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Home My WebLink About2872-ZFORM 1~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'I"OWN CLERK'S OFFICE SOUTHOLD, N. ¥. CEI~TIFIP. ATE rlF 13EP. UPANEY THIS CERTIFIES that the building located at .~/.5...0...~.a..w~...~.~.. ........... Street Map No.. ~ ........ Block No... ;K~ ....... Lot No. ~ ........ 8..O~..t..h.o.l.d,...~..,.~.? ...... conforms substantially t,o the Applicati, on for Building Permit heretofore filed in this office dated ........... ~t .... ~.1..., 19.6~. pursuant to which Building Permit No..~..~.~...~. dated ........ 8et~;. ~ ......... 196~., was issued, and conforms to all of the require- ments .of the .applicable provisi.ons of the law. The .occupancy f. or which this certificate is issued is ... P~.~¥I~[~..011e..l~alai~.. d~e~l ~1,~ ........................................ The certificate is issued t~o . .R.o.b.e?..~...K_~0p.®~ ..........0]~el~. ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .,~p~.~. ~t..1.96~[ .]3~..l~,..V~],],8~ ........ Building Inspecto/ l~ouse ~ 3260 FORM NO. 2 TOWN OF $OOTHOLO 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? 2872 z Date ......................... B~ p.t, ......... 2~ ............ 19..6~. Permission is hereby granted to: (]eO·. · AbZ. et'.a · .. · .k/¢. · .]~l~e~t. · ~e ~ ................ ....................... Cuf.~tm~e ................................... to ..... Bl,ttlsl..ne~..one..£amll,g...~walling ................................................................................. Gt premises located at ...W~.....021~l&3133..A3g~ ..................................................................................... ................................................. S~thold~..l~.Z. ............................................................................... pursuant to application dated ............................. Sel3t....~, ............19.~[.., and approved by the Building Inspector Fee $... lO.e.l~. ........ Building Inspector FORM NO. 6 TOWN OF $OUTHOLD 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 ~=~ 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. B. For existing buildings (prior to April 1957), 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 informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 ce of occupancv on nre-e×J~tino d~ ertificnte nf n~m~o~ncy ~1.00 4.Vacant Land C.O. $5.00 $15.00 ...... ..... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ..... .{~..~ .... ~....~.~ ...... Ho,,,~No. ./ ~ /~ Srr~ , __ .... Owner or Owners of Property ...... ~( ...... ~ .................. ..... ' ...... ...... ..... Subdivision .~;~ '~'7~ ........................ Filed Map No ........... Lot No .............. Permit No.. ~.~0.g/.. Date of Permit .......... Applicant .................................. Heahh Dept. Approval ........................ Labor Dept. Approval .... .,, .................. Underwriters Approval ~OdO(~h ~L/ ~)["~(.,]Cr ........................ Planning Board Approva .............. : .. S-9 SUFFOLK COUNTY DEFkRTM~IT OF HEALT~ Date Aoril 2, 1968 Bldg. Permit No. 2872Z TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at Oaklawn ~venue~ Southold (Give deed location) have been inspected by this department and found to be satisfactory. District E~gineer ~ District Engin~'er FOBM NO. 1 ~OWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..~....~: .~... .......... , 19...~.~i-- ........................................ , 19 ........ Permit No ............................. Disapproved a/c ........... ................. ....... ...... APPLICATION FOR BUILDING PERMIT Date ............... ................... , ............ 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 thi.s 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 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 o 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 regulatipps, o ......... ...... State whether applicant is owner, lessee, agent, architect, ~r~lineer, 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) Location of land on which proposed w~one..Mop No.: .......................... ~ ........... ~¢~t N~.: ....... Street and Number ..................~ ............................... ~ ................ ~ ................. Municipality 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 ..; ................................. ...~..~ 3. Nature of work (check which applicable): New Building ..... ~ ...... Addition .................. Alteration .................. Repair .................. Removal .................. Demolitian .................. Other Work (Describe) ........................................ 4. Estimated Cost ......... .~...~.,t2..O..O. ............................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ./~ ................ 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 olterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... .~.3.~..~ ................. Rear ..... .~...~....~.~. .......... Depth ..... .~..~......~. ....... Height /~'~' Number of Stories I 9. Size of lot: Front ........ ./.~..O.. ........... Rear ........... ./...~.~..~.. .............. Depth ......... ~..~....~. .............. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 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 ..~.q~...Z~.F.q.t.~....e./.....Address ...J~'.C.X....~....~......~..../lg.~..c'.~ .... Phone No ..................... Name of Architect ....~....~.~....../.)..~..q...~.~..c..].......'. .......... Address It ............................................ Phone No ..................... ,.x/l/ Name of Contractor ......... ~....~../.~'.CS ......... Address .~,~..b.~..¢~.~..~...../.~..~......~....~,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. II, O STATE OF NEW YORK, } c c COUNTY OF ................................ ....................... ~ ....................................... '~ ~b,~ing duly sworn, deposes and says thot he is the app cant (Name of ind~idual signing application~_~ ,,. above named. He is the ................................... -~~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 a.nd 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. Sworn to before me this ,,~.,~ ....... ~. .........day o f ~cz...~~_ .~rr.. ........, ..... . .................. Notary Public,'~4~.¢~.~- ....... ..~. ~C~ ~. RECE~ ';~ applicant, ....................... ~ (,// NOTARY PUBLIC, State 0f New Yor~ No. 52-3233120 Suffolk Country Term Expires March 30, 19~