The URL can be used to link to this page

Home My WebLink About25-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ........ ,~...~.~ ....... Date .................. O~'t~o~)e~'"9 .................. 19..~7.. THIS CERTIFIES that the building located at~t~&....]~].....~..~]Ot~d..~rj~.~...A~r~... Street Map No .........~'~bv .......... Block No .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..................... LT~I~'~,,'"'~ .................. ~9~,..., pursuant to which Building Permit No ...~...~..~ ............... , dated ....................... ~'~.~...~} ................ 19~...., was issued, and canforms ta a(I af the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ............ ........................................... ~ ~V~.'~'' · "D~',~G ............................................................................. This certificate is issued to ....~-~t.D.,~l.~,j?~,c~y~.r.j(i;~/?~,~.e~i ................................................. of the aforesaid building. uilding Inspector NO. 2 TOWN OF $OUTHOLD BUILDMNG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. I~UILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: 6~,..~,...~.~,~..&..~.-....A]~....~.-~... ................. ~o~8....~ ................................... pursuant to application dated ................................. ~e..~ ................. 19.~..., and approved by the Buildin9 Inspector. Fee $ .'1[11. ,.011. ....... Building Inspector l~OltM NO. 6 TOWN OF $OUTHOLD Building Deportment To~n 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 dispesal--(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 $5.00 Date October , 1972 New Building .................... Old or Pre-existing Building ....... ~. .................. Vacant Land ............................ Location Of Property north east corner of Kennys Road & Soundview Avenue Owner Or Owners Of Property Ruth Gibson Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Rudolph H. Bruer, Attorney for Permit No ..................... Dote Of Permit .................... Applicant ............... : .................................................. Ruth Gzbson Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ......... ~ .............................. Fee Submitted $ .................................... Construction on above described building a .n~ll/appl~b~Acodes~~//~/~ ~/~ and regulations. Applicant ...... ~~,~ .~..~.'~...~ ................................ RudGrI~h H. ~j~uer, Attorney, for Ruth Gibson Sworn to before me this October 1972 ................ day of ...................... ~ ..................... Nota PubUa ......... .......... County (stamp or seal) PUBLIC, Sf~f~ B~077685 . Suffolk Ceun~ TOWN O~ $OUTHOLO 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 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 approva~ of Health Dept. of water supply and sewerage dispcsal--(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 aT property showing oil 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. Dote 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 $5.00 Date Octl~o~e~ , 3.972 New Building .................... Old or Pre-existing Building ....... ~ .................. Vacant Land ............................ nc~h e~st co..~...e~ o£ Ke~y~ ~ ..&. $o,~Vierv~ Avenue Location Of Pr~erty '"'S~1~ ........................................................................................................... ~h Gi~on Owner Or ~ners Of Property ....................................................................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No ..................... Date Of Permit .................... Applicant R~dO~h ........................................ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ......... ~ .............................. Fee Submitted $ .................................... Construction on above described building and ,~eret~it m~ets .all o~plicpl~le c-,~des and regulations. Sworn to before me this ................ day of .......O~_~e.;,~,!,.,.~,,~.~,2. ......... ~u££olk Notary Public .................................... County (stomp or seal) L~-~P~-RTS pAIIN'~ BDSOi~j FORM NO. G TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE O,F OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, in triplicate to the Building 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. Date .... New Building .................... Old or Pre-existing Building ....... 3[ .................. Vacant Land ............................ Location Of Property .... ~.~h...e~.8~'"~'"~..~"~"&"~~"&V~ ..... Owner Or Owners Of ~roperty ..................... .~t,h'.~ ....................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No ..................... Date Of Permit .................... Applicant Heolth Dept. Approvol ............................................ Lobor ~ept. ,~pprove~ ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......... ~ ............................. Fee Submitted $ .................................... Construction on above described building and pe~?C)/x.~/,, /~/'/~/,L-~x~ ~/,~/~, ,~ meext~ a'J)/ap~icab~e/c~e~ and regulations. Sworn to before me this Rta~lO[]~h ~. B~:~. At;~O~l~y, :gO~ Ra~ G~,bSOn ................ day of ..... OK[~)~t~ r ...~9.~.~ ........ Notary Public ..........~t~Jl~ ......... County (stamp or seal) OWNER FORMER OWNER TOWN OF SOUTHOLD PROPERTY - ]' --':' .,~' - , RECORD CARD VILLAGE E D~: SUB. LOT ACR. ~22t~ I TYPE OF BUILDING P, ES, LAND AGE IMP. NEW NORMAl FA~V~ Acre Tillable 1 Tillable 2 Tillable 3 Woodland Swampland Brushtand House Plot Total VL TOTAL -. FARM DATE COMM. CB. MISC. Mkt. Value 4TAGE ON WATER ..... ,ITAGE ON ROAD DEPTH BULKHEAD DOCK COLOR Bldg. -Zxtension :xtension Extension >orch Breezeway aoroge Patio ITotol ~Z 0~ 2-- Foundation Basement -Zxt. Walls Fire Place Type Roof ~.ecreation Room Dormer Driveway Both Floors Interior Finish Heat Rooms 1st Floor Rooms 2nd Floor ~- 47°49'4o'*E,* · · ~zS,0. MAP OF~ ~L. AND V~N TUYL, & SON ~o~ NO. ~! TOWN OF SOUTHOLD BUILDING D~-PARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. Approved.....(~.. ....... !~ ......... '..'. ........... 19 ........ Permit ~ Disapproved a/c ............................................. ~ .................. .;;.,.~,,... ................. .................................. ;~./;~. ............................................................................... .......... ....... ......... .............. (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No....~.?.....~....?~~. ....... INSTRUCTIONS c~. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on ~remises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this location. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Up~)n 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 progress of 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 c~ Building Permit pursuq,qt 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//~ ~ ~ ~/'~x~-~and regulations, ffOI4'c~ ~ ~ Z~ ~ature of a~plicant, or name, if a corporation) (Address of applicant) ~' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. ................... ............................................................................................................................................... p re m ises....s~,J...