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Home My WebLink About7605-zFO~M NO. 4 TOWN OF $OUTHOLD BUILBING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. 2;63F.(~ ...... Date .............1.4gr.c.h.. ~. .... , 19.75:. THIS CERTIFIES that the building located at ... lt~trT.'.s .L~r~ .......... Street Map No. p.e.c..o.~.:l..c..~9~ck No ........... Lot No..~. ........P.e.c. 9.n.~.c' ~..N.:Y.: ....... conforms substantially to the Application for Building Permit heretofore fried in this office dated ............0.c.t....~.8..., 19. ?.~. pursuant to which Building Permit No.. 760~'Z. dated ............ Oct.. · 28., 19 7.1,., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .P.r.~..va.t.e...(.a.c.c.e..s.~.o.r.y)..Qa..r.age ........................................ The certificate is issued to . .D.o.u.g~.~.s.~..E~[.~g~R ..... .~..e.l~ ......................... of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) · N. oR. .............................. UNDERWRITERS CERTIFICATE No. ~Io~,. ........................... HOUSE NUMBER ....~.9.~0 ...... Street .... HOn~Y.°$..L~ne ........................ · . . ~' J f ~ /'~ Building Inspec~br I~B~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT fl'HIS PERMIT MUST BE KEPT ON THE P'P, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 76O5 Z Permission is hereby granted to: ....... ~..,/..~ ......... ~..,.~ ........... ....... ~.....~ ...... ~/..,..~.~,.~ ................ at nrem,ses located at ~/'~r~/,~ ~' ~-~ ., .......................... ~c~,~....'L...:~..,. ~..;~.) ...... ~.....~; ........ ~.~.,~,..~,~ ................................ pursuant to application dated ........................................................ , 1~.~...", and approved by the Building Irk~ector. Fee $_ ./...~. ................ Building Inspector FOu~W NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, '6~°Pr°vecl ~-~:~' ~ '9 7/~ Permit No. ~ ..~..~"-~ Disapproved a/c ................. ~ ................................................................. ....... ........................................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT .................... , INSTRUCTIONS Application No ................................ o. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building 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 adioining premises or public streets o~ areas, and giving a detailed description of layout ofproperty 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 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 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. f, ............. //'. (S gna~ur~"~"~'~'"l~cc~t, or nome, if a corporation) (Address of applicant) .................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, e ectrician, plumber or builder. .................... ......... .: ..................................... z"': .............. : ...................................................................... Name of owner of premises .......... .'~.~..t,d.~.Z~..~.~ ........ If applicant is a corporate, signature of duly authorized officer. (Name and t,tle 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 done. Map No.: ....... .~'....~.....~...../.. Lot No Street and Number ...................~.~-.-~./~..~.~....S ....... /~.~..~...'~, ................................................... 2. State existing use and occupancy of premises and inten, ded use an~p.~ncy of proposed constrMu~tniioCin~ality a. Exisiting use and occupancy ............. /,.....'~..~).4~3.~../.~f ........... ~...~....../.d...~...~..C.~ ......................................... b. Intended use and occupancy ............ ..~.. ...... C~,~. ....... .~..~../~.. q...~.. ................................. 3. Nature of work (check which applicable): New Building' ....~ ...... Addition .................. Alteration ................ Repair ............. r.'/' Removal .................. Demolition .................... Other Work ................................................ .... ~/ / (Description) .fP~/ 0 0 O, o-O Fee 4. Estimated Cos~ ..... I.) .............................................................................................................................................. (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, speci, fy n~]ture and extent o~)e~ch type of use .................. ~. ........ 7. Dimensions of existing structures, if any: Front ............................ Rear ..... ~ ....................... Depth ....?~.~.. ........ ~ / Height ..... /...~. .............. Number of Stories ................................................................................................................. Dimensions of some structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ........... 8. Dimensions of entire new construction: Front. ...................... ~- ~ ! , .,...--, .... Reor ........ .~. ................ Depth ..... ~ ............. ~ / Height ...... /..~ ......... Number_ ,°f Stories ..................................................... : ..................................................... ~' ........ 9. Size of lot: Front ........ /...~[~....~ .................................. Rear ....... /...~....~....~ ................... Depth ...... ..~.....'~....6. ............. 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: 13. Will lot be regraded . ......................... :. Will excess fill be removed from, premises: (,,'~Yes ( ) No N o.7~..~.T./...0. ~ .~.... 14. Name of Owner of premises .~.O...~.~J..~.5.$...~.../....~...~...~.-.~. Address .~..~'..,~'.~.~..~....~ Phone Nome of Architect ............ :. .................................. / ~, .......... Address ................................ Phone No ....................... Uo,,~a of Contractor ... ~..C..4. {~...C.. ..... ~. ., ........ A~ress .Cr.~:~: L.. Phon~ Ua. ,..ZT....t ......... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street ond block number or description occording to deed, and show street names ond indicate whether interior or corner lot. z, o 7' ,-/o ~/~ COUNTY OF~... ~Z~...:.: .S (N~me of individuel signing contrec~ ~bove nemed. ....................................................................................................... He is the ............................................... ~ontr~ctor, egent, corporete officer, etc.) o~ seid owner or owners, end is duly outhorized to perform or h=ve performed the s~id work ~nd to ~ke end file this ~pplication; thet ell statements cont=ined in tNis ~pplication ere true to the best o~ his knowledge end belief; ~nd th~ the work will be performed in the m~nner set ~o~h in the epplication filed therewith. Sworn to be{ore me this ................. o, ....... .................................... (Sign=ture of epplicent) JUDITH T. BOKEN I~otary Public, Slate of New Y~rl[ No. 52-0344963 Suffolk County Commission Expires March 30, 19_~ FOltM NO. $ TOWN OF $OUTHOLD , Building Deportment 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 dispasal--(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 Date .~/1Z~.1:'..... !..~.~,. Z..~. · · ~. · ..~. · ......... New B~ilding ...~'~.. ......... Addition ................ Old or Pre-existing Building ................ Vacant/and .............. Location Of Property ...... /~.~.~g...~...~...~. .......... .~...../<~....'~.....~.. .............. ~..~..~..O...~..../..C,. ......................................... Owner Or Owners Of Property Subdivision ........ r ..................................................... Block No ............. House No..f.~..??.. Permit No. ~.~..O.~.~....~... Date Of Permit ..~.?.....~.F.:..~.'~....Applicant ....... .~..~ .~....~.....C.~~ .... Health Dept. Approval ........ .~....*...!.¢~.. ....................... Labor Dept. Approval Underwriters Approval .......... ..~...:....~:.. ........................ Planning Board Approval .... ..~...:,...~,.: ....................... Request For Temporary Certificate ........................................ FinaJ Certificate ............. .~ ...................... Fee Submitted $ S ~ Construction on above described building and permit meets all applicable codes and regulations. Applicant ......................................................................................................... Sworn to before me this ...... dayof ..... Notary Public .......... ~..~.... County (stamp or seal) ~ & ~ 7 ~ .NOTE. LOT NL:;AEE. R5 5~0WN R~):£i~,TO 'IAI~P OF P~CONIC ~/A~ · 5[CTl0~ T~VO' F1LEB iN T~[ 5UFFOLF, COUNTY CLt&~ OFF[CE 'I 0