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Home My WebLink About5674-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.~ ....... Date .............. l~e.. ~0 ....., 19.?:~. THIS CERTIFIES that the building located at . O~A .ga.~t .llo~td ........... Street Map No..~ ......... Block No.. ~ ...... Lot No.. ~ ... ~ltrO]....I~. ,~.,. ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... I~e. · ~6 ...., 19.?¶. pursuant to which Building Permit No.. ~6~+Z. dated ........I~.Q.. ~ ...... , 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 ../,$~lel~l..~"tt~tl..Z~;or~g~. b~til, cl~ng. ................................... The certificate is issued to .... l~r.~k. }~tx~h~. ........ .0~tO~ ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .I~.,R.,. ............................. UNDERWRITERS CERTIFICATE No... ]{.,.R. ~ .......................................... HOUSE NUMBER.. $~0~ ...... Street .... 0:1.5 .I~;LI~ .llOa~ ............................. Building Inspector FOKl~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 THE WORK AUTHORIZED) : Permission is hereby grohted to: pursucm~ to application dc~ted .......................... .~.~L....;....~,.~!,..~., 1c),.~, and approved by the Building Inspector. FORM NO. 6 TOWN OF $OUTHOLD :': ~uilding Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and subr~itted in duplicate to.theBuilding inspec~ tot 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 building~ and installa- tions, a certificate of Code compliance from the Architect dr Engineer responsible 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 peoperty showing all property lines, streets, buildingS and Unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupanc~ and c~ndition of buildi-gs. 3. Date of any housing code or safety inspection of buildings or prem/isas, 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 New Building ... Old or Pre-existing Buildin Z) .......... =/Vacant Land ............. Location of Property .... ~/,~. ~" .~...¢~.~/~. ~ ' ~~ Hou~ No. ~treet Ham/et CountyTax Mep No. 1000 Section ............... Block ............... Lot.. [ ............. Subdivision.........~.................. .... Filed MapNo.. : .". . .Lot No. .~ . . Health Dept, Approval ....... ~. · ............. Labor Dept Approval ...~... ~ ............. ~.. Unde~rite~ Approval ..................... ~..Planning Board Approval ....... ~ ........ .'..~..~ Request for Tempora~ Certificam. ~. ~ ................. Final Certificat~ ....... .-...'.. ~... - regu lations. Constructio~ on above described ~ building and es and R.v. 10.~o.~ Apphc~~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined I~_.~--..~' l [ 19.!./. ................... Approved ............................ ~ ......... , 19....!.I. Pemit No ...... ~/'~"' Disapproved o/c ........................................................ ................. ....................... ................ APPIJCATION FOR BUILDING PERMIT ... Dec. 16 ~ote ................................................, INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin~ Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets oJ~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this opplicotior~ 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 el~ cant. Such perr~it shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used Jn 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 nonces, building code, housing code, and regulations. Spencer Fisher (Signature of applicant, or name, if a corporation) Box 867 Riverhead . (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.~ ...................................................... ......................................................................................................... Name of owner of premises Frank Murphy. . If applicant is a corporate, signature of duly authorized officer. ~ (Name and title of corporate officer) 1 Location of land on which proposed work will be done. Mop No.: ~ ......................................... Lot No, ....~ ............. Street and Number .....~/R.....O~cl..~ia,$Z~.~(~ ...... .La~e% .............................................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ....~..~.S..~TX~.~.~......(...~.~TJ,~,fi.¢.~,p~L~F~s..~%~..~.~'~...~O~.~S.~ e.~,c., ............. b. Intended use and occupancy .....%.~l~.....~.~..~,~...~J~O~.~,~;~...~.'l~,'l~l~ ............................................................. 3. Nature of work (check which applicable): New Building .... F.v]gf~.... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .....1...~..~..0..0..Q....+_. ................................. Fee ,.~.O,*.OO ........................................................................... (to be paid on fitJng this application) 5. If dwelling, number of dwelling units ......D:..Q..~..e. .............. 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 with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of'Stories ................................ 8. Dimensions of entire new construction: Front ..... 1~20 ............... : ........ Rear ..... .1.2G ............... Depth -...~0 .............. Height ......1..~. ......... Number of Stories ..:......o~e...s..%oz'.~ ........................................................................................ 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ................. .' ...................................... Name of Former Owner ........................................................ 11. Zone or use distr!ct in which premises are situated .............. !!~--~.!~......d.~s~ ............................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation.; .............. R~ ......................................... 13. Name of Owner of premises .~'.l~lc.l~iu/:ph~. ......... Address ........ l~at.t.~.t%tc:k .............. Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ....Tr~Z%oW-%k.i ........................Address ........ J~.m~s~o~.t ..............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. STATE OF NEW ×aRK, 1,, COUNTY OF ..... ~.~Q~J.~ ..........$~'~ ................. · ,.~ .................... ,,q~e~ee.~,..F4.s~e~, ...................... being duly sworn, deposes and says that he is the applicant [r~ame of individ6al signing application) above named. He is the ......................... ~en~..~£...oW~_~._l~ ............................................................................................. (Contractor, agent, corporate officer, e/c.) 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 in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the applicqt,~ filed therewith. , , Swam to before me this ~' ~. ~. [ J .................. .'1.,6.. clay of .................. ................. , m..2!. / Nora Pubhc ..... ' ............. .... .......................... ry ' ' ~'l Notary Public, State of New York ;' o 52-0344963 Suffol~ Count)' ( ~ion Expires March 30, 19~ ,I