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Home My WebLink About5837-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~,, .~08.~ ..... Date ............. Apr&l.. ~[2. .... , 19.73. THIS CERTIFIES that the building located at 1~/3. goore, a. Lane .......... Street Map No...x~ ....... Block No.. XXX .....Lot No..x.xx... 6r. eenpo~.t.. I?..¥o ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ~,pr:L].- ·-2~., 19 ~2. pursuant to which Building Permit No.. ~83~Z. dated ....... ~,l~r;l,~, - - ~ ..... , 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 . .Bus&ne as .bu:EIAiug. ,~ .mo.~.:/~g .&. s.tor&~e .war~hou~m, .(.app. r .o~. 0.d .bl~ Bd Appl; The certificate is issued to ,lernick .lno.v.:l. ng. & .atomnge. Ina ...... axenel'. .......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...N. :.R., ............................. UNDERWRITERS CERTIFICATE No ...... .pend~ag ................................... HOUSE NUMBER.. '1~0 ....... Street .....Motlroa. ~&llO ............................... FOB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 5837 Z Permission is hereby granted to: · . 4'~r~e~.-~o~..~..~e=&~ ..~e ......... ..... ~t,..l,~..~.!.Llk~& ........................................ ....... .a~e ~t e-:r · ..~.a.~.a~ ......... ~I~¥~ ................... to ...~..u. LL~...P.~..~..°-~.e...r..q.~...~,.~...z.~..n.~...C.t.~..°.~.~.~ ...v..~..o.~..e.) ................................... at premises located at .....~..~J~,~.~...~ ..................................................................................... ................................................ G~ee~po.~t .......... l~.~.-v.~. ....................................................................... pursuant to application datecJ ........................... ~::~,~....~.~ ....... 19.~.., and approved by the Building Inspector, Fee $.,i~C)0r .......... FORM NO. 6 TOWN OF SOUTHOLD Building DelMJtment 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 fram Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildin.g.s 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), No~-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all praperty 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 3. Copy of certificate of occupancy $1.00 New Building ...... ..~. .......... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property .~g.~.~'.~.~.~.....~D.~.~...~.~IIZLI~.9.~.t~.~..~.^ .............................................................. Owner Or ~ners ~ Pr~e~y .~.~.~.~...~...~..~.~.~.~....~.~.~. ............................................. Su~ivision ................................................................ Lot No. ............ Bilk No .............Hou~ No ............. Permit No...~.~.~ ...... Date ~ Permit .~.~/~..~plicant ~.~.~..~.~..~...~.~?....~o. Health ~pt. Appr~al ............................................ ~bor ~pt. Approval ................................................ Unde~ritem Approval .............................................. Planning B~rd ~pmval ........................................ Request For Tempom~ Ce~ificate ........................................ Final Ce~ificate .......................................... F~ Submiff~ $ ...~.R~.~ ....................... Construction ~ a~ve de~ribed building:~:::: a~~~l~i~. ~pl,cant ..~.~~-../~~ ........................... Sworn to ~fore me this~ , , ~ ' /~ 5 '73 d~ of ......... ~....~ (stamp or ,al) ~t ~O~F N,~ry Public ....~.... County NOTARY PUIBLIC. STATE OF NE~ YORK Qualified iff Suffolk Counb/ Commission Expbes/vtatch 30, 197~/c I~ORM lqO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N. Y. Approved ~' ~ ~"'~.. '~ 7 ? ........................................ , 19 ........ Pemit No ............................. ~. .... Disopproved =/c ................................................. ......................... ..................... ~ ~/~ APPLICATION FOR .UILDINa PE~IT Date ~. INSTRUCTIONS r ~ a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector wit~ 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. · Upon approval of th~s application, the Budding Inspector wdl ~ssue a Budding Permit to the applicant. Such permit shall be kept onn t~e premises available for inspection throughout the work. ~L e. No building shall be occupie~l or used in whole or in part for any purpose whatever until a Certificate of Occupency shall have been~ granted by the Building Inspector. ~ ~. APPL[CA.TION IS HEREBY MADE'to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of ~he Town. ot Southold, Suffolk Couhty, 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. