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Home My WebLink About9559-zTOWN OF SOUTHOLD BUN.DING DEPART~t~NT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. ~_9.3.5.4 ...... Date ... dctoba~.....16 .........., 19..78 THIS CERTIFIES that the building located at .. 2.lZ+~. Walls. Ave ......... Street Map No ............. Block No ...........Lot No .................................. conforms substantially to the Application for Building Permit heretofore ~ed in this office dated . .~oy. eI~ber.... 2J ..... , 19..7.7 pursuant to which Building Permit No... 9.~9Z dated . .No.v.eaber .... 2.1 ...... , 19.7.7., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is ~ued is ........... . .~.~.¥.a?.. ?.n?..~..~. A~.~., .~..e.~.ng ............................. The certificate is issued to ..... .C;h~U~. ?.s..C:. ?i.a.~.a .a?~X .lV!~.b..u.~ ....................... (owner, ~ o! the aforesaid building. Suffolk County Department of Health Approval ....... .7.-,$0,-.7~ .................... UNDERWRITERS CERTIFICATE No ............ N}9.~07.4 ......................... HOUSE NUMBER... ~1.~5 ...... Street ......... ~ elis. g.v.e ...................... ............................................... 8ot~thold,..Ne~v..York ........... Building Inspector County Tax Number 1000-70-4-21 TOWN OF SOUTHOLD BUiT.I)INC DEP]LRTMENT Town Clerk'. Office Southold, N. Y. Certificate Of Occupancy No. Z9tl6 Date J%fl.y 19 19. 78 THIS CERTIFIES that the building lo~ated at ...2.~.~.~...~.e.l.1...A.v.e. .......... Street Map No ............. Block No ...........Lot No .................................. conforms substantially to the Application for Building Permit heretofore ~ed in thi.~ office dated .....I~.o.v..e.m.b.e.r...2.~ ..... , 19..7.7. pursuant to which Building Permit No .... .9.5..5.9Z dated .....N.o.v..e.m.b.e.~...2.~ ...... , 19.7..7., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is ~ued is ........ .~'..~×~. ~.e..~.~..~..~..~Z..~.?Z. ~ ....... ' ......................... The certiZicate is ~ued to ...... .~.~.e.~...~... ~e..~.u~ .............................. (owner~i~i~ili~ of the aforesaid building. Suffolk County Department o! Health Approval .... ?.--.~..fk-.?.8 ........................ UNDERWRITERS CERTIFICATE Ho. .... ...... ......... ................. FOBM NO. ~B TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFfiCE SOUTHOLD, N. Y. BUILDING PERMIT 9559 Z Permission is hereby granted to: .~.~"~.~...(J.~...~m~ ......................................... ..... J~ ...... ~l~...A~m .......... Ozoft~o~ ............ at premises located at .~.~...~I~,..AY~.....~...~/...~14~ 11.]M. ........ ; ............................................. ........................................... IJ~IW3~....~..~ ................................................................................... pursuant to application dated ........................ ~lO.~.. ....... ~t ............ , 19.~.~..., and approved by the Building Inspector. FORM NO. 6 TOWN OF SOUTHOLD Building Depmtment 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 triplicate to the Building Inspector with the fallowing; 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--(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 a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or ~and use 3. Copy of certificate of occupancy $I.00 $5.00 ....... .................. New Building ..... ~ ............ Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ........ ~/.,~L:/_~..~..~..~....~:..: ...... ..-~....0...~,~..~'...~..~...4~..4~...~,..~......~...~ ........................... Owner Or Own~4s Of Property ...... ~.~.~..~.~Z,/~.~ ............. ..~.......~,~.~,~:,~..~.- ' 5 ......................................................... - Cc. 2. / ~ ......... /..~...~...g..T...~...~'.~.....-T....~'...~.....~..(...Lot No ............. Block No ............. House No ............ Permit No. ~...,-~,,..~.,~,~..,,~-, ........ Date Of Permit~/,/Z.///,7,,7. ApplicantZ · ~,/,/~.~,.,.~,:.~,.~'~;:,' (- ....................... Health Dept. Approval .'~'~../.7.~.....~./~..'.Z./.~-~..Labor Dept. Approval ..... ....~.,~- .............................. Underwriters Approval ....~.. ........................................ Planning Board Approval ..... Z'.L~../~.: .................. Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. /jJ App I ica nt '~'- .- ."~.~...~----~-.: · :"'~-'~'~¢'~-"'~' · ............................. Sworn to before me i~s (stam or sea) '"~' ................ day of ............................................ P h,, FOBM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPUGATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate 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--(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 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 ..Q.~..?... ....... /..~....),./...~..;Z...~, New Building ...~,~ ............ Old or Pre-existing Building ............................ Vacant Land ............................ O ner O. O ners Of Prope.y ..C.. Subdivision ...................................................... .~ ....... Lot No ............. Block No ............. House N~./..~..~. Permit No....:LC ............. Date Of Permit .................... ,'~pp icant ~..,.).('~......,,:.~. ....... ~'~....,.~..'.~.~'.~.S ........ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ......~ ........................... Fee Submitted $ ..~..~.:.~i.~.. .................. Construction on above described building and permit meets all applicable codes and regulations. Applicant .~.~..