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Home My WebLink About3725-zFO~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z.7.. ~Y?. ...... Date ............. .0.q .~ .... ~.. ...... , 19. THIS CERTIFIES that the building located at . .Ge.P~g.q .t. tp.a.d...&. Map No....x.x. ....... Block No..'.z~. ....... Lot No....~.... ~q~.q..S.u.~.$p.l.k....iq:.~: ..... conforms substantially to the Application for Building Permit heretofore filed in this officq -~ted ............ t~o.~... 28. , 19.67. pursuant to which Building Permit No.. dated .......... ~0¥...2~.. ., 1967.., 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 .. ?,~¥':a~;.e.. 9.n~..~.~.m.~.~..y.'..d.;,(~:.~.~.lg. ..................................... The certificate is issued to .g.e~;~te.q. ~'. ~.a.~.,g.a.2e..%..~4~c.~9.r~.~.a.~.~ .... .G.V.ngy:s' ............ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .9~.~.z.t.~.n.~. ~¥~.~?? .~ ................ UNDERWRITERS CERTIFICATE No.. ap~r.~vod..by. ~....Kub~cki...10/6].77 ...... HOUSE NUMBER .... .20.~... ~,e.o. rg~'i-e~l~ ..... 4. J.~.7.O...Q~.a. ~.b~fo..h~..I~.d....E.e.V' note; ki.~chen to be discontinued in garage apt, ~ regular accessory building Building Inspector TOWN OF soUTHOLD BUiLDiNG DEPARTMENT ,TOWN CLERK'S OFFiGE SOUTHOLD, N. Y. BUILDING I~ERMiT N? (THIS PERMIT MUST BE KEPT ON THE PREMISES uNTIL.FULL COMPLETION OF THE woRK AUTHORIZED). 37'25 Z :' Dote Permission is hereby granted to: to ...~tLt,341,.~w..,~ ..~;L~...~,~zr~!~:l,l~ ................................................... ;.,., ........................ at premises located at ,...~,~...Gea~e...~:o.~..p~...g.~,~t~..~,^,..,...q~,w ..................................... : .... .............................................. 1~/~...~. ~;EIc ~ .. ~ oZ~ ................................... ~ ..................................... pursuan¢ to application dated ............................. ~'O,1~J ....... ~J~ ......... , 19...6~, and approved by the Building Inspector. Building Inspector FOlh~I NO. ~ TOWN OF SOUTHOLD I~UILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3725 Z Permission is hereby granted to: ...~es.. &.4,~a~,§a.~,e ~ ..~;~k,~, ~-~,....~ ........... ............ ~,~.~ ...... ,.~,.~,, ..................................... ~... ................. ~:..~.~.C~. ............. to ... ~., ~,,.. ~,,.. ~,l~a..~. ~,,~....,.~. -~.~ .............................................. ~ ................................. at premises I~oted at ..... l.~,*...~.[t~g~...,Jm.l~]...~...~.~ k~.~:.~. ....................................................... .............................................. ~...~.[.~, 4~g ~.. ~, .Z .......................................................................... pursu~n~ to oppHc~tion'dot*d ............. ...." ....... ~-,.~0~, ....... 28 ......... , 19...,~ ond opp~ov~ by the Building Inspector. Fee $..~,~ ........... ......... ................ 1~0~ NO. 6 TOWN OF $OUTI'iOLD Building Del)o ftment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector with the following; for new buildings or new use: ]. Final survey of property with accurate location of oil buildings, property lines, streets, end unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposol--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences end similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit P~anning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April ]957), Non-conforming uses, or buildings end "pre-existing" land uses: ]. Accurate survey aT property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $I,00 $5,00 Dote ................................................ New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ..................................................................................................................................... Owner Or Owners Of Property ....................................................................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No ..................... Date Of Permit .................... Applicant .................................................................. Health Dept. Approval ............................................ Lobar Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and.~rmit meets all~i~esy regulations. Apphcant ~., .~../..~. · ..~, ...-~./...,¢:~....-~.. .............................. Sworn to before me this ~ ................ day of ............................................ (stamp or seal) Notary Public .................................... County l~O~ NO. ~ TOWN OF $OUTHOLD Building Depa~tmenf Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector 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 I~ildings and installations, 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 19§7), Non-conforming 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 in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 New Building .................... Old or Pre-existing Building ............................ Vocont Land ............................ Location Of Property ..................................................................................................................................... Owner Or Owners Of Property ....................................................................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No ..................... Date Of Permit .................... Applicant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building andgermit meets all applicable codes and regulations. Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County A roe . 19 ~.[. Permit No ~' ~ ' ' pp v d ....................................... , ................................... t~/~ ~ /~ ~'~ /,~-,_ ~ 0~ ~ ~ Disapproved o/c ............. ~~ ....... :... ' ' '~ '/' ~ ~ O ~ (Bui aing insp~t~) /0~7 ~ ~ ~(~ Cp I~STR~CTIO~S o. This opplicotion must be completely filled in by typowriter or in ink ond submitted in duplic*to to tho Buildino~ Inspector. b. Plot plan showino location o{ lot ond o{ buildin0s on premises, relationship to ~dioinin~ promises or public streets ond ~ivin~ o dotoilod description o{ I~yout of proporty must bo drown on tho dioorom which is part o{ this oppllcotion. ~re~s, The work covered by Ibis ~pplication m~y not be commencod bofore issuonco o{ Buildin0 Pormit. d. Upon opprovol o~ this opplicotion, tho Buildino Inspector will issu* o Buildin0 Permit to the opplicont. Such permlt~ sh~ll be kopt on the promisos ovoiloble for inspection throughout tho pro~ress o~ tho work. e. ~o buildin~ sh~l[ bo occupied or used in whale or in p~rt {or ~ny purpose wh,tever until ~ Certi{ic~te o{ Occup~nc~ sholl hove been ~ronted by tho Bu~Idin~ Inspector. A~PklCATIOM IS H[R[BY ~ADE to tho Buildin~ ~ep~rtment for the issuonco of a Buildin~ Pormit pursuont to Buildin0 Zono Ordinance o{ tho Town of Southold, Suffolk County~ ~ow York~ ond othor oppl[c~blo kows, Ordinoncos or ~e~ulotions, ~or the construction o{ buildinos~ odditions or olterotions, or for removol or demolition, ~s herein described. The opplicont o0reos to comply with oll oppl~coble laws, ordinonces, buildin0 code, housin~ code, *nd re~ubfions. · ..~0~..~ ........................................................... (Sionoturo o{ oppficont~ or nomo~ i~ o corpor~tlon) /~ddress of applicant) State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. ................................................... o.~e~....-....buil~e r. ......................................................................................................... Name of owner of premises ..~T~iJ~B.$.,~.,~A.8,1~.gal~.e.~...~.~e.~l~,:t:k ..................................................................................... If applicant Js a corporate, signature of duly authorized officer. .................. ................... (Name and title of corporate officer) / 1. Location of land on which proposed work will be done. Mop No.: ............ ~ ...................... Lot No.: ...... ~1[ ........... Street and Number ...g:~.g.?.~.~.....~..O..~..~..,.~...~.~..~...~.~..~.g..~..]:....~..o...~..cl: .......... ~..e~...f..~...~..~...o..~..~.. .......................................... MuniciPa lity 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .&~;g.e~.8.f)~.~...l~L~l,~...~,..~.q~ ............................................................................... b. Intended use and occupancy ......... O~fL..~'i~l~$,],~r...gl,.~.f~.~.~.l~ .......................................................................... 3. Nature of work (check which applicable): New Building ...,~: ....... Addition .................. Alteration .................. Repair .................. Removal ..................Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...... ~l,~'.)..~Cl0 ....................................... Fee ..... ~,~..,.Q.Q. ........................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... O~e .............. 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 ......... ..~.0 ...................... Rear ..... ~.0 .................. Depth ..~, ................. Height .................... Number of Stories ........ lr, W~) ....................................................................................................... 9. Size of lot: Front ....~60 ................ Rear ............... ~)O0 .............. Depth ........ ],0,~../].3]. .... 10. Date of Purchase ................... 'lc~.~.~ ........................... Name of Former Owner ....... .~2~,~1'ID~,. .......................... 11. Zone or use district in which premises are situated ....!!~.!!...ClSS:t, ............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ...,.....~O .............................................. 13. Name of Owner of premises,}'etme.~..I~.el[e~,m~.~ ....... Address ...~.~.1~...~.~'..9.~q .............. Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ........... ~..~..~..e., ............................... Address ............................................ Phone No ..................... 