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Home My WebLink About5949-zFORM NO. ¢ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~' '~ O ~J Date ~' /~)~'~ 19'~-'~ THIS CERTIFIES that the building located at ~ I 0 0 ~ L V ,~ t ) ~ LA NK Street Map No .......~ ..... Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore fried in this office dated .......... !..~...O.?.~.l?.-, 19 .?.~. pursuant to which Building Permit No.S.~. dated I ~ dl,;~J~- 19!.~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to ~N~$-rE~ ~ '~'~ENL' (owner, lessee or tenant) of the aforesaid building. Suffolk Count), Department of Health Approve] .. .~/. ............. UnDerwrITErscerTIFIcAT£ no. /x/ 7?_. ~-. 0 8 ~ - House numBer..!.J. ~ .... street .... ~..L..v.A..~.~ ..... ~..~..~{.~-. .................... ~.~. ............... Building Inspector FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5949 Z Permission is hereby granted to: at premises located at ..........~I,vI~L~..S..L& ......................................................................................... ........................................................................... gxt, ehol~o ....... li.,XA ............................................... pursuant to application dated .............................. ~BEJ...-.56 ......, 19.~.., and approved by the Building Inspector. Fee $....6~f~Jil~ ....... PERMIT INCLUDES APPROVAL TO REMOVE EXCESS FILL FROM ABOVE PREMISES BY REGR/~DING LOT DR,VEWAY CONSTRUCTION CE<,SPOOL CONSTRUCTION "~ ~R CONSTRUCTION FORM NO. $ TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, H. ¥. 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 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 unusuai 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. 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 ................. New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ....~..~/.,/.~...~ ........ ~.'.r~...~... ......... '-'"'~'""~'" '~'~"~'"~'""~""'~'""r'"~"/"~'~-r-., /..-- ..... / -- Owner Or Owners Of Property . .~..~.~..~...~.....~.~.. '~..~.~.~.. ...... :..~.~..~...~.~'...I...~.~..~..~,~.'/.~..~'_ Subdivision ...~..' ../../.i .................................................. Lot No ............. Bmoc~k~l',lo ............ ._House.~i,.].7~..... Permit No. ~..~.: .~'.~.~... Date Of Permit ~,7~/~.~.Applicant ~~....~'-.'~:.........~.:..~......~ Health Dept. Approval ..... ~1.~i .........~ .................. Labor Dept. Approval ................................................ Underwriters Approval .... /~r~. ............................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ ...~',~.~.. ..................... ~ ~ C~ c~ ~ I ~'~ .~ c~/~ Construction on above described building ~it~,~,, ~ .~-~ ,~'~- -~_meets all applicable cod~s and regulations. Sworn t~o before methis /-~-~/ ~ //" -~'~f---///-~ ~ ~/~ ...~.....~d~f~.~.~.~.g.~.... ~mp or seal) Nota~ Public~~~oun~ ,~lllrnissi0n £~Pires ~V:arch 30, ]~ 7~ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH JAN 2 3 1973 Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give~deed locatio~) ~ have been inspected by this department and found to be satisfactory. On~e~ o~ ~eneral ~,~c~neer~ng ~ervzces ,4- - 104- TOWN OF SOUTflOLD ' ~ ~:~'~¢ , ,~ BUILDING DEPARTMENT &//~. ~.,,,~_ /.2,:~/ /~ ~ TOWN CLERKS OFFI~ "'~ .... ~ ~?,LI ~ ~UTH~D,N.Y. ~~~ ~ ~ Examin,d ........... l.... 19.?....F / . Applic~ti~ No. ~Z..~ .................. ~.,: APPLICATION FOR BUILDING PERMIT "~ · , Date ,'~ G../.J~,;~.(;,, ........................ , 19..'7..."~,,... ~ 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 I~ans,~acourate 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, ana~ gk;ing a detailed description of 1~96'~t 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. on(~l d. Upon approval of th"is application, the Building Inspector will issue a Building Permit to t~ ~pplicant. Such permit shall be kept the pr~mises, ~.vailable for in~pec~i0n throughout ,the work. . - : : b~ ;Nd buildh~ shell he oeeupied ~ru~d id .whd[e O~ in' part for an~/'purj~iSse whateveF~il a Certificate of Occupancy shall have been granted by the Building Inspector. AppL!CATION IS .HEREBY MADE to the Building Department.,f~.r.lthe !~,sua~ce of a Building P~ermit pursuant to the B~*ilding Zone~ Ordinance Of the~T'OW~ of Southold, SuffoJk County, New York, and 6th~' applicable Laws,.Or6tinan~ei~· Or R~gutations, for the'eoflstruction buildings, additions or alterations, or for removal or demolition~ 'as herein described. The appliCant agrees to comply with ali appliCable laws.