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Home My WebLink About4699-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. 7,~172 ..... Date ........... Ma=eh .... 16 ..... ,197.1. · (PW I~0) THIS CERTIFIES that the building located at . ~//S. C~dar. B~reh .~ ..... Street Map No..~ ..... ~ .. Block No .... ~ ...... Lot No. ~... 0~ent~ -N-.~, ........... conforms subst~ti~ly to the Application for B~ding Permit heretofore ffl~ in this office dated ........ A~I-'-21.-., 19.70. pursuit to which B~lding Pemit No. ~. dated ............A~r&l. · 22, 19.70, was issued, ~d conforms to ~1 of ~e requ~ ments of the applicable pro~sions of ~e law. The occup~cy for which this ce~ificate is issued is .. ~vat~ .aeeez=e~ .b~'~i~- (~tora~e) ........................... The certificate is issued to .. '~'~1~ '&' J$~ '~aTl$~ ........................ (o~er, levee or ten~t) of ~e afores&d building. S~olk Co~ty Dep~ment of He~th Approval .... ~,R, ........................... ......... s pto; FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWH CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 4699 Z Dote ~,;:.r -~3, ~3 70 Permission is hereby granted to: ..... ~.~..L.~.....~ .~...?.~. .............. ............ I~o~r...~.~.~.. ~1. ............................... to ....... ~...~..e.~...s..~.?.~.".~.*.....{.~?.~.?. ~.~.?~)....~ .~.. ~.~ ~.~?:r, ....................................................... at premises located at ................ !~./..~.~.C`..e.~.~.~.~.~?.~.~.~..?~.~.~..(..~.~.~..Z.!.~.~.¥.??~...~ .................. ........................................ ~/~ .... I~L~ .~ ..0~e=t .. ~'~,~,, ........ ~z~t .............................. pursuant to application dated ............................ ~.,.~-. ....... ~.~ .......... , 19...~.~., and approved by the Building Inspector. ........... Building Inspector ' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ^pproved ........................................ , 19 ........ Permit No ............... Disapproved a/c ........................................................... APPLICATION FOR BUILDING pERMIT 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 adjo n ng prem ses or public streets or areas, and giving a detailed description of layout of property ~ust be drawn on the diagram which is p~rt of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upqn ,a. pproval of this application, the Building Inspector will issue a Building Perm t to the applicant. Such permit shall, be J~pt on the premises available for inspection throughout the progress of the work. ¢. 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. APPLI'CATtION~IS I-I~REl~YJyu~DE'fb'the Building Department for the ~ssuance of a Bu'd ng Permit pursuant to the BRUiludrl.n.g' .~ene, O~.. inance of ..tl?e .1'o, .~ .o,f Southold, .Suffolk COunty, New York, and other applicable Laws, Ordinances or eg arians, tar me construction o.t Dui:aings, additions or alterations, or for remova or demolition, as herein described. The applicant agrees to comply' wzth oll applicable laws, ordinances, building code, housing code, and regulations. (Signature of applicant, or:name, 'if a'corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 1~eme of i~vner oT premises ....................... ~i~r~......~........~.. ................. .~.~.....~..~.. .......... ~ ............................................. lt'apl~fican{ is a corpor0te, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No..' ........................ Street and Number~--,,-~.~.J~.~..~.~.!~J~ ~.~ "~ 300 ~9 Municipa ity 2. State existing use and occupancy of premises and intended use and occupancy of proposad constructiori: bo Existing use and occupancy .......... ..~.i~'..' ............................................... , ......................................................... 3. NatUre'Of work (check which applicable): New Bu!!.ding ..~...... ......... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ......................... . ................ (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 ........~ .......... J ....' Depth Rear Height .............. --7 ......... Number of Stories .......... :....~ ....................................................................................... .......... Dimensions of same structure with alterations or odditions: Front ~ Rear ............ ~ ............... Depth .............. ~ ................. Height ............. ..'~... .......... Number o~ Stories ........ ': ....................... 8. mens aris of ez3tire new construction' Front /..~. Rear //~. D th g ................... Number of Stones ...... /. ..................................................................................... 10. Date of Purchase .....L~...~..~./..'7..7...~.. ................................. Nome of Former Owner ..E...~...~...!..~......d.'......~.~./.~....C~/.. ............. 11. Zone or use district in which premises are situated .......... .~'~..~SlI)~'I~TIR L.~ ... 12. Does proposed construction violate any zorn' 9g aw, ordinance 9¢, regu at on;) ..~....O.. ~ 13. Name of Owner of prem ses .~...1~o2· 4r,~o~PiNNfl Address ~r'~.~..~OU-~.~. Lqe'~ EcL hnn~_ Kin - 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 ind cate all set-back dimensions from property lines. Give steer and block number or description according to deed, and show street names and indicate whether interior or corner lot. t STATE OF NmEW .,YORK, I COUNTY OF ....~.~.~...~.R.&'...I[ ........ )' ' ' ........................ · (~./-~../n1~49/2.../~..,....~..~..~ .~.~ ................. being duly sworn, deposes and says that he is the. (Name of individual signing application) above named. He is the ..................... .......................... .~....~.....~..~-..~.. ................. i ......... i ............................................................. (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 conta.ined 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- ........ Notary Public, .~11~....,~,..~..~, ........ County ~ .......... .: ' (Sig~'~'t~r;;';V';l~lica;;;i ......................... IHV,N~ L. PRICE. JR. NOTARY PUBLIC, STATE OF ilEW ¥~IRK Residing in S.ffolk Co. ~t time ef a~ll~ei.lmeflt lily Commission Expires March 3~0.A9~/ . 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. 9. 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 (pr[or 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. 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 Date..~../~.~.~.~ ............. New Building . . ./[' ........ Old or Pre-existin~g.~g Building ............ Vacant Land ............. Location of Property .~.(.".~...~. ~'./'~,~[:~...~Jt'~..~. ~-3 ~.U..~.q~'... ~?~.~ ~.(~. 47./... ,.~..~.... House No, Street / Hamlet Owner or Owners of Property .... )? . ,~. ...... ~t.,,'2.1: d,4.. . . ~./"~,.. . . .................. County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot 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 and permit meets all applicable codes and regulations. .......................... ,,ff. c.o. ' ' '/