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Home My WebLink About5911-zFORM NO. 4 TOWN OF $OUTHOLD BUW,r~ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~656 Date [~ 21 19 73 THIS CERTIFIES that the building located at ...D~..ep..H. 9.1.e' .D..r.~..1~. ........ Street Map No. xx Block No. xx .Lot No. 31Z Eattituck N .Y. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... 1.~.~.....~..., 19. ?.2. pursuant to which Building Permit No. ~9~ .1.1 ·. dated ............ ~.~Y.... ~.Q., 19. ?.2, 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 Pr~wate one family dwell~ The certificate is issued to .?.h..o~...s. ?.~.e.e.f.e. ..... . .Oj~..e.r ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .~.,2, .............................. UNDERWRITERS CERTIFICATE No. ~.e.n.d...~.g .................................... HOUSE NUMBER 2600 Street Deephole ~riv~ Building' Inspector FOBM NO. 2 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? 5911 Z Permission is hereby granted to: .... {im~me..ltertmm..&,.limm..tsme.&~-.~m~ OUieefe ......... ilev..~.~£olk ......................................... :.. at premises located at ........... ~ee,g..~.~l~..~)l~ ................................................................................... pursuant to appllcation dated .......................... ~i1,~' ............ ~....., 19...~., and approved by the Building Inspector. Fee $:~'~'~'i~' ........... IrOn'M NO. S TOWN OF SOUTHOLD Building Department Town Cleda Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCGUPANCY 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 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. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Swam 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 ..~..~.....~.'~ ...~ ................ New Building....................V/ Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ....~.~......~..~,~,,......~....~.~..-.~.......) ......... ~..1~-~....~..~....~. ~ .............. Owner Or Owners Of Property ....... ~..~.~.~.,.,.~.~.~ ........................................................................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. // Permit No....~..C~././. ..... Date Of Pel~mit ..~...~..../'.~Applicont ....~.........~.e..~..I..'"' ~..~.....?.......~......~J..~ ........ Health Dept. Approval .......... ..1~../..~).. ....................... Labor Dept. Approval ................................................ Underwriters Approval ......... ~/z~ ........................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .....~...%.~.~) ................ Construction on above described building (~1~ermit~ ~ JL_~j~meets all 9pplica~ c~odt~regulgtions~ ~~ · Appl,cant .~...- · · .~..;....~....~ .......... Swam to before me this ....... . .~..../.. day of ....~.....~....~...~..~.. ....... (stamp or seal) Notary Public .................................... County r ~ ~ :'' ' ' i' !'~ ;! 'P~WN CLERK'S OFFICE $OUTHOLD, N. Y. E×am ned ...}...0.. .............. ,, ~*~/! ~-- Approved ........... J..?....~.. ................. , 19 ........ Pemit No ..................................... ~o~ No. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT Application No...~ .~..~ ................. Disapproved a/c ............................................................................................ ....................... i'~'~;;;i ................................. APPLICATION FOR BUILDING PERMIT 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 location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving o detailed description of layout ofproperty mUst be drawn on the diagram which is part 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 o Building Permit to the applicant. 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 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 nances, building code, housing code, and regulations. ....... ........ .......... (Signature of applicant, or nome, if a corporation) ................. (Address of applicflnt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................... C..~....~.~....aP- ................. ~ ......................................................................................................... Name of owner of premises ......~..~.~.~;~ ............ ~..~,,~..~ ............................................................................. If,~pRlicant is a corporate, signature of duly authorized officer. ~ ............... (Nar~ and title of corporate officer) Location of land an wh.L~h~Eropo~,ed wgrk will be done. Map No.: ........................................ Lot No ....................... Street and Number .~..~.......~L~..~..... ...... ..~..~.~.~.~.. ................... ~'~.~.~ ...................... .? Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy .....~...~ .......... ..~.~.~.~%~f~,~t~..y-- ....... ........~-~,L~ ..................................... b. Intended use and oc~Penc~ ........ ~.~. .......................... .~..~. ..................................................................................... 3. Nature of work (check which applicable): New Building .................. ,&xJclition ...~ ........Alteration .................. Repair .................. Removal .................. Demolitior .................. Other Work (Describe) ........................................ 4. Estimated Cost .........2..~.~..~..~.~. ......................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... .~. ................. Number of dwelling units on each floor ......... ~ .................. If garage, number of cars If business, commercial or mixed occupancy, nature and extent._of ~ach type of use ............................ 7. D mansions of exist ng structures, f any: Front ......................... Rear . ...E.~' ~. ................. Depth ...~.~.~. ....... Height ...... 1.~ ........... Number of Stories ....... ~ .................................................................. Dimensions of same structure with alterations or additions: Front ...... ~,~.~.. .................... Rear ...~,~.. ................ Depth ..... ..L.~.' .................. Height ...... .~ ................ Number of Stories ......... ~. ...................... 8. Dimensions of entire new 'COnstruction: Front ...... ~,..~.. ...................... Rear ....... .~. ............ Depth ..... '..~/. .............. Height -...~.J,e .......... Number of Stories ........ ~. ......................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........ .....~ .......................................... Nome of Former Owner 11. Zone or use district ' ' ~ ' m whmh premises are situated .................................................................................................... 12. Does proposed construction violate any zoning aw, ordnance or regu at on? .'.~.'..~... ........................... 13. Name of Owner of premises . .'~..0..~........O....~.,.E.~.~.~....~....Address ..... ~...~..~...'t...~,..~;..~.....~. ..... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ~-. l-~.~'",~r .'~'c~x/.5 A,~I,~ ' e.)~-:,~ ~Fr~'~.L_ ............................................................................................. Phone No..~.....:L..~,.~."~,~ PLOT DIAGRAM. Locate clearly end distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr~ p.rop..erty, li.ne.s. Give street .and block number or description according to deed, and show street names ancl~nd~ate ~. whet'her In?erlor or corner lot. t r .~./ ~ --1 I I 1 I !. STATE OF NEW' YORK, ~ c COUNTY OF--..~. ........................ J~'~ , . .................... ~i.-..~..1~..~. .......... ...~.~-.'~.~.. ....................... being duly sworn, deposes and sa that he is the a~olicant (Name of indi~idual:g~nLng~ica.~,~! ^.fl ~. · . ys rr above named. He is the ...... ~ ~~ ........... ., ' , ', ,,-' (Con r ,:tor, ag t, ............... 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 contoined 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 application filed therewith. Swam'to before me this /I . ,I/~ ~ ~ ~ ~ ~ .~...~.~......~. .......~...~:~...?.. ,:....'. Notary Pub~......,~.... :.../. ~~ (Si~l~¥~ r;'~'[~pIi~'~)' ........................ II'PITH T BOKEN Nolary Pub c State of New Yor[~ 52~0344963 Suffolk Cou · Expires March 30, 19'''/-'~..,~..~