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Home My WebLink About6118-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificale O[ Occupancy No. Z.~.9~3 ...... Date ......... ~.aIR1;,rY.. 3~ ...... , 1973. THIS CERTIFIES that the building located at D. og*ggO, d[. ]4~. ............... Street Map No.~;~.d ~. ~..E. ~lock No ........... Lot No ............ gg~l;. F~a~.~tO~ ........ conforms si/bstantially to the Application for Building Permit heretofore filed in this office dated ........... Sept.. l~., 19.~9. pursuant to which Building Permit No.61.~ dated ........... ~.sp.~....~.~..., 1977.., 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 . P~i¥a.t.e.. m~e..£e~i~,v., d~,] lng ....................................... The certificate is issued to .R.e~....i~..~.t..~...8.~.~..e~.e...&. ~.1'.~. ..... ./~.. ~.I-.~. ............ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .1~ ,t~,. .............................. UNDERWRITERS CERTIFICATE No... ~.o. li..d..~.g ...................................... ItOUSE NUMBER...~0 ....... Street ..... .L)Og'~t.O.Od. Larle ............................. Building Inspector FORM 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) 6118 Z Permission is hereby granted to: .....~...~..~:~;],~..a~e......~Zq...l&e[,..~.t~..~.teege ................. ~.o~t~ ........................................... at premises located at .......~....~...~..?...&....~..~......~.~..~..~l~X~.~'.fl..~.lg~...~..I.~..,~[ ...................................... pursuant to application dated ........................l??.~.~.......~ ............ , 19.....~...., and approved by the Building Inspector. Fee $....1.~.R..(~.. ......... FORM ~qOo 6 TOWN OF SOUTHOLD BuJtdJng Deportment Town Cletrks 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 fram Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, MuLtiple Residences and similar buildings and installations, a certificate of Cede 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. ,6~ccurate 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. B n JJ~/~( ~ / / New u' dig ...~,~.,:.:~....~f~ld or Pre-existing Building ............................ Vacant Land ............................ Location Of Property .....~....~/..~.~ ........E./...i/,~..: ......................................................................................... Owner Or Owners Of Property ~..C~) ~ ~.~....1~......t.~¢~...~ ....... ..~..~ ............................. Subdivision ...................................... ~ .................. ~ot No ............. Bilk No ............. House No ............. Permit No.~.(.~.~ ...... Date Of Permit ~.}.~.~pplicont ...~~.....~..~~...~ Health ~t. ~proval ............................................ Labor ~t. Approval ................................................ Unde~ritem Approval .............................................. Planning B~rd ~pravat ........................................ Request For Tem~m~ Ce~ificate ........................................ Final Ce~ificate F~ Submiff~ $ .................................... Construction on above described building an~?rmit meets all applicab[g codes, and regulations. Appllcont ........................... Sworn to before me this Notary public, $~ole of r~ew York C~enm~.~ Exp re~ Ma ch 3Q,L 19~ (stamp or seal) lrO~TM NO. 6 TOWN OF $OUTHOLD Building Department Town Clerks Office Southold, N. ¥. 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 dlsposal--(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), No~-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. New Building ~....~.. Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ~...~!..~....'.~/..~.~...~ .................................................................................................... Owner Or Owners Of, Prope~ '~.¥...~..~.~.....~.~...~.~.. ................................................... .................... Permit No ~//~ ~ Date Of Permit~ ......... ~pplicont .~.,~.~:....~% .......... Health ~t. Approval ............................................ Lair ~pt. Approval ................................................ Unde~rite~ Approval .............................................. Planning B~rd ~proval ........................................ Request For Tempora~ Ce~ificate Final Ce~ificate Fee Submitted $ .................................... Construction on above described building and permit meets all applicable, codes and regulations. pp - . ............................. :....~ ................................... Sworn to before me this of ...,,,~.,//~ ~¢¢~¢¢~ / ~,~¢/,~Coun, ty,/~.~.~./.Y.~¢ (stamp or seal) Notary Public ,4T ~ u~-~o. ~' ~. AL. Y' FORM lqO. I ~ ,' / /J £~'*/ 4~ ~,~e~,'~ ~*~C~,BUILDING DEPARTMENT /~/~ ~~ ~/~ r ~ ~. ~ _ ~ TO~N CLIP'S OFFICE ~ ~ ~' ~ ~ ~tl ~ ,~,[~ ~UTHOLD, N. Y.~.~/ ~ ' ~ _ ~ ~ -"' .... Examined ...... ......... . . ..................., · ............................ .......................... APPLICATION FOR BUILDING PE~IT ' a. Thi~ opplic*tion mu~t bo compl~tel~ fill~ in by ~writer or in ink ond ~ubm ~d in duplic~t~ ~o th~ 8uildinfl In~p~tor. b. ~lot plon sh~in~ I~otion o~ lot ~nd of buildin~ on pr*miser, relotion~hip to ad~oinin0 premise~ or public *treet~ or~o~, ~nd ~ivin~ ~ d~t~il~ d~ription o{ I~out ofpr~*~ mu~t b~ drewn on the die, ram which i~ ~ of thi* opplication. c. ~e work c~md by thi~ o~lication may not b~ commenced before lssuamo o{ 8uildin~ ~rmlt. d. Upon oppmwl of thi~ application, ~e 8uildino In*~tor will issue o ~uildino ~rmit to th~ ~pplic~nt. Such ~h~ll b~ kept ~ th~ premise~ ~voil~bl~ for inaction thr~hout th~ profess o{ ~ ~ork. ~. ~o buildin~ ~hall b~ ~cupied or used in whol~ or in p~rt for ~n~ pu~ose wh~tover until ~ ~ificat, of ~cuponc~ ~h~ll h,ve been ~rent~ by th~ Bui~dino 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 Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descr bed,~ The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. t 'g at appticant, or name, it a corDoration) ............................. (A~cj;~;';f ap"*~4~lJcant'~;Y~'~ ...................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... ..~LL..~.....~I~.~.~ ........ J~..~.l~. .........~.~.~.~.~. ...................................... If applicant is a corporate.~_signature of~dly authorized officer. ..... (Nome and title of corpo,,bte officer) I. Location of land on wh c~h proposed work will be done Map No..~....?...-~.. ...... Lot NoYZ..~...~ mc~e~ '~" '~'~J~j,~ ~ '"'~'~_j~'~,.~ ¢~ ..... . .................. Street and Nu ~.~._. ............................... ~...~....J~,O,I~L.~3o~ .......................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ....... :..~.~¢.%~.~),g4~...~ ................................................................................... b. Intended use and occupancy ................................................................................................................................ 3. I~ature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. ,~[emoval .................. Demolition .............. .~ Other Work (Describe) ........................................ 4. Estimated Cost ....... ,~.....~..~...).~:11::~.,:..,..'~.. ................ Fee ........ IZ:....I...~...:.~ ............................................................ (to be paid on filing this application) S. 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 ex st ng structures, f any: Front .....~..O. ................... Rear ..~..~/. .................... Depth ..~.,~.f ......... Height ..... ~-~..~. ........... Number of Stories ...... /. ......................................................................................................... ¢ Dimensions of same structure with alterations or additions: Front .... ..~..O...~ ........................ Rear ...~1. ................... Depth ..... ~[,~.t. ................... Height ...... ,L.~.../. .............. Number of Stories ....... /. ....................... 8. Dimensions of entire new construction: Front ....... ~[.r. ..................... Rear ...~,~..(.~. ............... ( Depth ...~/.~ ............... Height ....~..~ .......... Number of Stories .......... ~/. ......................................................................................................... 9. Size of lot: Front .........~.1...~.. .......... Rear .....~..~.~...~..O. ................. Depth .......... /..~...~.......~.O...~ · 10. Date. of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ....." ' '-"~ "-- ..(-~....cl.~.~..)..~.....e~..~'........~:~.~........~y~.~.~L..,~..~... ........................ 12. Does proposed construction violate any zoning law, ordinance or regulation? ........... ~L,~. ........................................ 13. Name of Owner of premises .....~.~..eT.....Address ...~...~....~..~...~.G.~1...c~... ............ Phone No.Z/~.~...?.?.../..~..O...~ Name of Architect .~.~,.~,.~....~.~1 ................ Address ............................................ Phone No.~....~.l./...~..~¢ .. Name of Contractor ...~....~....~.~.....~~....Address ..~..~.o...~..~.. ................ Phone No. ~..~..]..~....~......(~.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from propert~ lines. Give street and block number or descr according to deed, and show street names and indicate whether I~terior or corner lot. 0 STATE OF N~ ~/A t ~ ~ ..... ~~~~~/~ ~ ~~ b~ln d I w moses an sa t~ ~ '1~ t~ a canl ................. ......................... (Nam~ of I~ivi~ual signing app~cation) ....................... ................................................................... (Contractor, agent, co.rate officer, ~tc.) of said ~ner or ~ners, and is duly authorized to perform or have perfo~ed the said work and to ~ke and file this application; that all statements contoined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the applicati~ filed therewith. Swam ' '~o~fom me this ~. ~ ....... ~.~ ........ ~y of .... ~~ .......... ~.~, - ~ ~ ~, ~"~ .... 7 ........... ~;d~...~....~ ...................... Nota~ Publi~..~~~~ (Signature of applicant) ~N~a~ St~ of New Yo~ No. 52~.0344963 Suffolk County~ ~ Commiss~b~ Expire~ March 30, -.,::