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Home My WebLink About2785-zFOR~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPABTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..~.2. 3.8~. ..... Date .............. .A.P.r.~.~.:. ~. 9..., THIS CERTIFIES that the building located at. ltXS. t~.~r~.~.-.h[. 8~ ?~n~f~e~Ve ) Map No..P,I.~Zt... Block No .... ~. .... Lot No. 3. .... ~.~h~..~.. ~... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. ~a~..~.., 19.6~. pursuant to Which Building Permit No. dated ......... ~ .... ~ ..... , 19. ~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .Pr$~$O..qO~. ~'~$~ .4~$~g ....................................... The certificate is issued to .Pa~.e~O~ .~0. ~le~..~. ~a~. A~ ..... ~ ..... (owner, lessee or ten,t) of the aforesaid building. Suffolk County Department of Health Approval .~,~,..~ 96.~ ........................ UNDERWRITERS CERTIFICATE No. ~ ~.. ~ ~ ........... ~ ........................ HOUSE NUMBER .... ~ ..... Street ..... (P~.~t~..~q~.). .................... FO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at Map No. ~,.Z~,,~B.~ ..... Block No ......... ~. ........ Lot No. ,~.....~,~l~f~.~...~.~..~..~.~.~..,.~..:.~ ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....................................... ~8,t11~,~.~...l+....., 19.~..: pursuant to which Building Permit No....~.~...~....~ dated ......................... ~ra,~te,~'~......~. ...... , 19..(~.., 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 ........ · ~..~.~.a.~e.. on.e-£a~t~...dwe]~,lin~ ............................................................................................... The certificate is issued to ....... ~o[3zk.~.~i~e,~t..~.~.~.t.e.~.~TX ................. ~.e..~.. ............................. (owner, lessee or tenant) of the aforesaid building. 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) Ne 2785 z Permission is hereby granted to: A. J, Oada....~.C...Jahn..~,..~tte~.~m3, ................. ......... ~.~.e.r..a.....Z..s.~.~ ..................................... to ...... 9xmld..new..on~..£amil~r...cLwe.lliag ................................................................................. at premises located at ...... .~..:~.~..~.~.~'~..t:~..~..~..~.~..~..]:.~...~..~.~..2.~..~..~...~.....3 ..................................................... ...................................... ~. .. ~ . . ~ .O. .a. .~ ............ .~. . . .'. ~ ~ r. ~ . . .X. . ~ . .~. . . . .~ L . .~ :. .X. . ,. .......................................... pursuant to application dated ................................... ~..1~.~......1~. ......... 19..~.., and approved by the Building Inspector Fee $..~Q ~.QO .......... FORM NO. 6 TOWN OF SOUTHOLD Building Depar~ment 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 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), Nomconforming 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 formation, required to prepare a certificate. built prior to 9/64 New Building .................... Old or Pre-existing Building ..- .......................... Vacant Land ............................ Private i~ ' rs si o d Location Of Property ................................................................... .c~.;,fi~.¢.......[.....~.,...T.9.W.~k.9.~..~...~J;~q~. , NY Owner Or Owners Of Property .....H...e..l.e..~..[~.:]:.m..e..~...~..~..~....A....¢.~..~. ....................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No ..................... Date Of Permit .................... Applicant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .....¥. ................................... Fee Submitted $5.,..0.Q ............................ Construction on above described building and all regulations. Applicant Sworn to before me this .... .~..5..¢..b..... day of ......... ~_p.~.~.~,....~..g.?..8.... Notary Public TOWN OF SOUTHOLD ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~ t/~ SOUTHOLD, N. Y. Examined ...... /x¢.-/-~,.,~...~ ....................... l~ Approved ........................................ , 19 ........ Permit No ................................. Disapproved a/c ...... m~.~.z~.....~ ........... ~ ......... >~..~: ......... ................ ................ ........ .................................. (Buildin~ ~ns~tor) Application No, C~' -~ (~' ~ APPLICATION FOR SUILDING PERMIT . Date ~ r NST U¢:nO S 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 drown 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 ~or any purl?ose.?hatever unti. I a Certificate of Occupancy shall hbve been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permitpursuant 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. ...& .~.. ,3..o~ .. Gm:~a,,., .G~e,~cel .. Co~t:z'..... Znc~,. .............. (Signature of applicant, or nome, if a corporo¥ion) * (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... ; .................. G. en~-'~,Z.. Co~t,.z',~,c~.t, or. ............................................................................................................................. Name of owner of premises ....................... ~.~..~..~~ ........................................................................... If applicant is a corporate, signature of duly authorized officer. ..................... ~,.. ,,'t*C~r~. ~,cl~.,.. · ID~ ~ ...... r~'~a~, ....... (Name ond tit e of corporate off cer) Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and Number ....................................................................................................................................................... Municipality 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 ...................... 1~,~1L~8~. .................................................................................... 3. Nature of work (check which applicable): New Building ....~.. ............ Addition .................. Alteration ............... Rep0ir .................... Removal .................... Demolition .................... Other Work (Describe) ................................... 4. Estirhated Cost ......~.SJO.,.D.0D.o.0D. ............................. Fee ............... ,~;l.~,~0 ......................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ........................ If ggrage, number of cars ........................................................................................................................................ 6. If bHsiness, commercial or mixed occupancy, specify nature and extent of each type of use ............................. 