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Home My WebLink About5902-zFOB,~ NO. 4 TOWN OF SOUTHOLD BUII,I)ING DEPARTM~,NT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.t... Z~.{~br~.. Date ............. Apr~....~...., 19F. I~. THIS CERTIFIES ~at ~e b~dMg locat~ at ~8.. Ne~. ~ .~ ... SMeet Map No..~ ........ Block No .... ~ .... Lot No.. ~....Cutoho~...N,X, ....... confoms subs~g~ly !~ the Application for B~ld~g Pemit h~etofore filed ~ tbls office ..... .... .......... , 19 .... p~u~t ~ whxch Bml~ng Pemt No..6~ dated .. 7~/''~', ..~ ....... 72 . .... , 19 .... , was issued, ~d confoms to ~ of the req~ men~ of the applicable pro,ions of the law. The occup~cy for w~ch this ce~fica~ ~ issued is PrinCe. ~e. f~llY..~l~ .~. a~dl$io~..&. ~ev. ~eS~.Q~. h~ll~g The certificate is issUed to ~a~. ~.*..~.... ~ ........................ (o~er, lessee or ten~t) of the afores~d b~d~g. S~olk Co~ty Dep~ment of He~ Approval ..~?~ ~ ............................. UNDER~ITERS CERTIFICA~ No..[. ~ ~292 .... ~ec...20...1.97~ ........... "' HOUSE ~MBER . ~ ....... Street ~ ~fo~ Ave Building Inspector/ FO~.,M NO. · TOWN OF $OIJTHOLD 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? 5902 Z Permission is hereby granted to: ....... at premises located at .............. ~l~..J~l~',~e~..A'~l~ ......................................................................... ................................................................. (~atahal~ ....... Il,Z, ......................................................... pursuant to application dated ................................ J~l~. ......... ..~...., 19...~., and approved by the Building Inspector. Fee $.~ ~e,l~. .......... Building Inspect~ r~ FOI~M NO. $ TOWN OF $OUTHOLD Building Depoffment 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 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 .......].¢..O..~.. :...... ~..6.. ,.,..'1. ~.~.,~ ........ New Building ................ Addition ..~.~ ....... ...~rOld or Pre-existing Building ................ Vacant Land .............. Location Of Property .... ~./.~..~.~..~.L1~'~D~.~..;~.V.~ .......... ~fi~D~ .................................................... Owner Or Owners Of Property .....].{.~..~..Z.?..~...~.::,~...!./.~..Z.~..~..~...s ..................................................................... Subdivision ............ ..~.?.. .............................................. Lot No.......~...... Brock No..~...~. ....... House No....]...0.~.,~. oO Z ~'/2k-/72 . Permit No. ....... Date Of Perm,, Z/.~.../.~...2......Applicant .?..e..o....~..o..~.~.~.~...o. ....................................... · ~. E .~. .~. ................................ Labor Dept. Approval ................................................ Health Dept. Approval ...1.~.}~ 2 ~ 9- Underwriters Approval .... .L~..~...~.3..I ........................ Planning Board Approval ...~..'.~...*. ........................... Request For Temporary Certificate ........................................ Final Certificate ...~ ............................. Fee Submitted $ ~.,...0..0.. .......................... Construction on above descrlbed building and P,.~,~i~/r/r~et~ll ~)~.~)~/. ?lo codes and//.///. '~ regulations. Sworn to before me this / ....... ~..,~.. day of ..~,,.o.y.~.~.~..e.~...J.~.~ .......... (stamp or seal) 7 No' Public ,~,~,~"~,/~4"- County JUDITH T BOKEN York ~'7/~/ THE NEW YORK BOARD OF FIRE UNDERWRITERS I--- CE BUREAU OF ELECTRICITY. ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CE~IFIES THAT o~y t~ ~t~ ~ulp~t ~ ~seH~ ~ ~ int~ ~ t~ ~f~ant ~ 0~ t~ a~ ~pi~n ~um~r in t~ p~ o~ Had~e~ ~a~z, ~/~ ~e~ ~u~fo~ ~ve. ~00'~ e/o ~o~n w~ e~ami~ on a~ found to be in ~mplia~e ~it~ t~e requirementS of th~ Board. RX~RE ] I I - RXTURES [ RANOES [C~KING ~KS OVENS ~SH WASHERS EXHAUST FANS DRYERS I ~RNACE MOTORS [ ~'UR' A~I~E ~E.,S IS"~*''C"I "Mm CLX' I ,~ ~ '~I~~' DI~ERS ~R~ ~NN~T I ~' OF I S E R V I C E OTHER APPARATUS: Water heater/~; 1-4.Skw ~- po~t light. W.B. Ruland Matt ituck, L.I. Per ~ COPY FOR THIS COPY OF CtKitrlCATE MUST NOT BE ALTERED IN ANY MANNER. I~,RM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Dote ................................................ , 19 ............ a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, witl~ 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, al~j~ 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 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. L' granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zon/~ 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. .............. ........................ (Adv~ress of applicant) State whether applicant is owner, lessee,,agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................. .1~...c5,... ~ .~...~..-~.. ........................................................... , ....................................... Name of owner of premises .../t~;...o~..~.~L¢_~.~ ....... ~..,.......~...~..c,4~.~../,,~ .......... '...~..z.~.l..4.o,,.~.~ ................................ if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) · 0~-' ~' LotNo ~'~ 1. Location of land on which propose.d, work will be done. Map No.: ..~,.~.. ...................................................... St.--t .-d N_.,.be ......~.. ............................. ~.. ...... ]~.....~t~ .......... ! ....................... .~. ...................... ': ...... .e.¢,..,.~. .......... ~unicipadty 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: I - ...... a. Existing use and occupancy ................................... =~ .......................................... b. Intended use and occupancy ........................ .~....o,, .y~ ........ ..~ ...... ~.~ ..................................................................... 3: Nai~re of work (check which applicable): New Building ....................... Addition ..~. ........ Alteration ........ ~. .... Repair ............. · ............ Removal .......................... Demolition ........................ Other Work ............................... ~.,..~ ~ _ (Description) 4. Estimated Cost ...~./..~,..Q.?. ............................ 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 .....~....~..~.../. .......... Depth ....~.~.../. .................... Height ............. ~.~...~. ................................... Number of Stories ...... ~..~. .............................................................. Dimensions of same structure with alterations or additions: Front ....~7..~.. .............. Rear ..2~.. .............................. ......................................... Stories .../.:.~, ............................. Depth ............ .~..~.. ......................... Height Number of 8. Dimensions of entire new construction: Front ..... ~'..../. ....... Rear ....~.~'..../. ........... Depth ...~...~.,.f.. ................... Height ............. 1./....~ ........................ Number of Stories ..... ./ ................................................................................ g. Size of lot: Front ......~..~...~ ..................... Rear ...... ~.0...~....-. .................. Deptl~..~.~..c~-...==...~.~...s~, ................. 10. Date of Purchase ........ ~...~.~...~. .............. Name of Former Owner ........... ~..~....~..~...~.. ................................................ 11. Zone or use district in which premises are situated ....J~.~.~!...~.~. ~...~..~.L. ..................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..J..~..C~ ................................................ 13. Will lot be regraded , J~L~.. ......................... Will excess fill be removed from premises: [, ]r_Yes_,_ [~1~o 14. Name of Owner of premises ..... ~-~..~..~..~.~.~.....~,......~..)5.C~....~..~...,...~...LJ.[~;~ ..... ..~.~..~ ......................... ~. _ ~ ~ _ -[Address) ~, , ~, ~,, . (Pho~ne No.) Name of Architect ........ ~c%~e~j~L~[3~L~j/~`q~[~?~qk~~ ............... ,~ ,3 , ~ . ~ (Addre~)' _ ( o I~) Name of Contractor ...~..~.?.,~..~.~.Tzn.w ....... .~,l...~t.?.~..~f,~.~. ............. ~...~..~..:,~J.;~,.~...~. ............................ ! ' (Address) ~Phone No.) 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. ................ · .~.,,°.~,.e...~9..~..~.~..l~. .............. being duly sworn, deposes and says that he is the applicant above named. (Name o/individual signing contract] He is the .................... ,.B~...5...i.q..e..~. ............................................................................................................................................................................. {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 applicafion~ that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith.