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Home My WebLink About5930-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at .~..~....~.I.~.1....l~.'t~.~ff..C...~. ?...~,. F-/~eet Map No ...... : ...... Block No .... ~ .... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. [..~J(~N.E, 19.7. ~ pursuant to which Building Permit No..~..~.~..~. ~ dated ............. ~. ~/)A/~; 19 7~,., 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 .... ~... ~.N ~ ..... .~ .~../. 6. ~. .....~..W..~:~..~J../~..~/. ...................... The certificate is issued to .. ~..TD. #..r(..1~.. ~..¢.7'./¢.....~./..~..~'..~..~..~: ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....... ~ ....................... UNDERWRITERS CERTIFICATE No. "'"'- HOUSE NUMBER. i~..~.7.~,,,..Street.. ~J~A .T .... ~ ~.~.M! .~:....~.~..y'.....'~../...~'.'..a~. ..... ......................................... ¢..% ..... ................ Building Inspector FOB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5930 Z Dote Permission is hereby granted to: ........... ~.%.t~.t.u~ ....... ~..,..X.., .............................. Build an addition ea existinE bulldin~ .fo~ oae. family dwe~l~n~ ~ c .~ B ~1_ ' at premises located at .........J~.~...~.~L~.Q~'~,.....~., ....... .~. ....................................................................... ....................................................... ....... ....................... pursuont to opplicotion doted ........................... ~'3,LI0.~...~. .............. , 19.~..~..., ond oppro~ed by the Building Inspector. · ../-'r~' ............ ~'~il'ding Inspe f'~ ......................... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks 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 from Board of Fire Underwriters. 4. Commercial buildings, industrial buildings, Multiple Residences and similar buildings end 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. 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. C. 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 Date .... ~.,~tt. ~. ......... ],.~.~.3 ............. New Building a~de~l../co. Old or Pre-existing Building 'e .......................... ~ ........................... Location Of Property ~:~Is t 11) ~ner Or ~ners Of Prape~ ....~.u~..~,...,;&~&~e/~..~....~&te ................................... Su~ivision ................................................................ Lot No ............. Bilk No ............. House No ............. Permit No...~...~... Date Of Permit ~[~:A..~...~plicant ...~...~.~..~...~.t.~.%~'~te Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ..~.,,0£....~.~.~...*~.,,£~0 fC~ Cop7 Construction on above described building and permit meets a/U,, applicable cedes/,gnd regulat/ions. × / Apphcant ....... Sworn to before me IS/? c ~ '/~ 2~ ~./~ayo,..~.. ~/.../fZ...~ (stamp or seal, ~E~ YORK ~o, 52-~79~) ~o~ ~, ~, z Commissi~ ~plre~ M~rch 30, 19 / ~ IrOBM NO. ~ TOWN OF SOUTHOLD Building Depmtment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF O~CUPANCY 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 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. 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. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dweJling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ... ~,~'~.~, ........... .?.~..~ ............. New Building ~d~ecl:"~o' Old or Pre-existing Building ~ .......................... ~J~q~Lc~ ............................ Location Of Property ~c~z~`~:;~-~vd~c~&~:~s~`~£~-~a~7~d~:4~t~£tu~(~a~ Dist 11) ~ner Or ~ners Of Prope~y .,..R~h..-~.,...~.~n~a-~e~th~...H.~..-~.~a~e ................................... Su~ivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No...~D...~... Date Of Permit~.~C..~...~.~plicant ..~....~,~.~...~/.~..~j~[~[e Health ~pt. Approval ............................................ ~bor ~pt. Approval ................................................ Unde~riters Approval .............................................. Planning Board ~proval ........................................ Request For Tempam~ Ce~ificate ........................................ Final Ce~ificate .......................................... F~ Submitted $ .~.O~..~s..;~.~O0 f~ Copy Construction on above described building an~ petit meets al~lic~ c~es ~ regulations. ~ , Applica,t ....~~.~ ...... Sworn.~~y~;-~~.~:~to before me~s,- ~ ~ ~ , (stamp or seal) NOTA~ PU~IC. STAT[ OF NEW YOR~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No....~..~....~...~.. ................ Examined ................... , 19 ........ b~oproved ,~ ,,'1 19...'~..... PemitNo.~.~....