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Home My WebLink About5040-z~ NO. · TO~N OF SOUTHOLD BIB~.BIN~, DEPART~.NT Town ~lerk's Office Sou*hold, BI. Y. Certificete Of Occupency No. ~?.~. ...... Date .............. .0~.t.. 3~. ....., 19.?~. THIS CERTIFIES that the building located at . .R,.Q,¥,. ]1/.8. I&a~. ~.. Street Map No. ~ ......... Block No...~.. ...... Lot No..~...~.a..I.t...~.?.~..~.....N.t.~: ...... conforms substantially to the Application for Building Permit heretofore filed in t. hl, office dated ........... Fab.. ~.~.., 19~l. pursuant to which Building Permit No. ,~)~0~.. dated ............ .M..~..e...2.., 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 . TT~v&te. a~e .fmatly. dYelLt~ ...................................... The certificate is issued to . .~.1~ e..~..~.~.e..C. ~..C..~.k ......~. ..................... of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant ) · Oat...~6.. ~.2~. · b~. !1...Villa . . . UNDERWRITERS CERTIFICATE No.. p~,QI'. ;Lttsp~l~.91~ .0 ,~., .................. HOUSE NUMBER... ~ ....... Street..l~.~'&t®. ~a~. ~..¶ ................... .. FO~I 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 TIlE WORK ^UTHORIZED) N? 5040 Z Permission is hereby granted to: pursuan,t to application datL~: ............................ ~ti~..~). ......... :~...., 19.~., and approved by the Building Inspector. · Fee $..,'J~* JJO. ......... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF i )CCUPANCY Instructions 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 buildihgs, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage ~Jisposal-(S-9 form or equal). 3, Approval of electrical installation from Board of Fire Under~riters. 4. Commercial buildings, Industrial buildings, Multiple Reside~hces and similar buildings and installa- tions, a certif cate of Code comp~ anco from the Architect qr Engineer :~'esponsible 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:Coperty 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 6r premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1, Certificate of occupancy $5,00 ~--~_~,,~42. Certificate of occupancy on pre-existing dwelling $15.0 D ~_ · Copy of certificate of occupancy $1.00 .Vacant T.and C.O. $5°00 Date New Building ............. Old or Pre-existing Building . ..... ~ .... ~Vacant Land ............. Location of Property . /. ............................ House No. Street ' Hamlet Owner or Owners of Property ~ ~ ~.t.~. ~ .... ~d.~. ~ ~.~ County Tax Map ~o. 1000 Section 0 ~ 1 Block ... kot... Subdivision ................................. Filed Map No. .......... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval .Labor Dept. A~3proval Underwriters Approval ........................ Planning Boar~l Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $. .(;~. Constru~ct, ion on above described building an p~. mit meets all appliq~ble c~-a~nd regulations. (~k~-.~ \ ....................... Rev. 10-10-78 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date .... '~ ~t0ber 16, 1975, Health DeP~artment Reference Number SH /~937 Bldg. P/~rmit Nd. TO WHOM IT MAY CONCERN: at. The sewage disposal faciliti~s for a structure way AOO~ north of. RouSe' 25~ East Mar%gn, N.Y, . (Give deed location) located hawe' bgen inspected by this department and found to be satisfactory. TOWN OF SOUTHOLD BUILDING DEPARTM£N~ TOWN CLERK'S OFFICI~ SOUTHOLD~ N. Y. PLEASE TAKE NOTICE there exists a violation of: Zo ,ng Oral,nonce Other Applicable Laws, Ordinances or Regulations ............................................ at premises hereinafter described in that .~,4~~.. . ............ ,,_ ~.~. stat~Zch6r6c'teF af vi~i~ti~n} in v o at on of ................................ ; ............. ~... ~ (State section or paragraph of applicable IOw, ordinance or regulation) YOU ARE THEREFORE DIRECTED AND ORDERED to comp. ly with the law and to remedy the conditions above/mentioned forthwith on or before the .... ; ....... ./'~¢,~~...~.,¢.~,.-../. ....... Th~.~premises to which this ORDER TO REMEDY VIOLATION refers are situated at Failure to remedy the conditions aforesaid and to co~np[y with the applicable provisions of Iow may constitute on offense punishable by fine ar imprison~nent or both. TOWN OF SOUTHOLD, "'"~/',~ "// BUILDING DEPARTMENT ,/ ~ ~/' ~ TOWN CLERK'S OFFICE _ ./. /7/ SOUTHOLD, N. ¥. '~s.~'/ ~/ ~--~,,~/ ,H~- Exominecl .. ........ ' .................................... , 19..?.,0 -'~ ~ O ^pplic, ation No ............................. ..... ............... , ,'orm,t pp / ................. ./ ........................................................................... ,::/.,.~,,~, ~ "?" .............. ' ........................................... ~,~..~,,,z~.,.-.~ .,-,.~-,..~ (Building Inspe~or)~ .... - APPLICATION FOR BUILDING PE~'~ ~.. ~/~- 7o ........ . ~_.../ ...... ~. Thi~ ~pplic~tion mu~t b~ compl~t*lg fill~d in b~ ~owrit~r or in ink ~nd ~ubmitt~d in In--tot. ' b. ~l~ plan ~howi~O I~otion o~ lot and o{ building, on premi~*~, r~lotion~hip to adjo n nr~*, ~nd Oivin0 ~ ~il~ ~ription o{ I~out o{ pro~ must ~ dr~wn on th~ die, mm which c. ~ work c~r~d by thi~ ~pplicotion m~ not be commenced befor~ i~u~nc~ d. Upon ~pr~l o{ ~hi~ ~p~lic~fion, t~ Buildin~ In~e~or will i~ue ~ 8uildin~ ~rm t ~ the ~pplic~nt. Such ~rmi~ ~h~ll ~ k~pt on the pr~mi~*~ ov~d~bl~ {or in~paction throughout th~ pr~r~ o{ the wor~ ~. ~o buffdin~ ~11 ~ ~cupi~ or u~ in whol~ or in port {or on~ pu~o~ whiter ~holl hay* ~n ~mnt~d by the Buildin~ Ink,tot. APPLICATION IS HEREBY MADE to the Building Department .for the ssuance of a Bui d ng 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 altercd~s, or for removal or demolition as h~rein described ~ The applicant agrees to comply with all applicable laws, ord' ces, 't~uilding c , h sing c ' d re ulations ' / z/~// £ ~ ~ .. :.. ~ ~, ~ ,, ,~ .77.. '~ (Sij~'(otureofapplicarLt, orp/g~t~e, if o'~;'~'~'~;~'~')' ........ ~? .. ,:. t'~ ~ ,,.,~ ~ ~, (~dare... of~p~c,',,',~ .......... ~, State whether a~essee, agent, architect, engineer, general contractor, electrician, plumber or builder.-1'~ Name"'"'"'"of owner ........ of'"'""'"'"'""'~'"rem ses ...... """'"'"'"'-'~"~" ....... ~..~,~..... ........ If II nt I P ........ ~ ......................... ~'" .................................................................................... '.......ap.~. i.~ .~..... i~...a...~ .o...r~..o...ra.t..::..~ i..g..n..a.t..~ r..~..~.f...~ ~,..~.r.i.~.~ .~...o.f.f. ice r. (Name and title of corporate officer) 1. Location of land on whjr,.h-groposed work will be done., MaP N~.: ...... ,~ ............................... Lot No · ~Str~eet and Numb~ ~~...~...~....~.t..~......~....~..~. ~'/ f/~0 /-/,.-),-~ ~¢ f-- "'/~u;;i~;~,i~; ................................. 2. State existing use and occupancy of)pr/~/~, s~,,an_d ~,~e_.n_ded use and occupancy of proposed construction: a. Existing use and occupancy ...... ..v...~.....,. ....... .~ ................ b ntended use and occupancy ~.'~....~ ~~... '. .................... ~ .......... Repair .................. Removal .............. ;,~ Demolition .................. ~Other Work (Describe) ........................................ 4. Estimated Case- ......... '~'1~/' .......................... ......... tee ............. ~..'~ ....................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............. 1. ............ Number of dwelling units on each floor ............................ If garage, number of cars ................. /.. ......................................................................................................................... 6. If business, commercial or mixed occupency, 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 ..~.'. .......... ~ ........... DimensionsDepth ..... ?'"'of ............ entire '~'n ....... constructionHeight ......... Front~'"Nuynber~"-"~> of StoriesR ''''~ .......... ~" ..............." " ....-~....-- '~...~.../..... ,~.. 8. ew : .................................... ear ............................ ueprn Height .................... Number of Stories ................................ ./.. .................................................................................. 9. Size of lot: Front ...... ~,..~. ,O..~.~.. Rear ........... ~ ................Depth ...... /,.,'~..~... ............. 10. Date of Purchase ............... ..~....~..~.~.~ ................ Name of Former C)wner .~./~'~x....~....i. 11. Zone or use district in which premises are Situated ........... ~.~ .................................. .. ...................................... ~ ...... 12. Does proposed construction v~ate any z_~gin~aw,~p)~dinance or regulate? '" '/'~'"'~'"'"'~'1'/ ............. ~."/'/' ........ , 13. Name Of Owner of cr~.. A~.~..~kddress "./..~ne No....~....~..:~.......O~../ Nome of Arch X.VZ . ..A ress .................. Phone L/~ ,~'~ .~ ' ............. Name of Contractor~..~.~.~.,. J:J,~_~)~dclress ............ :: .............................. Phone I~o~...~....~...~...~.~'... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock 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, ! S.S ~ cou ** ........... : ...... .................. .'..~.~'~..:L~E...~.(~..~.~.'..: ................. being duly sworn, deposes and says that he is the applicant ( Nr~../~n~in~.g~/~tion) above named. He is the ..~-x-~...,m~. ................................................................................................................................. (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 Jn 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. . Swam to before me thisc~.~......Pubic ~X/~....~.~. '7~"....~... ~.~.....~.... d~ .~.....~..... · ~~ Of ap! Notary ..... Count~/~ ( ~J~'t~'~ .......... '~ii~'~' .................... J~LIZABETfi ANN NEVILLE ~IOTRRy PUBLIC, State al New York N0. 52-8125850, Suff0Jk Cbu~Jy Term Ex?ires March 3.0, 19~[P