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Home My WebLink About5753-z FORM ~0. TOWN OF $OUTflOLD BUILmNG TOWN CLERK'S OFFIC:E,~ SOUTHOLD, N. Y. BUILDING PEI~MIT (THIS PERMIT MUST BE KEPT ON THE PREMIsEs UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ............. ... (~.~t,'?,~Y~a',,~.... ,~,, L ......... :. ......... to ...~....$.~,e...~..~.a..~.~..~% ~.t..~.~.~g..~:~,:L~.,:~ ........................................................... et premises located at .............. ~,~'"~'~L~'~'.~J~"~;~'~('"~'~;~"~'~r ............................................... ........................................ ,~e~ ..~u~.~.~:U~ .......... ~.,¥, ............... , .......................................................... pursuon¢ to application dated ............................ ~*~C~ ....... .~i;..--., 19.~.~,.., and approved by the Building inspector. Fee $......'~.,~., 0~1 ...... [ ~' Buildi~j~'lnspect~r / FORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificste Of Occupancy THIS CERTIFIES that the building located at . ~/~ .New..,~lff: ..lk. ~oad. ~ L~;lreet Map No. ~;x Block No. Xx .Lot No. ~ New ~llffo~k l,~,~ conforms substantially to the Application for Building Pea'mit heretofore filed in this office dated ....... }~ ... 18 , 19.'~.2. pursuant to which Building Permit No. dated ............. i9a;¢.... 2.0., 197f2.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .~.,~., .............................. UNDERWRITERS CERTIFICATE No..p.~.rt.d:~pg ........... ! ............................ }IOUS[~ NUMI3ER....lt:600 ..... Street..~e'4. ,c'~tlff.o2k .I}~).~.~. ............................ Building Inspector / FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Yo 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Inspector with the following; for new buildings or new use: 1. Building Final survey of property with accurate location of all 6~uildings, 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 Undterwriters. 4. Commercial buildings, Industrial buildings, Multiple Regidences and similar buildings and installations, a certificate of Code compliance from thelArchitect Or Engineer responsible for the building, i 5. Submit Planning Board approval of completed site plan irequirements where applicable. B. For existing buildings (prior to April 1957), Non-conformingu~Ses,~ or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, sfreets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, o.~cupancy 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 ........ ~.,.... ........... ~a~;ant Land Location Of Property ....).q.~f....~...~..~:.~i.~.q~,~..~..~.~/(,~...A....~..:.c~...~ .................... -'~ ~c,q' ~ ,~, '-~/(/ .......................................................... . Owner Or Owners Of Property ..... ~.~.....~-.....~.: Subdivision .......... ~,. .................................................... LotNo ........... .. Bl~ck Not ..... ;5 ..... House No ............. Perm.t No...~....~.....,J~.... Date Of Perm,t ~,~.,...' .~....Apphcant .~~...~~ 7.~.. L .-. ............. Health Dept. Approval ................. '~. .......................... Labor Dept. Approval Underwriters Approval .............................................. Planning Boa~d Approval ........................................ Request For Temporory Certificote ........................................ ine iCertificate'. .......................... Fee Submitted $ ....~...~.~L...~....q~.. ................. Construction on above described building and permit meets all adplicable codes and regulations. Applicant ......~~..,..~z'. ~, .~...,.~.-...¢z~.....~. ........................................ Sworn to before me (A~is .......... do,, of ......... or .otary ub,,c .................................... Co.nt ~0~ NO. 6 TOWN OF SOUTHOLD Building Depaztment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF ~CCUPANCY 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 us~,: 1. Final survey of property with accurate location of all ~uildings, p~operty lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal--IS-9 form or equal). 3. Approval of electrical installation from Board of Fire Und~erwriters. ' 4. Commercial buildings, Industrial buildings, Multiple Re}sidences and similar buildings and installations, a certificate of Code compliance from thei,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 u~es, 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, o¢,cupancy 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 '~- Loeat'on of Property ...... ..... Owner Or Owners Of Property ..... ..-M-....~.rr.~er~,..,.,,Z.~z_~,~,c-~c.:~. .......................................................... Subd~ws~on ................................................................ Lot No ........... ~. Block o ............ House No ............. Permit No ......... Date Of Permi ~. ..ZApplicont .. ~. ..] .......... Health Dept. Approval .................... ;..~ .................... Labor Dept. A~pproval Underwriters Approval ........... ~ .............................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ..................................... Fee Submitted $ ,,~,,'.,,~>~,. .................... Construction on above described building and per,it meets all c~ Applicant ......... ~'./'~-" :~.....~ Sworn to before me this ................ day of ............................................ Notary Public .................................... County ~licable codes and regulations. (stamp or seal) FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z.~2..2~ ...... Date .............