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Home My WebLink About4487-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building .... .A.c.c.e..s.s.o.r.y...b.u.5:. ]: .d.5_.~.~ ...................... Location of Property 6 .1.3.5...~.n.d.J:.a..n..~l.e.c..k..L.a.n..e ..................?.z. 9.n3.q ........... House No. Street Hamlet County Tax Map No. 1000 Section .. 9.8.6. ...... Block ...0.6 ........... Lot....0.~.9. .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated .......... S..ep.t.:..2.4.., 196. .9. pursuant to which Building Permit No...4.48 7 g .............. dated ..... O. 9.t.... 3. ................ 19.6. .9, was ~ssued, and conforms to all of the requirements of the applicable provisions of the law The occupancy for which this certificate is issued is ......... ..... &c.c.~ ~ ~.o.r.y.. ~.~ ~, .z .a.hn.g .................................................... The certificate ~s issued to .. ~J41~l~..~..,. fi. fi..g.~B..B.O.p.E.VS.T..Ei.I.lX! ........................ (owner,~:~;~r~) of the aforesaid building. Suffolk County Department of Health Approval ... lbly.~ ................................... UNDERWRITERS CERTIFICATE NO ........... N~/./k ................................... Building Inspector Rev 1/81 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) Permission is hereby granted to: ...... : ........ ~ ........ ,l"'Z. .......................... to ....... :. ........ !~.. ~.~...~em.. ~ee~j,...l~..~ ..................................................................... at p~i~e~ ~o~oted ~t .................. Jlt~..l~O,II,....il/aL.~zia.t~m..l~eic..l,m~ ............................ ............................................... · l~l~eJ:l.e ........... 3t.~'.. .......................................................................... pursuane to application dated ............................ J~t. .........~ ....... , Jg..J~, and approved by the Building Inspector. J=ee $...~J~ ....... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- t802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 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 p=operty showing all property lines, streets, buildings and unusum 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. 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 $15.00 Date..~%%.Z~,~ ........ New Building ..... :~ ....... Old or Pre-existing Building ............ Vacant Land ............. Location of Property 6135 , Indian Neck Lane Peconic House No. Street Hamlet Owner or Owners of Property ....... ~.O.D.~..~.S.~..~..[ .~;..A..~.~.~.~.~...~....&...~..U~.~. ................... County Tax Map No. 1000 Section ...... 0.8..6 ...... Block ..... ,0.6 ........ Lot .... 9.1.9. ........ Subdivision .......... .Z. ..................... Filed Map No ........... Lot No. Permit No. ~.~..~.?.~.., Date of Permit .I.O!.~) .~.~..Applicant .... ~.].~e.~.~. ~ ~..B.o.d.e..n.s.t.e.i..n ...... Health Dept. Approval ....... .~/.A. ............. Labor Dept. Approval .... ~./.A ................. Underwriters Approval ....... .~].~. ............. Planning Board Approval . ?. ,/.A ................. Request for Temporary Certificate ..................... Final Certificate ..... .X ................. Fee Submitted $...5... PO ...................... Construction on above described building and p~,rmit meets all applicable codes and regulations. Applicant... ~>-..~'.~. ~~ ................. 0. o-Ta o2? ;1 ? q.o. z/Y z TOWN OF SOUTHOLD BUILDII~IG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. Y. ItOTICE OF DISAPPROVAL File No ............................................................. Date ..................[~et~.temhe,~.....~0 .....19 69. · ,~rew C. Smith ........ .~1~.. ~x, ea~[wa2 .......................... ......... L~mbro~k · I~,X., ................... PLEASE TAKE NOTICE that your application dated ...... for permit to construct .AC~eSSO~T~..blli~ premises located at .... 1~.~i ROad ...... ..... ~-~5 .. Ind i.~...l~e ~t. ~ ............... Street P$conic Map ......... ~ ...... Block .. ~g ................... Lot . .. ~ ................................. is returned herewith and disapproved on the followin~ ground~ .......... Apt~].~.~&tioI~...i~ ...... ..... no s.i.g~e4 o~ no.ta.~zed-..&s...~e~l~e4 ................................................. .......... leee-..a~t ~2~eT' aet4'c/n' h~ld pe~di~g"~,ceip~* of- signed a'pplic&t: .... .~.. ~. ............................... Building Inspecto~ Examined '~ Approved ...................... .~ ............... , 19.!.