~t~ ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessety inspections. Stat'e whether applicant is owner, leseee, agent, architect, engineer, gene.ral contractor, electrician, plumber or 'builder. · ' · .' " L :'2: ::. :... Name of owner of premises .~.Z/-/~ ~.'..~ .......... ~.~;.....:..,!:.,!~ If applica~,t is a corporate, signature of duly authorized officer. ................. ..................... 1. Location of land on which proposed work will be done. Map No.: ......... i .......... Lot No .............................................. Street and Number ......... ~...~...~....P'...~../~.......~..~.~...~ ........................ ,.' ............. :., .......... ~.4~--.~..c.~..~..~..~...~. · //<O 0 Municipality 2. Sta~ existing use and occul~ancy of premises end intended use and occupancy of proposed con.ruction: a. Existing use and r~. ~n~ /~'~'~- ~o..~.. .................................. Intended use and occupancy ......... ..~...~::~...~/..~..Z'.~. ...... ..~..~..~../..~.~.z~.~...~.,~ ............. , ............. New Budd~n 3. Nature of work (check which applicable): ' ' g ....................... Addition ..................... Alteration ............... Repair. ...................... . . Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. ..... ~-:r.~;~J~. .......................... Fee .............. ~ .......................................................... ; ....... ,.....~i~. ....... Estimated (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 ..... ~l;~..~....~...~.... ....... ,..;~ .................................................. ~ .......................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front ..-~ec~::~...... Rear ..~ ........... , Depth ................................... Height ...... ..................................................... Number of Stories Dimensions of same structure with alterations or ac~ditions: Front ........ , ................. Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ....~...,~..~..~....i~... Rear ..~...~...-/.~...~./. ....... Depth ......~...~.../. .................. Hei ht /~ --~ ~ g ................................................. Number of Stories ..... ~ ................................................................................ 9; Size of lot: Front ...~'.~....~....,....,~..~..o. ........ Rear ....~.....~...~.~....o...~.. ................ Depth ...~r... .......................................... Height ...., ............................................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 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 ....... _/~..~. ...... v .............. Will excess fill be removed from premises: [Z-~es [ ] No 14. Name of Owner of premises ~,~ .~..~....~.....~.~..t~.'~/lg.~.....~..~'..~..~.~.~.....~..~...~...~..'~ ......... .~...~..t~...~...~.. (Address)~ (Phone No.) Name of Architect ..................................................................................................................................................... / /, ~ . / (Address) (Phone No.) Name of Contractor .~.~..~/-.t',~..~.........~.-...~./.d' .~..~ ....... ...~.~..~..~..~ ................... .~....~...~..:.....~./..~ ./.."' .... (Address) (Phone No.) PLOT DIAG RAM Locate c early and distinct!y all buildings, whether existing or proposed, and indicate all set-beck dimensions from p oparty lines. G~ve streat and .bock number or description according to deed, and show street names and indicate wheth- er interior or corner Int. '~ MIRY. .4'.3 "' N 1~5/ ~ .,. 7/~ .~..~.~. '~/¢ .~....~.~/~..~...~ ~' .'being duly sworn, deooses end r $ that he is thee ,,cant above named ............................ :*?: ....................... ~ ............ I-"; pu qy pp . : ~ (2Varrteoftndipidualsl~tingcolltr~.t} . , .: . ,e,s,he ......... : .......... ............................................................................................................................................ ' {Contractor, agent, corporate officer, etc.} o~ said owner or owners, and is duly authorized to pedorro orJ~ll~l~ tb~ ~aid work end to make end file this application; that ell statement~ contained in this application are true to the b~o~f~.l~,~..o~9~,,~.l~~ l~tdif;~ndthet the wodc will be performed in the manner set forth in the application filed therewith. ............................ of ................. .............. ...... .......................... ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS ~b IBUR~AU OF ELEGTRIGIT~ --- '85 JOHN STREET. NEW YORK, N~iW YORK IOO31 Ohes~e~ Sawas~ynow$~ e/s A~Yans Lane~ z~vu n/~ ~u=. Cuteho~ue~ "Furnace/s: Motor/s: 1-1/2hp