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Home My WebLink About9742-ZTOWN OF $OUTHOLD BUH~ING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No... ~9.~.~ .... Date ....All&qla~; .... 2./* ........... , 19..7.8 THIS CERTIFIES that the building located at . ./~O0. ~uzll~.e.~; .Pl~,t,h ........ Street Map No ............. Block No ...........Lot No .................................. conforms substantially to the Application for Building Permit heretofore flied in this office dated ....M.ay...23 .......... , 19. ?.8. pursuant to which Building Permit No .... 97.~Z dated .... M.ay...23 ........... , 19..7.8, was issued, and conforms to all o! the require- ments of the applicable provisions of the law. The occupancy for which thi.~ certificate is issued is ....... .~..i.v..e.t.e..O~.e..Feml,l.~'. l~e3-,1,1ng. ~,t,h..e~dcU..t,t.on ................ The certificate is issued to .......... .RO~. l~eevie ................................... (owner, ~ of the aforesaid building. Suffolk County Department of Health Approval ............. N/l~ ................... UNDERWRITERS CERTIFICATE No..' ....... .I~9.7.6.2.7 ............................ HOUSE NUMBER .....6~0 ........ Street ...... .S.u~..a.e.~..P.a.~b ....................... ............................................ S. o. .u. .th.o. ~. .d.,. .N. .e~. . .~. or.~ .............. ...... /.z.../~..~.,C:..~ .... Building Inspector IUILINN~ DEPARTMENT TOWN CLEP. K'S O~FICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 97~Z2 Z Permission is hereby grm-d'ed to: .......... ~..~..er. ...................................... .......... ~.c .......... ~or~l~e~r~ ............................... at premises located at ...................... .~....~........S....LI~....~..e..~.....P..~...~..~.. ............................................................... .......................................................... ~.~,tZ~o~O,,..NASA ..................................................................... pursuant to al~PflcatJon dated ..... ..~..~.~. ....... 2~. ............................. , 19..~.~.~, and approved by the Building In~oector. Building InspeCtor 1000-5~-1-17 ~ FORM NO. $ TOWN OF SOUTHOLD Building Depar~ment 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 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 dwelHng or land use $5.00 3. Copy of certificate of occupancy $1.00~....~1c~ Date .... % .~/~ '~ ~' New Building .................... or Pre-existing Building ............................ Vacant Land ............................ Location Of Property .... ~'~.~'~S.~e~!~?~.~u~ .0..J'...~.....~.:'.!!...h.!.'~...: ............................ Owner Or Owners Of Property ....~..6.,'tct ....... ~.~..~o.,~..~..~... ............................................................................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No..~..~..~....~..:..~. Date Of Permit ..~.~...~...~J.~..~..Applicant ...~-~.~.....~ ................ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............~ ........................ Planning Board Approval ........................................ V Request For Temporary Certificate ........................................ Final Certificate ........ .~...~... ........................ Fee Submitted $ ..~'~..,..?. ...................... Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me this Applicant ...~<U~....?.,.,~..,.,~.-(~.~ ................ day of ............................................ Notary Public .................................... County (stamp or seal) Co- Z-. q/ THE NEW YORK BOARD OF FIRE UNDERWRITERS f t BUREAU OF ELECTRIC~rY ~ al..[gUl~(~ 10, 19~IS JOHN STREET, NEW YORK. NEW THIS CE~IFIES THAT was e~amlned on IE~ACLIS SWITCHES ~ lst Fl. [] 2nd Fl. Section Block and found to be in compliance with the requirements of this Board. RANGES I 3 R NXTURE FIXTURES OTHER APPARATUS: ~.lec. ~oom heaCere: 1-1.~, COOKING DECKS OVENS DiSH WASHEIS )~T* K* W, ~T. K,W. [MT, K.W. TIME CLOCKS BELL uNIT HEATERS MUL~I..OUTLET V I C E EXHAUST FANS 143 ....... t4aCCiCuek, L.I. 11952 lie. 242E / ?his certificate mus~ no? be o~ered ~n a~ monner;~ re~urn ~o ~ o~ice of ~he ~urd if ;ncorr~, In~ors moy be idenfifi~ by ~r c~ls~/ COPY FOR BUILDING DIPARTMENT. THIS COPY G_C_CERTIFICATE MUST NOT BE ALTIRI0 IN__ANy MANNER. SOUTHOLD, N. ¥. Examined ................... ~:~....:J.....':..;, 19.;..,;.. Application No~.~./'-.~'. ......................................................................................................................... '// (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o~ 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 showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproparty 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. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the 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 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 ,~]me, if a corporation) · (Address of applicant] J, '? ~ ~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ~'- Builder's License No ............. .~...~ .............................. Plumber's License No ...... .~.....././...'...~ ......................... Electrician's License No....~....~.j....~....'.....~... ................. state whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of prem ............. ~ ................... .'~/. .................................................................................................... ~e~ Tmde's ~icen~ ~o k ~[~ of 1Q~ on w~ic~ pr~ed wo~ will be done. ~ ~o,~ ........................................ ~ot ~o ......................... Street and Number ~.t ................................ , ................... · .......... ,....1 ....................... ~.~..~ ......... t..b.......~ ........... t..~.~ 2.State existing use and ~cu~ncy of premises and intended use and ~cu~ncy of p~ c~tm~ion: a. ~isiting u~ a~ ~cupancy ~.~ ~ I.~J ~ ~ c ~ ....... ' b. Intended use and ~cu~ncy ................. ~..~..~ .................................................................................................. 3. Nature of work (check which applicable): New Building.. ................. Addition ......~.. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ..................................................... ~. ,~- (Description) 4. Estimated Cost ...... ,~.~L;.~.:.%...~.~ ................................ Fee / j> (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... ~}...~..~ ........... Number of dwelling units on each floor '~'~ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each .h/pe of use ............................ 7. D mens ons of ex st ng structures, f any. Front ............................ Rear ................................ Depth .'.~. ................ Height ......... ~. .............. Number of Stories ...... ~.:::~.'% ............................................................................................... Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Nu?,l?er of Stories .....~;..21, D:?,, ............ X/- ,:Z ................. 8. Dimensions of entire new construction: Front .......... ~..,...::. ................. Rear ........... : ................ Depth Height ...,~.~.,'.~ ....... Number of Stories '~' .... 9. Size of lot: Front ...... /..~-~ ......................................... Rear ............. :Z.?. ....................... ' ~' ' Depth ...,..;....: ................... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated .... ~ 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... [.~:~.~ ........................................... 13. Will lot be regraded. .......6!.:; .............. Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .i~..,,r. .......'..~..:'...::..~:.~. ................ . ..-.~A~d~ln~ee ...~/'...· '"~.'" ..~ .... :"/'~ c .. Phone No. ~/~.~.......,'............ Name of Architect .............................................................. Address ~ ............................... Phone No ....................... Name of Contractor ....... ..~,.,~....:.; .......... ...~ ......... ,. ............ Address ............................... Phorm No ...................... PLOT DIAGRAM (. ,'- :., Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock 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. J STATE OF NEW YOR~, ,)/7 [¢ c COUN O/.. ...;..J...~.~.~'..~i~/~ .......................... being duly sworn, deposes and soys t~t he is the applicam (Name ~ ~divi~ signing ~troc~ above name. J ~ . U ~,~'~ . /.. ~ ~ He is the ......~.~.~.;~.~ ........................................................................................................................ {Gontroctor, ag~t, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained Jn this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set fo~h in the application filed therewith. S~orn to ~fore me this / ) ~ ~' ...... ' . ................. Nota~ Public, .d __f.~ ......... C~n~ .... ~~....~:/'~ ~ '~] .............................................. l/ ~ ~ ~ ~. . ~ ~ / ~ (Signa~re~pplicant) TOWN OF SOUTHOLO BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ....... - Disopproved Q/C .................. ~.......-.....~ ....... ._. ............ ........... ........................ (Building Inspector) Application No...~.....~...?..~ ....... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter or, in ink and submitted in triplicate to the Building Inspector, with 3 set~ 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 o~ areas, and giving a detailed description of layout ofprpperty 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. Upo~n approval of this application, the Building Inspector will issu~ 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. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the 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 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 ~'me, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~c,,//.- Dc ~- Name of owner of premises ........ ~.~...~L. ....... .~...~...?-:....~.....~'... ............................................................................................. If applicant is o corporate, signature of ,duly authorized officer. (Name and title of corporate officer) Builder's Liconse No ............. .~..~ ............................. Plumber's License No ....... ~.../...J.~.~./~.. ........................ Electrician's License No...~.......~...~:.....-.....~.. ................. Other Trade's License No ............................................... Location of land on whi.ch proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number .~..-O-.~...~....D.....~.(~.C~...~....~.....~.../~../~...?..°./~.....P..~..~.~.....~.~......~.~.Z...~...~R~Z~.~.~.L'~. State existing use and occupancy of premises and intended use and occupancy of proposed construction: !~.~..e....~... c "-"- .......... a. Exisiting use and occupancy ........... ~..~..~. ........................................................................................... b. Intended use and occupancy ................. ~...~....~......~... ............................................ ~ .............................................. 3. Nature of work (check which applicable): New Building.. ................. Addition..................~ Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ..................................................... ~ / ~ (Description) 4. Estimated Cost ..... m~,.Q..~..(~ ....................................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....~...~....~m... ........... Number of dwelling units on each floor ...~,..~.,~ .............. If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ...,¢i~C.~.?.::!:: ........ Rear ....... ~.~....-Z~... ............... Depth .~..;!.~.:Z.:. .... 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 ....~t~_ .... Number of Stories ..... ~.....~.....~.. ................................................................................................... 9. Size of lot: Front ...... /.~..~. ....................................... Rear ......... ~...?...8..; ..................... Depth ...~...~..~.;../...~ ............. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ....... /~...c..~j..~...~....?..~l~..~... .............................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... .~.....~. ......................................... 13. Will lot be regraded .........~/....0. ............. Will excess fill be removed from premises: ( ) Y~s ( ) No 14. Name of Owner of premises ./'~.P...'~........~....~....~..~....~... ............... Address ~..~o~..~.~......J...~.~..~..... Phone No.'~,...~.~./.~£...~... Name of Architect ....... ~ ................................................. Address ................................ Phone No ....................... Nome of Contractor ............... No. PLOT DIAGRAM C Locate clearly and 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. / 3,,0, STATE OF NEWY~K~ . ~.~,-,- ...... ~~ ............. being duly sworn, deposes and says that he is the opplicam ab~d~al signing c~racf). He is the ........... ~.......-"T.: ................................................................................................................... (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 Jn this application are true to the best of his knowledge and belief; and that the worl~ will be performed in the manner set forth in the application filed therewith. /! FEE:~ D~PAR~r^c~ ~OTIF¥ ~u~'" 4P~ ~OR REQU~R' BEFOR-. cTA~.T NOT UCTION [RRORS 2~ c°~s~"'?~'. £X~ s r~ N~ __