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Home My WebLink About9267-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin§ Inspector Town Hall $outhold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the bmlding ..... .A.d.d. ¢.t.i. qr~ ................................. Location of Property ..... 2. .0 .6.5..M..~ .Iq.I~.~ H. ~.HA. B..L y.D... ................. S..0 .[J.T.H. 0..L ? ........ House No. Street Hamlet County Tax Map No. 1000 Section . .0.8.7. ....... Block . ...0.3. ......... Lot ..... 0.5. .~ ......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Buildmg Permit heretofore filed in this office dated .... ~..ay..~ 1 .......... ,197.7. pursuant to which Building Permit No..9.2fi. 7..Z ............... dated ...... [qa~ .3 ~ ............... 197.?., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which ttfis certificate is issued is ......... .... B u.i.~L d. an..a d cl..i.t, 5, o n..qr~, ex.a, ~ 1; ;i.~g. ql ~.e.l. ], ~_ rz.g .............................. The certificate is issued to ...... J..E.A.N..M. ,..L. QH..N ....................................... (owner, ~oX~ Xe~r~XJX of the aforesaid building. Suffolk County Department of Health Approval ........ .lq./.[ .............................. UNDERWRITERS CERTIFICATE NO ................ ~.).N.3.6..2 ~.6.~ ........................ Budding Inspector Rev. 1/81 TOWN OF SO'UTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUS'I' BE KEPT ON THE P~REMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9267 Z Permission is hereby granted to: ' ~.~..t...F.~.~.t, ...~?......u,..c....~..,~.,....~ ...... .......... ~. ........ ..s.~.o.~..a. ................................... at premises located at Building Inspector. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY I nstructions This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor 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 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" land uses: 1. Accurate survey of p~operty 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 informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 New Building .... .~.. ...... Old or Pre-existing Building $15.00 Date ............ Vacant Land ............. House No. Street Hamlet Owner or Owners of Propertv ....~...~-~...~....~.. t~.-..~...~...~. ........................... County Tax Map No. 1000 Section . S~, ,%..~, ....... Block ... ,C,~..~,. ...... Lot...~. ,¥'./~, ....... Subdivision .......... ;...~--~. ................ Filed Map No ........... Lot No .............. · om ~_~2 ¢-~ ,~./.~.l .).~?.App licant .................................. Permit N . ~ ......... Date of Permit 1,1 ~. ...... '-. .......... , ~...Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ........ . ~.~,~. ...... Final Certificate .... ~ ................ / \ Fee Submitted $ ..................... .~ ~ .t /~ Construction on above descr,bed bu,lding a~¥m~~t Jl~al~e. coU~d/s i~d r.egu ,ations. Apphcant. ~~/..~: .~. ......... : .~/. ~ ....................... ~~RK BOARD OF FIRE UNDERWRITERS ____ i]l~ - BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK. NEW YORK 10038 ..,~ove.,ber i, ~ ~,."~-,'--',,-.,-~"~ N 362468 THIS CERTIFIES THAT Mrs. Jesn Lohn, N/s Mlnehaha Blvd., 800' W/o O~echee Ave., southold,L.I. ~,, ,~e.~o,o.,,.~ ~,,~,,~-m L~ ~.,.,~ ~_ ~ r/ X~ ~.~ r, outside .~,~o. m~-~ ~o~ ~XTURE i FIXTURES '{ RANGES ',~E~w OVENS DISH WASH~U~ FANS DRYERS FURNACE MOTORS ' ~TURE APPLIANCE FEEDERS SPECtALREC'PT] TIMECLOCKS ' SELL ~UNtTHEATERS MULTI-OUTLET DIMMERS~ ~ ~,,~ ,.,~. ; i x , 1 3/0 ~__~i/0 ~: Elco. roon Heatems: 1-2.0k.w.,5-i. Sk.w.,3-10k.w. i-G.F.C.I. ~ 2-smoke detectors ?, Ru!~nd glec. Co. // ~i i~ Mattituck,L.Z. liES2 L!c.2~2E ...... ~ ~) ~ Th~,ered ,~. ~.ner. return to the o.,ce of the Bo~:d ff incorrect Inspectors ~ay h~ie~,r cr~enhol. ~, TOWN OF SOUTHOLD BUILDING DEPARTMENT ]~,~ ~ TO~N CLERK'S OFFICE OL,, ,. Y. ........................................ , .......... ..... ............. , ...................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by h, pewriter or in ink and submitted in triplicate to the Buildi, Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on pram,sas, relationship to adjoining premmes or public streets, areas, and giving a detailed description of layout ofproperty must be drawn on the d,agram which is part of th~s applicatio 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 apphcant Such perm 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 Occupan, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to fi Budd,ng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances. Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) Southold (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bu~ld¢ ............................................... b.u~ldem ............................................................................................................................. Name of owner of premises lIrs J. Lohn If applicant is.n"~orporate, signature of dHly?