The URL can be used to link to this page

Home My WebLink About6011-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No...gl~... ....... Date ........... 8~%* ..... 8 .... , 19.~. THIS CERTIFIES that the building located at .XS~I~I. ~'$~. ~ ........ Street Map No..658 ........ Block No.. ~ ..... Lot No. '&38 .... (~l'oolapOl~ .. · I[,~, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ,Tlll,y...~.¶..., 19..~2 pursuant to which Building Permit No..~Ol~l.S · dated ........ ~Tgl~y...~.~ .... , 19.~l., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is 1~1~$~,~. OD~ .fl~llt,tllr. 51~to1~$11~. ....................................... The certificate is issued to .. It~Ol'f~ .~o. 13Lt~ ........ 0~®~ ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... ~,II, ............................ UNDERWRITERS CERTIFICATE No..~.,.l~ ............... . ............................. HOUSE NUMBER..~.0 ......... Street.. llla~l..V, iew. Lane ............................ Bttilding Inspector / FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 6011 Z Date ~'TL~.y 'J 3 19.....~.... Permission is hereby granted to: ....~ e~,e..~ .... ~li~ ........................................ .......... .t~ex..~. e~ .................................................... .......... Oz~eOZil~O~,~..ll.Z. ................................. to ...~,;L~...~...~d.¢~,.M, on..a~...ox~t~..d~.e~-~ng ............................................................. at premises located at ........ ~t..~.~....~,s.p..~,~;$ .... .PeeoF~Je..J&y..~,&t~t~el~ ........................ ........................ JljJ..j:~.:Lend,..¥.~e~..~,~,e ........... ~reetW;~'t.-...lt.6.¥t~ ........................................ pursuant to applicotion dated .................... ..d-~. .......... ?.~ ............ , 19..~.~.., and approved by the Building Inspector. Fee $. fJ.,~-6.O~. .......... THE NEW YORK BOARD OF FIRE UNDERWRITERS ?~%" BUREAU OF ELECTRICITY* ~ 85 JOHN STREET, NEW YORK. NEW yORK !O03~ THIS CERTIFIES THAT ~ly the e~t~c~ ~u~t ~ ~c~ ~ a~ i~t~ by t~ appli~nt ~ o~ the a~ ~pl~at~ num~r in t~ p~mises of in the following location; [~ement [] Ist FI. [] 2nd Fl. 01t t ,~ ~. d F~e~tlon Block Lot wa~ examined on October 7 ~1~7~1 andfoundtobeincompllancewiththerequirementsofthisBoard. FIXTURE OUTLETS ~ECEPTACLES SWITCHES iNCAt, iDE~CE DRYERS FURNACE MOTORS A,~T, K.W. O1[ H.P. ~A~ H.p. FUTURE APPLIANCE FEEDERS AMT, NO, A.W.G. RANGES SPECIAL REC'PT ICOOKING DECKS OVENS DISH WASHER TIMECLOCK!I BE UNITHEATERS MULTkOUTLE ~T. ,~wPS. . H.P. NO. OF FEET SERVICE DISCONNECT NO. OF ~U~T METER ~1~°° Ic~ I I Ix I I I OTHER APPARATUS: R V I EXHAUST FAN: DIMMERS C .o. o~ cckco.o. ^. w. o, OF CC. COND. a/o NO. OF HI-LEG Peter Bo~ov~e Hain Rd. Southold,L.I. 1].~71 11 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FO~M NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, H. ¥, 1~971 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 o~ 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-exis~ng or land use 3. copy o, certi,ica,e o, occ.pancy ~ate ... ~.~.~.~ N~w Buildino ..........w ....... Old or ~r?~xi~tln~ Buildin~ ....... ~ ............ V~con~ ~nd ............................ L~ation Of Pr~eg/~./~.......~.....~....~.~.~...~.~. ........................... ~ner Or ~ners Of Prope~ ....~.~.....~,..~/~.~ ............................................................................. s,~,~, ...~.~.~.~. .............................. ~ ~.. ~3.2.. m~ ~ ............. ~.us~ ~ ............. Heolt~ ~pt. AppraYol ............................................ LQ~or ~pt. Ap~ra~QJ ................................................ Underwrite~ Approvol .............................................. PlQnfli~g B~rd ~praYol ........................................ Request For Tempara~ Ce~ificote ........................................ Fi~oJ Ce~ificote ...... ~ ...................... Fee Su~i~od $ ..~J.~.~ ...................... Construction on above described building and perm~_a)l ~~s and regulati~s. ~p,~..~ ....................................................................... ,o,, .............. lrOR~ NO. 6 TOWN OF SOUTNOLD BuJJding Department Town Cterks 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 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 P~anning 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. A, ccurate survey aT 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 .................... Old or Pre-existing Building ...... ...~... ................. Vacant Land ............................ Owner Or Owners Of Property ............. .' ............................................................................................ Subdivision 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/g~rmit mee~s~ll/~pplicable codes and regulations. ~ ~ Applicant ........................................................................ ................ day of ....:.~......~ ..... ~ (stamg or seal) ,,O ~ /, ~' ] (-" Notary Public ....... /..~.....~...~ ..V~..., ........ County N ot~ ry pF,~.C~ teN Uo fC t~ ew York. No. ~4-~9] 5330 Qualified in Kin§s County Certificate filed in New York COU~_ Cornt~ission Expires March FORM NO. 1 TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ,9..:! .... Peru, ....... Disapproved o/cT__ Z- ........ ....... ........................ (~ilding Inspector) APPLICATION FOR BUILDING PERMIT Date ................... ./.~.../. / ........, 19..".-~.....",~:'.. / 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. 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. 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 o~ buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicabte lawson_ ordinances, building code, housing code, and regulations, and to admit authorized inspectors on p~remises and in buildings for necessary inspections.~' - (S if a corporation) State,~ ..whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· Name of owner of premises ..... ~/,E.~.4~...~...;..../'_~...../.C~.. 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. ~.,~..~., Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........... ~....~.!.~...~. ...................................................... (/ // b. intended use and occupancy .................................................................................................................................. 3. Nature of work'check which applicable): New Building ....................... Addition ....... ~ ...... A)t~ratiort, .............. Repa r . Removal ......................... Demolitign ........................ Other Work .................................... ,~, ~- ~ ,,~ I Description) 4. Estimated Cost ..~....~'),~. ............................... ~0 Fee ..~-E..../.3 ....................................................................................... (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 ....... _2:~../ ....... 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 ......... ./..o. ............ Rear ........ ./...O. ............... Depth ..../......>~.. ..................... Height ................................................. Number of Stories ..........~ .................................................................... 9. Size of lot: Front ...~,~....~ ...... Rear .......................................... Depth .................................................. 10. Date of Purchase .//3~,V,4.&..~....~.. ....... Name of Former Owner .../....c~. ~ 1 1. Zone or use district in which premises are situated ...../b-/,~t:~f, zM:....~......t~.../ 12. Does proposed construction violate any zoning law, ordinance or regulation: .......A~....~.. ............................................... 13. Will lot be regraded ~J~___._O- ......... ~-~ ~ -~, J ~.,o/~ ............ ~,~. Will excess fill be removed from ~emises:J~' ~-,~[ ] Yes [ ~]-~No iv 14. Name of Owner of premises ...~Z~.6~.....':~/.,../..~..L.~......]~..~..~,,~a~...,..~.~ ...... ~,4~...~..~.,(~../....1~/....~t~.~22! ~' ~' {/ J (Address) / (Phone ~lo.~ Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor ..... ; ............................................................................................................................................. (Address) (Phone No.) PLOT DIAGRAM I. ocate clearly and distinctly a(I 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. STATE OF NEW YORK, -n ,/ ! ) COUNTY OF ...~.):L~.....~ ............ ) .................. .E....~.~... . .~.....-~.. ............................................. being duly sworn, deposes and says that he is the applicant above named. ~Name of individual signing contract) He is the ....~)~ ....................................................................................................................................................................................... {Contractor, agent, corporate officer, etc. of said owner or owners, and is duly authorized to perform or have p~'~i~rrned the said work and to make and file this application; that all statements contained in this application are true to the best ~d~,~a~oelief; and that the work will be performed in the manner set forth in the application filed therewi~ Notary Pubt~c~5$30' ["1' No. ~ ~ Qualified. [~_-~r~ork .......... ............. da¥of ............ ~ V(Sl~gnKtdre of applicant}