The URL can be used to link to this page

Home My WebLink About2530-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z. 1.2..8.7.7 .......... Date ...O.c.~.°..b.er..9. .................... 19~zt. THIS CERTIFIES that the building ....... .O.n.e...f.a.m. 5:..~.y..d?..e .l?_.i.n..g .................. ...... 1.5. 5..~. ?.a. yy.~.e.~, .~.v.e.n..u.e ................. 9?.e.e..n?.q~.~. ....... Location of Property House No. Street Hamlet County Tax Map No. 1000 Section . .5..2 ....... Block ...5. ........... Lot .1.1.: .~ ............ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated · .. ge P ~ .... a 9 ........ ,19 .~.zt pursuant to which Building Permit No. 2. 5..3.0.Z. ............... dated ...s.e.p. ~.....2.9. ................ 19.5.~., 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 ......... .... qn..e. ?.a.m..~.zy..~. v.e.z.z.~..n ~. ?.~..t.~..a.~..~.~.~.~.9 .n.. .................................... The certificate is issued to . .~ .~.c.h.a.~..d..14.....~..C. 1. a. ?.a..E.:..~.ke.d.O.e.s.k.¼ .................... (owner,~;~,,f( ~qitir~ X X X of the aforesaid building. Suffolk County Department of Health Approval ............ .N./..i .......................... · UNDERWRITERS CERTIFICATE NO ..................... I~/. & .......................... Building Inspector Rev. 1/81 FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOU'I'HOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2530 Z Permission is hereby granted to: Walter $Ie4 ,~e si~.[. · A~G .. ~f~eha~. · ~ te d.Se ek~[ ...... ........... ~X~.eemp~r.~ .............................................. to ...~ld,..~q..e~[.t.i~m..~..~r~..~x,~s~!ng..~e~..~i~g ...................................................... ct premises located of ...L~tl...~.~l~....~anel, ha~e:a ............................................................... ......................................... .W/B.....~a~'~..~5,e~..A~e ~ ....... ~}[~eeal~e~, ~, .............................................. pursuant to application doted ....................... ~h[~ ..........~ ..........19...(~, and approved by the Building Inspector Fee $.~.OQ ............. Build~n~ lnspTor FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall · ~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in Wpewriter OR ink, and submitte~pl[catc to the Building Inspec- tot 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 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 2. Sworn statement of owner or previous owne~ as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land use --Pre-Existing C.O. $15.00 /3. Copy of certificate of occupancy $1.00 Vacant, land C.0. $ 5.00 Date . ./'(2. 7..~....5 .............. New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property. ?..~.~. ~ .... ~ ~?../.~..~.....~f~...~..~..~-'7 ............. ~../~..~-..~..~/~..~.. House No. Street Hamlet Owner or Owners of Property .~J~..~, Z.~....~....~'/~,~l~q-. . .~......~.~.~'~/,". .... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision..~.~-~/~.~¢g~....,z~ .~..~L..-- .Filed Map No. ~]. ~.~ .... Lot No. ~,~. ~¢ Permit No. ~. ~, Date of Permit ~~ .Applicant ~//~.~~: .~.~ ...... Health Dept. Approva, ~J/ ........... :.Labor Dept. Approval ...~ .............. Unde.r,ters Approval ~ ~ ~ ~ ~/~ ........... Planning Board Approval .~/~ .............. Request for Tempora~ Certificate ..................... Final Certificate ....................... FO~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..... ~ //' .X~::, ,',~.~.?..?. ·. · · · · ,~)....~, ......... Approved ........................................ , 19 ........ Permit No ................................. APPLICATION FOR BUILDING PERMIT Date ........................ ~.e..~..t.,.e..~...12.e.~......c~..,.~...., 19..0..~. ..... INSTRUCTIONS a Th~s application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin. Inspector. b. Plot plan showing location of lot and of buddings on premises, relahonship to adjoin,ng premises or public streets c areas, and giwng a detailed description of layout of propertymust be drawn on the diagram which is part of this applicatior c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of th~s application, the Building Inspector will issue a Budding Permit to the applicant. Suc permit shall be kept on the premises avadable for inspection throughout the progress of the work. e. No budding shall be occupmd or used in whole or m part for any purpose whatever until a Certificate of Occupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuance of a Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulahons, for the construction of buildings, additions or alterahons, or for removal or demolition, as herein describe~ The'applicant agrees to comply w,th all applicable laws, oral,nonces, building code and regulations. ...................................................... (Signature of applicant, or name, if a corporahon) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electriciart, plumber or builde ................... ~ez...0£...la~l, .