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Home My WebLink About6675-Z!~O~ NO. 4 TOWN OF SOUTHOLD BUILI~INC. DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificete Of Occupancy THIS CERTIFIES that the building located ats0h~o~. -lions®. L&(pike .St.) Street Map No. x~ ......... Block No..xx .......Lot Bio...~...~..p..1.e....L~...:~ .Mal;~cttuek..' conforms substantially to the Application for Building Permit heretofore ~ed in thl, office dated ............. J. une...ii) 1913. · pursuant to which Building Permit No. 6675Z.. dated ..........,hxtl~''' 2(~ ''" 19~., 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 ... 'Ae~'ssory '(starage') 'bui'lding ................................... The certificate is issued to . John. &- .T. he.lma · Loper ................................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval · ·..N .R-, ........................... UNDERWRITERS CERTIFICATE No.. Il .%21~1.1+3....Qct. al... 1 ~).7.3 ............... HOUSE NUMBER .~ '2~0 ...... Street ...Pike .St..(..School. aouse..Rd) ........ Building In .~l~-~tor FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6675 Z Permission is hereby granted to: ~.o...~.....~..~.~#,l,~,..~r~ .................................. Mattituek at premises located at ~.~..~..~.~Z-:c..~.`:.~..~::.~z~..e~.~.~..~.~:~.?..q.-rF~?{~?~k4 .................................... ............................................... ~...~..t.~.~.*.~ ........................................................................................... pursuant to application dated ..................... ~..~.......1.~. ................ 1~ ...... , and approved by the Building Inspector. 1,0,00 Fee $ ........................ Building Inspector/ FORM NO. 6 TOWN OF ~OUTHOLD Building Depaztment Town Clerics 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 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 dispasal--(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 dwelling or land use 3. Copy of certificate of occupancy $1.00 New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ · ocation Pro, erty ........................................................ : ................. ....................... Owner Or Owners 0' Property ..~.~.~...~....~....~.~..~.~..~.....~........~..~.~...~.......: .............................. Subdivision ............................................................... Lot No ............. Block No ............. House No ............. .................... H~alth ~pt. Approval ............................................ Labor ~pt. Approval ................................................ Underwrite~ Approval .~,.)..~.~.].~.~ ................... Planning B~rd ~proval ........................................ Request For Tempora~ Ce~ificate ........................................ Final Certificate ........ ,'.~ ......................... Fee Submitted $ ....~ ..................... Construction on above described b. uilding and/~.ir,rn~m~e~//~p~codes and regulations. Notary Public ................................... ~ County THE NEW YORK BOARD OF FIRE UNDERWRITERS C5 BUREAU OF ELECTRICITY r~ es JOHN STREET, NEW YORK, NI[W Y?,~cK 10038 Date 0 ~ffcob (~ ~' ~],:i ~pplicationNo. on~ile ~ ~' ~ · .,. c.~,.,....~ N 124143 o~y t~ ~t~ ~ui~ent ~ ~scd~ b~ ~ int~ b~ t~ ~oI ~ o~t~ ~p~t~m~mb~ ~ t~ premises of inthefollowingl~at~.; ~ B~nt ~tFI. ~ 2nd Fl. ~zara~;e outside S~tlo. Bilk FIXTURE JECEPTA LEI I FIXTURES I OUTLETS I C S SWITCHES INCANDESCENT FLUORESCENT '~vI~"~ J / DRY~RS FURNACE MOTORS FUTURE APPLIANCE F~EDERS AMT. K.W, 01/ H.P, GAS H.P. AMT, NO, A.W.G. RANGES SPECIAL REC'PT [COOKING DECKS OVENS [DISH WASHERS TIMECLOCKS [ BELL [UNITHEATERSUNIT HEATERS MULTI-OUTLET 't TRANS. ~ SYSTEMS II SERVICE DISCONNECT I NO. OF A.~T METER · ~u,~p 'rY~ muir. t t,qO Ci OTHRR ~ARATUS: EXHAUST FANS DIMMERS S R I C E A.W.G. NO. OF HI-LEG A.W.G. A.W.G. OF CC. COtdO. OF HI-LEG OF NEUTRAL Ted Cheshire Jr'. Co. Box K llalnpa!':o!~; , i,.!. G~qBIAL MANAGER COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. BUILDING DIFARTMINT TOW a. K'S OFFh SOUTH(X.D, H. Y. 19 ........ Permit ~o~. ................................... Application NO.....~.....~...Z.~ ........ Disapproved a/c .~ ........................................... _ . . I Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. i.ST.UCneas a. T~,is ap~.~ication.:must be completejy fi ~ iq by:~ewnter ~j~':J~ a~,.s~m ~ in triplic~e to ~e Bui~n In~or, with 3 ~ of pl~, ~cGmte p ~ ~1~ ~ ~1~. F~ ~o~ing to ~h~ule. b. PI~ plan-~. I~hon.o~lot ~n~of bu~s ~ ~s~, mlat~n~p to adlmm~g premises' or pubhc str~ o~, areas, aha givi~ q qetai~ a~ripti~ at I~ ot~ musf.~ drown on the diagrams. Which is ~ c.' ~e w6~er~ by ~ a~ficati0n.'~ n~ ~ co~'~fore i~ance of Buildi~ Pe~it. . .~. U~ ~at of. ~is.