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Home My WebLink About3109-zFORFI 1~0. 4 TOWN OF BUILDING DEPARTMENT 'I~'OWN CLERK'S OFFICE SOUTI-IOLD, gERTIFIP. ATE OF' rlE:E:UPANP. Y No. ~.. 260~ .... Date ......... 0C.~;. · 28 .............. 19.66 THIS CERTIFIES that the building locaied at ~O~T~. ~l~l~ ................. Street Map No.0?..~.O.~. ·~. .~.~'. ~,ck~ts~ ....... ~ ..... Lot No. 1,6, .... 0I, iotat,..l~,.y, ........... conforms substantially to the Applicati. on for Building Permit heretofore filed in this office dated ........... 14t~r ..... ~'1.., 19.(~6 pursuant to which Building Permit No. '3J.09' ~ dated ............ ~tlne...~l. ..... 19~6., was issued, and conforms to all of the require- ments .of the .applicable provisions of the law. The .o.ecupancy f. or which this certificate is issued is .. P~.iva. t;e. one..famit.7. ~lwelt. ing ......................................... The certificate is issued to ...~/a~l. te~..IJll], ~n~ ............ ~$1~ .................... (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Appr. oval., 0Ct., .1~.~..J,~66..by..R,V.~I[~ ........ FOPoi~I NO. 2 TOWN OF SOUTHOLD BUILDIblG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT N? (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK ^UTHORIZED) 3109 Z Dote .................... : ....... ~q~....;~....; .......... , !9(~-.. ' Permission is hereby granted to: Tony.. ~c~;'Lu~ .....~¢/¢ - ...W a.~.Co~..:~...-~e ......... ~ pursuant to application dated ..... ~¥[~.. ~], ......... 19.(::~..., and approved by the Building. Inspector Fee $ ~ 0.,.0£) ........... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY I,OWN OF SOUI'HOLD Instructions This application must be filled in typewriter OR ink, and submitted mm I~mmmmmm 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 approvel 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 p~operty 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 informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.0 0 ,,, 3. Copy of certificate of occupancy $1.00 5.Updated C.O. $15.00 Date .. ~ ....... ~ ............ New Building ..... .~ ....... Old or Pre-existing Building ............ Vacant Land ............. Location of Property . .2.3.5. ................... .Sp.u.n..d..V..~.e..~..R.q .a.d .............. O.r. ~_.e.n.~. .... House No, Street Ham/et Owner or Owners of Property ..... ,F.I~.~.D...J.... &...A.~.~. g, .t~.E..~ ....~.O.~g..A~.D.[. ..................... Countv Tax Map No. 1000 Section .... Q%,5 ........ Block .... ,0,3 ......... Lot ..... 0.0.~ ........ Subdivision...O.~.~e..~..b.~'..t.h.~...S.~.~. .......... Filed Map No..3.4..4.4 ..... Lot No...4..6 ......... Permit No.. ,3~.0.9.~., ,. Date of Permit 5./..3.~/.6.6...Applicant ....G.e.o.~. ~r.e..A.:..N.a.q .~.e.,..~.~:.,, .~.s.q.. Health Dept. Approval .... .~/,A. ................ Labor Dept. Approval .... ,~/.A. ................ Underwriters Approval .... ~/.A. ................ Planning Board Approval . . ,N/.A. ................ Request for Temporary Certificate ..................... Final Certificate ,..~.op.7, ..o.~ ............. Fee Submitted $..~: .0.0 ..... CJ;~.~ ............. Construction on above described building and~ermit meets¢ll applicable codes and regulations. C,~o~,~ Applicant ...... .~..~ ..................... C~0% ~lease ~i'gn here Rev. 10-10-78 S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH 6~T - ~ 1966 Date Bldg. Permit No. ~ /0 ~ TO WHOM IT MAY CONCERN: at have been inspected by this department and found to be satisfactory. District Engineer District Engineer FORM NO, 1 TO%VN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Exam,ned ........ Approved ........................................ , ............................ Disapproved a/c .............................................................................................. APPLIGATION FOR BUILDING PERMIT Date ...................... ~.~....,~.,./. .......... , 19..~ .~..,.. 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 property must be drawn on the diagram which is pa,rt of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this applicatiorl, 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 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, 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. .......... ....... : .................. (Signoture~J~f-- '"applicant, or nome, if a corporation) ........................... ........ ............... (Address of applicant) State whether applicant is owner, lessee, agent, orc~hitect, engineer, general contractor, electrician, plumber or builder. .............................................................................................................................................. Name of owner of premises .......................................... ~. ....................................................................... 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. M~t~Nu;: ~L.~..~ ~ .... .~....~.,. ............ ........ ¢:.....¢ ..................... Lot No.: Street and Number ... ~.~:~, .... '.~;<,~..~'.~, ........................................... Municipality 2. 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 4. 5. 6. 10. 11, 12. 13. NatUre of work (check which applicable): New Building /'"/ Addition .................. Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................... : ........ Esti~nated Cost ....~..Qq..6~...~...O...,~..~.~. ......................... Fee ..................................................................................... (to be paid on filing this application) If welling, number of dwelling units ......... /. ................. Number of dwelling units on each floor ........................ If ~rage, number of cars ............................................................................................................................... If ~usiness, commercial or mixed occupancy, specify nature and extent of each type of use ....................... Dirt ensions of existing structures, if any: Front ............................ Rear ................................ Depth ................... HeilIht ........................ Number of Stories ............................................................................................................ Din'ensions of same structure with alterations or additions: Front .................................... Rear ....................... . Depth ................................ Height ............................ Number of Stories ................................ Din'ensions of entire new construction: Front ...... :..~...~....~.. ............... Rear......~.?....~;...,..~/.. ....... Depth 4-', . Hei~ ht ,..../z, ............ Number of Stories ....... L.....~.. ................................................................................................ F Siz~ of lot: Front ....... ./...O..~.'~.:...~.L... Rear ....l(..~....~...,. 0,,..' ............. Depth ..... .'.~,..~..Z..:..~....¢..../. Dat~' of Purchase ........................................................ Name of Former Owner ................................................... 'I'll Zon!e or use district in which premises are situated ..... ~..¢¢.:~.~ .................................. JL Doe~ proposed construction violate any zo0ing law, ordinance or regulation? ..... .,~..~ ............... ' /,j'' " ' 'onebJ ~/ ¢,./ ' .o No e of Owner of premises ....~..~'....~.~.~..'..:..tr~'..FvfT.:..Address ,.~.,...~.~*.~. ,¢~.'.C?..~.:.~..~..~...:~..~__.~/.. _o....~.. ....... ~.' Name of Contractor ~f~.Z/~¢.,:*....~....~..',.....?:~.....Address ...~..~.~*-"~-,--/~¢ ......... Phone No ............... ...... ~ - Phone No,-~.~..~.z..~...~:. PLOT DIAGRAM and indicate all set-back dimensions frJ~m to deed, and show street names and ind c~te kocat~ property Ii whether i,n ~ clearly and dis inctly all buildings, whether existing or pi -les. Give street and block number or description crier or corner I~ ¢ ~ L,'~-. 5'¢ ~ ~' P 6Tqb /Sc STATE OF COUNTY abow; nar of said ay this oppli that the ¥ Sworn to I ...... Notary Plblic, NEW YORK,., }cc OF ...~.~..,¢C...~'~..¢,ff.. ......... / ~"~' ........ .~'..4~..~...~......~..¢.~.4~...~.'..~.. ............................. being duly sworn, deposes and soys that he is the appli( Name of individual signing applicatiod) ~ed. He is the .......................................... .CT~..~..~..~/~f,..~..¢../~ .............................................................. , ......... ' (Contractor, agent, corporate officer, etc.) ner or owners, and is duly authorized to perform or have performed the said work and to make! and' arian; that all statements contained in this application are true to the best of his knowledge and belief; )rk will be performed in the manner set forth in the application filed therewith. afore me this 19 ~'. ~- day of ....... ......................... , ...... ~JdO'YI) lq'. KING. ~I~ . .......... ..J....:.....'7~.~.. ........ ...,~./...~~ .......... ........... ~14).I~.~.Y..P.O.~.~lg,..qale..0l. Nqw. Xof.k,.... County (/ (Signature of applicant) No. 52426?800 Suffolk [~e~.~, Expires March 30,