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Home My WebLink About9350-zTOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P1~EMISES UNTIL FULL COMPL~ION OF THE WORK AU:i-HORIZED) N? 9350 Z Permission is hereby granted to: ~ - FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANC Instructions A. 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, propertv 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. Bo For existing buildings (prior to April 1957), Non-conforming uses, or b~uildings and "pre-ex~sting" land uses: 7. Accurate survey of peoperty showing all property lines, streets, bui dings and unusual natural or topographic featu res. 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, Ior other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 c/r / 2. Certificate of occupancy on pre-existing dwelling land use $/5' $5.00 3. Copy of certificate of occupancy $1.00 t / I Date ............... New Building Old or Pre-existing Building .. ~ Vacant Land ............. Location of Property ~ ~.Q ~ h ~./..[-.' .~ ..... Owner or Ownersof ProperW ...~.U..~. g.~J...~ ....... ~).~>.~... .~..f.. .................. County Tax Map No. 1000 Section ../Q.4 ....... Block ...~ ............ Lot../.5 ........... Subdivision.6~.//)/~.l.L.,/../~).C~.~...~$J~L~.~ .Filed Map No. l ~ -~-~. .Lot No. /.//~ Permit No ........... Date of Permit .......... Applicant ................................... Health Dept. Approval ........................ Labor Dept. Approval . '1 ...................... Underwriters Approval ........................ Planning Board Approval ..................... Request for Temporary Certificate ..................... Final Certificate ..................... Fee Submitted $ ............................., Construction on above described building and,permit meets all applicable code~ and regulations. -- ~pplicant . . .'-~..v~# wp .... ~ J; 1 .~ ~. ~ ........................... / THE NEW YORK BOARD OF =,o," UNDERWRITERS BUREAU OF ELECTRICITY ~ ak 85 JOHN STREET, NEW YORK, NEW YORK 10038 o.t~ October 27, 1977 A..~i..t~o~No.o.,/,le 931394 ~ N ~ , , I ¢ THIS CERTIFIES THAT only the el~trical equipment ~ ~scdb~ be~ and int~uc~ by t~ appltcant named on t~ a~ve application numar ~n the premtses of Lubes Triner, 116 Central Drive, Mattituck, L.I- FIXTURES RANGES COOKING DECKS ~ OVENS DISH WASHERS EXHAUST FANS 4 8 5 4 DRYERS FUENAC~ MOTORS UTURE A~ANCE ~EDERS PECIALREC'PT TIMECLOCKS UNIT HEATE~ -~ .... Oustav ~rtra, : ::"-- ~-~-: :-227 East Breakwater Rd. ' - ' -: ~. :' ', ~- - -= ~ Lic 1529E GENERAL ~NAGEE -, .... ~- --_ _ . . ~--__ ,- . - , ~. _.; -_ 'I, . - ,- ........... t-rn to the'o~ce o~ ~h. Board ff mcorred Inspedors may be ~denhfi.d b~e~r ~edenhols. t TOW" OF SOUTHOLD ~' ~ ~ ~ '~/¢~'~/ ToWN CL' K OF.C. ~UTHOLD, N. Y. ~proved~ '~ ..... ~ ....... 19..:~ Permit No. ~ ~ ~ ,Application No. ~...~...E...~.. ............ Disapproved a/c ....................................................................... APPLICATION FOR BUILDING PERMIT Date .......................................... , 19 .. INSTRUCIION$ a This application must be completely filled in by typewriter or' in ink and submitted in triplicate to the Buildir 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 premises, relationship to adjoining premises or public streets ~ areas, and giving a detailed descriphon of layout ofproperty must be drawn on the diagram which is part of this applicatio, c. The work covered by this apphcation may not be commenced before issuance'of Building Permit. d. Upon approval of this application, the Building Inspector will issue o Building Permit to the applicant 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. I APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to ti- Building Zone Ordinance of the Town of Southotd, Suffolk County, New York, and.other applicable Laws, Ordinances, Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herren describe, The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and ~ admit authorized inspectors on premises and ir~ buildings for necessary inspections. (Signature of applicant, or n~ame, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bullde ............... ............................................................................................................................................. ame ....... ........ ................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) P Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............. ?.. ............................ /000- f& thor/raae s License No ............................................... ~r, ,_ 7:z.. _<,_ -'~" ~/ ~ Location of land on which proposed work will be done. Mop ~q~...~.....'¥ ............. Lot No."f'~--~..... ............ Street and Number ....... ..~...~....~.~...../'.)./~.I../K'...'(~ .......... ~./~.~....~..~..../../'~..J~.....~.~-_~.. ........................ Municipality State existing use and occupancy of premises and intended use and occupan(:y of proposed construction: a Exisiting use and occupancy ..... ~.~ ......................................................................................... ................. ......... .................................................................. b. Intended use and occupancy / 3, Nature of work (check which apphcable) New Budding ................. Addition I ................. Alteration ............ Repair ............... Removal ................ Demoht~or ...... Other Work ................ 4 Estimated Cast .........../f....:~): ......... ~ ................... Fee ..... :.. ' ....................... (to be paid on fihng th~s apphcahon) 5. If dwelling, number of dwelling umts .................. Number of dwelhng umts on each floor ......................... If garage, number of cars ........................................................... ; ............................................ 6 If business, commercial or m~xed occupancy, specify nature and extent of ,each type of use ....................... 7 D~mens~ons of ex~stmg structures, ~f any Front .................... Rear ................................ Depth .................. Height ....................... Number of Stones ............ D~mens~ons of same structure with alterations or addmons Front ................................. Rear ....... Depth ............................. Height .................... Number of Stones .............................. 8 D~mens~ons of enhre new construction' Front ........ ;..:~ ............... Rear ........ ~ .............. Depth .... Height ................ Number of Stones ....................... ~ ........................... 9 S~ze of lot Front ..:,. Rear ' Depth t0 Date of Purchase .............................................. Name of Former OwnerI ..................................................... 1 1 Zone or use dlstrsct in which premises are s~tuated .../. ............................................................................... 12 Does proposed construction violate any zoning Iow, ordinance or regulahon .............................................. 13 WEll lot be regraded .......................... WEll excess fill be removed from premises ( ) Yes ( ) No 14 Name of Owner of premises ....................................... Address ................................ Phono No ...................... Nome of Architect ............................ Address ................................ Phone No ...................... Nome of Contractor · ~ ........................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly oil buddsngs, whether ex~sting or proposed, and indicate all set-back dimensions frorr property hnes Gwe street and block nurrber or description according to deed, and shaw street names and ind~cab whether interior or corner lot ~TATE OF NEW YORK, ~ ~ S S COUNTY OF ....... ........................ '..~7/~/. ...... ~ .............. :~ ..................... being duty sworn, deposes and soys that he ~s the apphcar (Name of Individual sign~:s~r~ontracf) above named of said owner or owners, and ss duly authorized to ~erform ar have performed t~e said work and to make and f~ th~s application, that all statements contained ~n th~s apphcot~on are true to the best of h~s knowledge and belief; ar tha~ the work will be performed in the manner set forth mtke apphcat~on filed therewith. Sworn to before me th~s ............... ::~... day of ~:.:¥ ........ Notary Pubhc, ...~. .... [ ...... ' ..... :/q.~,.. ,/.....~ ....... [ ~Y E, ~WSON /' ~IC, State ot New Y~r~ ~ ~721, Sulfolk County~ T~ ~lres March 30. 19~ .,19 County