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Home My WebLink About6541-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z5.1.93 ...... Date ............. June"'13 ...... , lgT.~. THIS CERTIFIES that the building located at . .ItJ~ .To~ ltarbm~. Ia~ ..... Street Map No. ~ ......... Block No....~ ..... Lot No..x~... 8mlthold.. ~o]t, .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Pa~y.. I~ ..., 1973. pursuant to which Building Permit No..6~I,.~Z. dated ........... l~y... ~..., 19 ~.~., 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 ...P.r~.~&te. &cces~ory. htttldll~ .~tl~ ~dd~t:[o~ ...................... The certificate is issued to . K~ .Kat~enber. g.. .0~n~. ~'--~"---'~r (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. N. oRo ............................. UNDERWRITERS CERTIFICATE No. ~IeR.. HOUSE NUMBER...212.~ ..... Street ..... Tob~l..H~l~bo~..]~1~. Building Inspector / FOBM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ ¥. BUILDING PERMIT COMPLETION OF THE WORK AUTHORIZED) N? 6541 Z Date .................... ~ ............ k ............. , 19.~3.. Permission is hereby granted to: to ..~tLtd..&~.~dlt~.~..exl~t~u~..~ee~y...bl~I. ............................................... at premises located at ...,~/'~..~a~l~.~...L~l~ ........................................................................ · .: ................................................. ~mtJa~....i~o~o ........................................................................... pursuent to application dated ....................... ~1' ......... ,~ ............ , ~0..~,.~,, end ~pproved by the Building Inspector. Fee $.~.{~{~) ............ IOl&M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ,.~- t/ 19..?.,?·. ~r~d .................................... ~., 19 ........ No .......... ~ .......................... ~rov~ a/c ............................. ~...: .................................. ........ ................... .................... (Suildi~ In--tot} APPLICATION FOR BUILDING PERMIT Application No ................................. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wi 3 sets of plato, 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 e detailed description of layout of properW must be drawn on diagram which is part of this application. c. The wo~k covered by this application may not be commenced before issuance of Building Permit. d. Upon at.revel of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit,shall he kept the premim 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 bee~ gcented by the Building Inspector. ' APPLICATION IS HEREBY MADE to the Building Depertr~ier~:t' fdr the issuance of a Building Permit pursuant to the Building Zo~'~ Ordi.n. ence of ~ Town of Southold Suffotk County, New York, end other applicable Laws, Ordinances or Regulations, for the construction~of bu dmz, eddlt~om or alterations, or for removal or demolition, es herein described. The applicant agrees to comply with all applicable law~, 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, ff a corporation) .................. ............ State whether ap~lican,~ is own,~, lessee, agent, amhitect, engineer, general contractor, electrician, plumber or builder. ......................... .......... z... ................................ ......... '7 ........................................................................................ Name of owner of premises ................... ~',~../...z...c...~. . ~-.~. ............................... If applicant is a corporate, sjgn, ature of duly authorized officer. ......... . .......................... (Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be q!one. Map ~1o .................................. ~ .......... Lot No ......................... Street and Number ........... "~'~'-'/'~--'~4 ...... ~"A-. -/5'A"°--'Y". ...... ~..e....~.....~.. .......... ~..../....~:7..3..x.. ................. i ............................. Municipality 2. State existing use and occupancy of premises and intqnded use and occupancy of proposed construction: a Exlstln use and occu anc ..... .~....~:'....~.//~'/ \ ' ' g p y .......................... ~k~.. ................ ' ........................................................................... b. ~!ltended use and occupancy 3. Nature of work [check which applicable): New Building ........ ...~. ......... Addition ..................... Alteration ......... .~.....~ Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. stimatsd . ...... .......................... F. ..... ............................................................................ (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 occuoancy, specify nature and extent of each type of use ..................................... 7. Dimensions of exist'ng str~ctures, if any. Front ...... ~! ........... Rear ........................... Depth ................................... · 7__ Height ................... ~-...~....... ........................... Number of Stories ................................................................ Dimensions of same structure w th a terations or additions:_Front ....... ~......-~. ........ Rear ...................................... . L~ ~ ,~ ,'Y~ " ' Depth ............................................. Height .......................................... Number of Stories ..........~ ........................ 8. Dimensions of entire new construction: Front ...................... ... Rear ........................... Depth ................................. Height ................................................. Number of Stories ......................................................... 9. Size of Iot~ Front ..................................... ~ Rear .......................................... Depth ......................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proPOsed construction violate any zoning law, ordinance or regulation: ...... . .~/.~. .............................................. ~3. Wi, ~ot be ,~d~ ......... .../Z...~ ................. .~i,~x~ fi[be rcmov~ from premises: [ ] Yes ~ No 14.Name of Owner of premises ...................... ~..~.E.~.~x ....... - (Ad ess)"v'~'""'~;""' ................................................................... (Phone No.) Name of Architect ................ ~ ............... .,.., ....................................................................................................... ~', // / / ~ (Address) ~,o M (Phone No.) Name of C:ontrector .~.~:.~...~....~...~.........~...~....-~.....~f..,~......(~.. ................ . .~..~..c~...xj/..,¢~ff~...~.. ...... ~...7. ~...-~.....~.?..~... ........ ~' (Address) // (PhOne i~o.) 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 coirnar lot. STATE OF NEW YQRK, ) COUNTY OF ...................................................... ............................ ~'-~z'~'~'i;z'c~i'~'~'~';~'~'~'~ .................... being duly sworn, ~poses and says that he is the appli~nt above na~d. He is the ... . .............................................................................................................. (Contractor, ~t, coyote office~, etc.} of said owner or owners, and is duly authorized to ~Horm or have ~Hormed the ~id work and to make and file this application; th~ all statements contained in this application are true to t~ ~st of his knowled~ and ~lief; and that the work will ~ ~Hor~ in the ~n~r ~t forth in the ap~ication filed t~rewlth. ...................................... day of .................................................. 19 ............. ~ ~~ ~ Notary Public ~ ~(S~m~ of appli~t) FORM NO, 8 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 duplicate 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 /esponsible 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 3. Copy of certificate of occupancy $1.00 $5.0O Date ........ ~ .u..n..e.....~..Z..,....~. ?.?. ~ ............ New Building .................... Old or Pre-existing Building ............ .X, .............. Vacant Land ............................ Locc[fion Of Property ....... .E.~..~....T.~.~....I~..~.,I~.[~..R...[~J~.~ ......... ~[~l.-[J~.l,[~ ........................................................ Owner Or Owners Of Property ...... ~g.bJ.~?...~.~.T..7:~.~. ............................................................................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No....~.5..~.[. ........ Date Of Permit ...~../f/.7.~....Applicont ..E..~..~..H..T.,[..R.....H.[~I..~...~.~.~.~.~.~.J~I.[..~., .... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ....,5.,..g.D. ........................ Construction on above described building and pe~J~lT~eets all ~l~l~co~n~d r~e,~lot, i-~,~-. ' Applicant .......... ~(.~....l~.. ~~. i...~.~...i~;......~'~ ......... to me th~s E~nest F. Richter ////~.~ Swor. n ~before ..... 11~. ...... day of .....~....~.~..~ \(~'-1 ~ (stamp or seal) ,~~ Notary Public .~.~~County