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Home My WebLink About6183-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No~,l~ ....... Date ............ OCt...21~ ........ , 19.~2. THIS CERTIFIES that the building located at . Lake .9~ & 'glnneT. P& .... Street Map No.~ .......... Block No .... ~ ..... Lot No..~ ...8~tho14 .. II,.~, ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... 0et ..... $ ~.., 19..~ pursuant to which Building Permit No. 61 8~Z-- dated .......... D. It...¶.7. .... , 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 .l~ate. eae. family, dve!l.~ ....................................... The certificate is issued to .... Sa.].~a~ox'e .&. A~ .Desl~OS~to ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... I[,P~, ........................... UNDERWRITERS CERTIFICATE No..]~,R, ...................... ~ ..................... HOUSE NUMBER .... ~ ...... Street .....~lr~ .DI':t.I~t ................................ .................. ~.~. ~. ............. ~e .~..*~..~..a~.. ................ . ............... Building Inspector FORM NO. 2 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) N? 6183 Z Date ......................... ~ O.%O~F......'[~...., 19....~ Permission is hereby granted to: .... ~,-,.~.~r~,o~...~.~ .~;~.4 a, · ...[~e ~,~p es .i.t,e ........ ........... · ~ ....t~.~.;~e~.l.- ,L~e .............................. ................ t~ecl[v~X~"ee~re'""ll'~'~'~ ........... ro ~!~ a~ a~diticn (deck) ~l..~.~i~ ~.~..l~1~g .......................... ot premises Iocoted ot~l~;C...~X.'t~4~..~..]',;~;;~i~..},O&4[ ...................................................................... .................................. · eat~eo.~! ......... .~-~-~.; ....................................................................................... pursuant to application dated .......................... 0~, .......... [-~ ........ , 19r~.~...., and approved Dy the Building Inspector. Fee $.~..r,. ,.,[,~ ............ Building Inspector ZFOI NO. ~ TOWN OF SOUTHOLD Building IXBparlrmeM Town CleHm Office Southold, N. Y. 11971 APPMC. AI'ION FOR CERTIFICATE OF OCCUPANCY Ifl~tmcflonl 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: i. 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 farm 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 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. ^ccurate survey ot~ 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 $5.00 3. Copy of certificate of occupancy $1.00 Date ...(~.../~'../~7,=~ New Building ..~ ...... or Pre-existing Building ..~.~...~....-~..' Vacant Land ............................ Locaton c~ PrunerS, ~'-/~q//-~ ~.ll/~ .~Ou'THo~2) /V.~.. Subdivision ................................................................ Lot No ............. Block No ............. House No.....~....~.... Permit No. ~./..~..~....~..... Date /~/7-7~ · ..?..,~../~...~.Oe.~... Of Permit .................... Applicant .......................................................... Health Dept. Approval .... ../~.Z..~.. ............................. Labor Dept. Approval .....~/.~..~. .................................... Underwriters Approval ..... ?.../..~.: ................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ ......5~.....~.....~..../.:....c~.. /~c~/~/~ ~- ~. Construction on above described building and ~ermit meets oil applicable codes and regulations. Sworn t~ before me ttl~ '% /~ e . TITLE No, MAP OF PROPERTY AT ~0 ~/7'7¢ 0 ~. D GUARANTEEDTO FOR NEW YORK STATE LICENSED PROFESSIONAL LAND SURVEYOR SEARS R~ WEST ISLIp · I N ¥ 11795 BOX 291 GUARANTEE NOT TRANSFERABI~ FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ........................................ , ........ Pemit No ..................................... Disappro?ed a/c ...~ ............................................ ~ .... ...................... ................................. APPLICATION FOR BUILDING PERMIT Applicotion No ........ ~.. .................. Date ~ ~" .../~- 19...7..~.. ..... a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector~,with 3 sets of plans, accurate plot plan to acale. Fee according to schedule. b. Pict plan showing location of lot and of building~ on premises, relationship to adjoining premises or public streets or area~ an~ giving a detailed description of layout of property must be drawn on diagram which is pert 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 shall be kept the premises available for inspection throughout the work. ~)1 \,.~,. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall ha vA- 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,end other applicable Laws, Ordinances or Regulations, for the construction of obrU(~lidnJ~n~s, a.dd!t.i.o, ns or alterati?ns, or for removal or demolition, as herein described. The applice~,t agre~a3 _ce,.lr~ly with all aPPlicable laws, a cee, ou,d~ng code, housing code, and regulations, and to admit authorized inspectors On p~l~s a6d in ~build~lgs for necessary inspectio~,,s. (Signature of applicant, or name, if a corporation) (Address of applicant) ~ ~-~'~._, ~/'/.