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Home My WebLink About5761-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at 8~. M&~. 11o~4 ............ Street Map No. ~ ........ Block No .... ~...Lot No. ~.. C~t,O~Oglto .... 11,~! ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... M~,~... 2d~.., 19. ~ pursuant to which Building Permit No..~?~. dated .......... 14ar...23 ..... , 19..~r2, 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 .. fl..fro ............................. UNDERWRITERS CERTIFICATE No ..... 1~'..~.65] 0 ..................................... Building Inspector / FORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerlificate Of Occupancy No. ~.. ~.~.~ ..... Date ............ :Oat ....l0 ...... , 19..~ THIS CERTIFIES that the building located at ...8~ .l~$n .l~o~! ......... Street Map No.. ~ ........ Block No... ~ ..... Lot No...~.. 8~tOi~Og~. · .ll.]~. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... 14~,.. 2-3 .., 19..~ pursuant to which Building Permit No..~76.~. dated .......... .14a.r.,...~...., 19.7.2.., 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~$nes~ .aeces sel~..b~-~.~d.~ng .... (.1,ear..of. ~$n. b~ ld.ing) ..... The certificate is issued to . li.~.r .l~...I:~...$.1.]..~. ....... . .0~..e.~. .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....N ,[t, ............................ UNDERWRITERS CERTIFICATE No. ~[ .~. 6~.~.0 ......................................... [-lOUSE NUMBER..-2~'00 .... Street... [18.q~n. ~ ................................... Building Inspector 7 FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5760 'Z Date .......................... JJEl~l~.:..... ~ ...., 19J1~... Permission is hereby granted to: at premises ocated at · ..J/IJ...*IJ~J~I~..~IIB~ .............................................................................. pursuant to application dated ......................... Building Inspector, Fee $.Z~,JJ~ .......... Building 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) N? 5761 Z Permission is hereby granted to: at premises located at ........... ]~IIIL~.....]~rG~:L~II~;~..JlIEI:L~J,~I~..(...~I~IMI~..]IaB~ .......... pursuant to application dated .......................... ..~...11'......~ ............ , 1{11~....., and approved'~ the Building Inspector. Fee $..~. ~..'~ ........... Building Inspector FORM NO. S 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 tqq1~ate 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 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 /// Old or Pre-existing Building ............................ Vacant Land Location Of Property ....... ..~./..5........~..~/..~......~o.?..c/(......~....~,...~.~...~.~.~..~..~ ........................................................... Pro e /'/,1~ r~ .~..~..,~. I1'~"'~. Owner Or Owners Of p rty ...................... ~ ............................... : ............................................................. Subdivision ............ ..x:...x....~.. ........................................ Lot No....~...~'...... Block No....~....~..... House Permit No....~.*?.~../..z. ...... Date Of Permit ..J?..~.~/.7...~......Applicant ./::./..~. ~ '~ ~'~ ''~ "//' Health Dept. Approval ........./~..:..~.. ........................... Labor Dept. Approval ................................................ Underwriters Approval ..... ~...~.~...~.../..~.. .................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described buildin~~lica~nd regulations. Sworn to before me this Applicant ~~-~..~ ..................................................... .... ~..'~...... do~y~of .....~.....~.~.O.~..~..~...~.~...., ~ C~r~ , ~,~o\~: (stamp or seal) ~/,~c~t(,~' Notary Public',,.~_~_:__.~--~.~__..~-,~,~R_. County TERRI LEE ELAK NOTARY PUBLIC, State of New York No. 52-6168295 Oualified in Suffolk County Comrn[ssion Expires March 30, 19 FORM NO. 6 TOWN OF SOUTHOLD Building Delmrfment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY I nstructJons 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 disposol--(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 19§?), 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 ............................ Vacant Land ............................ Location Of Property ..... .~'.~.'t.~ ....... .~.:.~..<. .......... ..~...~.~..~....~¥.~...~'.,......~....'~...-~.~;~.?.?.~...~. ....................................... Owner Or Owners Of Property ........... ./~../?...~...~..~.......8.~...."?.:i./.(.°........~.~.: .......................................................... Subdivision ............ ~.~.x. ............................................. Lot No...?..~.... Block No...~..x...~... House No.~..~...~..~..