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Home My WebLink About3940-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. UP-DATED Certificate Of Occupancy No. Z14254 Date February 27 19 .8.6. THIS CERTIFIES that the burid[ng ...... .~.e.~. p~..e.l.l~.~g .............................. Location of ~operty $00 .................. .~.a.=.b.o.:..~.d: .................. .O.:.t.ep? ........ House No. Street Hamlet County Tax Map No. 1000 Section ...0.27 ....... Block .... 9.4 .........Lot ....0.0.5 ........... Subdivision ......... ~ ..................... Fried Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore Filed in this office dated ....J.u.l.y ..... .5 ........ ,19.6.8. pursuant to which Building Permit No....~.9.~.0.Z .............. dated .... .J.u.l¥....5 ................ 19.6.8., 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 ......... ........ :'r.-':'.-:':':':':':'. ~.e.w..l~-..e.l.l.ip~.. r.-.".-.-.-:':':'.-.".-:' ................................. The certificate is issued to LEWIS EDSON (owner, J~l~t~e.~lO~ of the aforesaid building. Suffolk County Department of Health Approval ....... .A.u~.. . .2.1. ,.17.6.8. ,. ~.o.b. ef.t..V.~.~.l.a. ........ UNDERWRITERS CERTIFICATE NO. N/R Building Inspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southo~a, ~. ¥. Certificate Of Occupai cy No.. Z 342.9... Date ...... ~,. ~4arch...14~ ........ , 1969.. THIS CERTIFIES that the building located at . .I;~il~lams. Road ......... Street Map No ............. Block No ........... Lot No .... 0r~,ent;,. N,~w. Yozk .......... conforms substantially to the Application for Building Penmit heret0£ore filed in this office dated ........... ~.uly. ~,.., 19 tiS. pursuant to which Building Permit No. 39.40. Z.. dated ........... ~ul¥. 5, ..., 19.68., 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. ivat~ .one..fam/3.y.. d~elling ..... ; ............................. The certificate is issued to . . .George. &. R~kta. MenegUS, ............................ (oWner, lessee or tenant) of the aforesaid building. : Suffolk County Department of Health Approval AugUm.~ .21.,..1968,..Robert. Villa ...... k:": ,... :' ....... tg Inspector TO~ OF $O~THOLD BUILDING DEPARTIv~ENT: TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT fi.HIS PERMIT MUST BE KEPT ON THE PREMIS~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) : N? 3940 Z pursuczn¢ to opp icotion dated ....................................................... ...., 19 ........, and approved by the Building Inspector. Fee ~ ........................ 13uilding Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hal~ Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OFOCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted m~ 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 featu res. 2. Final approval of Health Dept. of water supply and sewerage ¢isposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire UnderWriters. 4. Commercial buildings, Industrial buildings, Multiple Reside~cces and similar buildings and installa- tions, a certificate of Code compliance from the Architect 0, r Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan recluirements where applicable. For existing buildings (prior to April 1957), Non-conformin,g 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 informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 /.5. Updated C.O. $15.00 $15.0:0 Date ...... DIi .~./..~...~, ...... New Building ............. Old or Pre-existing Building ..... ~ ...... Vacant Land ............. ' OO Countg Tax Map ~o. 1000 Section ...... ~ ........ 8lock .... : ........... kot ................ Subdivision ................................. Filed MaO ~o. .......... Lot ~o .............. Permit No. 3~.~.9.~ Date of Permit .......... Applicant...~.-. ~ t..BCU~ ....... Health Dept. Approval ........................ Labor Dept. ~pproval ........................ Unde~riters Approval ........................ Planning Boar~ Approval ...................... Request for Temporary Certificate ..................... Final ;ertificate , ~. ................... Fee Submitted $. l~ ...~ ~ ................... __f~,~,o,9onstruction on above described building andJ~,z'mit meets all appli~;at~le co, des and regulations. Appl,eant' ' 'fA .................. Rev. 10-10-78 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH The sewage disposal Bldg. Permit NO. ~.~Tz/: ~ facilitie, s for a structure located (~ive deedZlocation) / have been inspected by this department and found to be satisfactory° Distriot Engineor District Engineer TOWN OF SOUTHOLD BUlLDINGDE~'^:TM'~N¢~ 'r '~'"'~ ~-"~""'~ ~-'"~ "' TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exomined ....... ~ ..... , ......... ........................................ . ,,=,, Disapproved a/c ............................................................... .................... ~'(Building Insp~c¥'c~;i ................................. APPLICATION FOR BUILDING PERMIT .~.~ Da,, ............... ...... ........ .......... 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 port 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 shell be occupied or used in whole or in port 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 re~g~lations. (Sign~u~e 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. 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..Map No.: ........................................ Lot No.: ........................ Stre~ and Number ...... ........~.-.....-.... ......................................................................... Municipality 2. State existing use and occupancy of premises end intended use and occupancy of proposed construction: a. Existing use and occupancy ......~...~..: ............................ ~ .................... b. Intended use and occuponcy .......~...~ ................................................................... ~ ......................................... 3. Nature of work (check which applicable): New Building ~ Addition Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..... .~.....~../...~....~....~. ................ ~ ................ Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... ./. ............ i....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 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 ..... ~...~..~...~...'.'. ................ Rear ~ ~' ~'" Depth ....~.. ~'Y" Height .....~....~..~. ....... Number of Stories ...~......../~.~....c~..:...~..). ........................................................... 9. Size of lot: Front .......~'...?..~ .............. Rear ....... ~ ......................... Depth ....~....~..~-...:. .............. 10. Date of Purchase ........................................................ Nome of Former Owner .~-~!.....~...~ 11. Zone or use, district in whic~h premises are situated ...~. { ~--~ ....................... 12. Does proposed construction violate any zoning law, ordinance or regulation.;> ..~ ........... 13. Name of Owner of premises ..4~..~..~..(...~.....Address .~..~.~....~..~.~.,Phone No Name of Architect ................................. ,,~ ................... Address ............................................ Phone No ..................... "~'"//~./.......~C....~...~ ........... Address ....... ...~.~ ................. Phone No~..~.~.T..~...~'..?.../.. Name of Contractor 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 number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, . 1 o ~ ~0 ~.o COUNTY Of .~.~.~.....~.. ........... ~ ' ................. · .'~..~...~'....~'......~'../~....~..~...~./'.. '~"~' ..................................... beind duly sworn'; deposes and says that he is the applicant (Name of individual signing application) above named. He is the ...................................... .(..~....~...~...~...~...C....~.?....~. ................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have Performed the said work and to ma:ke 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 Jn the manner set forth in the applicaffon filed therewith. Sworn to before me this ........................~' Z-'A/ dayof . ........................................ .~....~. Z ~.. , 19 ........ ........ ....... .......................... Notary Public, .c~.~4~..,...x....~. ~.~....~,l,~¥1~.]p:.if~l(;?,,~i~.nty // (Signature of applicant) ~" ~"'f.~ NOTARY p 8lin ~0. $2-7267800 Suffolk Counfy ~'~ Expires March ~, 19~