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Home My WebLink About5971-zFORM NO. 4 TOWN OF SOUTHOLD BUILr~ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z?.l..~.0 ....... Date ..............~..U~..S.t. .... .~.., 19.7.~. THIS CERTIFIES that the building located at . .~/.~...14.a.$.n.. '.rl.o.a.d. ........... Street Map No...x~. ......... Block No. ~ ....... Lot No ..... ~ .....0~..~.e.n.t....N.t~.: ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..............i~[...27, 19.7.2.. pursuant to which Building Permit No...~.97.~.Z. dated ...........J.u~.e. 27. .... , 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 .P..r~..v.~t.e..o.n.e.. ?.a.~.i..!y..d.v.e.1.],i..rig..w.i.t.h.. $.t..u~ .~.o.s... (~D~-.oy.e.~. bY...~.. Ap0eals ) The certificate is issued to ~..o.r.e.n. ce...~..P..e.t.e.r...G.l..i.p.p.e ..... . .0/~..e?.s. ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~o.~. ?..~....~.9.7.~...b.y.. R.'..v..~.l~.a. ..... UNDERWRITERS CERTIFICATE No. T.e.~. p..b~..J. ;..lt...u~..a.c.k.~....~./.~../7.~. ............. HOUSE NUMBER .... 2:8~ ~ ....Street ...... .~..L.'~ .R..o.a.d.....0.r.i.e..n.t. .............. ...... ...... /I- Buildin~ Inspector ] / FORM NO, 4 TOWN OF $OUTHOLD BUILDING DEPAHTMEi~T Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No..Z...~./.~.7. Date ............... }.(..~..C.T.., 197. cf THIS CERTIFIES that the building located at .. ~/./~ A. ! ~'1 ............. Street Map No ....... -"T ..... Block No ...... . .'-~...Lot No. conforms substantially to the Application for Building Pemit heretofore filed in this office dated ............. ~.W../~..~i~ 197.(/. pursuant to which Building Pemit No. ~. .~. .-]. /. . .Z_ dated ............ ~.~..~. Nfl., 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 .... F.~ ~)-~ a i.~.c £...~.. ~ .T ~ ~,... ~.~. ~.F..ff ............ (owner, ~ of the aforesaid building. Suffolk County Department of Health Approval [E~t~ OC- c) OCT 1~7~ UNDERWRITERS CERTIFICATE No ............................................. HOUSE NUMBER . ~.9..I. 0. 0.... Street .... I~.4. .~. ! .~.(.. ~ }.A. ~. .................. ............................................ ~..~.~.~.~! T ....................... .:: - . ........ ,/.../_.. :/..,Z.M. _~ ...... OF I~)1[~¢~,~ T'~.~'~7 597l 7_. Building Inspector FO~ NO. 2 TOWN OF SOUTNOLD. BUILDING DEPARTMENT TOWN CLERK'S OFFIC~ SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5971 Z Permission is hereby granted to: ......... ~net, e~ -.& ..F.~e~e~me ~ · 4~t,]m~e ............... .............. t.s, 9~. ~eF.~etem~.. ~ ........................... ............. ~lmete~.. ~%rpe~,..F&~..s ............ Ilmml. to ....i.~.te~i...rem~det..~nd...&dd...te..e~lt~ng..~ld. '~ ................................................ at premises located at '"O~"J~allZ%"~08.~l. ......................................................................................... .................................................... 0~4,~t, ............................................................................................. pursuant to application dated ......................... ~1.~'. ........ .'.L-~ f.; ...... , 19.J~2.., and approved by the t Building Inspector. Fee $'""%~i(~0 ....... , ' ' auilding mspector / FOl~I 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 DUPLICATE 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 disposol--(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, o 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 oil 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 formation required to prepare a certificate. C. Fees: I. 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 ...... ./.../.'.?,,.fL New Building ................ Addition ................ Old or Pre-existing Building .........~....... Vacant Land .............. Location Of Property .... .o. ........ Owner Or Owners Of Property ....-/~..k'.......~.......~..~'./~,.L...~.. ,~..~.. ..................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No..~....~.../..r).. ,~ YU/~' ~ h ant ~..~.. Permit No~.....~....21Z~. Date Of Permit ...~.~...~.. pp 'c ......... ~ .......... ~...'!.?~ .................... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ...... ~..~.'..k..~... .................. Construction on above described building and p/e,/'mit meets--,all app_licable codes and regulations. Appl,cant ....... ./.'....~?~z.......~. ....................................................................y./.~..~. Sworn t.~o before me this ~;~/~// //~ ~'~ ' '('/"'/, '~ .(..' ........... day o fr.. ~ .4. Z .~.. ~.~:.' .?..~.:.c.:../.. './.../..~..~... .... / / (stamp or seal) /,~c .............. ." - '-z__ TOWN OF SOUTHOLD ,~..p /.~ ,~ ~: a/'~' -~ ' ~. o. ~ :~ 7~ ~UTH~D, N. Y. Examined ........ Z~.~ ) ~ , 19 ~ A lication No ~..~. ~ ..........................pp .: ............ Z ............... .......... ...... Z..., ......... .... ........... ~..~...~.~ ............ .: ............................... ~~ .... ,~ ~,~ ~)~ ~ F ~ ......... ~ ................ ~ . L..~~~/GE ~ ~, /~ ~N APPLICATION FOR .UILOIHG ,ERMIT'~~*- ~~.:~ ' ~ ~ot. · ~ ..... ..~ ..... , 1~ .... ~] ~,~/' .-.--:-....:: ........... ~ " ., ........ / tv INSTRUCTIONS ~=~ ~ ~. ~. / e. This ~pplia~tion must ~ completely filled in by ~y~writer or in ink ~nd submitted in ~riplie~te ~o the Building Inspector, wit~ 3 ~s of plans, ~ur~e plot plan ~o scsle. Fee eccording to schedule. . b. PIo~ plan showing Ioc~fion of lot ~nd of buildings on premises, relstionship ~o 8djoining premiss or ~ubli~ s~r~s or ~rees, ~ '~iving 8 de~iled description of I~you~ of pro~r~y mus~ be dr~wn on disgrsm whieh is per~ of ~his Bppli~tiOn. ~. The work oovered by ~his 8ppli~sfion rosy no~ ~ commen~d ~fore issuance of Building Permit. d. Upon 8pprov~l of this ~ppliestion, lhe Building Inspector will issue 8 Building Permit ~o the 8pplicsnt. Such ~rmit sh~ll ~ kept ~he premises ev~ileble Jor ins~ction ~hroughou~ the work. e. No building shell ~ occupied or u~d in whole or in p~ for 8ny purpo~ whe~ever until ~ Cer~ifi~e of O~u~n~ shsII h~ve ~n grinted by ~he Building Ins~c~or. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of ;~he 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 laWSi 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) ...... ~../...?...9~.....~~ .................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .~,4;~fL~fl....&....~.fl~..Cr,~:J.~o.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.: ...~...8....-...~... ............................... Lot No ............. Street and Number .~..~..t~....~.~)....~....a~.....-....~9..u....t~.....2.~ .......... ~..~}~a...JJ..fiR..~t~ ...................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....?....aR'RI...~..~.l...~..~.g. ..................................................................................................... b. Intended use and occupancy .....i~......e~.......t~....~....~_~..~?..1.~JL..w~....t~..,...t~......e.~.a. ...... ........................................... 3'. "'Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration....][ ......... Repair ...... & ................ Removal ......................... Demolition ........................ Other Work .................................... { Description) 4. Estimated Cost .~ ............................... Fee ~--,~.~...,~L~.-~-,~ .................. :..........: ................................. ~ (t~'l~?pal~ oil filing this appdcadon) 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 -.~:~1~.~.~ ........ Rear ..~,~.~ ............... Depth ..~O.3.~...~.:~t~a..~ Height ...... '~.4-~ .......................................... Number of Stories ...~. ........................................................................ Dimensions of same structure with alterations or additions: Front ...~..~ ............ Rear ...... ~..f~ ......................... Depth .....96..~.:,ntal~..~a..eheel.. Height ....... [9~.:[,1~ ....................... Number of Stories ....... ~- ............................... 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................. Height ................................................. Number of Stories ......................................................................................... 9. Size of lot: Front ...~l.4~u ...................... Rear ..~.~w'~ ....................... Depth 10. Date of Purchase ~le~..;~[~,~ .......... Name of Former Owner ...~i{~r. ag~.~ ................................................... 1 1. Zone or use district in which premises are situated aeeai~la~a~u~.&.-,-4j~,~-n~3z~.~ ........ '- ........................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ,ae ....................................................... 13. Will lot be regraded .................................... Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of P re misas~[~l~aee '~' [;~s~ '6~"1~ '"" z :~t~c~r~i~"~"~ler~"~o.)'l~''''~ Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor .................................................................................................................................................. (Address) (Phone No. t 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.('~ ./~ COUNTY OF .....~....:.....~ ?/ .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract/ He is the (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 all statements contained in this application arcaJ~d~ ~0 Ifl~'~d~st of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed th~,66~,[~h~!~'~, .......................... f~..._..~...day of ............... ,,~,.../...',-_.T,,~...," ............. ~ ........ ,.(.... ~ _~ ~ · ., N pta ry Public, .~~...j~~..~nty ~~......~~ ................................ ~./ ~ (~gnatur~ of applicant) '-.%