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Home My WebLink About4178-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No .... S..~t7.. Date ....... THIS CERTIFIES that the building located at L0. ~l~'k..~.~m. ~l~e ....... Street Map No.. ~ ..... Block No ........... Lot No..g,...~t~:l~l~t,. II~. ~ ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... ~i1~... 27~., 19. Sg. pursuant to which Building Permit No.4].78. I$ .. dated ....... ~1~... ~.., 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 ..... 1~.~. ~. gm~tlr..~l~e~XSm~ ................................... The certificate is issued to . .. I1~., .&. Ilrm.. L..#a~ ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... Building Inspector POItM NO. ~ 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) N? 4178 Z Permission is hereby granted to: to premises located ot ...... ./~...~. ~./.~. V/,~., .......... ........................................................................ ~.~ ........ ~..r..~.~.~. ............................................ ................................................................................................... ~.~!.~..~7,. .................................... pursua~¢ to oppli¢otion dated ..................... ?.,.?........~...,~..,,,/~,. ............. , 19..~...~., and approved by the Building Inspector. Building Inspector 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 typewriter 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 disposel-(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 peoperty 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 or land use . Copy of certificate of occupancy $1.00 $5.00 Date Qc. Lober..29,. 3.981 ....... New Building r'/ Old or Pre-existing Building ~. Vacant Land Location of Property .1.0..P..a.~.~...'?.i.e.~...~.aD.e' ..................................... Ori~n~... House No. Street Hamlet Owner or Owners of Property .A.~C..C.,. ~.~,~,~.~j. ......................................... County Tax Map No. 1000 Section . p.ql.~, ......... Block . .Q0P3, ........ Lot .0033. .......... Subdivision ...'.~.~ ............................ Filed Map No ........... Lot No. ~.. .......... Permit No. t~..% .'7. ~.~..?Date of Permit '.~'/./.Y//~..Applicant .... ~ .~., ..~_~j .~,~-<.c~:/_~ .......... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .5., 0P ....................... Construction on above described building.an~l~erm~ m~e~ets,~all~applicab~~lations/~,,~/~l.H.,~.H ~,,,.,~ Applicant ~j..~III~T'~5'~'~< .~.. '~EORGE C. STANKEVIC~t, ~Q. R~. 10-10-78 ;F,ORM NO. 1 TOWN OF $OUTHOLD BUILDING D~PA~'/' TOWN .C'~JE~]US OFFICZ SOu-,-~O~-D. N. Y. Disapproved a/c .................................................... / 0 ~ff~ Application No..~./.7. ~C/. ........ APPLICATION FOR BUILDING P'~RMIT Date ................................ I . INSTRUu-,'~ONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building InspecWr. b. Plot plan showing location of lot and o~ buildings o n premises, relati~gmhip to adjoining premises or public streets or area~ and giving a detailed description of layout of property must be drawn on the dia,/am 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 ob in part for any purpose whatever until'a Certificate of · Occupancy shall have been granted by the Building InspeCtor. APPLICATION IS l-ni~l~Y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone O~dinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of build ings, additions or altera/tions, or for removal or demo- lition, as herein described. The applicant agrees to corn ply with all applicable laws, ordinances, building code, housing code, and regulations. State whether applicant'is owner, lesse~, builder ....... ~ .~."~./V~ ~ t ..................... ~ ............ ............................. ¢ ,V ,4 c '7"o ......................... Name of owner of p~mis~ ......................... ~ ........................................... H applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ~-Z~A,~ Location of land on which proposed work will be done. l~ap No...'~.~.'"'5."Z/~ Lot No... ~/'.. Street and Number ~ ! . .' ~' ~ ............. / ............................... ............ State exis~g u~ and ~cup~cy ~ p~mi~s ~ d intend~ ~e ~ ~cu~cy of ~ ~ction. ~ist~g ~e and ~cup~e~ ........... b. Int~ded ~ ~8 ~cup~cy ................................................................... 3. Nature of work (check which applicable): New Building ........ Addition ........ Alteration ........ Repair ......... Removal ........ Demoliti~on ........ O~er Work (Describe) ...................... 4. ~timated Cost .......... ~-f.~.~. ............ Fee ...... ....................................... (to be paid ~ fil~g this appli~tion) 5. If ,dwe~ing, number ~f dwelling units .......... Number ~f dwelling uni~ on each fl~ .............. If ~arage, number ~ cars .......................................................................... 6. If ~usiness, comm~cial ,~ mixed occupancy, specify nature ~d extent of each type of use .............. 7. Dimensions of existing st~ctures, if any: F~t .............. Rear ............. Depth ............. Height ................ Number of Stories ........................................................ Dimensions ,of same st~cture with alterations er additions: F~ont .............. Re~ ............... Depth ................ Height ................ Numb~ of S~ies ..................... 8. Dimensions ,of entire new const~ction: F~t ~ ~ Rear HeiSt ............ Number ~ S~ries ............................................................. 9. Size of ~ot: Front ..... ~. ~ ~.. Rear .... ~.~.~.~... Depth .. [.~.~ ...... 10. Date of ~rch.a~ ............................... Name ~ Fomer Owner ............................. situated .................................................... 11. Zone or use district in which premises are ~ t O . 12. ~s pro,ed co~ction violate ~y z~ing law, ,ordinate or regulati~? ........ ~ ............... 13. N~e of Owner,of pre ' s ..................... ~ddress ...................... Ph~e No ............ Name of ~ehitect ............................. ~ddress ...................... Ph~e No ............ Name ~f Contractor LFD ~/L~ Address I0~ ~1~ ~,~ No~- PLOT DIAGR~ II 7 7 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 de scription aceording to deed, and show street names and indicate whether interior ,or corner Lot. f ~0 ! ..... 7.;-...5.,~ ................................ being duly sworn, depos~ and rays (Name ~of individual signing application) cant a~ve nmed. Ho is the .......................... ~q~&¢.~ .K ............................... (Gontra~r, agar, ~ate officer, etc.) of said owner ~ ownem, and is duly authorized ~o perform or have pe~ ~e ~id ~k ~d ~ make and file this applieati.on; ~at all statements oontained ~n th is applieat}on ~ tree to the best of his knowl~ge and belief; and that the ~k will be p~ in the mann er set for~ in the application filed therewith. Sworn to before me ~o. 52-328~I20 Sut~o ~ C0 T~rm ~tre~ ~arch 30, '~