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Home My WebLink About274-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...z.1.3.5. 6..9 ......... Date ........ 5.??_.~....2 ................. 19 .8.5. THIS CERTIFIES that the building .............. .N.e.w...D.w.e.1. ]:..J..ns. ................... Location of Property . .4.9. .5 ........................ .lq.a.p. 1..e..I~.a.n. ? ......... O.r..J..e.n.~ ...... House No. Street Hamlet County Tax Map No. 1000 Section ...ql. 7 ...... Block ...0.2. .......... Lot ...0.0.3.: ,1 ......... comb±nec1 ]_o~cs 2 & 3~ 12/29/82 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Pem~it heretofore filed in this office dated .... ~p.r.$.l ..... .1.1 .... ,19.5.8, pursuant to which Building Permit No ..... dated ......... .g.]p.r.~.~...2.5. ........19..5.8, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ............. ~..e.~..p.~..~¥.a.~.~.. 9.n.~...~.a.m.~.]:. ~,..D?..~.~.~.n.~ .............................. The certificate is issued to .... R..~l.lg.V.~.8. t..lg.D?..X.N..K.: ... (..S.T.I~.R.N. ~...~.O.S. 1~..t>.H..'7..PF.°. ..o..w.n.e.r., ) (owner, IE~ of the aforesaid building. Suffolk County Department of Health Approval ........ .N./.g.. .............................. UNDERWRITERS CERTIFICATE NO ................ .Iq./.~. .............................. Building Inspector Rev. 1/81 N.o FO~%~. IN'O. :~ 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) 2?4 Z Permission is hereby granted to: ~eHi~h.....S.~;ex'~ ................................................ .................. ~ .~.~....~ ..................................... .......................... ~r~.~ .... ~..:[o. ....................... to ,_.~_~ ,~ .~w..~w~:1]-~.~ ............................................................................................................ ~t premis es Iocated at .~'~r&t,,~..~'.~i~l~ .... ~'~ ...,l(~r~...Pr, O~d ............................................... ............................................................ J~., ........................................................................................ pursuant !to apphcat,on dated ..................... 4~;!.~, ....... .'l.~ ............... 19.~. , and approved by the Budding Inspector F~ $-.;~,00.....~ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions ¢~(~''~c ~c~y~- A. This application must be filled in typewriter OR ink, and mbmitted ~ ~ to the Building In~ec- tor with the following; for new buildings or new use: 1.F[nal ~ev of property with accurate location of all build[rigs, property lines, ~mets, and 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 in~allation from Board of Fire Unde~riters. 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. B. For existing buildings (prior to April 1957), Non-conforming urns, or buildings and 'p~exist~ng" land uses: 1. Accurate ~wey of p~perty showing all property lines, ~reets, buildings and unumal na~ral or topographic features. 2.Sworn statement of owner or pr~ious owner as to use, o~pancv and condition of buildings. 3.Date of any housing code or safety ~n~tion of ~ildings or premims, or other pe~inent informa- tion required to prepare a ce~ificate. C, Fees: 1. Ce~ificate of occupancy $5.00 Ce~ificate of occupancy on pre-existing dwelling Copy of certificate of occupancy $1.00 Vacant ~a~d C.O. ~5.00 New Build,ng .... .~. ....... Old or Pre-existing Building $15.00 Date .... .~.."~,..~.~'~,-. ~ ,~,~. ........ ............ Vacant Land ............. Location of Property. ,/-'./,¢J.~.../~../~..~ .~... ~ ~ .)~..~-/ .... ,(,~,Jf>. ................ ~.../~r~...~'../~. ! House No. Street Hamlet ........ ¥5¥. . . . . .F. .................. Owner or Owners of Property ...~, ~J ~,~. /~ .' County Tax Map No. 1000 Section ...(~..t.S ........ Block ...~.~[~ ....... Lot...C?.~,. ,~.. ?.~. .... Subdivision ................................. Fded Map No ........... Lot No. ~-. ........... Permit No. ,~.7. ,~..~.. Date of Permit .~.!1.1{.~. ,~..Applicant .... , .~.o, .~.~ ..... %.~.~-.-~.~?~, ......... Health Dept. Approval ........................ Labor Dept, Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ..r~. ......................... Construction on above described building and pelmit meets all applicable codes and regulations. 0~=.~0~~° Applicant....~, .~,.../)~.....~,'..~ ,~, .~,. ....................... FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. NOTICE OF DISAPPROVAL ~,,, ~o .............. .~..~.~. ................... ~o~ ............................ ~~. ~.,~.~.~ PLEASE TAKE NOTICE that your apphcat,on dated ......................... ~...~.~.. 19.~.~.~/~ for permit to co. nstruct .~ ~at the premises located at~......~..~.