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............. ....................................................................................................................................................... Name of owner of premises .............................................................................................. ~..~... ....................................... If ap~plic~a~ is a corporate, lil)gnature of c~jly authorized officer. .......... ' ......... .... OT corporate officer) 1. Location of land on which proposed work will be done. Map No.: .................... Lot No .............................................. Street and Number ................................ .~JJ~ ~. ~.....~. ~/. ~ .~.. ..... ~.-/~-~ ~ / 7 ~ Municipality 2. State ~existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................................................................................................................... b. Intended u se and occu pansy ..~.~..~/...~...~-,~f...~../,'.,(?.........~-~/.~.~J~.' .~... .......... ~"~.~?.,~. ~:~ ................................. , 3. ~la~re~of work (check which apphcable): New Building ..... Addition ..................... Alteration...; .......... ; Repair ......................... Removal ......................... Demolition ...... ....... ........... Other Work .................................... (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 n/?.~...~..~...~.~ ........... 7. Dimensions of existing structures, if any: Front .....................Rear ......................... ,. Depth ................................... Height ........................................................... Number of Stories ............................................................................... Dimensions of same structure with alterations or addition's: Front .......................... Rear ......................................... Depth ............................................. Height ...................................... :.. Number of Stories ........................................ 8. Dimensions of entire new construction: Front ...~v....~... ............ Rear ...... ~...~.. ............. Depth ...~..~...- .............. Height ...~.~.....~.~ ............... Numar of Stories ......... ~ ............................................................................. 9. Size of lot: Front ..... ~ ................................ Rear .......................................... Depth .................................................. Height .................................................... Numar of Stories ...................................................................................... 10. Date of Purcha~------ --~...~.~....~.~.. Name of Former Owner ..~~.~---- --~----- .......... .~.~ .......... 11. Zone or u, di~rict in which premiss are situa~d ..... ~Z~.~. ................................................................. 12. D~s propo~d con,ruction violate any zoning law, ordinan~ or repletion: ............................................................ 13. Will lot ~ re~aded~..~~.... Will excess fill bo mmo~d from ,,mi,s: ~ ~ [ ] No 14. Name of Owner of p,mi. ~~....~.~~.../~..~/~~.~ Name of Arch,,,~,~.,.,~:.,.,,~..~,~~.~--~~~ .............. .~ (Aadress) (Phor e ~o.j ....... PLOT DIAGRAM ~nd dist!nctly all bt~!!gtings, whether existing or proposed, and indicate.all set-back dimensions from ¢tea(ly property lines. Give str~e't ar I ~10cJ~"nU~mb~i= 6r'de~cript. ion according to deed, and show street names and indicate wheth~ er interior or corner lot. STATE OF NEW Y~ORK// . ) COUNTY OF ...~ .................... ) SS ........ ~C,,,~....c~...~...~~vf~Jual$t~nin~,contr ..................... being duly sworn, deposes and says that he is the applicant above named. (Nerve of lndlt4&tal ~ttghing cont~ac ) He is the ............... ~ ...................... : ............................... : ................................................................................................................ U ~ (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 are true to the best of his knowledge and bel~l~l~j.~na~ tl~l~k will be performed in the manner set forth in the application filef~. ,therewith., r ~C A"v PU~'NOel S..~ .... c~..*2.~':d~ ............... day of .,.'.,.../~ X~e~'~_~ ..................... 19 .'.~'.~... Co...~9._o_o_o_o_oE~lj~n Expires Ma,ch 30~ i! · ! '1 OUF FO OUT $ Y~h~. A~. i I~.~.¥ LENGTH TOT~.L + ~"I . = OUT TO OUT CO~C~LTL ~~ Hw-mS0 ~- ~Y LtNGTH TOTal+ &~= BUT TO OUT %~L~ ~VE H~IOHtS ..... -~,~ , , ~ ~ ~ --' ANCHOR BOLT SETTING PLAN - -- f" ~ I~A.Y LENGTH TOT~Lt- ~,'~= OLIT TO OUT %T[.~-L DONALD A. BECKER-AIA RICHARD P. ARELT- AIA ARCHITECTS EAST SETAUKET, N. Y.