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Home My WebLink About3091-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~0.9.2 ...... Date .............. Dec .... 28.. , 19.70. THIS CERTIFIES that the building located at . .l~/i;... Cl.ippeI'..Dr ........ Street Map No..tt~2. L$.a ... Block No. (100..I .... Lot No.lkl ...... ~o.'ath¢)lcl.. I<i.,X, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... i~;~ ..... l.~., 19.6.6. pursuant to which Building Permit No.. dated .......... kl.aX....]~,~..., 196.6., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...Prlv~te. one. t'a.mily./lwe.]..1.i~g ..................................... The certificate is issued to . ~{a.ao~Lil..lk~e5~. ...... O~,n~.~. ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval t)ea...28...~970. · .!~y. il,. 5kLlkla ...... Undez'writez's Cez't ~ I~81~257h, .~5:17¥'. .( .... ~..~(~:q :~.,.-~. ............. House ~ 16~ Building Inspe ~r FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN' CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT : (THIS PERMIT MUST BE KEPT ON THE PREM1SES uNT L FOLL' : - COMPLETION OF THE woRK AUTHORIZED) · Permission is hereby granted roi : · , ~,.;. ; .... ...... . · ........... 8~.....~,mz..o~e..~,~¥......::...L., .:.. ........................ ~.eee~ ....... : ........ ......,....,..:... to ....B~tild.. ne.~., m,l~...f~zLl,% ..d:~e!~.~g....i .............. : ................ ; ............................. ~ .......... ; ..... at premises located at ....~:O~..../~.'l.~......~l~:~0t~..~L.~...~jf&'~(~$......,..~.....'~ ................. ;; ............. ....................... E./S..... {~.~.p~,er..*~ .............. ~.ott~ho~d. ~..*.~¢~ .~ .-.....: ...-~-.-.~ ................. ................... pursuant to application dated ............................ .~E~t .......... ~.~. ........... 19~.:.., and approved by the Building Inspector Fee $..~LO,.O0 .......... S-9 SCHD SUFFOLK COUNTY DEPARTMENT Date Bldg. OF HEALTH Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed location) -- have been inspected by this department and found to be satisfactory. 1970 6~h~ef of General Engineering Services FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in Wpewriter 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. B. For existing buildings {prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peopert¥ showing ali 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 informa- tion required to prepare a certificate, C. Fees: 1, Certificate of occupancy $5.00 2, Certificate of occupancy on pre-existing dwelling/ landuse--Pre-Ex£st±ng C,O, $15,00 3, CoPV of certificate of occupancy $1,00 Vacant, ].and C,O, $ 5,00 ~.~,.j~ ~ fi- Date Jull; 5, 1984 New BuiJding..,..,....,.. Old or Pre-existing Building ............ Vacant Land ............. Location of Property .......... .,. .......................................... ; ...... HouseNo. lot lO~' [J~v~ ~DF~-'b'~[~b'$treer £O~iJ ~ - Z~vlC~l '? Hamlet Owner or Owners of Property ...... J County Tax Map No. 1000 Section . .0 7,1 ........ Block ..... .~ ........ '. Lot .], Q,. ~.9,. 2,Q. and .... 11.2 Subdivision ........ .X ........................ Filed Map No ..... 4.6.8.], .Lot No .............. Permit No ........... Date of Permit .......... Applicant, , , ~.e,J,~, $ Underwriters Approval ........................ Planning B0ard Approv Request for Temporary Certificate ..................... Final Certificate ToWN 0 - Fee Submitted$. .'... ................... · · .. Co.struction on above e ribed regu ati?ns. ~~ ~ Brue~ atty for applicant '~ TOWN OF $OUTHOLD TOWN CLERK S OFFICE ..................... { ................. , lY ........ ~'~ Approved ........................................ , 1~ ........ P, rmit No. ~..~...~.-..~ ............... ..................................... APPLICLATION' FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildi 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!0yout of property must' be draWn on the diagram which is POrt of this application.~ c. The work Covered I~y thi~ applica~i0n '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 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, Ordnances 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,~.o.l~,..Ree.se ................................................................. - (Signature of applicant, or nome, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................................ 