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Home My WebLink About5486-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate O[ Occupancy No. ~ ...... Date ............... Apl"ll .... ¶9, 19..73 THIS CERTIFIES that the building located at . .Pl'lvete. Rd .~1.1~ .(14~n .La, feet Map No. x~x ........ Block No...X~X .... Lot No...:Kx~...0fleet-.. t~+Y, .......... conforms .~bstantially to the Application for Building Permit heretofore filed in this office // dated..//. ....... Sept- · I..., 19Ft. - pursuant to which Building Permit No.~86Z... & 'nd~ents to san~ date~-/.~. ........ S®pt...$.., 197.1.., was issued, and conforms to all of the require- ments of the appli~cable provisions of the law. The occupancy for which this certificate is issued is . P.I~IVa.~. 9ne .ffa~.~.y- d,~tl~ng ....................................... The certificate is issued to ..Ch.e. ster. E,. l~ay®l* ...... 0~xe~ ....................... ~ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .N,P~*. ............................. UNDERWRITERS CERTIFICATE No..pending ........................................ HOUSE NUMBER...'102~ ...... Street ....Pl'.lva'l;o..Road. ~ .1~...(Id'tlnn .La) ", Building Inspector FORM NO. g TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5t86 Z Dote ................................................ , 19....~... Permission is hereby granted to: ...~mm~.~m~.~..e ..Xe~z ............. at premises located at .......~i~..~I~IIi~..~....~R~..~ilii~..~..~i~ ....................................................... ................................................... ~*t~m~ ......... I~%~' ........................................................................... pursuan¢ to application dated ............................... ~ ......... ~ ...... , 19...~, and approved by the Building Inspector. ........ ing ~n~ector / ................ / TOWN OF SOUTHOLD Building Department Town ClerkS Office $outhold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector 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 installations, 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 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 3. Copy of certificate of occupancy $1.00 $5.00 Date ..... ..~ ..... ...... · . ~ New Building X Old or Pre-existing Building Vacant Land Location Of Property ........ ..4/.~.~......~...'~.....-~.'.~-9'...~.-:.....~...~f...-~c../..'.~.~-.L::-:.~-.~" ...................................... Owner Or Owners Of Property ..... .M..~.'./..;.'-~i'..~....../...!:/..:.../..¢~..~t.;/~,.~-~ .................................................. SubdlVlS,On ............. ..~-... ............................................. Lot No ....... .~..~' Block No .... ~ House No '/ .................... · ,a, ..4 Permit No. $~'~ ~- Date Of Perm~t~ ............ App c t ............................................................... /, . /v - Health Dept. Approval ....... .~.Z....L.: ........................ Labor Dept. Approval ................................................ ~,/ ¢.~.~L.~ ,, P n nm ................................... Underwriters Approval ...... ~..: .......... ~ ....... jr ................. a n = Board Approval ..... /(/',/~- Request For Temporary Certificate ........................................ Final Certificate .......~ ................ Fee Submitted $ S Sworn to before me this Notary Public ......... ~.~.~..~C. .... County Construction on above described building and persist meets ~.~;l~e/~s and regulations. Applicant .............. ...... J..'~....'~. day of ...~..~.] ...... ./.?...!.?. .... FORM NO. 6 TOWN OF $OUTHOLD Building Delmr~ment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector 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 installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. §. 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 in- formation required to prepare o certificate. C. 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 De,e ..... New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ .............................. Location Of Property ...~..~ ....... >? ............. ~ ....... : ...... .~..p ~:~ ...... : Owner Or Owners Of Property ..... ~.~.?.:.'?..~...~: ....... ;.'..~....(. ........ ..~..../.:(..~-~ ...................................... Subdivision ................. ~ ................................... Lot No....,~.... Block No..~-k...^. House No./...~..?..~. /~ ~ Permit No....-~..~.LL~..~.:...~)ate Of Permit~.../.....Z/...Applican, ...i ..~....L,.'~..:~.°..~.~...:..~.../~..~..~..-...~."!.?..~.. Health Dept. Approval ......... .#...:.'.~...: ..................... Labor Dept. Approval ....... ..A:.:~...~., ........................... 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. Sworn to before me this ../ .... day of ...... ................. Notary Public .................................... County Applicant ......................................................................................................... (stamp or seal) FORM NO. 6 TOWN OF $OUTHOLD Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector 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. j321 Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, 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 oil property lines, streets, buildings and unusual natural or topogrophic 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 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 3. Copy of certificate of occupancy $1.00 $5.00 Date New Building ..... ~ .......... OJd or P~xisting Buildings. ........................... Vocant Land ............................ LocaTIon Ut vroperty ....*.V.~ ...........~/ .......... ~ ............ : .......................................................................... ~ner Or ~ners Of Prope~y .......................... ~.....~...~ ............................................................. S,~v,,~o~ .......... ~. ................................................. ~o~ No ..... ~.~k No. ~ ....... .ou,e No./~.f..(~ o, ........ ...... . Health Dept. Approval ....... ~ ........................... Labor ~pt. Approval ..... Z~.:..~ ............................ ......... ,o. d A Underwriters Approval ......~.: ................ ~ ................................................ Request For Tempora~ Ce~ificate ........................................ Final Ce~ificate ....... ~~ ............ Fee Submitted $ ..;.~ .............................. Construction on above described building and permit meets all applicable codes and regulations. Applicant ........................................................................................... ~.;,, .......... this Sworn to before me ......!. ........ /...~., day of .....~?..~:..~ ~..7,~,, ......... (stamp or seal) Notary Public .................................... County LONG:"i" Z MAP BUILDING DEPARTMENT TOWN CLERK'S OFFIC:E SOUTHOLD, N. Y. Disapproved a/c .... 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 Iocation~of lot and of buildings on promises, relationship to adjoining premises or public streets or areas, and g v ng a detailed descr pt on of layout ofproperty must be drawn on the diagram which is part of this app cation. 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 te the app}icent. 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 a Building Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, ~4~w York, and other applicable L~ws, Ordinances or Regulations, for the construction of buildings, additions or alteration , ~[for removal or dej~lition, as herein deSCribed. The applicant agrees to comply with all applicable laws, ordinances, ,~l~ling code, housin~cod~ond regulations. State whether applicon~ is owner, lessee, agent~ ~rchiteg~, engineer, general contractor, electric an, p umber or builder Name of owner of premises ....... ~~.~-..Z..........~.....:.......~.../....~.......~.....~......~.....: ........................... '. .......... '"'.....'." If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which~_roposed work will be. done. Map No.; .......... /.~ .......................... Lot No ......................... State existing use and occupancy of premises end intended use and occupancy of proposed construction: b. Intended use and occupancy .......... ' ' property lines. Give street and block number or description according to deed, and show street names and indicate whether h~terior or comer lot. 3. Nature of work (check which applicable): New 'Building .................. Addition .................. Alteration .................. Repair .................. Rq~noval .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ....... .<~..i..~.O~. ................ ",Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units i ....... .'.../ .............. 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 wi~ alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ....... .~ ................... 8. Dimensions of entire new construction: Front .......... ./,~,.~.t~. ........ ~. Rear ........ ~..~,.. Depth ....~./.I ............ Height ...... t~,~.../ ..... Number of Stories ............'0~-1'~ .......................................................................................... 9. Size of lot: ~r0~t ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. 7one or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? .......... ~l~t~ ....................................... 13. Name of Owner of premises ..~.....~ddress ...~,, ........................ ,. Phone No Name of Arch tect .............. ~...- ~ 3~ Address ~,~1~! ~/'~. P~ ,. ' ~'""~'~r'l~ ....................... ......... ,one ,o Name °f C°ntract°r~'~ · J~4~~ ~ ~r~-- ...h~/7~f, ~,.~' Address ~~ ......... phone No' ]:~~~'~'' Locate clearly and distinctly all buildings, whether existing or proposed, ~an/d~in~Jca/~.~k dimensions from STATE OF NEW YORK, !.- .......... (Name of individual ~$ a?~ication) ~ ~ ~ ' above n~ed. He is the ...... ~.1.~ ......................... :.....,....~ .............................................. . (Contractor, agent, co~orate officer, etc.) of.~id ~ner or ~ners, and is duly authorized to perform or have pArfo~ed the said work and to ~ke and file this application; that all statements contained in this application are~r~e to the best of his ~edge and belief; and tha~.the.work.will be performed in the manner set fo~h in the _ applicat~ if ed therewith. ~wo= to before me this -- - . ................ ~of ....... 19. Nota~ Public, .~..,.. oun~ ...... ' .... Nota~ Pubfic, State of New Yor~ ~0, ~2-0344963 Suffolk Count_ Commission Expires March 30, 'I _-/' , Z .......... '--=-- ....................... L t/ tl- /~'-~ , ~ ~ ~ t