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Home My WebLink About5014-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~1.293 ...... Date ............. J~lly..~2 ...... , 19..71 THIS CERTIFIES that the building located at . .lifJ..~el~r. L~ue ........ Street Map No.I~..r.b~.r..~.~;S. Block No .... ~ .... Lot No...!6 .... 8eu~h~!~i...N,Y.~ ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Oct · · 20. , 19.70 pursuant to which Building Permit No.. 50~l~.J~. dated .......... 0¢.~... 2a..., 19~0., 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 . .P.~.:l..~.a.~.~...~.~...$.a~..~.ly. ~.~.~..]..]...$ng ...................................... The certificate is issued to . Hel~ry. Arfl~n.. [ f. ermel~ly..Jacobs. & Leak) .... Swner (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval llouse ~ 1.~1~' Building Inspector~ TOWN OF $OUTHOI4D BUILDING DEPARTMENT TOW, N CLERK'S OFFICE: SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5014 z Permission is hereby granted to: l~a~n,..~.,,..&~n~....~..h~ .......... ~.~.....~.,~..~ .................. ~ ................ ' l~ ................. G~.n~ ....................... ~ ................. to ............ ~ .:~..~..~..~ .............. ,. ......................................................... ~t p~m~ ~t~d ~t .................. ~a.-..46...~.-~J.:~J.~..J ............................ ............................................... ~/~..~,..~ ......... ~m~a..,,.~: ............... ,. ................ pursua~ to application dated ............. ~ ....... ~ ........... , 19,.~ and approv~ by the Building Inspector. ~j PO~ .Fee $'*'~G~ ........ ,: Building Inspector ~ f ~' ~...~, ~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building~ b. Plot plan showing location of lot and of buildings on premises, relationship to edloinin~ pr~mis~ or areas, andgiving a detailed desgrlpti°n of layout of prope~ must be drown on the diagram which is ~ of ~is application. c. The work ~Overed by'this application may not be commenced before issuance of Building Permit. d. Upon ~proval of this application, t~ Building Inspector will issue a Building Permit to the applicant. Such ~rmit shall ~ kept on the premises available for inspection throughout the pr~r~s of the work. e. No building s~.ll ~ occupied or used in whole or Jn part for any purpose whatever until a Certificate of ~cupancy shOll 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 alteration~s or for removal or demp/d~d~,,as herein described. The applicant agrees to comply with all applicable laws, or~ ....... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. agent of purchasers under contract .................. .............................................................................................................................. Name of owner of premises ....... ~?,t~9,~.~i~,Q~bs..s,D.d. Leah,...ux ..................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Harbor __ght E~ta~es, §1 . 1. Location of land on which proposed work will be done. Map No.: ..... ~.3...6.~ .......................... Lot No.: ..~..6. ............... ..~'~, - . , .... n/s Anchor Lane, Southold Street ~ ............................. :::.....~ .................................. ~ ........................ ,~/~ /.,~ / b ~ Municipality ........... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........................................ .V.~.Q~.~t~...].~A...d. ......................................... b. Intended use and occupancy residence 3. Nature of work (check which applicable): New 8utld~ ~,~......X.. ....... Addition .................. Alteration...... ...... Repair .................. Removal .................. Demoliti~_..~.~., ....... .,; Other Work (Describe) ........................................ 4. Estimated Cost .$ZCI,.D~.Q ...................... ~.i ......... i ........ Fee ..$'~.Q~!.~.~ ......................................................................... (to be paid on filing this application) one u .5. If dwelling, number of dwelling units ............................ N mber of dwelling units on each floor ............................ two If garage, number of Cars .............................................................................. ;;.; ............................................ . ............... 6. If business, commercial or mixed occupancy, specify nature ahd extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ......................... ~.. Rear ................................ Depth .................... Height Number of Stories Dimensions of some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ,-. ........................... Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... ..~..~. ...................... Rear ...... ..~.. ................. Depth 25~ Height ......... .3..2..~. ..... Number of Stories .....~..w...o. ........................................................................................................... 9. Size of llt: Front ............ .1...0..0.! ........ Rear ....1..Q.Q.?.. ...................... Depth .....w..gg.0.~[?.;~.0.Q~ 10. Date of Purchase un~J.e:..co~t:a~.t..t~.pumch.ae..N~q~/df/~dr~el/C~lrJ~r/.~..'. ................................................... 11. Zone or use district in which premises are situated .?J~,:.~ ............................................................................................. 12. Does pr,~cl~'d n ~ruct'~m~e~.co~,.~cZtonvio]ate n. lng law, ordinance or regulation?, ..""n"°" .................................................... 13. Name ~ ~ of premises ..~..e.....m~....A....~.....m~.....n. ........... Address .....g/..9...a.R.q..J-~.q.a...n.l~ ............. Phone No ..................... Name of Architect ~...e...o.