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Home My WebLink About9440-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No... Z~2.88 .... Date ..... .N.o.y.e.m.b.e.r. ..... 3. .......,19..7.8 THIS CERTIFIES that the building located at .... 9.6.5.0. ~I.a.i.~. R.o.a..d. ....... S~ Map No... ~01 ...... Block No ........... Lot No ....... .1..p~'.t..q..f..2. ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .. September...6 ..... , 19.77. pursuant to which Building Permit No..9i~/~.OZ. dated .. September...6 ...... , 19..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 issued is .......... ~] es.t. aurant ................................................. The certificate is issued to ...... Choa .ChLen. Sl~en ................................ ( owner, :~~ ) of the aforesaid building. Suffolk County Department of Health Approval .................................... UNDERWRITERS CERTIFICATE No ............................................. HOUSE NUMBER ..... 96~0 .... Street ............. Main. ~oad .................. ................................................... Matt£tuck.,..New..York ..... Building Inspector County Tax Map ~ 1000-1~3-1-1 TOWN OF $OUTHOI~D BUILDING DEPARTMENT TOWN CLERK'S OFFICE' SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PD, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N0. 9~0 Z Dote ............ ..6'~...., 19.....~..? Permission is hereby granted to: ........... /./..~./..~........./..~..~ ...... ~o ..... .(~.~.~..~....~. ~,~..;~.~.-~.~..-..~.~..~..~' .................. ot prem,ses ,o¢oted ~, ~ ~ ~/~ ~ ............... opproved by the Bu[Idin~ Inspector. FORM NO, $ TOWN OF SOUTNOLD , Building Department 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 DUPLICATE 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 u,nusual natural or topographic features. 2. F,inal 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 e:dstmg 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. 9. 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 $$.00 3. Copy of certificate of occupancy $1.00 New B~ikting ................ Addition ..~....T....~... Old or Pre-existiog Building ................ Vacant Land .............. Location Of Property ...~.~'.~,...¢r: ........ ~.,r~..~/~'~'. ....... .~, ............................................................................ Owner Or Owners O.f Property..~..'~./..¥~_~.....~,,¢,./.~.¢.7....~./.,~'./.~. ............................................................... Subd~ws~on .... /~,7,~/~,..~....a'C.~./. ............................. Lot No ....... ~ Block No ............. House No ............. Permit Nc,..~.../~y(,~.[~:.. Date Of Permit ..?.~./...~..~...Appl cant .... ~./J~9~7..~.....2~...-~;,~Z~. .......................... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .......................................... Planning Board Approval ........................................ Request Far Temporary Certificate ........................................ FinoJ Certificate .... ~ ................................ Fee Submitted $ .~G..~.......~.~.! ..................... Construct/on on above described building and p~mZsca~l oppc~l~_.~,~ o_d_ .~es ar~ regulations. Sworn to before me this ~/ ................ day of ............................................ (stamp. or seal) Notary Public ................................. County ~C ~ -- THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY -- JOHN STREET, NEW YORK, 85 NEW YORK 10038 THIS CERTIFIES THAT onJy the el~zri~al equipment as de~cHb~d beim~ en~ ~tr,~uee~ by zhe ~lc.mt stained o~ ~he ~bove .sppli~tio~ number in the premises of J&me~ ,Shen~ Xaln ?d,, ~lattttu~Ic, wasexaminedon JFi~Lt;~ ~ ~)~ andfoundtobeincompliancewiththerequiremen~softhis~oard. E S FURNACE MOTORS FUTURE AF~UANCE F~D~RS OTHER AFPARATU$: RANGES 1 20 COOKING DECKS OVENS DISH WASH~IIS AMT. K.W. AMT. K*W. ~AT, K. W, V I C E EXHAUST FANS DIMMERS A. W, G, NO. QF HI-LEG OF CC. COND. ~lsttituci~, ~f,Y. 1195:? 11 .~ This ce~ific~e mu~ not ~ .Ner~ in ~.~ mo..er; ret.rn to the oNi~ o{ t~ ~.r~ if i.(or~. Ins~ors ~ ~ ~e.t~i~ bM ~ T~OPY OF CERTIFICATE MT NOT lie ALTERID IN ANY MANNER. THE NEW YORK BOARD OF FIRE UNDERWRITERS ~' BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 N420540 THIS CERTIFIES THAT in the foliowin~ ioc~tion; [] Basement wo. sexaminedon J~ i~{J ~ ~lst FI. [] 2nd FI. Section Block ~ ~J ~ and found to be in compliance with ~he requirements of this Bo~;rd. K~NG~S DRYERS FURNACE MOTORS FUTURE AF~ANC~ FEEDRES SERVIC~ DISCONNECT ] ~o.M i s E R V I C E Lot 2 J~'~ DIMMERS This certificate must not be altered in any manner;, return to the office of the Board if incorrect. Inspectors may be identified by th&~'i~edentials. I'-- ----_--__--_.-- ........ -- ................ -- ..... ~ .... ~ .............. , ~ · G,~l~' FOII.IUIU)I~NG DEPARTMENT. THIS COPY OF CE. RTIFI~CA~TE M~US? NOT B~EE ALTER~m _IN _ANY_MA~NN~R. _ ~ ~ Lo'I' · I' Lot '4 bi TOWN OF SOUTHOLD ~.~--/~-~ BUILDING DEPARTMENT TOWN CL K'S OMC" E×amined ...... ........ ....... , Approved .........~,./4j/.~'./......,.a ......... , 19Z.Z. Perm,t No....~..