~/ Map ...............................Block .................... r. ................. Lot - is cet;,r~ h~cv.',th-c~z~d~dlsapproved on the following grounds .f~~~ ..... ~ Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ................... Approved ........................................ 19 ........ Permit No.....~.......~..~..~. ....... Disapp roved a/c ,, :.~..~.~..f~..~..~;...~.f ...... ~....'~.. ~. :..(m..., .....~;....~ .,:;~.., .~...%C~....~. ..... .......... ....... .................. (Building Inspector) Application No ........'~'...i~...~.. ........ APPLICATION FOR BUILDING PERMIT D ................ ..-~.....~......~ ~. ...................... 1c) ............ INSTRUCTIONS a. This application must be completely filled in bv typewriter or in ink and su~omitted 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 drown on the diagram which is port of this location. c. The work coYered 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 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 hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanoe 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. Zf, e applicant agrees to comply with all applicable laws, ordinances and regulations. ~X$ignatare of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................... ........................................................................................................................................................... Name of owner of premises.....~...~.-~:Z,~.....Z~/......~..7~..~...~-.~.. ....................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) i. Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... ~' Street and Number .~..C~.....~.....?..~.....~...~........~.../.~..?..~ .~....?...~?.~...~, ...... ~..4~........-Z~...: .~...i! ...................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy.......~.~.; .......................................................................................................................... b. Intended use and occupancy...~....u;~.'.~..z;../../~'...'.~T ..................................................................................................... 3. Nature of work (check which applicable): New Building ...... ../~... ......... Addition .................... Alteration .................... Repair ............ .~,....Removal .................... Demolition ............... ~Other Work (Describe) .................... 4. Estimated CostZ~-~..~'....~.....¢~.. ........................................ Fee ..f.?.. ................................................................................... (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 alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front.....~.~..~. ................. Rear .......~..~. ................. Depth ...~..~.~. .................. Height .....; ./....O~... ............. Number of Stories ....... ../. .................. 9. Size of lot: Front ......... .*.~.....~....~J.~... Rear ...... .~...6.'..i.~..~ ........ Depth .....~:~..~...0...~...~. ..... 10. Date of Purchase ....... .~.~ .................................... Name of Former Owner . ' ' 11. Zone or use district in which premises are situated.....,~....~..t.~ ............................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............ ..~.....~.. .............................. 13. Name of Owner of premises...~/..?.'...~.~..~..4'..4':.. ................. Address ..~.~.X'.....'.Z..?. ....... .~..4'./..~...4/..~...~ ...... Phone NO.~'.z../J~.~./.T..fJ'... Name of Architect.......'.~.~...~...°..'.....~'..(/~ .................. Address ............................................ Phone NO ..................... ~/ Name of Contractor,~m,~.~/-~,~.....i~i~t~..~lR.S ......... Address .M~...~Z....Z~.6.dI.~.. ............ Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back 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. Zi,,'E // STATE ~OFJNEW~.yo.g~,~?,/~, ) S S COUNTY OF .-~..' ........ ) ' __ ~ ~ "~ '~ be ng duly sworn, deposes and says that he is the applicant ................ ............... obove homed. He is the ....................................... ~ .................................................................................... Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to )erform or have performed the said work and to make and file this application; that all statements containe~t~pplication are true to the ~st of his ~owledge and belief; and that the work will be performed in the ma~f~h in the applicatio~ filed t~rewith. ~, . Sworn to be(ore me th~s ~ ~ .... ..... /.~.~.... day of .... .e~ "fi,~ ~ /~nat~ ' ............... ' '~J~-~ ~ · of apphcant) Nota~ Public, ..~.~...~e,~ ',&' ~