The URL can be used to link to this page

Home My WebLink About8290-zlrO~M NO. 4 TOWN OF SOUTHOLD BI.m'~r~ING DEPARTMENT Town Clerk's Office $outhold, lq. Y. Certificete Of Occupency THIS CERTIFIES that the building located at Megann Lane Street M -- East Shs ....................... ap mo .............Block No ...........Lot No, ~ Greenport conforms substantially to the Application for Building Permit heretofore fried in this office dated ...........l/.o.v....~.0...., 19.7.~.. pursuant to which Building Permit No .... 8.2...~Z. dated Nov 12 197..~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is ~sued to Charlem Lieb Owner (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval N .R. UNDERWRITERS CERTIFICATE No.P.e.n..d.iP~ .................................... HOUSE NUMBER ..... ~.8~. ..... Street .... ~q..Ca~.,,, .L.~..e. ........................ Building In.~poctor ~ TOWN OF SOUTHOLD BUILDING DI?A~,TMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. · BUILDING PERMIT fi'HIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8290 Z Permission is hereby granted to: ~ ~, ..~ .'~me' ' ':~ m'~ ~-m~'~ ~.' '" · ~'~' "~B~'.~.~'j" 7.,J.eb ........ ~,x..~,~& ......... C,~een~o~ ........................ ~ ~u~,~,..~.. ~d~l.$t~om..~.. ,~.$.s ~.n~..d~e t.l.~,rtg ............................................. ~ ............ ~ ..... at premises I~at~ at ..~o~..~....~t~e~..~h~e~ ....................................................................... ............................................. ~..~ ....... G~e~t ........................................................... pu~uant to a~lication ~ ...........................~v...-.4~...~ ........ , 19.~..., and approv~ by the Buildi~ I~or. Fee ........... FORM NO. $ TOWN OF $OUTHOLD , Bnilding Deportment Town Clerks Office Soutbold, 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: ]. Final survey of property with accurate location of oll buildings, property lines, streets, end unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposol--(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, o 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), Nomconforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey.of property showing oll property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os 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: 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 Building ................ Vacant land .............. Owner Or Owners Of Property ....~;~...~X~.~.~.~...~.;....f;:..~'.~./.~.~. "7:~?'".-......~..~..~..¢..-~. .................... ~-- Permit No. Of [~rmit ...~.~.'.~Kpplicant ........ ~..~...~.....~..: ..... Underwriters Approval ....... ~.~ ............. Planning Board Approval ..... --,',,.~.....j..(~......~.. Request For Temporary Certificate ............... FinaJ Certificate Fee Submitted $ ...~..~ ............... Construction on above described building and permit meets all app~cable codes and regulations. App,,cont ........ ............... ....... Sworn to before me this ,_ . ' ~/////~77~' .... ...~....~..... day of ......... ~ ~,.(~Z:~. (stomp or seo')~~-- cou. a. Th~ appltcatian must be completely filled in ~ typewritm o~ in Ink ond.~m~, itt~l in tripIie~e to tim Buildtng~ ~ b. ' Plotplbn dl~eing loc .at~an, of~!ot _c~r. of buI.Eli~ on pr .~.' ,,mlotlan~..ip ~ bajo:. _.r~,_~ ,_pr~n~ m. _.l~bi. ic ~ o, ~ amos, and glvlr~ al detotied delcrtptJon of layout ofpe'eperty mu~ De afowfl on me alog~a., m ~ il ~ ot IWg&.elpl)liccltion..~ e. No building ,hall be occupied or u~d in whole or in part for uny purpoee whatever until u ~i~ ~ ~ ~ shall have been granted by the BuiMIng In,pector. APPLICATION IS HEREBY MADE to the Building Departmem for the I.uance of a ~ ~ i~,~uant to ~ The apl~icont ~gree~ to,comply with all applicable taW~ erdinenea~, b~lldlng cod~, homlng code, and re~l~gtiom, omi to~ admit ault~rlzed inq:~ctors on premiles and In buildiflgl-for neceua~ Inql~'eJo~.~ ........ f._..'g' ...... . (Signature ot applicant, or name, Ir · co~mormmm ('Address of ~licent) Stote whet~er opplicont Is owner, le.ee, ~gent, orchitect, engineer, generol contractor, electricion, plumber or builder, ,~:b~..~_~. -.: ......................................... i... '.~ ...... .... ,~.~.~..~.~ ........... ~.~ . 1~ ....................... .................... Name of owner of premises ...... ~....~.~.~O...~.~'..~.~.~. ......... J,,~ ~.