¢/~t'. //~-7o State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder~ Name of owner of premises ..... ~;~...~....~.....~ ............................................. If appligant is a corporate, signature of duly authorized officer. ...... ................................................................................... (Name and title of corporate officer) 7-:- 1. Location of land on which proposed work will be done. Map No.: .................... Lot No .............................................. Number Street and ............................................................... ~ ........................... ~.../ ........ ~..; ........................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ~ a. Existing use and occupancy ...... .~..?..E.......~..~...~/./..z:.~.. ...... .5..~..../~....o..~..~.~........./~....~;...5.../.~...~...~'....~..~.. ............................... ~ ......... b. Intended use and occupancy ....... .?...~....~...~...: ........ ~ ............ ;; .................................................................................... 3. Nature of work (check which applicable): New Building ....................... Addition ....... ~ ....... Alteration...~...L~....'... Repair ...... ..~./...PC. .......... Removal ....... .~...~..~... ......... Demolition ..... ..~-~...'~... .......... Other Work ..... .~....~T....~;.. a ....~...°...°..~. .... (Description) 4 Estimated ..................................... Fee ..... ./...~..: ..o..~. ........................................ · Cost I 7..~. ~ ................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ....o...~...E... ..... Number of dwelling units on each floor ..~...~.R.~....,~..~..~.....~4~.4~.. If garage, number of cars ...../V'....o......~..~9..,,~,../~...~ ............................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ......~../..~..: ........................ 7. Dimensions of existing structures, if any: Fron~ ..5..°..'...~..../.".. Rear ...~;...~...~....45.../. ......... Depth ......~-,.~:..~...I. ................ / ' Height ........ .~. ............................................... Number of Stories ........ .O....N....~... ......................................................... Dimensions of same structure with alterations or additions: Front .....~;....°..L...~-..../. ..... Rear ....... .~..?..:....4:;....~. ................ Depth .............. ~. ........................... >-.-.u ................................................... of Stories ....... .q...~....~;.. .................... ~ Rear ....... /. ................... Depth ....... ./...~...:...o..f. ........... 8. Dimensions of entire new conlstruction: Front ...... ./.~.:...o. ......... 6 , o t Height ~ o~ t ed.--~r of Stories ........~..~..~...'. ........................................................................ ........... 9. Size of lot: Front...........l 4-~ .. ! . ............. Rear ........... ~../...3..d~..../. ................ Depth ............................. ~. .................. I Height ....... ~ ......................................... Number of Stories ......°..~..&7. .......................................................................... /~£~.1.~ ~qT./.. Nameof Former Owner .................. .~..: ................. ~. ................................. 10. Date of Purchase .............. ;~ .................... ~4~S, . 11. Zone or use district in which premises are situated ...... ..~.....~..!..O.~.N....~..(.~....t= ................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ../~/...o. ................................................. 13. Willlotberegraded__ ._/~.,.o. ......................... W excess f ll be removed from premises: [ ] Yes [~ No 3//~ 14. Name of Owner of premises ............ ~./~.9. ................................................... LC.. .............................. 7. ........................... '~'~'Z)~-z$¢ozz... ,~)~',~" ~°~-'~"'"cc~A~d~L,,~,~. /I/" (Phone No.I , · . . Name of Architect ...... . ................................................................................................................... (Address) (Phone No.) ,/e. ........................................... ....................................... . ............... (X~';;;~')"' 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 wheth- er interior or corner lot. STATE OF NEW YORK, ) SS COUNTY OF ...................................................... ) ............ :...,..;........'~..~ ............... being duly sworn, deposes and says that he is the applicant above named. (Name Ol inaividual signing contract) Ha is the .......... ~.x~. ................................................................................................................................................................................ {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 ell 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 fort~,~ the application filed therewi~/!~ ........... ......... ' Notary Public .......... ......... .~..~._.,...(~.~:: CountY ~;t~/./~ .k_. ................. ................... ~ ~ U ~' 'r ~ /f '" (Signature of applicant)