0~me3~. ............... !,~..;, ............................ ; .................................................................... Name of owner of premises ...~3:.cz].r~ ..~eese ................ , ................................................................................................... If applicant is a corporate, signature of duly authorized ~fficer. ~ (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ...~,~'.bD;~...~,~.g]3.t;~."j.. Lot No.: ;..~.;L.....~ ........ Street and Number .....~/.~......~]-1.g~e:...D~.v. es.....~o~¢b_e~.~..~,.~,. ......... Jl .............................................. 7'~/ ~ /~_~' ~ Municipality 2. State existing use and occupancy of premises and intended use and o~cupancy of proposed construction: a. Existing use and occupancy .............. ~'~l. Qa_rL~,...].&~c~ .......................................................................................... b. Intended use and occupancy ..... oz~e..£am~..~.~...c~we3.3A, ng ................................................................................ 3. Nature of work (check which applicable): New :Buil~l[ng ~[,...~ .... Addition .................. Alteration .................. Repair .................. Removal .................. .'Demolifion.::;~.,?~¥..: Other Work (Describe) ........................................ 4. Estimated Cost ~-Ot~0~...]~/.. ...............:.:.[...i.:....~......Fee .~.~,.~.~.~.:'i ............................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units .....Q~. ............ i...Number of dwelling units on each floor ............................ if garage, number of cars ...................................................................... ~..~:..~..?........¥~.~ ................. ~, ........................ 6. If business, cornmercial 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 wi~h a:lterationS or additions: Frbnt ................ : ........... :: ...... Rear ............................ Depth ................................ Height ............................ Number of '~to~Jes ................................ 8. Dimensions of entire new construction: Front ....... :,....~...~.~. ......... :~:: ~Reor ......... .~ .............. Depth .....2.~ ................ Height .................... Number of Stories ....... o~.e..: ......... : ........................................................................................... 9. Size of lot: Front ........ ~...0...0. ............ Rear ......~..0...0. ........................ Depth ................................ 10. Dote of Purchase ................ ~Lc,:,:J6~ ........... ~ .................. Name of Former Owner ......... ~LQ~..~.I~..]~.~ ............. 11. Zone or use district in which premises are situated ...... !!A!~....~.~.~ ............................................................................ 12. Does proposed construction violate any zoning law, ordinance or reguletJon? .......... ~ ............................................ 13. Name of Owner of premises ....... ~'.~,Tk~..~,.~.~.fi.~....Address ..... ~'~,~.~.~.~ .................... Pl'~ne No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... ~nme Ad r Phone No ..................... Name of Contractor .................................................... d ess ............................................ Locate clearly and distinctly all build ~hroperty lines. Give street and block nu ether interior or corner lot. STATE OF NEW YORK, ~ ¢ c COUNTY OF ...~.~'~.~1~ ............ )'~'~' PLOT DIAGRAM ~ whether existing or proposed, and indicate all set-back dimensions from r or description according to deed, and show street, names and indicate ...... ...................... ..... .. ..... .~,~' G~l,..~e ~.~e. ......... .......... ........ being~ .duly~ sworn,~dep,, oses. ~nd says that he is the applicant (Name of individual signing apl~llcotion) above named. He is the ..... O~ffi~...'.~...~.~,~'l~P-,~ ........................................................................................................ ~ ....... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform Or have performed the ~aid work and to rna~e 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 in the manner set forth in the application filed therewith. Sworn to before me this ................... aay of ................. ................... , ,4 ,,]/ , Notary Publi ,, ..... Count (Signature of applicant) No. 52-3233120 Suffolk Count'/ Term Expires March 30,