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Home My WebLink About7581-zTOWN OF SOUTHOLD BUn.DING DEPARTMk~qT Town Clerk's Ol[ie~ Sou~hold, N. Y. Certificate Of C)ccupency No..Z~.~O ..... Date ............ F~a~,.. 20 ....... ,19.~. THIS CERTIFIES that the bui]~l~,~g located at . .~mt.th .Dz~tve.//m~tlt ..... Street Map No0oase. Naek. Block No ........... Lot No..~2b~. ~12'~...80lkthQlit..I/,][.~... conforms substantially to the Application for Building Permit heretofore ~ed in this office dated ............./lct.. 2., 19.7~. pursuant to which Building Permit No. dated .............llct .... 9., 19..4, was issued, and conforms to all o! the requir~ ments of the applicable provisions of the law. The occupancy for which iht= certificate is issued is. P=iva.t~ .accessorJ. ls.toraz.)..bulLd~ui ........................... The certificate is issued to .Edward. ~3oln~nk$r. ..... /h~ner ........................ (ow,er, lessee or tenant ) of the aforesaid builrling. Suffolk County Depa~-tment of Health Approval .. I/,I/, ............................. UNDERWRITERS CERTIFICATE No. l~I/, ....................................... HOUSE NUMBER... ~.~ ....... Street ...Smi.th .Drive...~outh ................. TOWN OF BUII.~IN~ D~I~Rm'M~? TOWN CI.E~C'S Examined ! .......................... /.....~'....., 19, ....... 7 / Approved ........................... Z~......., t9...'.~.... Permit No ..................................... Application No .........: ........ ,.., ......... ~ Disapproved a/c .......... ~ .......................................................... (Building Inspector) APPLI~.TIOfl FOR BUILDING PERMIT ~ Date ,......~?-...7" ~ 19....~...~.' INSTRUCTIONS a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Building Inspector, with 3 set~ of plans, accurate plot pian to ~cale. Fee according to ~chedule. b. Plot plan showing location of lot and of buildings on premises, retationsh p to adjoining prem ses or public streW., al areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this applicat,an. 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 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 Build ng Department for the i~suance of a Building Permit purSUant to the Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Law~ Oedinances or .~gulati.o. ns, for the construction of buildings, additions or alterations, or for removal' or demolition, a~ herein d~cribed. e applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulatJam, and to admit authorized inspectors on premises and in buildings for necessary inspections. ......... ........................ ....... (S gnature of, appltcor~,, or name, if a corporation) (Address of applicant) //~' 7/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ......~...~...(r~...~.~...~.,.~..~./.~..e~....~....~...~.~.~ ................................................................... If applicant is a corporate, signature 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 ~cen~e)qo~./.......-.'. .................................. ~ ~ ~ -- 1. Locati .o.n j~f'(d41~[_~l~._ g,r~osed work will be ~n.. Map No.: ..... .~. .............................. Lot No. ~.~ 7~ . Street ~~r .~.~~/~ ~ ~'~.~~ ~.~ ....... ~"~ M~I~II~ 2. State existing use ~ncy of premises and intended use and ~cu~ncy ~f p~ c~tmcfion: a. ~,s,t~ng u~ a ~cupancy. . . /~ ................... .............................................. .J~D!TH T. BOKEN ~,~8{~]~ FubJi¢~ 5tare of New York ~.~ No. 5~.0344963 Suffolk County ~,/~ Comr~JsS]o~ ~xpJres March 30, 19__ I ~'~ 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................. Repair .................. Removal ..................Demolition .................... Other Work ..................................................... ~,/,,~,~ (Description) 4. Estimated Cost '/:~ .........; ............... Fee (to be paid on filing this application) 5. If dwelling, number g units ............................ Number of dwelling units on each floor .----...,... ............ If garage, number of ed~m ~'7 7,~., , 7~......~./.~.. ................. ~.~. ................. 6. If business, ~mixed occupa, ncy, i sPecify nature and extent of each type of use ............................ 7. Dimensions of existing ~uct~res~ ................. ".Rear ........................ , ....... Depth ....... ............. Height ......... ~--.~-- ....................................................................................... Dimensions of~/'~" "same structure wit~_,g~ratio~9~-ed~: Front .................................... Rear ............................ Depth ................................ ~.~.......~....'..'../..~..'.T'~r of Stories ................................ 8. Dimensions of entire new construction: Front ........... ~ ..................... Rear.............../D x ...... .... . .. Depth ..?.. ................... ~ / Height .....~ ............ Number of Stories ........... ~ .......................................................................................................... /D~ /~/P~ /. -z~ ~ 9. Size of lot: Front ....................................................... Rear .......................................... De~13 ../~1~, .............. ... ]0. Date of Purchase .......... Y......;........~../... ........................ Name of Former Owner .(.T...~...~..~..~....~...~7.,~..~...~...v......J...... ] ~. Zone or use district in which premises ore situated ..................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ........................................................ 13. Will lot be regroded' . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .....~.~.~....~..,~.~......~..~.~..~...~,,~.-F~Address ...~,.~..c~..~..~...~.,..~ Phone No. ~.~.Z..K.[.~...O Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ 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. COUNTY OF ................................ ~'"'~ f'~y~',e~,~e. ~v~r/-~,~l~,~.~D~.7-~ ~ ................................................................................................. being duly sworn, deposes and soys that he is the applicam (Name of individual signing contract) 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 ~har the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........................ day of ............................................ , 19 ........ Notary Public, . .................................................... ~ounty (Signature of applicant) FORM NO. '* TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PER~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7581 Z L Permission is hereby granted to: ~~ ...... ~.~....~...~.~/.?.~ ........ at premises located at ~._~.._~ ~'p') I -r-/u ~/~'; ff/Z ~'~/J T'~ ..... pursuant to application dated ............................................. :'.~..., 19Z..~..., and approved by the Buildi~ In.~tor. F. $...!.~. ......... Building Inspector FOKM NO. 6 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 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 responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Nomconforming 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 Date "~ "'~ / ~ ~7~'"' New Building. ........... i'~.... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ._G...6. ~ ~'../~...,.' ~./Z.../~..~/~,x -- ~,~/ , Owner Or Owners Of Property /-- D ~-~4/~ ~ ~ ~'/-~cc/~' ~ Subd v s on [~'~'~ 4x~ 'c~/.~.~~x~ ~ /'.~'./~.~ Lot No/~'~'~-~' Block No House ............................. ................................. .o ........... Perm,t No ..................... Date Of Permit ........Z'...-..~..~...Applicant . .~...O....~.....~f..../~....?D.....¥.~...~....~.-...ff..~....~..~'.~... Health Dept. Approval ........... .~...;..(.¥.. ..................... Labor Dept. Approval .............../~.,.L~ ....................... . Underwriters Appraval ............. /~...I ......................... Plann ng Board Approval ..................................... Request For Temporary Certificate ........................................ Final Certificate .......... ~, .......................... Fee Submitted $ .~...~ ..................... Construction on above described building and permit meets all a~_lic,able codes and regulations. Sworn to before me this .......... ........ (stamp or seal)