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Home My WebLink About7375-zNO. 4 TOWN OF SOUTHOLD Bu~.r~ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~.~). 3.8. ...... Date ...............Na~....~.. ..... , 19.?.~. THIS CERTIFIES that the buildin~ located at ~)Sl~tat'. dl~Ve ............. Street Map No. ~al~,. D.t,~'. ]l~l[ock No ........... Lot No... ~'~....~.~..$]....]..,.Y.,. .......... conforms substantielly to the Application ~tor Building Permit heretofore filed in this office dated ............... J~..3,019..~. 'pursuant to which Building Permit No. ~.~.. dated ............ !.~.~...~..., ~9..~.., wu is.~ued, and confo,~s to ~n of the r~ ments of the applicable provisions of ~he law. The occupancy for which thl, certificate is issued is P~'~va~. O~..£~y. ~l~f,~ .~..~$0a .&. ~ .......... The certificate is issued to ....~...~..&..D..~..e....~q~.e ........ . .0~.. F.~. ......... (owner, lea~e or tenant) of the eforesaid building. Suffolk County Department of Heslth Approvel If :~, ................................ UNDERWRITERS CERTIFICATE No. ~.~Re ....................................... HOUSE NUMBER ....~.1.~0 ...... Street ...I~3~. ~).~W ......................... ..... ...... Building Inspector { FORM NO, ~g TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OIJTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON TIlE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7375 Z Date ,..~ ,,./U/_ y 19Z~... Permission is hereby granted to: .......... ............ at premises located at /! ,~0 J~EJ., /'q~ ,.~. /~li/}' pursuant to application dated 3~ ~Ju~/~ 19..~.~.' and approved by the Building Inspector. O0 Fee $../. ,~,, ............... Building Inspector 'rowN O~ ~l~L~ BUIM~IN~ TOWN a. IRK'S OFFI~ SOUTHOLD, N. Y. Application No. Approved ~'~ ~') i/~ '~' 19..~.. ....Permit No. 73 -/~: ~ APPLICATION FOR BUILDING PERMIT ' (~,~ -- ~"~. O_,~ LtI Pete ...ame, ll ........................ , )9..!k ...... INSTRUCTIONS a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Building Inspector, with 3 sete 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 street? areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram which is Part of this applicat,on. c. The work covered by this application may nat be commenced before issuance of Building Permit. d. Upon approval of t.his 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. issuance APPLICATION IS HEREBY MADE to the Building Department for the of a Building Permit pursuant to the~ Zone Ordinance of the Town of Southold, Suffolk. County, New york, and other al~licable Law~, Ordinances Or,~ Building 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, ordirjg~ces, building code, housing code, and regulation, ¢ and to admit author!zed mspactors on premises and in bulld.~!rt~ f~- nea~sery inspections. (Address of applicant) State wheth~r applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... I~..~I~..~IJLI~.~ ........... ~..¢.~,......~..7..~ .............................................. 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 License No ............................................... 1. Location of land on which proposed work will be done. Mop No.: ~1~' ............................... Lot No ...... ~ .............. Street and Number ..... ~J.~ll~lll~.~lLm.~l~..ll~~ ......................... .................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ........ J.J..JJ..J .............................................................. Intended use and occupancy ..... ,...~.....~ ....................................................................................................... 3. Nature of work (check which applicable): New Building .................. AzJdition ..... .~ .......... Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work ...... 4. Estimated Cost .........~ ................................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ~J~l~r......Number of dwelling units on each floor ......... ~..llJl~t .... If garage, number of cars ....... ~ ................................................................................................................................ 6. If business, comme~iol or mixed occupancy, specify nature and extent of each type. of Use ............................ 7. Dimensions of existing structures, if any: Front ...... ~1~11 .......... Rear .....~t~a~l ............... ' Depth ......~Jl~, Height ......... ~t. ......... Number of Stories .......... ~ ........................................... ~ ........................................................ Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new. construction: Fro~t .................................... Rear ............................ Depth ........................ Height ...~.../~.:[ ..... Number of Stories ...................................................................................................................... 9. Size of lot: Front ..... ~ ...................................... Rear ..... ~..1~ ........................ Depth ......... ~ ....... .~. 10. Date of Purchase .~1i1~.~.~ ......................... Nome of Former Owner ...Jlll.~ ................... 1 1. Zone or use district in which premises are situated ...~l~/lllll~ll~ ........................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ........... m ...................................... 13. Will lot be .regradec~ -...;~ll, .......... ~ ...... Will excess _ fill be removed from premises: ( ) Yes {J~ No 14. Nome of Owner o p emises ..1~..~ .............................. ~ ............................... .~ No...~ ...... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ..... ~ ...... :~ ..................................... Address ................................ Phone No ....................... PLOT DIAGRAM .Locate clearly a?d-diStme, tly .till buddings, whether ex~shng or proposed, and ~nd~cate all setrback di.mer~mns from.~ property lines; Give street 'arfd block number or description according to deed, and show street names and Indicate whether interior or corner lot: ,-Id I INO'C)~ ' i_ot: {l OD lnqor ' ' ST'AtE bl~. NEW YC~RK, .-~-~ COUNTY OF ................................................................................................. being'duly sworn, deposes and says that he is the applicant (Name of individual signing contractO above name. ~:8He is the ................. ~ ...................................................................................................................................................... (Contractor, agent, co~orate offiCer, etc.) of said owner or owners, and is duly a~riz~~ to perform or have performed the said work and to ~ke and file this application; that all ~atements cont~n~ in this application are true to the best of his knowledge and belief; and that t~ work will ~ per~rmed, in the manner set~o~h in the a~lication filed therewith. Swam to ~fom me ~ ' / ................. · ..... ...................... : ...... R~in8 in Suffolk ~' / BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19 ........ / / Application No. Examined ................. ~ ............. '. ....... , , _ Approved ........................ : ................ 19.: ..... Permit No ................ T. ................... ,,,~w~.4~ ~./j~,A ~ Disapproved o/c .............................. '1~~~'. .......................... ,,,~_~cx./~- ~ - ............................................................ ................. ..................... APPLICATION FOR BUILDING PERMIT ~ -- C, ~_ LJ~ Date ....JtJJ. ~. ........................ , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building r'- 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 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 o Certificate of Occupancy shall have been granted by the Building Inspector. B .A,P. PLIC~ATION IS HEREB, Y MADE to the Building Department for the issuance of a Bud ng Permit pursuant to the~ ui~aing ~one Ordinance at the Town of Southold, Suffolk County, New York and other a~,,licable La,.,~ Regulations, for the construct on of bu'ld'ngs, add.t.ons or alterat o'ns, or for rlmova or deanna ition, as'~re~nU'd"e~s'~i~e~l~./~' 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, build!ngs faf' necessary inspections. ( o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............. ............................. . ............... Name of owner of premises ..... ~J~0IJIARIJ.._~,..RIID..IJJJII~.~IT,~JA .......... .~....~..~......~..~...~... .............................................. 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 License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ~ ................................ Lot No ....... ~J .............. Street and Number ..... ~[(J.,J~J~JJRJJ..la~i[IJ..J~AJJJJJ~..]L'lJ..~JJJ..~:)t/~..J~...J~J:JmJ~tJ1 ........................... Municipality 2. State existing use and occupancy of premises and intanded use and occupancy of proposed construction: a. Exisiting use and occupancy ........ J~JJJ..~JJ~'..0~JJ.~&Jm~ZJ~..~ .............................................................. b. Intended use and occupancy ~/IJJ~ u ..... 3. Nature of work (check which ~pplicable): New Building .................. Addition ...... ~: .......... Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work ...~I~'~..A~..~ ................ . .... (Description) 4. Estimated Cost ..........~;100~-00' ................................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ~,..~lJl~......Number of dwelling units on each floor .......... ~..~ .... If garage, number of oars ........~ ................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ...... ~/~1 .......... Rear ..... ~/l~0n ............... Depth ...... Height ......... ~.~. ......... Number of Stories .......... 1 ..................... ... Dimensions of some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ B. Dimensions of entire new construction: Front .................................... P, eor ............................ Depth ........................ Height ...~.....L/. ....... Number of Stories ...................................................... : ............................................................... 9. Size of lot: Front ...... ~Q.~.JI~ ...................................... Rear ..... ~...(~ ........................ Depth .......... ~.~ ................ 10. Date of Purchase ..lllll~l~..:~..~ .........................Name of Former Owner ...~ll..JltllllJ~ll .................... 1 1. Zone or use district in which premises are situated ..llll:ldlllld. l~ ............................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........... ~ ........................................ 13. Will lot be regraded .....1~ .................. Will excess fill be removed from premises: ( ) Yes (Z]D No 14. Name of Owner of rem ses ~' ~' ~0 I~l~l~.kll I~11l~t1~ /~I~1~ p .... AA~k~A~ .............................. Address ................................ Phone No...~...~ ...... 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. Lo'J' ~ ( I1,~0 D~l mol- i~r'lve') STATE OF NEW YORK, { ~ c COUNTY OF ..~,.T~F.0Z~ ............... ................................................................................................. being duly sworn, deposes and says that he is the applicam (Name of individual signing contract) above named. :]He is the ................. f)T~/N~ ...................................................................................................................................................... (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 conta:ined in this application are true to the best of his knowledge and belief; and thru the work will be performed in the manner set forth in the application filed therewith. Sworn to before me ~h~ I \ / ................. BARBARA M. HAURUS (Signature. of~Jpplicant) NothlY public i. the State of Hew Yolk Ho. 52-6806770 Residing irt suffolk COU~I~J FORM NO. 6 TOWN OF SOUTHOLD , 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 disposal--(S-0 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 owne~' 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~i 2. Certificate of occupancy on p~e~-existing dwelling or land use $5.00 3. Copy of certificate of occupancy, $1.00 .... .......... Date New Building ................ Addition O.~C.~,;... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ....... 1...~ ~..~t '].~ClI~ 'J~..~.'...~[.~IL,J~.~..J...?...~....~.. .......................................... Owner Or Owners Of Property J J Subd v s o..LdI. JI E .L .CC.u. ...... ~.Z~..Lot No. Block No ............. House No...i.J.~-~ Perm t No..~.~;.~..... Date Of Permit ..... ;.:; ....... Applicant ~ lC['.~(~ ~{ ~ l...~.[ ~[.~.~J.~'.~. ...~..'~1.. (-~ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ' Request For Temporary Certificate ........................................ Fincd Certificate ..¥.x.~ .................................... Fee Submitted $ .....-..~. ........................... Construction on above described building and permit meets all applicable codes and regulations. App l ica nt .... /.L.~ )..~. ~..~..~ !..~.~. :.~,~C..~ ............................................. Sworn to before me this ................ day of ............................................ (stomp or seal)~,/~. Notary Public .................................... County ' . f APi~VED AS NOTED !1 ,1 , I I?