,~t ~r ~ i~ of a ~1~ ~ ~ ~ ~e ....... · 1=~ ....... . · .. _ ~,..-..~,*...,. ........ ~. ~ Store wh~sr a~llcont is ~r, I~, ~ent; e~hit~t, ~ngin~r, ~n~rol c~m~r, el~ricl~, plu~r ~ buil~r. ~ If ~licont is a colorers, slg~ of duly ~rl~ officsr. (Name a~ title of co~m~ ~i~r) Builde/s Uc~ No. ~ ~ ~/~ 7~ Plum~r's Li~n~ No. ~ ~' ~ El~trician's ~c~ No. ~/~ ~ ~h~r T~'~ ~1{~ ~o ..... ~ .................................... .[ ~F*~C ~ ~ ~r~ r~ o- ~ -//~ ~ 1. ~t~:O{ I~ ~ ~i~ p~ ~ ~ill ~ ~. ~p ~ .............. ~ ...................... ~ ~t a~ Numar ~ ~f~*~ ~ ~ ~ ~ . . ~..~ ................. z~ .... , ~ ~ ...~ ..~ .... ..................... ~ .. ....~ ..:~.~.~...~.~X 2. State .exJsti~ u~ a~ ~c~y of premiss a~ inte~ U~ and ~cu~ of p~ ~: a. ~isiting u~ a~ ~u~ ~ ~ ~ ~ ~ ~ b. Inten~ u~ a~ ~ ................................................................~....~ ..................... ,,..~....., .............. 3. Nature of work (check which applicable]; New Building....~-..... ...... Addition .................. AlteratiOn ................. Repair .................. Removal .................. Demolition .................... Other Work ................................................. ,~.. '¢~ ~...~. ~ (Description) 4. Estimated Cost ....e~..~.~..~.., ................................. Fee ........i~"l~'~' ~i~'~"~i'l't'~"~i~"~l~Ji~i~i .................. §. If dwellin~g, number of dwelling units ....... ../. .................. Number of .o~.,~lling units oneach floor'. ........................... If garage, number of cars ........ ./.. ............................ : .................................................................. ; ............................... 6. If business, commercial or mixed occupancy, specify nature and extent ~f'each type,.of u~ ............................ 7. Dimensions of existing structure, if any: Front ............................ Rear ................................ De th .................... Height ........................ Number of Stories ........................................... : ................................................. ....... Dimensions of same structure with alterations or additions: Front ................................... Rem ............................ Depth ................................ Height ............................ Number of Stc~ries ................................ 8. Dimensions of entire new construction: Front.............'~ ~g ~:..................... Rear .....~...~..~. ............. D ptFt,,;3...7..~.3.. ............ Height ...... ~..~..r. ...... Number of Sto~ies ../. ................................................................................................................ 9. 'Size of lot: Front .................. ~...-~.../..'~.. ........................... Rear ..... .'?...7..-.~.6....~ ....................... Depth /.T~' 10. Date of Pumhase ........................................................ Name of Former Owner ...~'.~.~.~......~.,....~.~...~..~...e~.~..~. .............. ] 1. Zone or use district in which premises are situated ............................................................................... 12. Does proposed construction violate any zoning Iow, ordinq~ce or regulation: ~....~..~.. 13. Will lot be regraded ...... ,~....~..: ............ Will excess fill be rernoved fr~n pm~l~e~.',,(/' ) Yes ( ) No Name of Ownel;~...~f premises .~..., .'~..~..~'~ R... m~...'r..~..~..~.. ......... Acidre~ ~;~.tt~.~.~.,~ ~-~.~--~,, ~w--,Ph¢~ ................... Name of ,a~e~t ..... ../~...~...~..~.,....'~..~.....~.../.~'.(/~...~.~./. ............. :Addre~ .~...~./.~--~_--~:Ph¢~, No..e~l~;;'/...:,~..'~..e.. Name of Contractor ............................................................ Addre~ ................................ Phoe N¢~ ...................... PLOT DIAGRAM Locate clearly and cll~tinctly oll ~ulldings, whether existing or proposed, and indicate all letJ~ ~ djme'r~ion~ 'from pr.~rty line=. Give street and block number or description according fo, deed, and show street narnel and indicate whether interior or corner lot. ,~ STATE OF NEW YORK, .~cc " COUNTY ~, ./,, OF ............... ...--....~..*~ ~'~ # ................. ..~../.~..?.~....~...../...~....~.~........'~...~.~..,~...~'- ............... being duly ~orn~ d~s a~ s~ t~t he is t~ /(~a~ ~ I~vidual s~l~. a~ve name. ' ' He is the ... .................................. ~ .,~ ....... ~ ............................................................................................. ~ .................................. :: '(~ntmc~r, ag~t, co,rate o~ficer, ~¢.) ' of ~ ~ner or ~ners, and Is ~y-'~rlz~ to ~ffor~ or h~e pmf~ the ~d work ~ to ~ke and file this ~licati~; t~t all ~,~ in this ~hcati~ am tree thru the ~rk will ~ ~ffo~:;J ~ fo~ in the a~lic~i~ fil~ ~. I .~.. ~. day of .~.....:...., 19.~ ',, ...... ........ ........... .... No. 41-4512950 0 F1 L F:,,' ¢ , # 'APPROVED AS NOTED, :,, 765.2660'9AM TO ~PM FOR REQUiR- TION OR 5TAR~ FRAMING !;I j' '1, .t