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Home My WebLink About5711-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerfi[icate O[ Occupancy No.. 5 .~6.i6 .. · Date ............ 0c.t.. 3.9 ....... , 19.7.3 THIS CERTIFIES that the building located at . 1~/.$. Pe.~om:[c..Z ay. l~l,~i.. Street Map No..xx ......... Block No. Z:x ....... Lot No... xz:~. Laur~..N,¥, ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... Feb. · · .1.?. ·., 19..?2 pursuant to which Building Permit No. 57.1 ]g.. dated ........ Pcb....].~ ..... , 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 . .Pr:t~,ate. ~ne..S-amit.y-~twel-ling. {~lth..add.~.tSe~.) ................... The certificate is issued to . .~;ar.y..~an~eL]. ..... 0~ner ............................. of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) · .N.go ............................. UNDERWRITERS CERTIFICATE No..~.,R.o ....................................... HOUSE NUMBER ...... 5~36~... Street . G~;, .l~eao,~ic. J]ay. 1~1~, ................ Building Inlpector FORM 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) 5711 Z to pursuant to application dated ............................ ./...Z........~..~....., ]9..~.....'~**, and approved by the Building Inspector. Building Inspector FOK~ 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 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 .... New Building ................ Addition ~ Old or Pre-existing Building / Vacant Land Location Of Property ......... .~.~,¢c,~.~.~,..C.. ~'~.~. ~ ~!..¥' ~ ..... ~ner Or ~ne~ Of Prope~y ~ ~ ~ ~ ~ 5 ~L u v,s on ..................... ..................................... ..... Permit No ..................... Date Of Permit .]~.~ ........... Applicant ..~.~ ........ ~.~.~.~.~.~; ................ Health Dept. Approval ........... ~.'.~.'. ................... Labor ~pt. Approval ............. ~.'...~. ..................... Unde~riters Approval ............. .~.'...~. .................... Planning B~rd Approval ...... ~.:.~ ..................... Request For Tempora~ Ce~ificate ........................................ Final Ce~ificate $ Fee Submitted .................................... Construction on above described building and permit meets all applicable codes and regulations. App,icant ................................... Sworn to before me this r'~ ~ ~( ...... .~.....~ day of .....~...!...~.....~...~... ....... (stamp or seal) ~4'/~ ~'~ [ Notary Public .................................... County ~ (,l/h TOWN OF SOUTHOLD ~/VC k/ ~cL~I~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~..e.br Ll.a:c~. ....... 12., ....... 19..~,~.. Application No ..... ~l~, .................. Approved ...........'.' .................. .". ........ , 19....."... Pemit No ..... 5.?.11..z ................. Disapproved a/c ,,,.,,,,,,,,w~w,,~,,~w . (B~lding Inspector) APPLICATION FOR BUILDING PERMIT Date / 7 /---~ 19Z..~. ,,,,, INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. 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 ofproperty must be drawn on the 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 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 hove 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, Ord nonces or..( R~gulations, 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. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... ................................... .................................................................................................................................... Name of owner of premises /'~J/~'~ ...~.., /~/V ~' ~'- L L. 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.: ........................................ Lot No ......................... Street and Number ,~..~. ~..~.. ..~:>....EA'7' _.'"P~'~.~..'.~... .-~...~.. y ~L ~ ~ ~ ~ ~ Munici~li~ 2. State existing use and ~cuponcy of premises and intended use and ~cu~ncy of pr~os~ c~stmcti~: a. ~isiting use a~ ~cupancy ~k- ~ ~/ Z ~ ~ ~L~ /N ~ D ........ b. Intended use and ......... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ................ ,.~..;;...;; ................................. 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 c~rs ............................................................................................................................................. 6. If business, commercial or mixed occupancy, speci~.f~/nature and extent of each type of use ......... 7......~,- ........ 7. D~menmons of ex~shng structures, ~f any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ............................................................ _. .................................................... Dimensions of same structure with alterations or additions: Front ................. ..~.~ ............. Rear ............................ Depth ............ ..?.?.. ............. Height ............................ Number of Stones ........ ..~'..~.. ................. 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ............................................................ : ....... .= ............................................. 9. Size of lot: Front ? ' - R, ~ ' ' '' ................. · ' .......... ear .................................... Depth .................. ~ ............ 10. Date of Purchase ........................................................ Name of Former ,Owner ...... ~ ................................................. 11. Zone or use district in which premises ore situated ..................................................................................................... 12. Does prOPosed construction violate any zoning law, ordinance or regulation.;> '~// I" ', ~ . 7,t .~4 >! ': / ~ ! ~ ": ~ ~- ~' ,:'/ · :3 '~ ~' '1~, .... i ~'~ 13. Name of Owner of premises ...... ;: ................................ /xaaress ............ r'~"-";r",'?_'_' ........... mane No ..... ......."...."/ Name of Architect ....................................................... Address ............................................ Phone No ..................... Name of Contractor ............................. 7. ..................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or prOPosed, ond indicate all ,set-lx~k dimensions fr~ef' ,~ properly lines. Give street ond block number or description according to deed, ond show street names and igdc~te~'~' whether nterior or comer lot ........................................... "~/' ,/ STATE OF NEW]yoIi~d / ! S c COUNTY OF '~..'..~1~.~.....~ ............ ~ '~ ................................................................................................. being duly sworn, deposes and says that he is the applicant' (Name of individual signing application! above named. He is the ......................... ;'. ........ :~ ....... ~.i.~ ........................................................................................................ (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 end file this application; that all statements contained in this application are true to the best of his knowledge and belief; and thru the work will be performed in the manner set forth in the application filed therewith. Swam to before me this ........................ day of ......... ,:. ........... ~.,~'..i .......... , 19.,.:....~ ,'4L):. b'~(/, ]~ ' ~ . ~ ............................................................... ~ ............................ Notaw Pubhc, ~,~'~.;~t. ............. .~- ........... ~.:._v..~L......: ....... County (Signature of applicant) No. 52-8125850, Suff0Jk