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Home My WebLink About8265-zFOEM NO. 4, TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No.. Z690E ..... Date ............. .l~'.~b.. ~1 ....... , 19 .'~6. THIS CERTIFIES that the building located at .. W/.S. Truman. P.a~;h ........ Street Map No. ~ ......... Block No~ ........ Lot No, ~..EaSt .~4ar:Lon.. t~t,~., ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ .0C'C. · .27., 19 .~. pursuant to which Building Permit No. 826~Z.. dated ............. 0et;. · -28' -, 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 PX, ivate, ga~'agZ .......................................... ............. The certificate is issued to .... J..o~o'~ .]~.*. ~.:L~,~g~ ......~.e?. ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval , ~,.R.,: ............................. UNDERWRITERS CERTIFICATE No. ~l,l', ....................................... HOUSE NUMBER ...... 68.0 .... Street ... T~U .Path ......................... .............................................. ...... ............... ...... ........ Building Inspector I 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? 8265 Z Date ............................ C~!C.t,....~ ............ 19...2~ Permission is hereby granted to: J ob~. ;~ .,...~'~;k~i ga~ .............................................. ......... ~oz...3~..~ ............ ;~s.t..~;ar.loa ............... to..~..u.~ ~.v....~.~..e. ~.. ~.~ .l..y.~ .t~.~... ,~, X'.e, g~ ................................................................................................. at premises located at ...... J~.~...Tz~a~r~...~.'~.t,13. ............ (~a~..~,a~.e..i-"J~.} ....................................... ........................................................ .~a.~...V.~.~.o~ ............................................................................. pursuant to application dated ................... .0.~..~. .......... ?..~. ............... , 19..~.~.., and approved by the Building Inspector. Fee $1,0.a~).~ ............ Building Inspector FORM NO. $ TOWN OF SOUTHOLD , Building Department Town Clerics 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 buildings 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--rs-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 fram 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 ]957), Non-conforming uses, or buildings and "pre-existing" land uses: l. 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: ]. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificateof occupancy $1.00 ~ ~///~/~////~ L/A~ Date ............ r....~......;; ...................... New Building ................ ilion ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ' .~.Z~....(.,;. Owner Or Owners Of Property ........................................................... x. ......................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No. .'.~. ...... Dote Of Permit ................. Applicant .................................. ?. .......................... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FinoJ Certificate .......... /~. ......................... Fee Submitted $ 5..: ........................... Construction on above described building a~/dXpe/Jm/~/t~ ]~e~p~J/).~6ble codes and regulations. Applicant --.~.:.~.~;~../..././..~ .............. ~......;. ...................... Sworn to before me ~his l day of ~., ............... ~ TOWN OF SOUTHOtD BUll. DINe DEPARTMENT TOWN CLERK'S MFICl SOUTHOLD, N. Y.- E~omined .........~......~.., ,~.~...~.-'~ Appli¢~'ion No.....~....~...~..[ ,, Di~ a/c ....... ~ ........~ ........ ......... '2~ ~ ~ APPLI~TI~ ~ ~"'~ IN~RU~I~S ~. This o~lic~ion mu~ ~ completely fill~ in by ~ewrifer In--or. with 3 ~ o~ p~s. ~cum~ ~ plon ~ ~le. ~ ~co~i~ to ~ule. b. PIo~ plan ~owing I~ofion o~ ~r~s. ond givi~ ~ det~il~ d~ription o~ [~ o~pr~ must ~ drown on the diogrom ~ich is ~ o~ ~is ~licofi~. c. The work c~ered ~ ~is o~licotion m~ d. Upon opp~ol o~ fbi5 ~lic~ion. ~e Buildt~ I~or will issue o Buildi~ Permit to the o~liconf. S~h shoU be kept ~ the premises o~iloble for ins~fi~ ~t ~e work. e. ~o building sholl be ~cupi~ or sholl h~e ~en g~n~ed ~ ~e Building In~or. ~PPLIC~TIO~ I~ HEREBY ~DE B~ilding Z~e O~din~nce o~ the T~n ~eg~l~fions. ~or ~he cons~m~ion o~ buildi~s. ~ifi~s or ~e ~pplic~n~ ~r~s fo comply wi~h admit authoriz~ in~o~ ~ premiss ~ in buildi~ ~ n~e~ i~ti~s. - ...... ............ ....................................... (A~m~ of ~licant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................... .............................................................................................................................................................. Name of owner of premises ...... ~..q~...Z~...,~.~/~.,~... ................................................................................................. If applicant is a corporate, signature of duly authorized officer. ; (Name and title of corporate officer) Builder's License No.-~...~....~.. ............ ...~..~....../~C ,~ ~/~/~/ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No. ........................ Street and Number ....~'.~./~..~w.~. ...... ~.~.~..~. ............ ~.L~....~..~/~....'~.. ........................................................................... Municipalit~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..../.....~...~....~.~ ................................................................. b. Intended use and occupancy ..... ...~./,~......~'.~ ................................................................................... 3. Nature of work (check which applicable): New Building.....~ ...... Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ..................................................... ~ (Description) 4. Estimated Cost ......~..~ .............................................. Fee (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 ............................ 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 ....6~...~.~ ....................... Rear .~....Y.. .................... Depth .~...~. .................. Height .L.~..~ ........... Number of Stories ....'. ................................................................................................................. 9. Size of lot: Froot ......... ~...°....~ ..................................... Rear ...Z.~'....z. ............................ Depth ...~....~..~...~ ................. 10. Date of Purchase .~...~?...../.~..~..o. .................................... Name of Former Owner .x~..~...e...~..~..~.~ ............................ 11. Zone or use district in which premises are situated ....~.?...~.~...~..~..~.. .......................................................................... 12. Does proposed construction violate any zoning law, ordir~nce or regulation: .~'...~. ................................................. 13. Will lot be regraded ........~...~.. .............. Wilt excess fill be removed from premises: ( ) Yes (~) No 14. Name of Owner of premises ...s~'.~.~,~....~...~..4~.,~..~. ............... Address~.~...~.~....~....~....~..'..'~... Phone No.~'.Z...~.E?....~...~... Name of Architect .......... ~'......../.~.~/.~.~'J .................. Address ................................ Phone No ....................... Name of Contractor ........ ~...~..........~.....~....~...,~../ .................. Address..~..~..'~..~.~....~... .......... Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oil 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 whether interior or corner lot. --- ' ' I . . 3'3/ STATE OF N~YO~_./ ~{, ~lf~ O~ ~Y ~ __ COUN~ OF ................................................................................................. being duly ~wom, departs ond ~oy~ t~t h~ (~ome of individual ~i~nin~ obove n~med. Ho i~ the ................................................................................................................................................................................. (Contractor, ~nt, co~orot~ officer, otc.) of soid owner or own~rs~ ~nd is duly outhorized to p~orm or h~w p~r~ormed the ~id work and to ink* ond file this oppllc~tion; that *11 st~t~ment~ contoined in thi, opplicatlon or~ tm~ to th~ b~st of hi~ know~ed~ ond b~lie{; ~nd tho~ th~ work will be p~rformed in the m~nner set {o~h in th* ~pplic~tlon filed th*r~with. ~oto~ ~ublic~~~~ ...... ~..;~.~.....~..~.~~ ................................ V ' // ~Signatur~applicant) JUDITH T. BOKEN