~thm4z-ed-~ficer. -- (N~me ~nd ~ifle o~ colorflect) Builder% Lic~se No .......... ~.~ ...................................... pb~'~ Li~,,e No....~.~...~.~.3.b .......................... Electrician% Eicens~ No. ~g~ Of her Tr~de's License No ............................................... 1 Loc~ion o{ I=nd on which proposed work will b~ done. M=p No ........... ~ ....................... Lot No ........... ~ .... s,~, ~,~ N~ !!Z:&.ki~.~b.~bg...~z~ .......... ~.~h~. ........................................................................ Municip~li~ 2. State exisfin~ use ~nd occupancy o~ premise~ ~nd infended use ond occupancy o~ proposed consfrucfion' = E~i~i~.= ~ ~ =~p=.w ..~.}!~EE ....................................................................................................... b. Infended use ~nd occup=ncy s~z~ '~N ~o~ 6- Al~ew~o~ 3. Nature of work (check which apphcable) New Budding ........... Addition ........ ~ ..... Alteration .~.. .... Repair .............. Removal ............... Demolit~or. ......... Other Work ................................................. (Description) 4 Estimated Cost .......... ~.O..~..0..0...C.'.. + ............................ Fee ..... .1. ~'..:..0..0.. .................................................................. (to be pa~d on fihng th~s applicahon) 5 If dwelhng, number of dwelling units ...... .o.b.e. .............. Number of dwelhng umts on each floor ........................ If garage, number of cars ............................................................................................................................. 6 If business, commercml or m~xed occupancy, specify nature and extent of each type of use ........................ 7 D~mens~ons of ex~stmg structures, ff any' Front ................... Rear ................................ Depth ................... Height ........................ Number of Stones ........................................................................................................ D~mensions of same structure with alterations or addmons Front .................................... Rear ..................... Depth .............................. Height ...................... Number of Storms ............................... 8 Dimensions of enhre new construction' Front ...Lk0.-..l.0 ...................... Rear ....... .LL-t0..-..1..Q ........ Depth .....~J~. ........... Height ................ Number of Stories ......... ~.~..O.. .................................................................................. 9 S~ze of lot Front ............................................. Rear ........................................ Depth ............................. 10. Date of Purchase ..................................................... Name of Former Owner ...................................................... 11 Zone or use district in which premises are s~tuated ."A]!...~;i,~; ...................................................................... 12 Does proposed construction violate any zoning law, ordtnance or regulation' .~.O.. ................................................ 13 Will lot be regraded ..........y~S ........... Will excess fill be removed from premises: (x) Yes ( ) No 14 Name of Owner of premises ..}.~.;~ .... ~...T~oh~ .................. Address ........ ,$.Q1.L%]:%O.~..d. .... Phono No ..................... Name of Architect ...~.........t~r.],ey ............................ Address ........... ~.°...'G..t...b...°..1..~.. Phone No .................... Nome of Contractor .~.: ..~.~a~...~.n.9 .................. Address .......... .~.o...~.~.~.z.~..~.. .... Phone No .................... PLOT DIAGRAM Locate clearly and d~stmctly all buddings, whether ex~sting or proposed, and md~cote all set-back dimensmns fro property hnes Gwe street and block number or descr~phon accardmg to deed, and show street names and indica whether interior or corner lot see filed plans STATE OF NEW~Y0_PxK,._ tS COUNTY OF ....~.:I:'.Z...O&~ ............ f S ................. .~..~b..~...~.9,.~..t; ............................................... being duly sworn, deposes and says that he ~s the apphc, (Name of mdlwdual s~gning contract) above named He is the ............................. .Qc~z'.~...Qf£~±~.~r...Lx..~.i2z~l.e.~ .............................................................................. (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and this apphcat~on, that oil statements contained ~n th~s opphcohon are true to the best of h~s knowledge and behef; tha~ the work wdt be performed ~n the manner set forth ~n the apphcat~on filed therewith. Sworn to before me th~s Notary,~ubhc, . .........~ ................................ County (S,gnoture of MARY E DAWSON NOTARY PUBLIC, State of New Yer~ No 52-464372~., Suffolk Cou.~ty Term Expires March 30, ~^~:0 II LIV~Nq / I U-nLrP'( ,IJ "7 ~TuD'.,,, ;1 ,/,,r' ~ i'-o" 51~oJ77