~mder... cont~ac.t..&..~.e~.t;...o~...P~tchar.(t.. I~.I~¢~ J.e.l~i.. ~l~r.~ ha ~,e.~,, ~ ...... Owner of adjacent land Name of owner of premises ....~..~..!~..e.?.....~...~...~..q...})~....c].....~..1...e.~.J.e.~.]f...~ ................................................................................ If applicant is a 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 ..,.~.~.e..~...,.H..,~.,~..e.,.~. ............Lot No: ~.~..~....~..8.... Street and Number ..~.~q.....~i~...~,f~..~,~.e.t...~,~.Lm.,.~e~.~p_~...G~'.ee~p~,'~ ................................ Mumcipality 2. State ex~sting use and occupancy of premises and intended use and occupancy of'proposed construction: a. Existing use and ~cupancy ...~.~A~.~..!~...~..~..~..~.~.?.~.~ ............................................... b Intended use and occupancy . ........................... 3. Nature of work (check which.applicable): New Building .................. Addition ...~j~ ....... Alteration ....... Repair ................~.. Removal .................... Demolition .................... Other Work (Describe) .................................... 4 Estimated Cos~.......~......'~...,(~.. 2 ..... ~ ......................... Fee ...... ~e(~ ....................................................................... [to be paid on filing this application) 5. If dwelling, number of dwe!]ing units ...... O1~ ...............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 ....W...C//...?...~ ..... Height ............................Number of Stories ....Q...~..,.~_ ............................................................................................ D~menslons of same structure with alterations or additions: Front ................................ Rear .............................. Depth .............................. Height .............................. Number of Stories ........................................ 8, ~mensions of entire new construction: Front "' '~ Rear ............................Depth ~ ~ Height ............................Number of Stories .... !'~.~,..~..~...'~... ........ 9. Size of lot: Front ..... ~0 ............... Rear .........~.~'~0 ............ Depth .~)..j~/.~ ............. 10. Date of Purchase ........................................................Name of Former Owner ...... ~'"]l~ez-~s~orl' ................ 11. Zone or use district in which premises are situated ........... a.4.a..~:~ ................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ................ D.~ ............................... 13. Name of Owner of premises ..~,,.&..~..,~[ed.~-~ek~ddress ........... ~-:l'een~',,o~,~ ........... Phone No ................... Name of Architect ...................................................... Address ............................................ Phone No ................... Name of Contractor .................................................... Address ............................................ Phone No .................. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro property lines. Give street and block numbers or description according to deed, and show street names and indica whether interior or corner lot. Lots %3 &Sl~ being transferred to Richard SledJeski STATE OF NEW YORK, 1 S.S. COUNTY OF ................. ~//al.te~'...S3,e¢l,~. ............. ; .......... ; ................ being duly sworn, deposes and says that he is the applio (Name of individual signing appfication) above named. He is the ~"~"a~e~'"~"~o'~'D~'~s~". ............... ; ..... W .......... .'"? ......................... (~on~roc~or, agent, co~orme otticer, etc.) of su~d owner or owners, and is duly authorized to perform or have performed the said work and to make and th~s application; that all statements contained in this application are true to the best of his knowledge and bel and that the work will be performed in the manner set forth in the apphcatiog filed therewlt~.~ Sworn to before me this ~ / / / J //] _ , ................ .............. ........ , ..... - Nota~ Public, ._.;.t~x~..Sj(,.c.~..~;'ur~.~¢..:.~ County~j' , F/.~ , ,v ~ ~ v~Jgna~re of appk~nt) '