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Home My WebLink About9431-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13067 Date December 14 ........... 19.8.4. THIS CERTIFIES that the building ..... .~ d d i t i o n & a 1 t e r a t i o n Location of Property . .1325..Qaklawz~. Av.~ .................... ~.qu~h.Q~ ......... ~se No. Street Hamlet County Tax Map bio. 1000 Section . ~ .0 ......... Block ....3 ........... Lot....3 ............. Subdivision ............................... Filed Map No ......... Lot bio .............. conforms substantially to the Application for Building Permit heretofore fled in this office dated .... R.u. ~....2.3. ......... ,197.7.. pursuant to which Building Permit No. ~.~.3.! Z. ............... dated ...~.u.g,..3.0. ................. - 197.7.., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .... q~. ~.cLcl ~ ~.o.:~. a~, .~ l.~.e.~.~ ~ ~.o.a. 9~..e.~ l~.%~,n, g..d.~e..~.~.~.n. ~ ..................... The certificate is issued to .I~y~L.e..t~. ~..~ ~ .i.z.a.b.e..~h..~.... ~.ered ±th .................... of the aforesaid building. Suffolk County Department of Health Approval ......................................... UNDERWRITERS CERTIFICATE NO ................... .II4 $ 75.7. Q ...................... Rw.l~l Building Inspector BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON ;THE PREMISES UNTIL FULL COMPLETION OF TME WORK AUTHORIZED) N? 9431 Z Date ........................ ~ ....... 30 ............ , 19.~.~.... Permission is hereby granted to: G .'..::,~,¢;:~.l.t ?.',,..I~..~,....c ........ ............. ~o~.th~]:d' ............................................... at premises located at .,.~'?/';.~'"O~a:~:~'~'.,zzm':,'~'~'~z ...................................................................................... : ..................................................... · ~o~o-~'"*'~ ~"~]'~' ................ ' ........................... : ............................ pursuant to application dated .................................... :?-~,:?....6~.~...., 19.:,.:¥:.., and approved by the Building Inspector. Fee $'l.p.**g 0 ............. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in Wpewriter OR ink, and submitted in duplicate to the Building Inspec- tor witln 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 featu res. 2. Fina, I 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 installa- tions, 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. For existing buildings (prior to April 1957). Non-conforming uses, or buildings and "pre-existing" [and uses: 1. Accurate survey of peoperty 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. Dale of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Cer~tificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Cooy of certificate of occupancy $1.00 Date . ./. ~..~.~.'~','./.~. ~.~' ....... New Building C./,.fCgj~ ~,'.... Old ¢~ ?re ~×:~:.,-~g Building f:~.,~ ~/t/~ ~,C.. Vacant Land ............. Location of Property ./~.2~..~.~../¢/¢.~. ¥.. ~. ¢.4~ ...... .~.'~. ~' ~./.¥. .......................... House No. Street Ham/et Owner or Owners of Property ~. y,/~.. ~'~. ~,,v.~.. ~/~,~ ~ .~d ./'.~. ~/~r,/~...~¢ ~,-,.~.z.~. ................. County 'Fax Map No. 1000 Section ..... ?.O. ....... Block .... ~ ......... Lot .... .~. .......... Subdivision ................................. Map No ............... Lot No ............... Permit No...~..~.._7/.Z,. Date of Permit~¥..~.'~../¢.~.~.Applicant ~.~./.~/J~..~.-~. ~¢-.- .............. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval . /~..~.~.].~.~.?../,¢. 7~ ........ Planning Board Approval ...................... Requesl for Temporary Certificate ..................... Final Certificate ....................... Fee Subm tted $ ~,~..~ ......................... Construction on above described building and permit meets all applicable codes and regulations. Applicant... ~. ~'..~,~..~.~ ............................ Rev, 10-1a-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS ~f BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK ]0038 ~.~ June 13, 1979 .~pp,c.t~, ~o.o.f~ 933357 N 437~'~ L, THIS CERTIFIES THAT in the following location; [] Basement [] 1st FI. [] 2nd Ft. out~lde s~tio, B~o~, rot ,~,.,~x.,..~do. June 11, 1979 andfoundtobeincompliancewiththerequlrementsofthisBoard. 29 ~18 .32 29 3 1 10 9 ' ~B x 1 ....... oke De tee ~o~- RANGES R TIME CLOCKS BEU. UNIT H~ATEIIS MULTI-OUT~T OF CC. COf4D, 3 NO, OF HI-lEG EXHAUST FANS AMT. H.P. DIMMERS 0]:' .*tpya~d La. So,~,: ,- Id, ~T.Y. 11971 ' This certificate must not be altered in any manner;, return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPy OF CERTIFICATE MUST NOT BE ALTERED IN AHY MANNER. TOWN OF SOUTHOLD'D'D'D'~/~'~/ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .... ~....~. ~. 19. ?..~.. Approved .......... '~'" ~'"'~ ' 19...'7..2 Pemit No...~....Y..'~..../. ~ o% o. ff. ~,,. C.o. u OJC. Disapproved a/c ....................................................... . ..................... (Suil~ .................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No. ,.. ............................. Date 9 i .