~..o~ -- I~'~ INSTRUCTIONS ::~ 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 scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on 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 a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout 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 ~o 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. ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...~.:.~..~..,~.~.~......,~....~..C.~..U...~...~..;..~/./.~..~...~....r..~.. .......................................................................... 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. Map No.: .................... Lot No .............................................. Street and Number ..,..~..~.~'~/(,/.C.,.....~....~....~.....~..~...~...z...~..~.~...~...~.. ................................................... .¥...~...~....~.,,~..~....,.../~.~.~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: occupancy . ..., ,~,, ,/, ,~. ,/,, ,~. ,~,.... ,~, ,~,, ,~, ,~, ,~, ~T, 4~, ,~, ............................................................... t ................... ~' a. Existing USe and b. Intended ...--.. use and occupancy ............... ........................................................................... ...................... i~ · 3. ' ~ature of work (check which applicable): New Building ....................... Addition .....~. .............. Alteratio6.....'...;; ..... Repair ............. ............ Removal ......................... Demolition ........................ Other Work ............................ ~ ...... (Description) 4. Esti mated Cost .~......~....~...°...O.~ ~ ..................... 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 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 ...;..~.../..[i~..~. ........ Depth ...... ~.o..."..~...~'. ............... I-I~inht 7'~ ,('~z~; ~' /~'" - Number of Stories Dimensions of same structure with alterations or additions: Front ......'~...~.....~.. .......... Rear ......J...~...;..'~.. ........................ Depth ............................................ ~4/-'o ' Height' ............ ~-o .~......~.zo ............... ~ /.~ -' ~... f Number of Stories' ....~..~'...~. ........................... 8. Dimensions of entire new construction: Front ...... ./ff...".~.~ ...... Rear ........ ./..~'..'.'..~...". ........ Depth J~ "~ ' Height i ....... ~ ............................. Number of Stories ...... ~ ....................................................................... 9. Sizeoflot: Front /~'~.,,~g,~Y /~'.~.~ n~nr~'z~'~ ~&,oo ri~nth~'~j~· ,~/& ~41 J~J~' Height ............... ~ ........................... Number of Stories ....... ~ ...................................................................... Date of Purchase ..................................... Name of Former Owner ............................................................................ 10. 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................................................ 13. Will lot be regraded ............. ~,./..O. ................ Will excess fill be removed from premises: [ ] Yes [~J No 14. Name of Owner of premiss /~.;.~..~..~.~....~ ...................................................... ........ ~~ (Address) (Phone No.) Nameof~ ............................................................ ~ ~. ~ ~r~/~ ~.;..~.~,~. ..... ... (Address) (Phone No.) Name of Contractor .................................................................................................................... ~.~ ............... (Address) 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 numbe~r or description according to deed, and show street names and indicate wheth- lot. >- / ~OTE / 0 EXISTING ~ COUNTYOF~ ................. ) SCALE I"= OO' .......................................................................................................... being duly sworn, depots and says that he is the applicant above named. (Name of individual si~ing con~act} Ho is tho ................................................................................................................................................................................................................. ~ Contractor, agent, corporate officer, etc.} of ~aid owner or owner*, and is duly authorized to ~rform or haw oarformed tha said work and to make and fil~ this ap~lieation~ that all atatem*nts contained in this apolieatmn' are true ton tho ~stuotr~of rhi~ knowledge and baliaf; and that the work will ba ~rformad in th~ mnnor set forth in the ap~ication filed therewi~ ot~ Publi · BOK~ ~ ~ ~ ~//~ ~ f ELEVATION J ADDITION ~'e ~L~ILDfNG' M-~- A.M ~/fNGATE PECOt,,'I~ B,~Y BOULEVARD MATTITUCI~ N.Y, q