~icati~ ~e.B~l~h~ ~tor ~fl i~-a BUildid~ Per~'it to the applicant. Such ~it snail ~ k~t ~ ~ pmmi~ ~ail~le for in~t~ ~t~ ~rk. ' e. 'No ~ild~ ~all ~ ~cupi~ or u~ in ~le or in pa ~.for any pu~e what,er until a Ce~ificate of shall h~e ~ gmn~ ~ the Buil~ In~6r.'. . .- .:" APPLICATION IS HEREBY ~DE to the Buildi~ ~ment for the issuance of a Building Pe~it ~t ~uJld~ Z~ ~i~e~of.~ T~~d~lk~'Cbd~, ~ew York, and ~r ~plic~le ~ ~i~m or K~u~s, mr the ~t~hon at ou.a~, ~ih~s ~ altemh~s; or .f~r m~l ~ de~llti~, as heroin ~n~. ~e ~plicant ogres to comply with~all a~licable I~, 0rdinanc~, :b~tldi~ c~; h~g c~e, and ~latl~,. a~ ~ admit au~riz~ in~o~ on premiss a~ in bui.ldi~ ~r' n~e~a~' i~ti~s~ -. ~ _ ..... ' (~'of '~licent) State whethar a~licant is owner, les~e, ogent, amhitect, engineer, general contractor, electrician, plu~er or builder. .................................. ....................................................... : .............................. N~me of ~ney of premiss ................................................... ~ ............... ~..; .............................................. If ~licont is ~ ~te, signeture of duly o~h~i~ officer. ¸. Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ......./e4~.. ar.~ ,~~' ........................ ~.~.. Lo~ No ......................... Street and Number ......'~....~.~..,.~..L....'~/-.R..~..~.~,~.....)~o.~..~..~.. .......... .~.~.....~.L~,/ .............. .................. Municipality State existing use and occupancy of premises end intended use and occupancy of proPosed construction: a. Exisiting use and occupancy ...................... ~ ......................................................................................................... use and o cu. ncy ........ ......... : ...................................... b. Intended 3. Nature of work (check which applicable): New BuJldin~j ,. ~. ..~. .. .... ... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition ......... ........... Other Work ................................................ . ..... 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 ............................ 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 ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with olterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ . ..jz' .Z./ ~ / 8. Dimensions of entire new construction: Front ............ ~..~.. ............... Rear ............ ~... ........... Depth .,~..~.. ............... Height ...~.~..~ ...... Number of Stories .......... ./.. .............................................................................................. · ......... 9. Size of lot: Front ........................................................ Rear ................... , ...................... Depth ................................ 10. Date of Purchase ....... ~..~.~..'('.. ......... /..~..~....~.. ............... Name of Former Owner .~.~........~..?...//..~....~...~....: .................... .:t~..- Zone or use district in which premises are situated ..................................................................................................... 1'~.. Does proposed constructio~ violate any zoning law, ordinance or regulation: .....~....6. ......................................... 13i Will lot be regraded ........... ~..~..~ ....... W~excess fill be removed fl:grq prqmj~eS: ( ) Yes ( ) No ~14. Name of Owner of premises ..... .~..~'.~..'/...'~"..I..'.~.-~...Jm.~.~. Address~c~ef~ .....~. P-Pho~ No. ,~...~..'..~...~'.~..~ Name of Architect ................ .J~....?...~....~=....; ........................... Address ................................ Phone No ....................... Name of Contractor ............ ,,~..~-...~ ...... ~ '. .............................. Address ..~...z~.....~'~.~./:?~Phone-- No......,................'-"~-~' ~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exi,~ting 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 comer lot. STATE OF NEW YORK. I ~ e COUNTY OF ......... ..................... ~..~....~...~....~Z'....~...~.~..~.~..~,...: .......................... being duly sworn, deposes and says t~t he is the aPplicant (Name of individual signing co~trac~ obove name. He is the ................... .~.~ ...................................................................................................................................... (Contractor, agent, co,orate officer, etc.) of said owner or owners, and is duly authorized to perform or ~ve performed the said work ~d to ~ke ond file this application; that all statements contained in this application are tree to the best of his knowledge and belief; and that ~e work will be performed in the manner ~t forth Jn the ~pplication filed therewith. Sworn to before me this ........ ......... ............................................ , ........ ,., ........... ....................... ~ ~lC, ~te ~ New Y~k ~m~iss~on Expires ~ch 30,