~Z ..... ~ / a. This application must be completely filled in by typewriter or 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. Plot plan sho~ving location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and~ giving a detailed description of layout of property must be drawn on 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 Suilding 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 a Certificate of Occupancy shall have beene, grantee by the Building Inspector. ~i APPLiCATiON IS HEREBY MADE to the Suilding Department for the issuance of a Suilding Permit pursuant to the Suilding Zone Ordinance of the Town of Southold, Suffotk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. 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. . (Signature of applicant, or name, if a corporation) ,~ , N9 ................ ..,~:..~ .o..~'~'..~.~- .~.t .1~/.:././. ................. IAddress of applicant} State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............. C~ ~...Z"~e~c.~....~. ......................................................................................................................................... Name of owner of premises ........... ~._y.~.. .......... Z~.&D.~,t~...~.X. 2~. ................................................................... If applicant is a corporate, signature of duly authorized officer. ............. ........ ~q~Jame andtit e of corporate officer) Bu~lder's License No .......................................................... /~oO - -FO- ~- 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 .~',~ ..~.....~.¢~... ....... Q~C'....~4~......,~f.u~.....-........~. ................~[~..7~2,.~.~ ......... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... .'~J~./.~.~-.~-=-Z~Z..C.L~"~..~,,,~ ~ .............. , ....... ~ ........... ,~ ................................... ntended use and °CCupanc~ . ..~....~..~'.'~ . . .~...~...~.....~.....~ . / 3. Nature of work (check which apolicable): 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 ....i .................................. If garage, number of cars ............. ../. ............................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of usa ..................................... 7. Dimensions of existing structures, if any: Front ...... .~. ........... Rear ........................... Depth ..~..!. ....................... Height .............. ~...~ ..................................... Number of Stories ........../. ................................................................ Dimensions of same structure with alterations or additions: Front .......... ..~..~.. ......... Rear ....~..~.. .............................. r r Depth .................. ~ .................... Height ........ -/..~. ........................... Numbe of Stories ..J. .................................. 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................. Height ................................................. Number of Stories ........................................................ t ................................ 9. Size of lot: Front .............. ,/.~). ............... Rear ............. ~.4~ .................... Depth ...-~.~..~.. ................................... 10. Date of Purchase ..................................... Name of I=nr,~=r ~wn~r ~'* ~ ~¢:~!~4~21 ~ ° . ............... 11. Zone or usa district in which premises are situated ...... ~.~_...~../..~..~4'Jk4~--,~.~;.~ ........................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... x~....°.. .................................... 13. Will lot be re(jraded ...... ~..~.. ................. Will excess fill,be removed from premises: [ ] Yes /[X~ No 14. Name of Owner of premises ..,~¢~,~F.. ........ ,/~J.~-~-~L-~D~.77.~. ................... ~'¢~=./7~.o~-~c~ ...................................... (Address) (Phone No.) Name of Architect ..................................................................................................................................................... ~ (Address) (Phone No.) .?..3.. Name of Contractor ....~.~X,Z~..A.~ ....... ~.~...~.. ..................... .~.r~.~/'~-~¥LZ3 ....... ..'7..~e~.. .... ..~.,. (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NEW YORK, ) SS COUNTY OF ...................................................... ...~.~...~.~..~..~,.~ ............ .~....o....~...~.~...t:..r~F-.~, ............... being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract} He is the ........--~°C~,~.~....: ......... ~/.~..ta.~.~ ............................................................................................................................................. {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 that the work will be performed in the manner MARY E. DAWSON set forth in the application filed therew;th. NOTARY PUBLIC, State of New York ' / -~ ~-,~ No. 52-464~121, Suffolk County ~.--~(~r-~ -- of //-~..~...~..~.. ~ 19 ?~.:'~- Term Exp,~ March 30, ......... ...~-.~.>.....X..~./. .......... O, ay .... ~.~':. ...,,.n:..,,~. ........................ .....,, ..... '. . .... ........ ..................... r'"'~-'"~/ ....... // (Signature o.f applicanO '1 :i :