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Home My WebLink About5929-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy v, ............ Date ............................ , 19 . THIS CERTIFIES that the building located at...B~..nn..e.t.t...p.o.n' .la.. ......... Street Map No..~..r~. ~ett ...P~Block No. .Lot No. 6 ~attituek conforms substantially to the Application for Building Permit heretofore fried in this office dated .......... .J.~,..... ~., 19.73, pursuant to which Building Permit No, . .~9.2..~Z dated ........ Jnne .... 6 ..... , 19.73., was issued, and conforms to all of the requir~ merits of the~ applicable provisions of the law. The occupancy for which this certificate is issued is Private one family dwelling(approved by ~d Appeals) with a~ additim The certificate is issued to J..o.hp T ? .P~..e..v~. ...... (owner, lessee or tenant) of the ~foresald building. Suffolk County Department of Health Approval N°R, UNDERWRITERS CERTIFICATE No. aee original C/C . HOUSE NUMBER .~.0.~;~ ......... Street ....~..~1..~.t.t., .P.o.n.d, .L~.. ~! ..................... FOB3K NO. ~ TOWN OF SOUTttOLD 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? 5929 Z Date ........................ ~ ......... 4, ........... 19..~1~. Permission is hereby granted to: ............... I~.~.,t~,k ........................................... at premises located at ..... ~ltt~.&....~t~3[t~..~4;~ ......................................................................... ...................................... ~azua~t..l~t..La~ ........... l~a t,t ~,tttek ............................................... pursuant to application dated ...................... ~IBIte-.....~ ................ , 19....~, and approved by the Building Inspt~:tor. Fee $.~.~.e.~. .......... Building Insl%'~t6r / 'rOWN OF soUTHOLD BUILDING DEPARTMENT TOWN CLERIC'S OFFICE ~H~D, N. Y. ^pp i tion ............. DiSapl~roved a ........ ; ................................. ; ............................ ~ APPLICATION FOR BUILDING PERMII' o te .................... ............................... ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Buildin Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premiees ar public streets areas, and giving a detailed description of layout of property must be drawn on the diagram wl'dch Is pert of thle appllcatlon.~ c. The work covered by this application may nat 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 on the premises available for inspection throughout the progress of the work. e. No building shall be oc_c, upied or used in whole or in part for any purpose whatever until a Certificate of Occupancy~l~_ shall have been granted by th~'Building Inspector. ^PPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pumuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable L.awl, 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 ap!olicable laws, ordinances, building cede, housing code, and regulations. (Signat~l ~f applicant, or name, if a cor~ratlon) ..... /. .......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................................... Oz~em....Garter. al.. aoz~t~a~ t~v ......................................................................... Name of owner of premises ..................,T..9..~l~...~.e...~9..e.~.~ ................................................................................................ .~ if applicant is a corporate, signature of duly authorized officer. 0r~~ (Name and title'qf corporate officer) 1. Location of land on which proposed work will be done. Map No.: ~'~,~.~.'G~..~.QI3.0, ......... Lot No.: ...~.~. ............. Street and Number ........... ;.~..~. T~IRg.~..~I...~'.9.~.~..~.IR~q..9. ......... ~.'J.~..~ ...................................................................... Munlclpellty 2.State existing use and occupancy of premisqs and intended use and occupancy of proposed construction: o. Existing use and occupancy ....~Le...~...'[.~r...~lll~.;~Jl~ .................................................................................. b. Intended use and occu[:an:', .A~l,~L~.g:~...9,~....~a~C,.~l?,~?...11r..~.g~..~l,~g~ ....................................................... 3. Nature of wosk (check which applicable): New Building .................. Addition ...~[:~[][Z.. Alteration .............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost ............................................................ Fee ...~...1.~,.~.0..0. ............................................................... (to be paid on filing this application) 5. If dwelling, number oi: 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 existing structures, if any: Front ....TO,~e, ............ Rear .~.O,~:be. ................... Depth .,,~.;~.~,e ....... Height ~..~..~..e ............. Number of Stories .......... .~.. .................................................................................................... Dimensions of same structure with alterations or additions: Front ...... .~.Q~.l~b .................. Rear ......'/..0.;~.~n ........... Depth ...... ,~.9f'~,., .............. Height ........ ~0~ ......... Number o~f ~t~ies ............~ .................. 8. Dimensions of entire new construction: Front...................................Pht'~;* -~ Rear ....... ~.~..9. ......... Depth ....1..~.e. ......... Heigh~ 0.-t~e ........... Number of Stories ............~./.~ ................................................................................................... 9. Size of lot: Frontl..~.~.~...O. ................. Rear ....... .1...~.8..e.y ................. Depthl.8..0..e...0. .............. ~ ....... 10. Date of Purchase ..... ~.~1~....1.c~.~.1~ .............................. Name of Former Owner ~T~,.~..ea ~'. & ,To]3z~ ~eeve 11. Zone or use district in which premises are situated. ....... ~g.~l~l,~.T~..~.ll~ .................................................................. 12. Does proposed construction violate any zoning Ic~, ordinance or regu at on? ...~..O...e. ................................................. 13. Name of Owner of premises .~o]3~,...~,.,.~.e.e~r.e. ........Address ...~e~....~,~....~.b...o..9'...e. .......... Phone No~. ~.~...'.~..1...~.... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .............Oie3~e~. ........................... Address .' ........................................... Phone No .................... PLOT DIAGRAM Locate clearly and distinctly oll 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 Y~)R_K, tee COUNTY OF ..... ~D.¢ ~. ~..~,k~...... }'~'~' ............... .J~.~.~.....,..-~..^.~.l~ .~..~.~ ....................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ........................................................................... '~ ............................................. ~g~'~i ~orpor;~;~ '~icer, etc.) of said owner or owners, and is duly authorized to perform or have ~ 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 that the work will be performed in the manner set forth in the application filed therewith. Swam to before me this _ ........................................ ................... . ..................... No.62-0344963 Suffalk Co, r~y Commission Expires March 30, ]9..~T---~ FOIIM NO. 6 TOWN OF $OUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFIGATE OF OCCUPANCY Instructions A. This application must be filled in typeWriter OR ink,, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: ]. 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 ]957), 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 os 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: ]. Certificate of occupanc~'~,',~ 2. Certificate of occupancy'~-p~s:existing dwelling or land use $5.00 3. Copy of certificate of occupancy $I.00 Date ...... New Building ................ Addition ~ ...........Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ~..~..~...{~..~...x~..~..~..~..~.~....~.~.~...~....~...~..~..~.~/.~.'~.~Z~..~.~W~ .............................. Owner Or Owners Of Property .......... J~..,~....../.'~.:.....~.~...~'...~...~.. . ........... Subdivision/~...~.~ ~: ,~,~"~',~ ~',~'_~ ,~,~, ........................................................ :~..Lot No.....'~..~..,.. Block No ............. House No..,~...~.._~-~..~- Perm t No..o~..~..~......~... Date Of Permlt~'/.~'/..7..../....Applicant ..... ~...~.4(....~....7~.~....~..~...~..F..~.. ................... Health Dept. Approval ~/ ' -- · '~..."~ ................................ Labor Dept. Approval ... Underwriters Approval ~ ............................ Planning Board Approval .............. ~. ......................... Request For Temporary Certificate ............................ Final Certificate . .../... ...................... Fee Subm tted $ ...,,?..~ .......................... Construction on above described building and permit meets all applicable codes and regulations. Appl cant ........ Sworn to before me this ................ day of .....~.~....~.. ....... /...~...?. ........... (Stamp or seal) Notary Public .................................... County