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Home My WebLink About6876-zNO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No.Z.6J3. ? ....... Date ........... 8.e~;.. ~0 ....... , 197.~.. THIS CERTIFIES that the building located at .~..~..1.o~..L.~. e..~..P~t....P~. ~ .... Street Map No.Na $ .sa.~.. P.°..~.tBlock No ........... Lot No ...... .C~..t.e..h.o..gu.e....N.:Y.: .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ .S?.p.t....~.~. .... , 19.?.~. pursuant to which Building Permit No.6.~{~Z... dated ......... .~.e.]~.t...~.~. .... , 197.~.., 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 .. ?.r~.~..t.,..o.~. ,..f..~..~.~..d.,.,.~.~..~. ~..,.~.t..h...~.. a.~.d.~..t.X.o.n. ................. The certificate is issued to . .1~...J.o..h~...H..a~.$e.~' .... . .0~1...e.~ ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N. :R.: ................................ UNDERWRITERS CERTIFICATE No..]~.n..d.~B. g .................................... HOUSE NUMBER ...2.~..~ ........ Street .... .S.a..i.l.o.r.s...L..a~.e. ....................... Building Inspector FO]F~I~ NO. Z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) 6876 Z Permission is hereby granted to: Geo~g~..~h~r~.. Jlu~.~de~... ~no....~/C.. Dr.~..,Toh~ Hal~=en to ~.....~...,...d.~..~..t..,...o.~....o.~...,.~.,..~....d..,..?~ ............................... [ ............................. at premises located at ..~j~;L~j.~`~..~L~.~T`~2~[[:.~.j;~.~:~d~)~.~..~.~.~.~...~..~..~..` ............................ pursuant to application dated ............... : ..... ~t~$,'""~'9 ............... , 19.~.3 .... and approved by the Building Inspector. Fee $.~ ~Ogt ........... Building Inspfor TOWN O~ $OUTHOI. D Building Depaffment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CEI~TIFICATE OF OCCUPANCY Instructions A Th~s opphcat~on must be filled ~n typewriter OR ~nk, and submitted in DUPLICATE to the Building Inspector w~th the follow~ng; for new butldmgs or new use. 1. Final survey of property with accurate location of ali buildings, property lines, streets, and unusual natural or topographic features 2 Final approval of Health Dept. of water supply and sewerage d~sposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters 4. Commercial buddings, Industrial buildings, Multiple Residences and s~milar buildings and installations, a certificate of Code comphonce from the Architect or Engineer responsible for the building. 5 Submit Planmng Board approval of completed site plan requirements where applicable B For ex~stmg buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1 Accurate survey of property showing all property hnes, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or prewous 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 formation required to prepare a certificate C. Fees' I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelhng or land use $5.00 3 Copy of certificate of occupancy $1 00 Da te .~..~ ~P .t, .~...m..b..e...r....2...0. ~.....]. ~.~ .4. .... New Building ................ Addition ....X.. .......... Old or Pre-exist~ng Building ................ Vacant Land .............. Location Of Property .~/..~..~..1.or s..~a~.e....(~..v.~....~..o.~rL)...H.~.r..'9..o..~.....C...o.~.,e ~.....~.~.9.~..u... ~...o..~...~..¢. .... Owner Or Owners Of Property .... ~ .... ~T.o.~l~,...~.~rk~q~ .......................................................................... Subdiwsion ............................................................ Lot No ............. Block No ............House No ............ Perm,t No .(~8.?.6~. ....... Date Of Permit .~.?~.~L./..~.~...Apphcant ~..e.9.~.~.e.....~..b....Z..?..~..s.....B..~..~..]:~..e.~.t.....~.?..?.:.. Health Dept Approvo~ ........ ~...' !~.: .................... Labor Dept Approvo~ .............. .~....:..(..~.. ................... Underwnters Approval .~....~.~...~...~.,./....~......~. ................ Planning Board Approval ......... ..~...:.....~...: ............... Request For Zemporary~e, rt~ficate .................................... F~nal Certificate ......................................... F ~u' tte~ ~ '-~ ee ~ Dm~ a ~ ................................... Construction on above described building and permit ~ets all applicable ,~o,~s and regulations. Sworn to before me this ......... Notary Pubhc ............. ,~.~~'. County (stamp or seal)~" ~[ '~,7 / / Examined Approved ........................................ , FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT 1 NSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wit~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing iocation of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, an~ 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 or~ 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 beer~, 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, Suffoik County, New York, and other applicable Laws, Ordinances or Regulations, 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, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) {Address of applicantl State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder~ Name of owner of premises ..~..~.~....%~.4~.)~....~'~ ............................................................................ If applicant is a corporate, signature of duly authorized officer. me and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ................. Z/Lot No Street and Number .,,~.~-~/~-,.~11:[~-,~...~...j...~~.,~/...~~...~ ~ ~ ~ ..... ~ r ~' ~ Municipal4ty 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy ..... ,..~...~.~~~__ ............................................................................................. a. b. Intended use and occupancy ...~ ............................................................................................ 3. N ture of work (check which applicable): New Building ....................... Addition ............ Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... { Description) 4. Estimated Cost ....z..j.6¢.~..~. ......................... Fee (to be paid on filing this application) 5. If dwelling, nuffiber of dwelling units .......l ....... Nurqber of dwelling units on each floor ..... ~. ................................ If garage, number of cars ....~, ........................... ~..; .................................................................................................... 6. If business commercial or mixed occup.anc,y, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structureS,, if. any.'..F~ron, t ..~.j~. ........... Rear ..... ..~....3.... ............ Depth ..,..'~Z¢,~/. ....................... 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 ..... ----~.~. ............. Rear ......... ~...(~...'" ........ Depth ..... ./. ~...~..~. ............ Height ......... ~..;. ................................. Number of Stories ........~. ............................................................................... 9. Size of lot: Front ...... .~..;~.~.0.~... ............. Rear ......... ..'~..;~.. ........................ Depth . .. ...'~. .. £.. .". ..'. . .s~:~.. .. .- ...................... Height .................................................... Number of Stories ...................................................................................... Date of Purchase ..................................... Name of Former Owner ............................................................................ 10. 11. 12. 13. 14. Zone or use district in which premises are situated ...... Does proposed construction violate any zoning law, ordinance or regulation: ......................................"~7 ............... Will lot be regraded --~.'.'.'.'.'.'.'.'~......~.. .......... ~... WiLl excess fill be removed_from premises: [ ] Yes [~1 No Name of Owner of premises ..z~..~,...~.~.~./~/~....~...~/~.~..~.....~.~ .................................. (Address) (Phone No.) Name of Architect ...... (Address) (Phone No.) Name of Contractor ~..~J~--.~...~-..~' ~:~ ~ L. ~..~..-~...../..&::~ ....... ...... ......... ............... (Address) 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 wheth- er interior or corner lot. STATE OF NEW YORK,t -- ) COUNTY 0~~'''~' ................ ~'. ............... ~. .................................................................. being duly sworn, deposes and says that he is the applicant abova named. He is tho ............................................. ~ ........ ~ ............................................................................................................................... [Contractor, a~nt, corporate o[ficer, etc. J of said owner or owners, and is duly authorized to ~rform or have ~rformed the said work and to make and ~ile this application; that all statements conta[ned in this application are true to t~ best of his kn0wled~ and ~lief; and that the work will be ~rformed in the ~nner set forth in the application filed therew;th. JUDITH T. ~O~EN ~ ~ ~ -- ~ ~fo~ Publtc, State of New ...................................... __ "'"~ ....... Tv'~"'""~ .................... cure,,ss,on ~p,r~a~. o~, ..~ ~[] V M(Si~mre of appli~t}