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Home My WebLink About7340-zFOI~M NO, ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .H.t.~.w.a.~;.ha..P.a.~.h ........... Street Mar No...XX ........ Block No... ~ ..... Lot No .... ~... ~.q~.~t.~?~d.., ~:~: ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... .J.l~. e.. ~8 ..... , 197~.. pursuant to which Building Permit No. dated ........... J.l~e.. J.~.., 1~!~..., was issued, and conforms to all o£ the require- ments o£ the applicable provisions of the law. The occupancy for which this certificate is issued is .P.r.~y.a~;~e...o.I1~..f..a~. ~.l.y...d.w.e.~..~.~.n.£..w.~..~.h..a.d..d~.~.~. 0~ ....................... The certificate is issued to . ?.a.v.~..d..~..~.~.u.~.h...~.~..~.e...~..~. ...... .0~.. e.r.~. ............... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N :~ ~ ................................ UNDERWRITERS CERTIFICATE No. ,1~,~,8,]J~.!? ...... .~.~.p.t...!0...~.~.?.1+. ............ HOUSE NUMBER .. ]3.0.~. ....... Street ...U,.ifkw. a..~.If,.a.~. . .P.a.t.h. ...................... TOWN OF $OUTHOLD 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? 7340 Z Permission is hereby granted to: Ge.o..&hle~.s..t~u£1d.~...Zr~..A/C..Da~.i.~..& Ruth Gunselman at premises located at ...~.,~,wa~a,~..J?,~h ....................................................................................... ............ ....................................... ~..¢~t.~lfl .......... ~,.~~. .................................... , ................................... pursuant to application dated ......................... ~,.~...].~. .............. , 1~,~,.,,., and approved by the Building Inspector. Fee $~. ~..~..0...0. ............. Building Inspector FORM NO. 6 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 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 os 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 .....9. Z.~L Z../.~F...~. ........................... New Building ................ Addition .....~ ........ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..[.~.z~wat:~i.~s *-aC.h~ Sottt:hol, c~ tq'.Y. Owner Or Owners Of Property .~)~r.~..:¢': .}!~r.~.~....~.v.X.d...~tt~.~.e...Z.~..~.~ ................................. Subdivision ................................................................ Lot No ............. Block No ............. House No Permit No. ~ '/ '~ ' .?.,AO ........... Dote Of Permit .6.Z.l.L~./..Z..~....Applicont Health Dept. Approval ........ .~....{..~'...; ....................... Labor Dept. Approval ...............~..{..!.~.. ....................... Underwriters Approval ..... Board Approval Request For Temporary Certificate ........................................ Final Certificate .......... .~. .............................. Fee Submitted $ ~-~ &~ Construction on above described building and permi,.t,.,meets all applic~b~ codes and regulations. Applicont ............. ~.. .................................................. Sworn to before me this ~x'~'~~' 27' Notary Public ............ ~-~/~ County (stamp or seal) TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOU HOLD, N. Y. ....... .......... :.! ......... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS % Date Ju~e 15~ , 19..',(,~...,..~. a. This application must be completely filled in by typewriter or. in ink and submitted in triplicate to the Building Inspector, with 3 sets of pla,ns, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot ~nd of buildings on premises, relationship to adjoining premises or public streets or 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 InspectorwiJl 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 o Certificate of Occupancy shall hove 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 Lows Ordinances 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. ......... :~g.!Z.~,~...A!!..~..~.'!.~.....S..g,,I,.L..~,LC.~...;~.aC. ......................... (Signature of applicant, or nome, if o corporation) ~ L .......... ?.a.0...g.o.x.....~.%....qu.~ ck~ au ~ ................................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engipeer, general contractor, electrician, plumber or builder. l~ut lder Name of '; " ' ' ~' owner.'~f, premises ...Da.v.i~l...a~ad...}Lg.t;h...~.~ma.elman ........................................................................................ If opplican te,~duly authorized officer. (Nom~£~d~*.l~s,title of Pres.c°rp°rate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's License No ............................................... l. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number ~i~a~h~a~`'.~fA~.~-~p~L~j~d~}~e~J~ ............................................................ / ~ (9 _%' Municipality 2. State existing use and occupancy of premises and in~,ended use and occupancy of proposed construction: a. Exisiting use and occupancy ..~.~,al.Li~.~ .............. ..~.....~..;~, ............................................................................ b. Intended use and occupancy ..~.~r.~..Z..Z...t.~ ...... (Signature of al~llamt, o~ frame, if a cm~mm~) State whether ~ i~ mme,, IMmm, agm~t, ard~itect, engineer, ~1 c~r, e~ri¢~, p~ ~ ~r. duly authorized officer. B~iklM's Llam~e hie ......... Lacatien of land an whlch pralzeMd wodc will be dant Map No.: ........................................ Lo'No ......................... State existing use and ~ of premises and intended use and acc~xzr~/of ~ c . ..q~Jct, lan: Exisiti~g tae and ~ ..lh~3t~.~n~ ....... ~..7.,/~..,~.~ .............................................................................. · ,,,.~,~.~ ..... :.. ~ .................. ,- .~t~.~,~~. . ,.~....~ ............................................................. 3. Nature of work (check which applicable): New Building .................. Addition .....~.. ........... Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work .................................................... ~__?~_ (Description) 4. Estimated Cost . ..$..8..,..0...1.~^.0,0. ........................... Fee .,./. .................................................................................... (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, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ........$,7 ................ Rear .....3.7. ...................... Depth ...24 ............ I-teight ....... 1.~.t ........... Number of Stories ..... o~e ..................................................................................................... Dimensions of same structure with alterations or additions: Front .....8..7. ............................ Rear ....3..7. ..................... Depth ......~..~:. .................... Height ....... .],.4.:. .............. Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... 2,4 .......................... Rear ....2/1 .................... Depth .Z0 ................... Height ....].~! .......... Number of Stories ....Q~.~ ........................................................................................................... 9. Size of lot: Front ...... 1.0.5,.CI9 .................................... Rear ..... 10,~..0 .......................... Depth ...... J.4.5..,66. ........... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ......... J~ ......................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ...No ................................................ 13. Will lot be regraded' ......I~.0 .................. Will excess fill be removed from premises: ( ) Yes (X) No David and Ruth 237-03 93rd Ave. 14. Nome of Owner of premises .G.un.~elma~ .............................Address .~,.~,,...,,~..Y ......... Phone ~o ....................... Name of Architect .............................................................. Address 2'5i~'"CR'~"~;4['; ....... Phone No ....................... Name of Contractor Ge~.~¢.e..Ah,l.e~'.$.,~.lr].!.:~,'.,.~,'tc,,,. AddressC. u.t.ch~.~u~ ........... Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly alt 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. SEE ATTACHED ..... STATE OF NEW YORK, ~ c c COUNTY OF ..J~.tt.~,~O.lJ¢ ............. ~'~'~ .Qe~:g,e ,~h.l.e~.~. ......................... be ng ~uly sworn, deposes and says that he is the applicam (Name of individual signing contract) above named. He is the ........ .Ce.n~m~to.~ ................................................................................................................................................ (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 th s app cation; that all statements contained in this application are true to ~b~_best of his knowledge and betief; and tha~ the work will be performed in the manner set fo~h in the application fi ed~i~LERS B~ILDER INC. Sworn to before~this ~ ~""~ t~gn~Ture aT ag~licant/ FOB~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N? Y. Permit No ..... Disapproved a/c ............................................................. /(Bulling Inspector) APPLICATION FOR BUILDING PERMIT Date June lB, 74 INSTRUCTIONS o. This application must be completely filled in by typewriter ox 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 adjoining premises or public streets o~ areas, and giving a detailed description of layout of property 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. GEOi~GE ^}ILERS BUILDER, INC. (Signature of applicant, or name, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Bui 1~ aa~;li°cfo~Wr~ 'of P reo rmL~;'~'~:; i '~ ~;'t't'~h;; i'G'z~ ~: fl 'c'le~ ........................................................................................ ( N a ~)R~[JdAtttl~}~,, oj~ ~ r p o r o t e officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number ~.!.~.~.?~?.?.~.h..a..:..~!.~.~a.~.~.~..~..~.~..~..u...t.!!?..~.~.~.~.~.~?..~.~.~ ............................................................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..]?.V..e.~..~.~.~..~ ................. ,~ ........................................................................................ b. Intended use and occupancy ..'!~..e.~..1.?'.t.~ ......... ' ///~~...(~.....~.....~.....~.. ...................................................................... 3. Natqre.of work (check which applicable): New Building .................. Addition ...,~ ............ Alt~ro*; ................ Repair .................. Removal .................. Demolition .................... Other Work .................................................... / ~--'-~c~O~ (Description) 4. Estimated Cost ..... $.~[,~J~.,0.0 ................................. Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...ea~ .................. Number of dwelling units on each floor ........................... If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. [Dimensions of existing structures, if any: Front ........ 3~' ................ Rear ..... 35 ....................... Depth .-24 ............. hteight ....... ]-4.". ........... Number of Stories ....on~ ..................................................................................................... 3 Dimensions of same structure with alterations or additions: Front ....~.7. ............................ Rear ..... ~' ...................... [Depth ..... .4.4.! ..................... Height .,~...,.[:4~.: ......;.../..Nunfil~erLof Stories ................................ 8. Dimensions of entire new construction: Front .... 2A.....:,,...~...,,...,,k..~ Rear ...~4 .................... Depth 2~ ................... Height .._[.4.! .......... Number of Stories ......C~. ............................... ,.,, .......................................................................... 9. Size of lot: Front ...... [O,~,O~ ................. :;.....~...........J Rear ..4~.O5~.O .......................... Depth ...... ~,4~,/~6 ............ 10. [)ate of Purchase ....................................................... ~.N~mo,,of FdrFner Owner ........................................................ ] ]. Zone or use district in which premmes are s~tudted .:. ...... ~;;.,,..:,..../. ......................................................................... ~2. Does proposed construction violate ari?',zot~[ng, Iov~,,9~rdi~adce 6r regulation: ...No ................................................ 13. ' ~ ' "';'?~ '~' ' ' .... ' ' ' Will lot be regraded ..... ~.[~._. ................ Wdl exc*~s~ fill,~bo removed f, rom premises. ( ). Yes (X) No ].~avtd and 'i~,./~.h.. '. ,~ ., 23'i-03 93~d ^ye. ] 4. Nome of Owner of premises .f,~.l,~s,~.~n ..................... ~,~,.,~.'.~ ~ddre~s's .~.,.'~.,....~.~,1,,.'~0 ....... Phone No ....................... Name of Architect ' Addressj ..... ~ .................... Phone No ....................... Name of ContractorG~'.~,..6J~.~.r.~.~.J$1d.!.~.,'.L[~.o.._ AddressC;~t,~¢u~ ............ 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, end show street names and indicate whether ;nterior or corner Jot. ,' STATE OF NEW YORK, tS.S COUNTY OF "t~'~l'*'~,i~']:k ............. ........... ('~J~J~me~'"~ollf;tm~'Ividual'J ~ ...................................................... signing contract) ' being duly. sworn, deposes and says that he is the applicam above named. He is the ......... ¢.,,~.~,~.t~i~.~t~.t~ ................................................................................................................................................ (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 knowledoeand belief; end thor the work will be performed in the manner set forth in the app icotion filed tlI]J~[I3~J£hAtlLERS BUILD£R INC, Swornz .~..!...-=...t~/~'~e me this ......... dau of ........... ......... , Pub,,c, ' '--- ............................... ............................................... c/ JUDITH,. BOKF-N (Signature'lSf applig~ant~ ,5¸ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY .~epte~e~ ~0, ~.~/~"" ST.EET..EW VO...~ti~":~,~.~ ,OO~ THIS CE~IFIES THAT Southold, L.I. w~ exami~d on ~e pt 0 ~O e ~ b ~ and found to be in compl~a~e with the requirements of this B~rd. FIXTURE OUTLETS FIXTURES RANGES OVENS DISH WASHERS FANS DRYERS TIME CLOCKS MULTI-OUTLET SYSTEMS NO. OF FEET E R C OTHER APPARATUS: COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.