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Home My WebLink About7016-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z13424 No .................. Date . .~.~.:g. ~ .......................... 19 .8.5. THIS CERTIFIES that the building..A. 9 9 .e ?. ~. .o .r y. ............................ Location of ~roperty ...... ~ ~.0~...~.~.~.V..L~.K .~..R.S.V.p. .............. .~A~.T .A%qc.~. ......... House No. ~b'eet Hamlet County Tax Map No. 1000 Section . 1 Q.? ........ Block ....... '~ ....... Lot ...... ~ .......... Subdivision BROWERS WOODS Filed Map No. .Lot No. conforms substantially to the Application for Building Permit heretofore f'led in this office dated DEC, 4 197.3. pursuant to which Building Permit No 7.01 6. Z. dated .. D E C. 4 197.3.. , was issued, and conforms to all of tho requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ..., ..... Accessory stora e building The certificate is issued to WALTER R. SILLECK (owner, levee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ......... .N./.A. ............................ . N/A UNDERWRITERS CERTIFICATE NO .............................................. ... . Building Inspector Rw.l~l FO;F,M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 7016 Z Date ....................... ~~...~, ...... , 19.....73 Permission is hereby granted to: ...... .~t~z..~..~;haak ................................ ........... I~a~t ~.tue. lc ............................................... ~o ... J~a~]xI..~. aac e~ sa~...s.tor& g... bua ;~.~ ~g .................................................................... at premises located at ...J~/.R....~e,~t...~;~¥..,DW~ve. ........................................................................ pursuant to application dated .................. ~.~11~. ....... .~. .................... , 19..~.~., and approved by the Building Inspector. Fee $..$Q.,~ .......... Approved ............... :i .......... ~ ........ , BUILDING DEPARTMENT ~. ~/ TOWN CLERK'S OFFICE ~ "~.~/ SOUTHOLD, N. Y. 19o?..~. I ...73 P, ,t ......... Disapproved o/c ............. ~ ................................................... APPLICATION FOR BUILDING PERMIT Date ....... ../....'~..[....~.. ....................... ,19.~7....~,..... P\ INSTRUCTIONS a. This application must be completely filled in by typewriter ~ in ink and submitted in triplicate to the Building~j 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 areas, and giving a detailed description of layout ofpraperty 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 work. e. No building shall be OCCUpied or used Jn whole or in pa rt 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 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. (S.gnature of applican~/r~ na2e, if (Address of applicant) State whether applicant ~see, agent, architect, engineer, ge~ctrician, plumber or builder. ........................................................................ ....... me of owner of remses ~ ~ ~ Na p ' ...' ...~ ................................................................................................................. applicant is a co/~te ~Lnature of duly authorized officer. (Name and title of corporat,e]fficer) Builder's License No .......... :.....~'.../~. ......................... Plumber's License No ........ ...~...~......~... ........................ Electrician's License No .... ..~...Z.,./~... .......................... Other Trade's License No ...... ....~..Z...~... ......................... Location of land on which, p.r_oposed work will ~e don_q_. Map No.: .............. ._ ..... ..~ ........... .~. ~o,t No ........... ~. .......... Street and Number .~....~/..~.~..~ ......... ~/.~.~.~ ......... ./'~..../~..~ ........ ./...~'~ .~..~ ....... ./.../...~..~....~ .... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancyoccupancy .......................... ......... ..~...~.~... .................................. '~'~Z~-'/.~..~ .................. ......................................................... , ................................... b. Intended use and ...~....~.../, ..'~....'~... ~.. 3. Nature of work (chock which applicable): New Building .......... Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ...................................................... 0'~ (Description) 4. Estimated CosF'.~.~ .................................................. Fee ..... ..................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... /'. ......... Number of dwelling units on each floor ......... ~.i ............... If garage, number of cars ................................. ~.,~,~ ................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ...... ..~'./,~1~. ........... 7. Dimensions of existing structures, if any: Front ...........~././e. .....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 ....... I. Ct ........................ Rear ....J..~k ................. Depth ....~.~ .............. Height "'7 .............Number of Stories ................ ./ ................................................................................................. 9. Size of lot: Front .. ........ J;/..~.....~,~..~..'~.. ................... Rear ...~,~.~.~.~...~-...~ .............. Depth ...~..~..~..:i~?.....~....~ 1~; Date of Purchase ..~.~j~,...3~/.~'~...~,Z- ...... Name of Former Owner ~.~J/IJ...~.=...--~C~L4.JJ..~... ......... 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .......... ~./,J ...................................... 13. Will lot be regraded ...... .~ .............. Will excess fill be removed from premises: ( ) Yes (~ No 14. Name of Owner of premises .................................................... Address ""7/~", ......... ~ ........ , Phone No..~,,,..~.~.. ....... Name of Architect ....&~J,/~/~..~.~.,'~..../.~..-5'~-~//~.~-~. Address .~'~,~Z,,..~....,..... ---,/,~ ~- Phone No ....... ,$.~.~....Z?~.,. Name of Contractor ..~.....~..&:'~J~.'.~.~'.....Z.~..~./..,Z'.~.~,~... 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,'* iS S obove nam~. ~ ~ ,~J '~ ; ~ .(Contractor, agent, c0~orat~-:offJcer, etc.) of said owner or owners, and is duty authorized to ~form..6~. have performed the said worked to ~ke end file this application; that, all statements contained :i~ th~s appli~tion are tree to the best of his knOWledge and belief; and that t~ work will ~ perfOrmed Jn the manner set fo~h in the application filed the~with. Swam to before me this ~ ~ // NOTARY PUBLIC, Siat~ of New FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall 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 Inspec- tor 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 installa- tions, 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~'operty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 Date .... . .~.//..~./?.~..'~. ........ New Building ~ Old or Pre-existing Building Vacant Land Location of Property .,~,,~.P..,'-~,,..,........ ~s,~.?'..~...........~-~¢'~ .,~,~¢~?'.,~.....~,.~.,.~,,,,~,~. House No. Street Ham/et Owner or Owners of Property ............................... County Tax Map No. 1000 Section .... /.~-.7 ....... Block ....~...~., ...... Lot ..... ~.. ........ Subdivision .~..~.....~..~?...o'~.--? ......... Filed Map No ........... Lot No .............. Permit No. ~.~/~ ..~DateofPermit .................................. ....... ,/.~/Y/?.~. Applicant Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporar~ Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Con struction o n above described bu lid lng ~i~rn e~/o,~b~c~: a~?regu lations. Applicant . ././/'..'%.~..~< 7.~/. _ .~~'_ .~. ................. ~f, /~