~l:~e.. 2~I: ...... , 19 THIS CERTIFIES that the building located at . ;4/a .l~e~r..8utf.~lk. R~aa. (~lreet Map No..~. ....... Block No .... ~ .....Lot No. ~ ~ew S~fo~ conforms substantially to the Application for Building Permit heretofore filed in this office dated ..........~;ar ..... 1~., 19.7~. pursuant to which Building Permit No. dated .............~r.... ~, 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 .~i~a~e..~e. f~IlY..dwe~g ....................................... The certificate is issued to .~e.~. ~$~d~9~ .~. ~gg~ .... ~er~. ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .~ ~R.* .............................. UNWaWa T aS No..pen ing ........................................ ttOUSE NUMBER,.. ~6~ .....Street..~0~. ~.~rOl~ .~Oa~ ............................ Building Inspector FORM NO. 2 TOWN O~ SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. BUILDING PEIIMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5753 Z Permission is hereby granted to: ............... C....~o~k~..~/c..~.~t~..~e~ ]iu~d ~n add~t$o~ ~n ,..~..~stf~.~E dve~.~.~ at premises located at .............. J~reit'~l~:r.~k"t:,~l~"~'"~th"i~t,'~ ............................................... ........................................ lle~..au,fSe.ll[ .......... 1,,I...~.. .......................................................................... pursuant to application dated ............................ ~.J'.(JJl ....... .~JJ ....... , 19.~'~..., and approved by the Building Inspector. Fee $......'J.~J. eOi~J ...... 'Vr FORM I~'0. 6 TOWN OF $OUTHOLD 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 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, an6 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 ........ ..~. ................. V~:ant Land ............................ ........................ c/(/ Owner Or Owners Of Property ..... ~.....~i ........................................................... Subdivision ................................................................ Lot No ............. BLock No ...... ~ ..... House No ............. Permit No...~-..."~..~.~.... Date Of Permit ~....2~../~...~'.Applicant .~...~ ..~...m: ............ 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. Sworn to before me ~_s ,~,~ ~=~ I .......... ...~... day of ~.../...~..?..~. ......... (stamp or seal) ,/~7~'~Z~ Notary Pub,,c .................................... County FOI~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. Application N ................................ 7" APPLICATION FOR BUILDING PERMIT ate ............. , INSTRUCTIONS o. 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 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 a~terations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature of applicant, or name, if a corporation) .......... ................................... [~kddress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..~..~...~..~.....~...~ ................. ~- If applicant is a corporate, signature of duly authorized officer. Street and Number ....~o,~s.~...~_.~..~r~ .................... ~....~..-. ...................... ~ (J~ ~ V 0 MunicilibaJty -- 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ....... ~...~...,~ .............................................................. b. .ntended use and occupancy ......... I.~.~ ~.. ft/4.'~,,-~ ............ 3. Nature of work (check which applicable): New Building .................. Addition ....~ .........Alteration .....;..:.....~.. Repair .................. Re,~.n. oval .................. Demolition .................. Other Work (Describe) 4. Estimated Cost ............ ~r~...~ ................................ Fee ........... ~. ~ ~. ~ ............................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... .-t.. ................ 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 t~pe of use ......~. ....... .~ ............ 7. Dimensions of existing structures, if any: Front ........~...,~ ............ Rear .....~)..,~.. ................... Depth ...~.....(~ ........... Height .....:~,.~../. ........ Number of Stories .......... .I......~.,~....-?. ....................................................................................... 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 Star es ~ ..................................... t C~~ ~ ................ 9. Size of lot: Front ........~:~..O. ........... Rear ........ ..~. ....................... Depth .L.~...~..-...~..O.2 .... 10. Date of Purchase ...... L.,~,..~..~' .................................. Name of Former Owner .~.,..~...,..~ ...... ~ 1. Zone or use district in which premises are situated ...~-~...~ ........................................................" -- ]2. Does proposed construction violate any zoning law, ordinance or regulation? ....... ,..l~....'~.......,,'~, .................................... 13. Name of Owner of premises ~. '~Add ress ....~......~M... ~ ........ Phone No.~.;~ ..y..:..~.~. ~. :i-- Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .~...~.~~.....Address .~..~...~.1..~...~..~..~.. Phone No.l.,~..~..'-..~..~l.~1 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 whether interior or comer lot. I · 0! STATE OF S S .............. ~-.~.,~-~[,~....~~,,~ ......................... being duly sworn, deposes and says that he is the applicant (Name of individual signing applicatian) above named. He is the ......................................................................... ~...~ ........................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, 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 application filed therewith. Swam to ~fore me this