~. ............................ D' F ~sapproved a/c ............................................................................... , .............. ........................................................................ ........... ,.-.,, ............... ....................... ~,¢~..,r¢/.. , (Build~sp'~tor) APPLICATION FOE BUILDING PEIUGIT Date INSTRUCTIONS 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 plat plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout ofproperty must be drawn on the 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 Building 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 been granted by the Building Inspector. r,~ APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th~,, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances ard 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 necessa~ inspections. /' .................................... (/~ignature of applicant, or name, ifa corporation) .......................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ...................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Budders bcense No ................................... Plumber's License No ........ ~.~...~ Electrician's License No ................ ' /¢ ".~.~'" // Other Trade's License No ............................ ~. ............... /0¢0- H-/~- / -/ Location of land on which proposed work will be done. ~ .: ........................................ Let No. %. ..................... Street and Number ..~rr~......¢~.....~:..~, .......................................... ~~.. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ......... x · ~...~.~. ................................................................... b. Intended use and occupancy .L~,.,~P~ ..... ; ............... 3. Nature of work (check which applicable): New Baildmg~. ................. Addition .................. Alteration ....': ........... Repair ..i ............... Removal ,~ ................. Dema~itior ..................... Other Wark ................................................ ~.. ~ ~,l (Description) 4. Estimated Cost ................... ~.;/...~.O.~,~ .................. Fee ..~f:. ................................................................................ (to be paid on filing this application) 5. If dw.elling, number of dwelling units ............................ Number of dwelling units on each floor ..... , ...................... If garage, number of curs '~ ............................................................................... 6. If business, commercial ar 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 ............................/Nurdber of Stories ................................ 8. Dimensions of entire new construction: Front ~,,-,~.: ...... Rear ............................ Depth ........................ Height .................... Number of Stories ................................ : ......................................... ' ........................................... 9. Size of lot: Front ...~....~ ............. Rem'. ......................................... Depth ................................ 10. Date of Purchase ......................................................../' Name o£ Former Owner ........................................................ 11. Zone or use district in which premises ere situated ................~.~..~ ............................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ~.. ........... .......................... 13. Will lot be regroded ....~,~'...-,~....',~,~ ,~:~;~,~Will~,,cess fill be removed from~~,~.~premi,se.~_( ),Yes 14. Name of Owner of premises ...~..X'~/~..: .......... Address '~~. Phone No ....................... Name or- Architect ...........I~'/ .......... : ................................. Address ................................ Phone No ....................... Nome of Contractor ............................................... ~-~,"~'~'~":"Address" ............................... Phone No ....................... PLOT DIA~(~,., ~.~' ,'' ' Locate clearly and distinctly all buildings, whether existing or pro~o~ed, ~d~r~dicbte"a[t ~set-bac~ d.mensions from property lines. Give street and block number or description according to ~ crud show ,~t, reet~'n'~rnes and indicate whether interior or corner Io~. ~ ~ , , ~,"~,~, .......... STATE OF NEW YORK, COLJNTY OF .......................... ~'~ ........................................ ~.~-'~:,,,s~:z~.~ing duly sworn, deposes and says that he is the applicam (Name of in~ua~signing control'S) 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 end file this application; that ali statements contained in this application are true to the best of his knowledge and belief; and thru' the work will be performed in the manner set forth in the application f,~d therewith. Sworn t,o before me this ........ d.~ .......// day of ...... ~.~,~...~...i .................. , 19,~...~ Notar ........ ........... ............................ Coun ...... .......... ~/~/~ ~ ] (r /' (Signatur~ o~f applicant) ~OTARY POBLIC,/~e o!. N? Yet Ne. 52-464372~', Suffolk County Term Expires March 30,