~ ~'7~ ,~ ,z ~.~ / Permit No...~.;Z~/....z. ...... Date Of Permit ?./..'~..~Z.7...~......Applicant //~.. F'~,'/ 0 Health Dept. Approval ........ .~..'....~.. ......................... Labor Dept. Approval ................................................ Underwriters Approval ,~! ~/~ ~/O ...... ~ ..................................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building~/~ ~r_~mit meet~~le~and regulations. Sworn to before me this ~ ' ~/~/~ .../..~...~.... da~c~f .(~..~x. ~.~,.~..~....~..~..~.. ...... (stamp or seal) Notary PublicX-~&~~.. County TERRI LEE ELAK NOTARY PUBLIC, StaLe of blew York No. 52-6168295 Qualified in Suffolk County Commission Expires March 30, 1~ '~ ............ -- m .... _t_.,LL_L_U t A TOWN OF SOUTHOLD -, ~ BUILDING DEPARTMENT~ ~ TOWN CLERK'S OFFICE i ~' SOUTHOLD, N. Y. Application No. ~'"~/'/ ~" (Building InspectS) ~,a APPLICATION FOR BUILDING PERMIT ~ Date ......~-.. '/.....~.~ .~..~......~.. ............. 19. . INSTRUCTIONS o. This opplicotion must be completely filled in by typewriter or in ink ond submitted in duplicote 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 c. ]'he work covered by this application may not be commenced befor~ issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue ~ Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the prog?ess 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 iYork, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or ~or removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances, buil~ii~Tg code, housing co~, ~nd regulations. "'""~"i~i~nVatu?e~plic(~ft, or, name, if a corpo~iJg~i ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generbl contractor, electrician, plumber or builder. ............................. Name of owner of premises ................................................. ~ ......................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. kocotion of Iond on which proposed work will be done. Map No.: ...~ ............................. Lot No ................. Street and Number .... :~/..,,~/..4'//......~.~..~r,. ................................ ~ ........................... ...................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .~/.~....~.~..~.../.....~..~.~....~.. ...... . .............. b. Intended use and occupancy ......"~ "/ ./..~.....~....&.'.Z....~...~..ff...~'.........~..-'. .................... ~j3. "Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. ~' ~,.- -'~-Rem°val .................. 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 cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .~..~..5.(...~...~...b'.~ ...... 7. Dimensions of existing structures, jf any: Front Rear Depth Height ........................ Number of Stories '~ Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ........... ; .................... Height ............. : .............. Numbe~r of Stories ................................ 8. D mensions of entire new construct on Front .,..~ ..~.... - Rear ................. Depth .....'~......~.. ......... Height .................... Number o_,f Stories ..... .,.....~.....~.,.:~ ............................................................... 9. S.ze of lot: Front ....../.~..~..5.. ....... Rear'~'--"''..~'.~....~..?_~." ............... Depth ..~..~...~......~..,..~..:.....~...o~--- -- -- t""' '~,',~'~'"", 10. Date of Purchase ........................................................ Name of Former Owner .................................................... 11. Zone or use district in which premises are situaled ....................................................................................... ~ ,~/~9 ' 12. Does proposed construction viola, re env zoning law, ordinance or regulation ...................................................... j.. 13. Name of Owner of prem ses~..~..~........~.....~.../..~...~.~. Address.~.....~'/..."~.....f.~....~'...~...~'~-'"... PhoneNo,'~'--~f/-,,~f/~-~-~ Name oF Architect,~_~,~,~, ~--~''~ ......... · ,- ~.~,,,~i"'J~ ................... Address i~....i~..~..i~iiiiiiiiiii Phone No ..................... Name of Contrac~,........-- ................... 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 whether interior or corner lot. STATE OF NEW YORK, tc ~ ............................................................................................. g duly sworn, deposes and says that he is the applicant (Na~c]~'individual signing application) 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 make 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 forth in the application' filed therewith. ~) ~ Sworn to before me this ~ /' ~ i/,,?/~ ~ JUDITH T. BOKEN / / ' ' No. 52~0344963 Suffolk Cou~ P~UILDI~ .4. :/