~O ....................................................................................... If-applicant 'i~ a corporate; signature 6f duly authorized' officer. Builder's LEan. No ..... ~a~e .......... ~.. .................. Plumber'= Ltcen,e No ................................................. Electrician's Licen~ No ............................................. Other Trade's Liceme N~ .............................................. 1. Locatlam of land an which proposed work will be darm. Map No.: ........ ..~...~.~--.~. ............... Lot .r~ street and Number ....... ~li~.(:..~,.l~la'~......J-/~.~d-~-~ ........................................................... ~' ....... 2.State existing use and occupancy of premises and intended use and occupancy of propmed camtmetion: a. Exi$iting use and occupancy ........ L...,'~,:/~;r~'.'.[~,____ ........ . ~,,M~.,..~,.~.~,L'~P.¢~ ....................................................... ....... ............................ . ............................ b. Intended use and occupancy ........... ..~.. 3. Nature of work (check which applicable): New Building.. ................. Addition ....~..... ...... ~ ~Alteration .~ ....... ,, .... Repair .................. Removal ................ Demolition .................... Other Work ..................................................... (Description) 4. t,mated ........................... Fee ...... ...................................................................... (robe paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each,flOOr ............................ If garage, number of cars ..........~.' .................................................................................................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ Dimensions of existing structures, if any: Front ...... ..'~....l~..~ .......... Rear ......... .?.J~...../'. .......... Depth ....~..~...../. .... Height ....... L.~. ........... Number of Stories .......... L ............................................. 3, ..................................................... Dimensions of same structure with alterahons or add hans: Fro~ ......... .~...~. .................. Rear ......7..~ .............. Depth ,~...~....~...~'.......~...~...: Height ........... .I....~. .......... Number of Stories .........~. ..................... 8. Dimensions of entire new construction: Front ........ ~,..~....,./. .............. Rear ....... ~..l~...~. ......... Depth ...[..~./. .............. Height .....J....~...~.... Number of Stories ............ .L ....................................................................................................... 9. Size of lot: Front .......... J[..'Z.(~)...~. ............................... Rear ........ ;L'~.O..../. ................... Depth ....J..(~....O..../. .............. 10. .Date of Purchase .........~ ......................................... Name of Fo,rmer Ov~er ................. ~ ............... 11. Zone or use district in which premises are situated ............ ~-~...~.!..~..~/~, ..................................................... 12. Does proposed construction violate any zomng law, ordinance or regulation: ...... ~L~....~ Will lot be regraded .....~'~,~ .............. Will excess fill be removed from premises: (~)' Yes ( ) No Name of Owner of premises ..~,.~.~.~..~.~-~ ............ ~ ....... Address .~l~.l~~ No. Nome of Architect ................ ~ ........................ ~ ................... Address ................................ Phone Na~ ...................... 13: 14. Name of Contractor ...~,~.~..~..I,_~ ........ .,~!.~..~..~...~.. ........... Address .~..9...~..~...~...~. ............ ho~ No../-~..~..~.~.~.~" STATE OF NEW, A(OI~%~.. L COUNTY ' · ................... ~[.~ ........ ~',......'....~.~C~ ....... being duly ~orn, d~es and says t~t he is the applicam (Name of ~ividuai si~ing c~tm~ ab~e name. He is the ............................................... ~~ .................................................................................................. (Contractor, ag~t, c~rate officer, etc.) of said own&r or ~ners, and is duly aurar,zed to pe~orm or h~e perfbrmed the said work and to ~ke and file this application; t~t all statemenb contain~ in this application are tree ~ the ~st of his ~ledge and belief; and thru the wo~ will ~ performed in the manner ~t ~h in the application fil~ ~r~th. Swam to h~om me this ..... o, ................ , Nota~ Public,. ......................... ~/~:... C~ ~....~~.~~~ .......................... ~~~~~~~ ~ (Signature of a~l,cant) ~LIC. T.M ExpifK Milch · 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 whether interior or corner lot.