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Home My WebLink About5463-zNO. 4 TOWN OF $OUTHOLD BUIIDIN(~ DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~ .0~.9 ...... Date ...........&tlgust...1.6 ..... , 19. ~ THIS CERTIFIES that the building located at . P~rk. AYe.. Street Map No..~. ..........Block No.~ ....... Lot No.. ~.. ~;~;~-.~k...N..,.Y.; ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...........AXlg...16.., 19.71. pursuant to which Building Permit No..~t~6~Z. dated ........A~g.. :16 ...... , 19~1.., was issued, and confoms to all of th~ require- ments of the applicable provisions of the law. The occupancy,, for which this certificate is issued is .P..r~y.a..~....on.e..ff..a~...fy..~..v.e.l.l...~. (..,.e.a.,.o..ha. ,~). ............. r · · · · The certificate is issued to .Y~hae. l..&..G.$~I,..Fr~.e~u.. ~...~..e.rj! ................. (owner, lessee or tenant). of the aforesaid building. Suffolk County Department of Health Approval I{,R, ................................ UNDERWRITERS CERTIFICATE No. pe~l~ .................................... HOUSE NUMBER . .1.~.3~. ....... Street ... ?.a..1,.k: .A.?e. ............................. ding Insp r TOWN OF $OUTHOLD 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? 5163 Z Permission is hereby granted to: ......... ~.!..q..~.,E...,L......~.....~.....~.,L.. ..... ,..,~,.~ ~ fO J3uilding Inspector. .Fee $ ........................ ' Buildin~ Inspector l~'OI{~Ti 1",10. 6 TOWN OF SOUTHOLD Building Deportment Town Clerks Office Sout½old, Iq. ¥. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A This appl,cation must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following, for new buildings or new use' 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 F~re Underwriters. 4. Commercial buildings, Industrial buddings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer respons,ble for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable B For exist,ng bu,id,ngs (prior to April 1957), Non-conforming uses, or buddings and "pre-existing" land uses. 1 Accurate survey of property showing all property hnes, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and cond,tion of buildings 3. Date of any housing code or safety inspection of build,ngs 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 $5.00 3 Copy of certificate of occupancy $1.00 New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ........ !.7'~.....~....,~'. .............. :..~.,~..%.~ .............. ..~...*..~...~..~.~ ............................................. Owner Or Owners Of Property ..~.,h~..,~,...~,.~.! ....... ..~. ......... ~..~.. ........ ...~.,.¢..?.,{ ........ ,,,~.,~.,.~,.?...,.~,...~.,t~. ............ .... r-r3S Subdivision .............................................................. Lot No....~T.. ....... Block No ............. House No ........... Permit No ..~.....~...~.....~.... Date Of Permit~, r~ !..~....~..~.~..J~..Applicant '"~"("5"~'"'&'~'l"'"'0"~'""~""~'"~'~'l°'",, v3 Health Dept. Approval ............. ..~..:....~., .................... Labor Dept. Approval ........... .I..~J.:.....~..: ...................... Underwriters Approval ............. ~.t:...~,, .................... Planning Board Approval ....... .~.!:.,.~...:: ................... Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ........... ..~...~ ............ Construction on above described building and permit ~eets ~ll app.~cable codes and regulations. Sworn to before me this ~//~//// ....... ~dayof ..... ~....~..~9 ~' (stamp orseal) ~Z/O~f Notary Public ........A ...... ~ ................ Coun~ . S6~(0,~C J, U,,*rCAt, M ~--~7 ~' No. 30,30532~ ~ ~ ¢ ~uallhed m Nassau 0o~¢~ ~ .omm,ss,.n .ptres Marc *, 1~. ~ 6 I~x ~0/=- I u \' 5 '"'-'- PA~K AVENI .~[. / TOWN OF $ouTHOLD _~. "~ '~' ~' c. ~. BUILDING DI~PARTMENT ~ ,~.~-~Y- , TOWN CL,~K'S OFF:CE ~/,~ ~ ~_ ~ , ~ ~ ~ SOUTHOLD, H. Y. Examined ........~'.~..~..~. .........., 19 ........ Application No. ~3 3 ' ~proved .............~...~..~..]~l.t ...... , 19 ........ Pemit No ................................ .. · ~- ~ ~- /~ce~/~ - Disapproved a/c ..~ ...................................................................................... ~.. ~ ~ ~- ~7~c/~- ........................................................................................................................ ~- ~ - ~ ~ ~.,~.~ ~/~e~ /~ ~ ~ ~ APPLICATION FOR BUILDING PERMIT~'~ ~ ~c~ ~ ~ INSTRUCTIONS a. This application must be completely fill~ in by ~pewriter or in ink and submitted in duplicate to the Building J nspector. 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 ofproperty must be drawn on the diagram which is port 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 a Building Permit to the applicant. Such permit rtI 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 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, ordi nantes, building code, housing code, and regulations. ~ (Signature of applicant, or name, if a corporation) /~,,~G-,-~ (Address of applicant) ~'~y, /~'zp ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, pluml~er or builder. ......................... p ~,gv'~..-~**. . . Name of owner of premises ............... ?....].~....H...~...E...~. ...... . .~.........~...~..!.L........~....~...~....~....~..JJ.../~.. ................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Mop No.: ........................................Lot No ......................... Street and Number ............ .. .............................. ..~ ........................................... .' ;'"".' ........ '*C ............................. ]; Mumc~pahty State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ................ ~t.~....~.. ............ .~..~....~...!...~.....~. ............ ..~....h~...~.-..j,...~.../...N.....(~.. ............................. b. Intended use and occupancy ..~/~/v/~' J,~/I -TH j~- ~::>~1 -7-1 0 .~. 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ............................................................ F ......~ ...................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ ~....~....L.~.'~.. ....... Number of dwelling units on each floor ............................ If garage, number of cars .... 6. If business, commercial or mixed occupancy, speci_fy.n~gture and extent of each type of use ............................ 7. ~,m D mansions of existing structures, f any Front ..... Rear ..... r~m~th ,~ -'L Height ....... ~..~. .......... Number of Star es ...................... ~.../..~'....~... .................................................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ Depth 8. Dimensions of entire new construction: Front....................................~ O Rear .................................................... Height Number of Stories ~ IV 9. Size of lot: Front ( (00 Rear ! .~..O.. ................. Depth ...... ...'~....~....~.. 10. Date of Purchase ....... ~./...A~....~......../.~....?./. .......... Name of Former Owner .S/)L .~...L-...-~../,---/~/ 11. Zone or use district in which premises are situated ' .... Does proposed construction vioJate any zon ng aw, ord nonce or r_egu at on? ..................... · /~/ ~- /=~/: ~:,e,/~,--- 13. Name of Owner of premises ....... .~. .............................. ,~lress ......... R.~..~...~ ...... ..~.~ ....... 7 '~' I o'1 o.,~ / ~ 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 comer lot. ~..~ lj~_~c__g.__.__.~ STATE OF NEW,~Y~J~Jlq,~0~ Icc COUNTY OF ...~ .......... ~a'~ ................................................................................................. being duly swam, deposes and says thor he is the applicant (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 oil 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. Swam to before me this /C A d- / ........................ * of ....................................... , 19 ........ · . ......... ....... ............................... ignature of . NOTARY PURLIC, Stele of New York No. 52~8125850, Suffolk County. Term Expires March 30,