7. Dimensions of existing structures, if any: Front .......................... Rear .......................... Depth ......................... Heig,ht ............................ 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 ............................ Number of Stories ............................ 9. Size 'of lot: Front ............................ Rear ............................ Depth ................................ 10. Date! of Purchase ........................................................ Name of Former Owner ..................................................... 11. Zon~ or use district in which premises are situated .............................................................................................. 12. Does. proposed construction violate any zoning law, ordinance or regulation? ................................................... 20 - PLOT DIAGRAM Lacatel clearly and distinctly all buJldin§s, 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. STATE OF I~IEW ~OR~J ~ )~ .. COUNTY OF...~-~t.~ ......... ~ ~'~' /~¢~,~,~v,~_.~c(~C_-/U//' ~ ..... bein dui sworn de ese and sa s that he rhea 'c ............. ~ .................................. ~ ...................... g ~Y.~ , p s y s pp~ a (N~meof individua~j~,ning~;~,~ --~l,, , ~1 ~.",~ ~. ~..~ t o~ 71 ~ tLap~i~ati°n) ~/ ~ // . I ~ ~ /~ above He is the ..~....j%..--~...~..~..~....~;;:~¢..~....~..~.(.~.... , (C~f~tractor, 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 fi this application; that all statements contained in this application ore true to the best of his knowledge and belie and that th~ work will be perfqr~ed in the manner set forth Jn the application filed therewith. Sworn to lac,fore me this [/ ~ .......... day of~ './/~.(.~ ...,..¢ ....... , 19f. ..... ~ ~ , ,l II Notary Publlc, . ................ ..'. ~.....~ ....... Count~A L/ (Signature of applicant) // · FOP~iYI NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...... -~,,~ ............. 19 ..... Approved .................. '-" ...................... , 19 ........ Permit No.....v................. D,sapproved a/c .........;~,.,~ ......... >.¢ .......... ........................ ................ ................ :::;.......__z.z ........................... .......................................... i...Z .~.~. .................................... (Building I ns~/~ctor) Application No, C~' '~ ~ ~ APPLICATION FOR BUILDING PERMIT Date ~......~...,: ., ~ ....................... : ....... , 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 o 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.o~ in part I:o~ any purpose wha~tever unti_l a Certificate of Occupqncy shall h~ve been granted by the Building inspector. APPLICATION IS HEREBY MADE t'o the Building Department for the issuance of a Building Permitpur~uant 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. ...A... J. ohn.. G~cla....General.. Co~tr.... In=. .............. (Signature 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. ......................... ~r~acal,.Co~rac~. ............................................................................................................................. Name of owner of premises ....................... J..O..~.....~..~.a.~..O.~ ........................................................................... If applicant is a corporate, signature of duly authorized officer. ...................... A...JC~hl~,.~CtS, s...P~eS~ ...... ~ea~ ....... (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and Number ....................................................................................................................................................... Municipality 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 ...................... l{al~,,~i~l, er~e. .................................................................................... Locate clearly and distinctly all property lines. Give street and block whether ir erior or corner lot. 3. Nat0re of work (check which applicable): New Building ....X. ............ Addition .................. Alteration ............... Repqir .................... Removal .................... Demolition .................... Other Work (Describe) ................................... 4. Estimated Cost ...... $.8.0.,.D.0D.o.0D. ............................. Fee ............... $1.0,~0 ......................................................... (to be paid on filing this application) ,5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ........................ if g~rage, number of cars ....................................................................................................................................... 6. If b~usiness, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, Jf 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 ............................ Number of Stories ............................ 9. Sizelof lot: Front ............................ Rear ............................ Depth ................................ 10. Dat6 of Purchase ........................................................ Name of Former Owner .................................................... 1 1. Zoni~ or use district in which premises ore situated ............................................................................................. 12. Doe? proposed construction violate any zoning Iow, ordinance or regulation? ................................................. 13. Nome of Owner of premises ~,....T.....P.a;k_ter. sc~'~...Address ..... ~;kf~'~i...-T,~,~.~.Yl:~none No, .7...8...~.=...~.2.. 20~o.- 9 8 NonCe of Architect ..Al~er.t...Cla~. ......................... Address ....~..~..~.~.~g.,.....C.Q~.~ ........ Phone ~.-~...r...~; Na~e of Contractor .~..-....~.°...~.P....G...~.~.¢....G...e.~.~..[....g.CA~,ess ~.~.~...e.~.~...~.fL~..~....~..~.,. Phone No. 7. .8. . .8. .-. . .7..2. ~ PLOT DIAGRAM buildings, whether existing or proposed, and indicate all set-back dimensions numbers or description according to deed, and show street names and indic~ STATE OF' HEW [~OR/K~/j~. t ¢ ¢ COUNTY OF~,.(~,~ ....... ~ ~'~' ........ ~~ .................................. being duly sworn, deposes and says that he is the appli~ racto , gnt, corpo a e officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and ' this application; that all statements contained in this application ore true to the best of his knowledge and bel and that the work will be perfo)',~ed in the manner set forth in the application filed therewith. Sworn to ~re me this j/ ............ ~..'/.~.~..~ ..... day of~ Notary Public, . ................ ~..'. -~/~.~.~ . 19~ j~.~ ~~>)Z~' Count~; V (Signature of applicant) HELF_.NJ _LJLM_E'W.. ¥,&,LJ. ,~.TT.~ t