HomeMy WebLinkAbout2603-zTOWN OF SOUTHOLD
BUILDING. DEPARTMENT
TOWN CLEI~K'S OFFICE
SOUTHOLD. N. Y.
I~I~FtTIFIOATIE OP Or. OUi:ANr.¥
THIS CERTIFIES that the building located at ~/1~ .Pa~k..~ie~ .Lahe ....... Street
~f~o.~.?Y~?.~?.?~;~oc~o ..... ~ ..... ~.ot ~o..~ ..... o.~..~.~.,..~.,~: ............
conforms substantially to the Applicati, on for Building Permit heretofore filed in this office
dated ............. ]~0~.. '9 .... 19~1~. pursuant to which Building Permit No. 2~3.
dated .............. De~ .... 9' ', 19.~., was issued, and conforms to all of the require-
merits ,of the applicable provisions of the law. The .occupancy for which this certificate is
issued is .. Mi'~a~;Et. cite. ~7. ~'~,~g ........................................
The certificate is issued to . .Rdga~.t~gner. &.Igtf~ ......... Owaerz ..............
(owner, lessee or tenant)
of the aforesaid building.
.Suffolk County Department of Health Approval . ~U~lg~-.~$..~1~)...~.]~.~ .V:J~La,..
............ '~il~'i~' ~;~b~8;' ' '~ ........
FORM NO. 2
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? 2603 z
Permission is hereby granted to:
............... Ag.9,e~.~ ...........................................
at premises located at .......~LI~I~...~ ..... ~eI~,..ILO4D~ .A~C...0~l,e~t .............................................
..................................................... ~.~...VJ, e,~..I~me .........................................................................
~ent
pursuant to application dated ........................... ..~j~..~/~......~1 ........... 19..~., and approved by the
Budding Inspector
Building Inspe~to~r
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
Ao
This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec-
tor 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 unusua~ natural or
topographic featu res.
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.
Co
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
$5.O0
Date O,c.t;Qber..2 9 ,. ~.981 .......
New Building ...... ~ .... Old or Pre-existing Building . ..~. ...... Vacant Land .............
Location of Property .~.q ?..a.~.~..y.~.e.w..~..~p.e. ..................................... Oriant..
House No. Street Hamlet
Owner or Owners of Property .A.q .~..C.... ]~¢.~;~$ ~zg. .........................................
County Tax Map I~o. 1000 Section . .0.0.~.5. ......... Block . .Q0P.Z. ........ Lot .003A ..........
Subdivision ................................... Filed Map No ...... ~. ....Lot No. ~ ...........
' - ~ ~ -~/~ . .Applicant ....-- ~ ¢~ ........../~¢4'~
Permit No. ~.k ./. ~ate of Permit ~// ~~
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ .5., O.O .......................
Construction on above described
'GEOR~ C. STANKEVI~t, ~Q.
S-9
SCHD
SUFFOLK COUNTY DEPARTMENT OF HEALTH
Date
Bldg. Permit No.
TO WHOM IT MAY CONCERN:
The sewage disposal facilities for a structure located
- (~ive deed locatiom~) ....
have been inspected by this department and found to be satisfactory.
District EngineeM~
Legend
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
Approved ........................................ , 19 ........ Permit No .................................
Date DecemBer
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 propertymust be drawn on the diagram which Is part of this application.
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 premises available for inspection throughout the progress of the work.
e. No building shall be occupied or used In whole or in pa rt 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 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.
The applicant agrees to comply with all applicable laws, ordinances, building code and regulations.
(Signature of applicant, or name, if a corporation)
A~uebo~ue
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.............................................. .g.~i~t~ r..~,c .t,.,~ ~'. ...........................................................................................................................
Name of owner of premises ..... .~cl.wa~.cl..~a~12~..&..Id'l.~.e ...............................................................................................
If applicant Js a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
1. Location of land on which proposed work will be done. Mop No: ....Gl'.el~zlac~l~.Jt ............. ;.. Lot No: ..... 9. ............
Street and Number ..... P.~...V..:Le.¥/....~.Bzle.~.; ...... 01'.~Le.12.1;. ................................................ [: .....................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ..v..$..a...a~.....~.
b. Intended use and occupancy ............... Ol:l. et..J~al~L~....dl~.et'l~.:J.l~ ....................................................................
3. Nature of work (check which applicable): New Building ...... ~,%.~. Addition ..................Alteration ..................
Repair .................... Removal .......L ............ Demolition .................... Other Work (Describe) ......................................
4. Estimated Cost ..... ~.~..~,~.~.Q...~'.~ .............................. Fee ........... '10. .........................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units .....o..n..e.., ................ Number of dwelling units on each floor ...... ; .....................
if garage, number of cars ......... ~....or~e ......................................................................................................................
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 .../~5. ................... Rear ....... L ....... 6~ ........ Depth .....~. ..................
Height ............................ Number of Stories ...... QD. el ...............
9. Size of lot: Front ..... ,I~.Q ............... Rear ...... .].~1:1 .............. Depth ....~L~[(~ ....................
10. Date of Purchase .................... .1~)~ .......................... Name of Former Owner ...... .~..~.~.D,~.~,!r..,~L~.~,~,~lr. .............
11. Zone or use district in which premises are situated ........... I~.A,~(..~.&~ ...................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ....................... D.Q ..........................
13. Name of Owner of premises ..~,...~.s.~n,t~,T....~..~'.~ddress ....~[~l. llt,~l,~t. ....................... Phone No .....................
Name of Architect ...................................................... Address ............................................. Phone No .....................
Name of Contractor ....~]~n~l~Z'...]~l.c:l~e...]31d~',~....Address ...JLazize'Do~e .................. 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.
STATE OF NEW YORK, ~
COUNTY OF ...~.~lff. olk ............ ~ S.S.
........................ ~(:~11~..Hoc]~ ................................................... being duly sworn, deposes and says that he is the applicant
(Name of individual signing application)
above named. He is the ..... DD/Lt~.a~:l;o~. ............................................................................................................................
(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 ail 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 application filed therewith.
Sworn to before me this ~ ~, /'-3 ~/w' /
..................... do, of ..... ............... ,
--~ · ?0,T~P,¥ ,fl~ ,/u ~, , ........ ~-z.~-~.....~.~....~...~.....,~......: ............... ~ ......................
Notary Public, .~'.~i~~.... County~ (Si~azur~'-'~'of applicant)----~