~.../~....ez...~. Name of owner of ........ ....../'~ ,41 u,..,.../~...im./,.. .................................................................................. If applicant is o corporate, signature of duly authorized officer, (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No ................................... Block .................................. Street and Number ........... ' ...... ~.fi.0......~.~..~. .... O...o~fd./)...V.C..e...o&. ......0..~-~ .............................. 2. State existing use and occupancy of premieses and intended use and occupancy o~ proposed construction: a. Existing use and occupancy ................. . ........ b. Intended use and occuponcy...~...~..~cZ..../'~....~.~.........~.'..~r~.?,~,¢ ....................................................................... 3. Nature of work (check which applicable): New Building ..~ .. Addition ................ Alteration Repair. ................... Removal ............... ;~/~D~emolition .................... Other Work (Describe) .................... 4. Estimated Cost ..,,~.:'.~..~:....~...~.........'.~.~..4.~. ...................... Fee ............ ~ .......................................................................... (to be paid on filing this application) FEES: ~'~-L.~ If dwelling, number of dwelling units ....... .~..~.....~r. ......... Number of dwelling units on each floor ............................ If garage, number of cars ........................................................................................................................................ 6. If business, commerical 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 alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ B. Dimensions of entire new construction: Front.......~.....~.. ............. Rear ...... . .~....~...: ........... Depth .....,~...~.: ................ Height .../.-~ ................... Number of Stories ............................ 9. Size of lot: Front ..... ~.~.....~. ............ Rear ....~.O ................ Depth .../.~ ............... 10. Zone or use district in which premises are situated ....... Z~...~:..~.~P..~Z~....~../...~'...~.. ................................................... 1 1. Does proposed constructio~ violate any zoning law, ordinance or regulation? .................................................... of premises.~.~-.,~.../~r...~/?J/:..~'Address ~.~..~..~..~.~..~.~.......~.:...~. ...... Phone NO ..................... 12. Name of Owner Name of Architect ...................................................... Address ............................................ Phone NO ..................... Name of Contracto PLOT DIAGRAM . Locate clearly and distinctly all buildings, whether existing ar proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, end show street names and indicate whether interior or corner lot. ST ATE--OP'F~W~YO~R[~'~ ~) SS' COUNTY 0~~.,) '. .... ~~ ......................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the .......................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of sam 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 in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the appli~tion,~ filed ther~ith._~cj Sworn to before me this ~ r'~/' ~ ~ .... ~.(...~ ........ day of ....... ~ ............. 19.~...~.. ~ ~~ '~~ Notary Public,. .. aunty FOEM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CL~:RK'S OFFICE SOUTHOLD, N. Y. Approved ................................... 19 ~. er ................................... Disapproved a/c .................. :;;,..-~../. Z ................................ ;;~ ...................... (Building Inspector) Application p~o ............................ APPLICATION FOR BUILDING PERMIT Dote ....... ....... .(e.- ....................... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this location. 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 oremises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o 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 lows, ordinances and regulations. ..................... ture of applicant, or name, if a corporation) ......... ................................ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electdcan, plumber or builder. Nome of owner of greta sos ~..~rT..~ .e'.. ~ . ....~......~..~,,f~.~....,:/. ........... If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) 1, Location of land on which proposed work will be done. Map No ................................... Block .................................. Street and Number ............... .~... .................................................................... 2. State existing use and occupancy of premieses and intended use god occupancy of proposed construction: a. Existing use and occupancy .................................................................................................................................. b. Intended use and occupancy ..... ~ 9, ..a~.,...~¢., .................................................... 3. Nature of work (check which applicable): New Building ....... ~...Addition ....................Alteration .................... Repair .................... Removal ............. .~¢..Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ...~...~...e,....Zr.~ ........ ~.~.~ ..................... 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, commerical 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 alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ .~....~....~...~....e... Rear ........................... .~...~' ~'~'" Depth .~ .~..~..~ ........... Height ....../..~..~..~..~ ......... Number of Stories ....~../..~..~.. ............... 9. Size of lot: Front ...... ~...___~..~.:...J ....... Rear ...... .~ ................... Depth ............................ I0. Zone or use district in which premises are situated .... ~.,,~,$'.,/.~...~...~.,,7'.?.4~..~. ................................................. ~ 1. Does proposed construction violate any zoning law, ordinance or regulation? .................................................... 12. Name of Owner of premises~..~..~..~.../~l,.!!.~.~.,e.."/..... Address .~Jo..~.~.~.~.~..~..~.....~..-..~.:...Phone NO Name of Architect ...................................................... Address ............................................ Phone NO ..................... Name of Contracto,,~4~..~.....~'..:..,~'.~..?,~...f'(..~.~..~...~/~. ...... Address .~.~....~r...~...~.R...4~......,,~..:..~/.:.....Phone NO.~..-:..,~..~L,K.~.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bi6'ck dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. ,. STATE OF NEg.Y,O,R.I<~/j.I ) S S COUNTY OF ~'t ....... )' " ..... ~.~ ....... :.....~ ..................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) 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 and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the ap~jcotion filed ther~ith. _ Sworn to be(ore me this ' (Singature of applicant) Notary Public~...~..~.,County