~.(?..,,..~.~,~....,..uf.......~ ...... ...~...).~:.~:~.~.~ ............................. Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) ,<c ~ t'/~/~ '/ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICr'FY ~- ~,usuat 15, :[97~s JOHN STREET. NEW YORK, NEW YORK 10038 ~,,. .~.,~,,.o. No. o./,,e 9.~2289 N 398074 THIS CERTIFIES THAT a~ fou~ to be in compJia~e with t~ r~ulrements of th~ B~rd. DRYERS FURNACE MOTORS FUTURE APffUANCE FE~OERS TIMECLOCKS MULTI.O~JTLET DIMMERS SYSTIMS SERVIC~ DISCONNECT S E R V I C E °'~4&~PTI~OOm heaters: 2-!. 5k~. 2 smoke de~ec~or., 1 GFCZ 2/0 2/0 G & $ Coat:ts. Box 215 Southold, L.I 11971 Itc. This certificate must not be altered in any manner;, return to the office of the Board if incorrect. Inspectors may be identified COPY FOR BUILDING ~AR~MENI'. THIS COPY OF CERTIFI~Tll ~_~ Bli -- -- TOW. CLmC'S ........................................................................................................................ , ....................... ......... ................................... ~e ~ lO~7~ .......................................... , I Y.....~...,~ I NSTRU~IONS o. This o~licotion must ~ completely fill~ in by ~ewriter oe in ink o~ s~mitt~ in triplicate to the Building~ Insp~tor, with 3 ~ of plans, accurate pl~ plan ~ ~le. F~ occo~ing to sch~ule. b. Plot plan showing I~otion of lot and of buildings on premises, relationship to ~joining premises or public streets o~ areas, and giving o detoil~ d~ription of I~o~ ofpr~e~ must be drown on the diagram which is ~ of this application. c. The work c~er~ by this o~licotion may n~ ~ commenced before issuance of Building Permit. d. Upon approval of ~is o~licotion, ~e Building Ins~tor will issue o Building Permit to the applicant. Such permit shall be kept on the premises available for insp~tion th~ghout the wor~ e. No building shall ~ ~cupi~ or u~ in ~ole or in pa~ for any pu~ose whoever until a Ce~JfJcate of ~cupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY NLADE to the Building Deportment for the ssuance of a Bud ng Permit pursuant to thevt 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 cdterotions, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable' lows, or~ances, building code, hous ng code, and regulations, and tog~ admit authorized inspectors on premises and in buildi,ngs f~necessary nspections. ~'~"i~i.~l'~'~'i~';;g ~"~'"'¥,~;;~pp ' , ................................................ or nome, if o corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............................................................................. Name of ow er o ..... ~ ................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ..... ~,~. ......................... /~00-- '/0 - L/_ ~,l , Electrician's License No ................................. ~.., Other mrade's License No ............................................. ~ 9 · ' ~./.~.~? ,~-../' ~, Locat on of and on wh ch proposed work w be d~ne JV~ap~J~lo · ~2~z~_ ~ Lot No Municipality 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 ............ ~ I 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ................ Repair .................. Removal Demolition .................... Other Work .................................................... .................. (Description) 4. Estimated Cost ........................................................................................................................ (to be paid on filing this application) / 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, numSer of oars ~ .................................................... 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 ~ (~ Rear ........... ~ ..........Depth ....?'...~.. Height ........ .~:......~.... Number of Stories ............. /.- ..................................................................................................... 9. Size of lot: Front ........................................................ Rear ..................................... j~.. Depth_......y/..;,}. ........... , ...... 10. Date of Purchase ...~ ......... Z ................................ Nam~exo~:~rmer Owner ........................................................ 11. Zone or use district ,n wh,ch premises are situated ..~4~.~...~ .................................................................................. 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ........................................................ 13. Will lot be regraded ......~ ..... Will_excess fill be removed from premises: ( )Ayes Name of Owner of premises ............. Address ........ ..-~ ........... .................. Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly end 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. STATE OF NEW YORK, I c S COUNTY OF ................................ ~'~' ................................................................................................ being duly sworn, deposes and says that he is the opplioan~ (Name of individual signing contract) above named. 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 are true to the best of his knowledge and belief; and tl-,ar the work will be performe$t in the manner set forth in the application filed therewith. Sworn to before me this // .., .~. ,~ .~ ....... o, ......... , .......... ................................. .... ............................. No. 52-4643121, Suffolk Cou~ term Ex,Ires Mar=h ~, [9~ O? 0? ~OU7740L D / The sewage disposal and water facilities for this lecation bare b~=sn Chief of General En~i?ee~i~g ~. ~'?-' ..87t /?!o" ,I