The URL can be used to link to this page

Home My WebLink About5697-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. CertiFicate OF Occupancy No. Z~2.~ ...... Date .......... Agr$3,... 2~ ..... , 19.~. THIS CERTIFIES that the building located at .. Nain. ltd .&. 01d. 0l, ohar~ ~reet Map No...XX ....... Block No. ~ ....... Lot No .... X~... ~tSt. Mal*io~..N,~Z,... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ,/~n ....¶2.., 19.~. pursuant to which Building Permit No. dated .......... g.~t ..... 12.., 19.~'1., 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 .. l~t'l-~alie. &oeesse~/- .l~t~.16~]~l · - (lleep-~tlS. ~'oom. onl)') · - ·: ......... The certificate is issued to C.o~ltnt~.lx~ .&. ~06¥1g..ZIF~OI ....... 0~1~[ ......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval I. oR, ............................... UNDERWRITERS CERTIFICATE No...N.e~e. .......................................... HOUSE NUMBER... ~O0 ..... Street...lcsail} -ROiI~ ....~0' 0~,.¢1- Ol'~lllll'~' ............... Building Inspector / TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5697 Z Permission is hereby granted to: at premises located at .........~,.~,~..,(L~L..~../~, ............................................... ............................................... ~o$..I~ ...... I1,~,, ..................................................................... pursuant to application dated ............................. ~'l~,t¥...dJ~ .............. , 19...,~., and approved by the Building Inspector. F~ $....i,0...0~ ........ BulldOg Inspector/ I~OEM NO. ~ TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, H. ¥. 11971 APPLICATION FOR CERTIFIGATE OF OCGUPANG¥ 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 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. New Building .................... Old or Pre-existing Building ~,.~,..T,~.,~.~;./.~ .~/... Vacant Land ............................ Location Of Property ~,,...~.[.,~......~...~ ...... .~,,(~,.,Q ...... ~,../~j~..JJ~.fl..'('~.~,......L.,...~. ....... ,~,~.....)..'[....(~/]./~.1~.1..0,...~ Owner Or ners Of roperty Subdivision ................................................................ Lot No ............. Block No ............. House No...~,..~,.~- C) Permit No ..................... Date Of Permit J..'t.L~,.'..~/.~Z.Applicont .i~.:.¢3.]x':.~'...c~....~....~..:~'.~.....~.'..0..~ ...... .~....~.. ~ v {9] Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ........ , ,.~. ~.'~'.. ~,~,, ,.¥... J,,~..1~(~.~:, .~,,. ,~. .............. Sworn to before me this 72-- day of ........... (stamp or seal) FORM NO. ~ TOWN OF SOUTHOLD Building Depmtment Town Clerk~ Offiee 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 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), Nc~-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. New Building .................... Old or Pre-existing Building .J~]¢..~..~..~.'.~..(~... Vacant Land ............................ Location Of Property /~1.1~....~..~) ......... ~.~.D......~)..~'~.C.~....~...~...~. ......... Owner Or Owners Of Property Subdivision ................................................................ Lot No ............. Block No ............. House No...~...~....9- O Permit No ..................... Date Of Permit .~..-...I.~,.C~.c~.Applicant ..G.~.~.~.~...~..~..~..L~..~.,~ ...... ..~..~...~..~.7..0.~.~ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets oil applicable codes and regulations. Applicant ..... ~. '~m~.L',.~..~ ....... ~.. ~-K'.......°...~. ...................... Sworn to before me this .... ......... (stamp or seal) I&AP OF AWl) ~ITtlATB EAST h\~V. IOH I'O\VN Of ~OUT~OLD, N.Y. 4o'= ~" ¢lFk ~ = IAOMI.IIAEHT - &UAE~HTE~D TO THE HOIA~ IITL[ DIYISIOH. HOETH FOKkL BAN;. AN;: TR. UST~Ot,,~AN~' '" '" ,-'..j- t " . L',r,E H 5 Er) LAHO SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Pemit No ................................... Disapproved a/c ................................................................... (Buddin~ Inspector) APPLICATION FOR BUILDING PERMIT TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Date ,,T~.~_ 1 2 19...?..~. ..... INSTRUCTIONS ~:~ ~ a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildir~, Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining prem ses or public streets Cl~ ~'~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this applicatior~/v 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 perml~ shall be kept on the premises available for inspection throughout the progress of 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. 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, os herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. ...... (S gnature or applicant, or name, if a corporation) .Q r~h~m~...L. ~ ~...Eas.t ...~'.:ar.l~ .................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................ Q~.~'....-....huJ. ld.e r. ...................................................... . ........ Name of owner of premises ..~.on-q~;~l'l.~.~l'~..&..~d~.~.. 7. e.l~v~)s ................................................................................. '~ If applicant is a corporate, signature of duly authorized officer. -~---~-_ L7~ ~ (Name and title of corporate officer) Location of land on which proposed work will be done. Map No.: .......... ~ .................Let N~x ........ :T~ ........... Street and Number ................ ......... ........................ State existing use and occupancy of premises and intended use and occupancy of propese~ construction: a. Exisiting use and occupancy ...... ~.-w..e.,~,~.;~3§...~..~-QZ3,e...~'~m'~ ].~.~..~3.zl~..a,e. ce~$~-...]~.i.l~.~3,~,% ........... b. Intended use and occupancy .~.~.~.;L~.~.~L~:~.t~.~-z..a.c~e~.s(~.~.~.~g.~.~.r~~ 3. Nature of work (check which applicable): New Building .................. Addition ....~ ...... Alteration .................. Repair - Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ........~.QO......+. ..................................... Fee ....... ~.0. A~.Q ....................................................................... (to be paid on filing this application) none 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 ........ .~.6 ................... Depth ....2.~ ........... Height Number of Stories one Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ....... 1.~ ...................... :. Rear ...1.6 ..................... Depth .....~ ............... Height .................... Number of Stories ............oZ~e ................................................................................................... 9. Size of lot: Front ....~.l.~.&.~ ............ Rear .......... .1.~..2..,.~. .............. Depth ........ .1..7.5.~[;..j~....1.92.6 10. Date of Purchase ........................................................ Name of Former Owner ..,~,..~];zCJ.D..~3]~.~'.~.i~ ............. 11. Zone or use district in which premises are situated .!!A~t.t...(~.8.~ ................................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation? ............. JP~D .......................................... 13. Name of Owner of premises .C~.ta~t,~te..Ze, lt.~dress ....... ,~..~..$..~.~.3~C1~ ......... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... same Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAAA Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether Interior or comer lot. See filed plot plsn. Addition to have one room with ~ 2ft X ~ft windows. no cooking facilities or kitchen STATE OF NEW YORK, t ¢ ~ COUNTY OF ...'~t~.f¢~lC ........... ~'~'~ Constantine Zervos · ................................................................................................. being duly sworn, deposes and soys that he is the applicant (Name of individual signing application) above named. He is the ........................... ~...9~.e..T.....~...~.~..~.e.~. ......................................................................................... (Contractor, agent, co~orate officer, etc.) of said owner or ~ners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; 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 fo~h in the applicati~ filed therewith. Swam to before me this ................... J.~ ~y of ............ ,...~..~...., 19.2.~.. ~ ~ / , , ~ ~ ~ f~ f~_ .~ ...~.~.~.,.~....~..~..~.~...~ Nota~ Public~~~Coun,~ - (Sig~tGre of ap~icant, ~0TARY PUBLIC, Stele of New Yore No. 52-8~25~5~, SuffolkCou~ou~_ Term Expires March 30, I