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Home My WebLink About5885-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.. Z1~982 ..... Date .......... ,Tazmal'y ... ~ · ·., 19..73 THIS CERTIFIES that the building located at . 'Gin'' 'l~me' a 'lel, dYaly ...... Street Map No. Bayhava ... Block No ........... Lot No. -%7.. 5outhold.. N.o¥ · ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... Jm"~e. - 5 ...., 19.72 pursuant to which Building Permit No. ~88~Z. ·. dated ........... JUly.. ~..., 19.72, 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. riYa%o -eno .falal. ly. d~,~lllng ....................................... The certificate is issued to .. William .&. Bel~tha..Ellwoo4 · · · O~el's ............... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .Jal~ '22' i973' ' Dy. R.o..¥ilika ...... UNDERWRITERS CERTIFICATE No ..... llS~t-~O · - lloV. · -1972 ..................... HOUSE NUMBER...9~.~ ....... Street ....GIL~I. l~.vl, e ................................... Building Inspector FOEM NO. ~ TOWN OF SOUTHOLD 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? 5885 Z Permission is hereby granted to: W~.~ We~.m et premises Iocoted ot .................................................. ; ...................................................................... pursuant to application dated .........................~..~' .......... .~. .......... , 1'~......, and approved by the Building InsPector. ~1i.10 Fee $ ........................ Building 'l'r~'~ 'e'~'t'~'~ [ ................... FORM NO. ~ TOWN OF SOUTHOLD Building Delmfftment Town Clerks Office Southold, hi. 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 dispcsal--(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 dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Janua 2 1 Date ............. ..z~........~.t .... ~..7,,3. .......... New Building ....,~ ............. Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ....... .G.~-~....~q~e.s....~.e~....~.~y.~s,..~.~,~h~l¢, ................................................................... Owner Or Owners Of Property ....~..~..1..1.~.~.~.~.~..oo..d: ................................................................................. Subdivision .~.~H.~wn at Southold . LotNo 1~ Block No. House No Permit No....~,~,~ .......... Date Of Permit .-~/~,?/..?~.....Applicant .... .~illia~..~e]~.,~ ................................... Health Dept. Approval ....... .?~..S. ............................... Labor Dept. Approval ................................................ Underwriters Approval ...........~C~S ............................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .~'~DD ........................... Construction on above described building and per.mit meets ,all applicoble,cecles and regulations. Applicant .....~...~ ....... ,~.,.~/.,~ ....................................... Sworn to before r~this ...... ,~ .... aay at/~....~'-~,..~'~ .............. Notary Public.~~.... County (stamp or seal) FOBM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. ¥. 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 oil 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 dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ~l~.....g~R..~ .......... New Building ~ Old or Pre-existing Building Vacant Land Location Of Property ....... ~..~R.....~.....'.~..?....~.....8...e~...?~..~~. .................................................................. Owner Or Owners Of Property ....................................................................................................................... Subdivision ... ~.j~ ................................................. Lot No.............~L? Block No ............. House No ............. Permit No. ~1~, Date Of Permit .....~...~...~.......Applicant Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... $'g. Fee Submitted Construction on above described building and permit meets all applicable cedes and regulations. Applicant .......~.~ ...... ~...~/.~"~ .................................................... Sworn to before me t~s .... .~.....~...: d ay ~,~~...7~ · -/.. ~.. 7"~ Notary Public~,~.(..q. ff..~.... County ~ ~. W'~.~ (stamp or seal) TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CI~ERK'S OFFICE SOUTHOLD, N. Y. Approved ..... --~ --~ , ~ '~' Permit No ~...~...~. ~'-- ~ Disapprov~a/~[[~[~~ .... ~ ........... ~PLICATIQ~ FOR BUILDIN, P,RMIT .~. Date .............. ff.~ ............ 19.. a. This application must be ~mpletely filled ~n by typewriter or in ink and .submi~ in duplicate to Building Inspee~r. b. Plot plan showing location of 1~ and ~ buildings o n premis~, relati~ip ~ adjoinin~ p~mi~ ~ public s~eets ~ m~, .~d givin~ a detailed description of layout of pmp~t~ must be drawn on the d~a~am which is e. Tho work ~ve~ by ~is applicat[~ may not be commenced before issuance of Bufldin~ Pem[t. d. U~ ap~v~ of ~is applieati~, the Buildin~ Inspee~r will ~sue a Build~g P~it to the applieant.q Such pemit sh~l ~ kept m ~e premiss available for ~ns~eti~ throughout the pro~ of the work. e. No building shall be occupied or us~ in whole o ~ ~ p~ ~ ~ pu~se whatev~ until a Ce~ieate Oeeupane7 ~1 ~ve ~n grated by the Bufldin~ ~CATION IS ~.~Y ~ to ~e Building Department for the issuan~ of a Bufldin~ Pemlt pursuant ~o the Building ~ne Ordinance of the ~wn of S~thold, Suffolk ~ntT, New Y~k, and o~er appli~ble Laws, Ord~nees or ~gulat~ons, for the ~m~ion ~ build lngs, adOit~s o~ alt~ations, ~ f~ ~mval or dem~ lition, as h~ein descried. The applicant a~rees ~ eem ply with all applicable h~, ordi~nees, bufldin~ h.~sing e~e, a~fl re~lations. ......... .... ..................... (Slgnature ~ applkant, or nme ff a ~ration) (Address of applicant) \ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber orA builder ................ .B.u.i.]:d. e. r. ........................................................................... ~, Name .of ,owner of premises . .~.~.l~..aln...~rld..B. ~.~. ~.,a..E.]jl,~qqcl ............................................... .~1 IX applicant is a corporate, signature of duly authorize d officer. ~, (Name and title of eerporate officer) 1. Location of land on which proposed work will b e done. Map No... 2~.~,Q ......... Lot No .... 17. ....... Street and Number . ...G.i.n...~..n.c...aqd..l~.$.d~..ay. ....................... .Sp.~'c~o~,q ....................... Municipality 2. State existing use and occupancy ,of premises an d intended use and occupancy of proposed construction. ao Existing use and occupancy .................................................................... Intended use and occupancy ........ pI'j..v~.t~e. Iia~idence ......................................... ~'X 3. Nature of work (check which applicable): New Building . X ..... Addition ........ Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... 4. Estimated Cost ...$~7~lg~0D.,OO ................. Fee . .~.~. ~.~..~.~.. ...................................... (to be paid ~ fil~g this appli~tion) 5. If ,dwelling, number of dwelling units ...~ ] ..... Number of dwelling uni~ on each fl~ .............. U garage, number ~f cars ........ .~. ............................................................... 6. If busings, comm~cial ,~ mix~ occupancy, specify nature ~d extent of ea~ type of use .............. 7. Dimensions of existing structures, if any: Fr~,nt .............. Rear ............. Depth ............. Height ................ Number of Stories ........................................................ Dimensions of same structure with alterat~ns or additions: Front .............. Re~ ............... Dep~ ................ Height ................ Numb~ of S~es ..................... 8. Dimensions ,of entire new construction: F~nt .... ~ ........... Re~ ... ~ ......... Depth ...~ ....... HeiSt ... ~ ....... Number ~f S~ories ...... ~ ...................................................... 9. Si~ of ~ot: Front ...~ ......... Rear ..... ~0 ....... Depth ...... ~2~ ..... 10. Date of ~rchase ..... ~Y. ~ .~75 ............. Name of F~er Owner ...~]q~.~e~ .......... 11. Zone ~ use district in whi~ premises are situated ....... Re~ide~ ................................. 12. Does proposed co~mction vi~laSe any z,~ing law, ordin~ or regulati~? ..... ~Q...~L.~ .~ .,.~dn. · · . ~6 Do~l~s~ S** ~ ~n~-au~u 13. N~e of Owner.of premises . ~1~$~ ~WOOd... ~ddre~ig~ ~ .~.. J~.. Ph~e mo ........... Name of ~chitect ............................. ~ddress ...................... P~e No ............ Name ~ Con,actor .~.~P ............ Address . ~.Ha~e~ .......... Ph~e No. PLOT D~GR~ ~ate cle~ly and distinctly all buildings, whether exist~g ~r pro~s~, and indi~te ~l set-back dimensions from p~y lin~. Give s~eet ~d block number ~ des~pti~n acceding to de~, and sh~w s~eet nam~ and indica~ wh~er interi~ ,0r ~er ~t. STAT~ OF N~W YORK, )S.S. COUNTY OF ..~..i~.Q.I~. ...... ) ............. .W.T.I:!: .~I....h~...LI_~. ......................... being duly sworn, deposes and says that he is the appli- (Name of individu.al signing applicati~on) cant above named. He is the .............. .Cqn.~.r..a.e.~.o.r .................................................... (Oontractor, agent, o~porate officer, etc.) of said owner or owners, and is duly auth, vized to perf(~rm or have per~orrned the said w~rk and to make and file this applicat~.on; that all statements contained in th is applieati,on are true to the best of his knowledge and belief; .and that the ve~rk will be performed in the mann er set fortl~ in the application filed therewith. Sworn to befm~e me this ........ ~.b.17 ..... day of ...4~e ............. 19.72. N~rtary Public, . .,~~. .... C~unty (Signture of applicant) TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIC, E SOUTHOLD, N. Y. ........................................ , ]9 ........ Pemit No ..................................... Disapproved o/c ...................... ~ .................................. ~ APPLICATION FOR BUILDING PERMIT ~) 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, m 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. T APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to 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 ell applicable laws. ordinances, building code, housing code, and regulations, and to ad mit authorized inspectors on premises and in buildings for necessary inspections. ~' William Wells ~ (Signature of applicant, or name, if a corporation) Southold N .Y. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Owner - builder Name of owner of premises ....... Wm..W~,.l~s 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.: ........ .B...a..~h...a..v..e...n...~...S...o..u..t...h..o...1.d. Lot No...~ .... Street and Number .....~...a.~P,.Y.~.. l~,~.e..~c....MLd.~a.~: .............. ~4)u.t,h(~l~,.,~.v~.v ................................................ ~ ~_~ 67 Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: vacant land a. Existing use and occupancy .................................................................................................................................... ,~ b. Intended use and occupancy ............ ~ne~..£a-m.i.l.y..~,we~..1.t.n~ ........................................................ X' ........... ~ 3. Nature of work (check which applicable): New Building ....... ~ ........ Addition ..................... Alteration ............... Repair ......................... Removal . ........................ Demolition ........................ Other Work .................................... _ C~ ! Description) 1,. 10 ....................... 4. Estimated Cost ............................................... Pee .......................................................................... (to be paid on filing this application) 5. · If ~welling, number of dwelling units ...o/;~P- ....... Number of dwelling units on each floor ......................................... ..... If garage, number of cars ..... f;~o ................................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of usa ..................................... '-7~. Q.ime*nsions of existing structures, if any: Front ..................... Rear ........................... Depth ................................... Height,). ......................................................... Number of Stories ............................................................ ~ ................ Dimensions of same structure with alterations or additions: Front ................ .... . ..... Rear....... ................ ............ ...... Depth ............................................. Height ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front .......... ~ .......... Rear ......... ~ .............. Depth ..~..~...~,~ .............. Height ................................................. Number of Stories ........ D~ft .......................................................................... 9. Size of lot: Front ...................................... Rear .......................................... Depth .................................................. 10. Date of Purchasa ..................................... Name of Former Owner ............................................................................ 11. Zone or use district tn which prem sas are s tuated ........................... ~,.~,~..~ ................................................................. 12. Does proposad construction violate, any zoning law, ordinance or regulation: ....... ~a ................................................ 13. Will lot be regraded ...... ~..e~. ................... Will excess fill be removed from premisas: [ ] Yes [ ] No 14. Name of Owner of premisas ....W~.'I '1 ~ P,~...W~,IZ~. .......................... 8~u,t,~o,T~. ....................................................... (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor ............. ..s.~,e~ ............................................................................................................................ (Address) (Phone No.) PLOT DIAGRAM I. ocate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-beck 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. r^TE Or N;W YO.p ) COUNTY OF ............ . .~ZT~...,,~. ~....~T... ............... ) -- ...................................... ~...~.~......~....~.. being duly sworn, deposes and says that he is the appli~nt above na~d. (Name of individ~ $i~ing conffact) ( Con~cto~, a~nt. co~mte offlcec etc.} of said owner or owners, and is duly authorized to ~rform or have ~or~d the said work and to make and file this appli~tion; that all state~n~ contained in this application are true to t~ ~st of his knowled~ and ~lief; and that the work ~11 ~ ~Hor~ in the ~nner ~t forth in the ap~i~tion filed therewith. JUDI~ ~. BOKEN ............................ o, .............. . .............................. t /;~,s-. ~{'~ /x"//ZD [/v/,~ V' ~0'~ ~ ~ ~ ~ S~CT~ON 7209 C[ DIE FEW YC~K Lo'r /7 G '~ 0 ~ · ,. ~l /60' ' ~ ,~. ~2 '0~ Z'9 '" ~, ~ I~0 ~ .... . ~' 14. 4! - EL WOOD Tho sewage d~spesal ~nd water supply f¢-,'~tleS for this location have been ~r~pected by this department and found . .~. Chief of General Engine~r~ Servicea J~--~ FOI~IV~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISE~ COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL ' N? 5885 Z Permission is hereby granted to: ~ld a~ ome f~t~ ~well~g ..................................... ~..~..~..~...~..~ .......... ¢...~~ ................ ;; ~,,.::~, ...... p~rs~on~ to opplicotion dated ....................... Buildin~ inspotfor.~ ·