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Home My WebLink About2532-zFOR~I NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No..~..2.~.g7. ............ Date ............ ~:~r.E..,2 ................... , 1965... TH IS CERTI FI ES that the building located at~og.e,,..&. O~'eh~"$[~.~i...~h;ij~,[~ Street Map ~ ..t~~.. B~ock No ..... S ............... Lot No .............. .Z. ................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. ~eD~e~]~...~lG ....................... , 19 ~.. pursuant to which Budding Permit No. dated ...~;~J~e~1~eZ...3~ ....................... , 19..~*$., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which th~s cerhficate ~s issued is ........ one £am~.~. The certificate is issued to .......... ~el.~.~h:~l~l~ .~ .................................................................... (owner, lessee or tenant) of the aforesaid building TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2532 Z Dote ............... ~}e.]Ff;tla]~] .......... .]0 ........ , 19..(~1~. Permission is hereby granted to: ............. {8,m~t~tm]:~ ............................................... into ..... t~tt:td..-a~.,add~%i.o~..on..an..~t_.s~nl~-./~.~l~ .................................................... ct premises {ocQted at ..... ~/~;~l;...~lI ..... }[~k...~.t...kl!i~(l~..est~te$ ......................................... .................................. lk~:e¢'~ ..&..O~eP.a~ ......... ~mathol~ .......................................................... pursucnt ~o opplication doted ............................... ~.....~ .......... ]9(:~..., ond cpproved by ~he Building Inspector Fee $...~,.00 ........... Building Inspector Bo FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in Wpewriter 0 R ink, and submitted ,m ~ to the Building I nspec- 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 budding. 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 pzoperty showing all property lines, streets, buildings and unusuat 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 informa- tion required to prepare a certificate. Fees: l. Certificate of occupancy $25.00 -- BUSINESS $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .... A..u~.u.s.t...2.2.,...1.9.8.8. .... New C on s t [- u c t. i on..x.... Old or Pre-existing Building ............ Vacant Land ............. Location of Property 55 Roger,s Road Southold House No. Street Hamlet Owner or Owners of Property ........ G. i. 9~.s...L....G.o..l~,s.m. ~ .t.h .............................. County Tax Map No. 100O Section 066.00 Block 0:2.00 Lot 020.000 Subdivision ................................. Filed Map No ........... Lot No .............. c/o #Z2107 (Addition) Permit No...2.5.3.2. .... Date of Permit .......... Applicant ....G.o.l.d.s..m~-.t. tt .................... Healtl~ Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .1.q ~ .0.0 ....................... Construction on above ~escribed building and pern~t meet.s ali appli~cab]~.~odes D,gd regulations. Applicant...~_.~...~.,.~:~..~.~ ................... rving y. Price, Jr.~' At~torney/Agent Rev. 10-10-78 I~, _%o 35 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .......~.....~......~ ....... 19..~.....c( Approved ........................................ , 19 ........ Permit No ................................. .............................. ................................. APPLICATION FOR BUILDING PERMIT Date ....................... Se,Dtem~......3.0 .....,19.6.br. ..... 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 buildings on premises, relationship to adjoining premises or public streets o areas, and giwng a detailed description of layout of propertymust be drawn on the diagram which is part of this application c. The work covered by this application may not be commenced before ~ssuance of Building Permit. d. Upon approval of this application, the Budding Inspector will issue a Building Permit to the applicant. SucJ permit shall be kept on the premises avadable for ~nspect~on 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 Occupanc 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 th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buddings, additions or alterations, or for removal or demolition, as herein described The apphcant agrees to comply w~th all apphcable laws, ordinances, building code and regulations. (S~gnature of applicant, or name, If a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde, ........................................ ............................................................................................................................... Name of owner of premises ....... ~a,~'.Q~],~..g.o~l,~m$.~]p, ..................................................................................................... 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 dane. Mop No ~::J,~ft~Oll..~.~fi.l~.ft~ ........ Lot No: .,~. .............. Street and Number ....... ~:~ge~.~..~..0z'.¢}:~a.~c~..~:l.~ ....... ~cxg,~}:~o,~cl. ................................................................... Mumcipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....D.~ft,'L].J,~g .......................................................................................................... b Intended use and occupancy ........ .~.~ ............ .~/....a.c-l.c~:Ltl.otl ............................................................................ 3. Nature of Work (check which applicable): New Building .................. Addition~ ......... Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...................................... 4. Estimated Cost ...... .~.~.~O~..~/',N, ............................... Fee ..~ ............................................. ~ ....................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... .~113.~l .............. 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 structur~: !f 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 ....... ~......3~ .......... Depth ........ ~,~ ............... Height ............................ Number of Stories ..OZttt ................... 9. Size of lot: Front ............................ Rear ............................ Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ......... .u.~/~.~.l; ....................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ....~O. ............................................ 13. Name of Owner of premises ...R',,..t'-O].Cl. AJa.$..~T~ ....... Address ............................................ Phone No ..................... Nome of Architect ...................................................... Address ............................ ~ ................ Phone No ..................... Name of Contractor ...~,.~P,:g.~13~..; ...................... Address ............................................ 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. COUNTY O .............. ~ S.S. .......... ~O]:tD..,t~,[DOII;I,~. .......................................... being duly sworn, deposes and says that he is the applicant (Name of indiviarua s gn ng app cat on) above named. He is the ............. .CDA:I;;t'~e,,t;OZ~. ................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is du'ly 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 n the manner set forth i,n the application filed therewith. Sworn to beforeo me this ~.kl.~___~ ~ ~ ~, .................... ~...~. day of ,. ....... I e . embez ...............19, Nato ry Public,, .....~...r ....... ublic. State of HeWountY. ,, ~_. t) v ~i~ ~Expi~'es March 30,