~..... permit ........... Disapproved a/c ....~. ............ ~ ......; ........... AI~LI~4TION FOR ~UILDIN~ PERMIT INSTPJJCTIONS a. This applicati°n must be completely filled Inby t~pewrlter or in ink and submitted in duplicate to the Building Inspector. b. Plot .pi.an showing location of lot and of building~ on prem.i~s, relationship to adjoining pmmi~es or public streets or areas, and giving a detailed description of layout of pra~tele~.n~mt be :drtmm on the diagram which is port of thle application. c. Thl. work. cove~ed by: this application may not be eammenced before i.ssua~ce of Building Permit. d. . .... ~ the Building J~ will Issue a ~uilding Permit to the applicant. Such permit Uppn .approval ~>f. ~ls..appltcation, shall be kept on the premises ava,ame for inepeation 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 Impector. ie.A,P..PLI ~CATIO~N ,IS HEREB. Y MA_DE to the Building Department for. the .issuance of a Building Permit pursuant to the u.a~n.g.x, on~, ur.amance at me lawn ..of.Southotd, Suffolk County, New ~rork, and other applicable Laws, Or~inam:es or u;ot,,o, ns, t. or the c .onstructi.on o.f..bu,!,d,ngs., addlt .~ or a!.torations, or..~.r removal or demolition, a~ h~eln( descr bed e appllcam agrees to comply wim a, applicable rows, orcllnances, budding code, h~ng c~ and regulations. · ..A .................. ......... State whether applicant is owner, lessee, agent, archtteat, engirmer, general contractor, electrician, plumber or builder. ................................... .i" . ............................................ Name of owner of premises .................................................................................................................................................. If applicant is a corporate, signature of duly autho~zed officer. 3. Nature of work (check which applicable): New Buildi~g:-......~... ....... Additj~on · ................. Alteration .................. Repair .................. Removal Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ........ ?..{..C:.~. .............................. ;" ......... I:ee....i..~,;..~.~:~. ............................................................................ (to be paid on filing this application) S. If dwelling, number of dwelling units ............................ Number of dwelling,units on each floor .............. ~ ............. If garage, number of c~rs .................................................... "t" ........... : ........... ~ ............................................................. 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 ................... r ............ I ~ 8. Dimensions of entire new construction: Front .......... 0.4 ..................... Rear .........../.~ ...........Depth ...... .~'...~ ............. Height ....... .~.I ......... Number of Stories ............ ~/ ......................................................................................................... / , .~Z?.g.:..?..?..'....~....~-~t~t. c~?, IO5-. A~' ' " .......... .~../:...~..~ ............ Depth 9. Size of lot: Front ............... ~. ........... Kear Owner ~. ]0.g~te of Purchase ..,..~.p~..LI......~..,....L~.~L .................. No~e of Former ........ ~.,...~....,.~.....q..~ ................. 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation.;) ..... .~.~ .................................................. 13. Name of Owner of premises ~.~.~{£~.~...~.b.~...~.~.~....:..Address 3o.~..~ ro3~J ~){, Phone No L_.~ cj._~.j.,~.~ Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions from property lines. Give street and block number or description according to deed, and shaw street n~rnes and indicate ~_~,~rj ~ interior or corner lot. , // ,1~ I~'~' I'~ STATE OF NEW yORIg, ......... ............. bei du,y (Name of individual ~idf.ning a)~plic?ion)~,~ ~.~ . (~~ above named. He is the ........ i....~...~.....~..~....~ ....... .~..~. ....................... :. .......................................................... (Contractor, agent, corporate officer, etc.) of said ..o?ner or owners, and is duly authorized to Perform or have performed the sa d work and to make and file this apphcation; that all statements contained in this application are true to the best of his knowledge and be ief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to~ befo~ me this ......... ............... ~^~ ~o~.~,~;'~'~o,}-~t~ /.~ JA J~t~^ · ............. ~ ............. ~...."~. Nota ry~ p, ~ ~j~ ~1~ ,i~,- k%4j/~.......,~/, .; .~Co~lnt,/ (sia~oture~,~lr appli~