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, 1S S COUNTY OF ...~.l~t~.~'ltf. ........... ~ '' ....................................... ~.f~,~t,~...~.~¢~.~..~l~. ....................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the .................O.~l~,~.:~....-....~l~,~l,~'. ................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make 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. Sworr, to before me this ~~ .~ ...~.....~._..~ ....... ................. 2.8...c,~.~ ·.~.day of ........, '~" 'O'~e"~l~;~'~"~'. 19'""6'2. ....... . ..[,,..,.....,~/'~/'~'~--~~-' plicont) :: ' Notary Publi ..... .~ ..... County ig~'~'~' of'~ NOTARY pU~L1C, State of New ?~% ~o. 52-3233120 Sufloll( Count~_ FORM NO. ! TOWN aZ: SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..... Approved ........................................ , 19.~.i~.. Permit No. > 7 ~ ~ ~ Disapproved APPLICATION FOR BUILDING pERMIT Dote ...................... ~X3YP.~:~e Z'..'... 28 .......... 19..~ ...... INSTRUCTIONS filled in by typewriter or in ink and submitted in duplicate to the Building This application must be completely Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving o detailed description of layout of property must be drawn on the diagram 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 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 Reflulations for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. Th~ applic~'nt agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. , noture o ,,cont, or name, *fo eorporationl (Address of applicant) State whether applicant is owner, lessee, agent, architect, enqinee~, general contractor, electrician, plumber or builder. .................................................. o't. fa.e ~...,,,...'b%t/3,,cl.e..~ ................. (. ........................................................................................ Nome of owner of premises ~mea,.&...Maltga~t 1~lekel*i~m:~ .................................................................................... if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) I. Location of land on which proposed work will be done. Map No.: ........... :l~ ......................... Lot No.: .....~r,:,l~ ............. Street and Number .(~f~.O.~g~...]~.~¢~...~..~'~.~.~;t,...]~.~.9,~ .......... .~..?_~....E?.~..~..O..~..~.. ............................................ Municipality 2. State existing use and occupancy of premises and intended use and occupency of proposed construction: a. Existing use and occupancy ~,Cl3,G~.~O~.~'...~],~...O~..,]~O~ ................................................................................. b. Intended use and occupancy ....... O]D.E~...~L~t...~.EI~i,.~i~ ............................................................................ 3. Nature of work (check which applicable): New Building ...~ ....... Addition .................. Altera.tion .................. Repair ~ ................. Removal ..................Demolition.~ ................ Other Work (Describe) ........................................ 4. Estimated Cost ...... '1~'.~0.{~ ....................................... F~ ......~.0.~..0..0..i ....................................................................... (to be paid on filing this application} 5. IF dwelling, number of dwelling units ....... .~l~.g. .............. N~mber 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 ~0 .... Rear brO Depth Height .................... Number of Stories ........ t'~.Q ....................................................................................................... 9. Size of lot: Front ....2.(~1~ ................ Rear ............... ~.00. ............. Depth ........ ..~..0.~.....~..;~..~. .... 10. Date of Purchase .................... ~..~.. ........................... Name of Former Owner ....... ..~..~...~..~...b:..~..O...~..~.. .......................... 11. Zone or use district in which premises are situated ...... ~,~.....~.~,~l.~. ................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ......... I~Q .............................................. 13. Name of Owner of premises~'tl~all..~e~;e~l~ ....... Address ~g~l' ~:['o'lk Phone No. 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-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 z~.~°-,~,, ! c c COUNTY OF ....?..~.~.~.?..~...~. ........... f~'~' James Neke~an ......................... ........................................................................ he~a~ d~ sworn, deposes ~nd s~ys t~f ~e ~s the ~pp~ca~f (Name of individual signing application) above named. He is the ..................~.~..~...~.~.~ ................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in INs 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 ~ . ~ ~. ~ __ ........ ' ............. ....... ; ....... ......... ;f' ' ....... . ......... Notary Public,[..~~....~.. ~.2 Countv, . /'" (~ gnature of appl cant) ~OTARY pUBLIC, Stme ol t~'.v~o~ ~0 52-3233120 Suiiolk Coa;~ .,, ~[~ ~xpires ~r~lt 80, 19~