~g.e....A.....h~...e..z'..s.. ............. ~.~ ......... Address .~..u..t..q.h...o.~t....e.~....N..~ .............. Phone No..7.3...4.-~5...0...1..0... Name of Contractor .................................................... Address ............................................ Phone No ..................... ~ See Exhibit 1' ~tt~ched he,eta s~d n~[~)~. ~DIAGRAM°~ he]~eo~. Locate clearly and distinctly all buildings, whether existing or propasecl, 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 ~:orner lot. · STATE OF NEW YORK, ~ ~ee COUNTY OF ..$U.F.F~)~.K. ......... ~'~' .............................. St.a.nle~'.~,..CoNNe'i~ ............................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the i ..................... : ............... .a.~.e..n.t.~.f..~.?..~..~..e.~..u...~.c...~..~.s~.e.~.u..n...d..e..~.~.c..~..n.~ .............................. : ..... (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 contoined in this applicator-ore, true to the best of hi~dge and belief; and that the work will be performed in the manner set forth in the (~pplica}fon filed therewith. / SWOrn to before me this ~/~ ................ .......... ................ , .... I .,T No. ~ualJfled in Suffelk Cgunty// .. Exhibit FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,¥, 11971 APPLICATION FOR CERTIFICATE OF~ OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and $ubr~itted 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 build;ings, property lines, streets,, and unusual natura~ or topographic features. 2. Final approval of Health Dept. of water supply and sewerageidisposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire UnderV)/riters, 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect br Engineer respons b e for the building. 5. Submit Planning Board approval of completed site plan requi~'ements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: ' I. Accurate survey of peoperty showing all property lin~s, sireets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occul~ancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings ~r premises, or other pertinent informa- tion required to prepare a certificate. 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 Date .. ~,a~..~ 7.,. ,% 9,82. ......... New Building ............. Old or Pre-existing Building ....x. ....... Vacant Land ............. Location of Property , . . ~1,3.. 3¢,5. /~n.¢.hp.r...L.a,n.e. ,...Sp.ut. hold~,~ . ~,e,w. ,~,O?.k. .................... House No, Street Ham/et Owner or Owners of Property . H,e.n.r.y..t~....A.r.f,r~a..n ......................................... County Tax Map No. 1000 Section . . . .7.9. ......... Block .z~ ........... Lot.., .3 ............ Subdivision }{ar]~.Qr. Lights. ,Est~:t.e. 8 ....... Filed Map No~ , .4.3.~.2.,. Lot No ...1.6. ........ Permit No ........... Date of Permit .......... Applicant . .E.' .s.t,a,t.e., .o.f..H..e.n.r,y..L,...A. ,3~m..a.n, . .. Health Dept. Approval ........................ Labor Dept. A. pproval ........................ Underw'riters Approval ........................ Planning BoarU Approval ... i .................. Request for Temporary Certificate ..................... Final ~ertificate .... .X. ................. Fee Submitted $. Construction on above described building an/fP~,, ~/m'pj~,,l;Y~c~e~and regulations. ~/d~lph H. ~ruer',~ Attorney for Estate of Henry R,v. 10-10-78 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 disposa~-(S-9 form or equal). 3.Approval of electrical installation from Board of Fire Under~vr~ters. 4. Commercial buddings Industrial buildings, Multiple ResidenCes and slrndar buildings and }nsta la- tions, a certificate of Code compliance from the Architect or~ Engineer responsib e for the bud ng. 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 peoperty showing all property lines, str~.ets, 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 o¢ 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 $5.00 3. Copy of certificate of occupancy $1.00 Date . New Building ............. Old or Pre-existing Building ... ~-':~ii*~ ............... House No, Street ' Hamlet Owner or Owners of Property ....... County Tax Map No. 1000 Section Block . Lot · Subdivision .... ,~,~. ........... ~t' ............... Filed Map No ........... Lot No...~,~. ....... Permit No. Date of Permit .... Applicant Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board ~pproval .............. ~equest for Temporary Certificate ..................... Final C~rdficate ....................... Fee Submitted $ ............................. Construction on above described building and pe~T~'~e~all appl~e~odes and regulations. S-9 SCHD SUFFOLK COUNTY DEPARTMENT Date Bldg. OF HEALTH Bermit No. TO WHOM IT MAY CONCERN: The sewage disposal facilit~s for a structure located / ' (Give ~ed loc%tion) i have been inspected by this department and f'ound to be satisfactory. TOWN OF SOUTHOLD BUILDING DEPARTMEN'~/ TOWN CLERK'S OFFIC]~~ SOUTHOLD. N. Y. l~OTICE OF DISAPPROVAL Fi,e .~o .................................................................. rote ......... ....i ............... ~.t.....l~ ....... ~...~ .... ~!~.... ~.~...~.~ ........................................... ......... G~eenp~t ,... ~ ~.$..'.. ~-t ..................... ~or permit to construct ~...~...~..f~ the pr~m~es located at ................................. ............. ~/8...~ho~...~ .................... Street 8outhold N~, returned herewith ~d disapproved on the followin~ grou~d~ ....~$~.....~..~..~.. .~ll~&..~S...~W~.. f~ly...dW~l~..a~..ne~.~:.~p~.~l...~.~ ~9~ .~ee..,~e~..,~..$...~ 0,~..~.~.~..~33!] ...................... ;. ................ ~ ........................................... L_L; ', F