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Home My WebLink About7225-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No... ~:.q.O~5:~. ....... Date ..... Zleoeoiber. 2~ ............. 19..~0 THIS CERTIFIES that the building ................................................ Location of Property ...2../I..~..~.Z'..~,.g??.~,..B..~.a.~..h? ............ .~..O~..~l..O.1:.~. ,..~.e.~..* .......... House No. Street Hamlet County Tax Map No. 1000 Section ...~.~. ....... Block ..... .0~ ........ Lot ..... 0.~. ........ Subdivision.. Ha-wve~.t; .Hoe, es~. Reo.. -1 ...Filed Map No.. 5~T..Lot No ..... .1-5 ...... conforms substantially to the Application for Building Permit heretofore Fried in this office dated .... .H.a~..~.t .......... ,197.~. pursuant to which Building Permit No .... '~.2.2~5..Z. ........... dated ..... .N.a.y..~.! ................ 19..7.~, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ......... A..c.c.e.~.a..o.ry., ( .s.t.or.a.g.e.)..s..t.~..q, .t~r..e. .................................... Tile certificate is issued to ...... .~..~,p.~.e...~.il~..a.~..a. .... towner,~ ................... of the aforesaid building. Suffolk County Department of Health Approval ....~.~. ................................... UNDERWRITERS CERTIFICATE NO...l~. ............................................ ~iild '~m~ector ......... Rev 4/7~ FORM NO. :8 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~/I1~ O, 7''5 Z Date .......... ~.....~........~... ............. , , 9."~.....~ ,o ...................... ~ ........................ .~. ...... ~ .......... ~...). ............................... re ,es ate t ~ /9 ~/.'"~.'/.~."~'~.~ ..................................... ;;';'"~::',~i'"';";"'ii'~iiiiiiiiiiiiiii~iii'~ ............... iiiiiii?'.-..'~/~ ..................................... pursuant to application dated ......................... / ..... , 1 and approved by the Building Inspector. Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S omcE . SOUTHOLD, N.Y. ~ Approved ............/.'. ........ ~ ............ , 19.?...~./. Permit No..~.....~.....~....~..~ ......... APPLICATION FOR BUILDIflG PERMIT ~ ............ INSTRUCTIONS ~ a. 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 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 a Certificate of Occupanc 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. (Signature of ap~cant, or name, if a corporation) (Address o aptlicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. Builder's License No ..................................................... Plumber's License No ................... Electrician's License No .................... ~ ................... Other Trade's License No ..................... o,,o ............. Street and Number ~~..~.......~::w~....~.....~......'~...L~..,,T~i;iaa~,~.'~..~ ............ ¥ ..................... nd~u~pan~cy o nLcl use~r at'nd ~ccupancy tMmUc~ioC~ ..pality State existing use a f ~~nte of proposed cons a. Exisiting use and occupancy ..... ..~c:~......~.:_:: ....... ~ .................... ,~ .................................... ~ ....................................... b. Intended use and occupancy ....... ~...~~ ............................................................... (Name and title of corporate officer) 3. Nature of work (checE which applicable): New Building .................. Addition .................. Alteration ~-..,.....~k. ..... Repair .................. Removal .................. Demolitio~ .................... Other Wore ...................................................... ~ (Description) 4. Estimated Cost ............................................................ FeB ./~...'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 ........................................................................................................................................... .~..... business, commercial or mixed occupancy, specify nature and extent of each type of use ~....~.. ......... 6. If 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth ................... / . Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction Front ........ [..0. ...................... Rear ...L.~. ................... Depth Height .................... Number of Stories ............~ ...................................................................................... 9. Size of lot: 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: ........................................................ 13. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .................................................... 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 oil set-b~ck 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. STATE Of NEWt'YO~(x.~, ~ (~ ~ ~ ~ ~ (o 0 )J ~ ,,~ ~ ~ cou. .............................. /~~....~.~.~ ............ being duly sworn, deposes and says t~t he is the applicanl (Name of individual'' ' "'' ' signing contrac~ above name. 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 ~ke and file this application; that all statements contained in this application are tree to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Swam to be~ me this ~ ..... ................ Nota~ Public,~~..: .. ~ · · · ~ ~..~.~..~.[~.w~...:....~.;.....~.....~ .............. ~ ' '~ (SignatUre of applicant) JUDITH T, ~OKEN ~ ~biic, ~tate ~f New ~ 52_~963 5u~o~ FORM NO. 5 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ORDER TO REMEDY VIOLATION Date December 19 19 80 TO . ,~ r,. ,-....A...~..t...°..~...e... ,S..b~.. A ~. ,~. ............................... (owner or authorized agent of owner) .... ~....~. ~..~.~..o..n..t..~....~.~.~.,...O.o..~h.o...z.~.,...~.. (address of owner or authorized agent of owner) ~971 PLEASE TAKE NOTICE there exists a violation of: Zoning Ordinance ART. XIV Other Applicable Laws, Ordinances'or Regulations ............................................ at premises hereinafter described in that ......... ..~.~$.]-..~..~.~...~p....z~.....i.~...~....~.~.~.~. .............................. (state character of violation) ..~..e. ~.....~./.~.../.Z~ .............. ~ ~..~....e. ?_ ~...t.~.e..~.........¥..o. ~...~.~.e.... ~.e...~.~ ~,.~.~...~ .o... a.~.~lz... ~.~ ~...~ ..... ne~ ~ez~J.~. in violation of .......... .~...~.9..:.!..0...0.?.~..4.~...~. ................................................................................................. (State section or paragraph of applicable law, ordinance or regulation) YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the law and to remedy the conditions above mentioned forthwith on or before the .... ~A~.~. ....................................................... day. of ...... ~§..~..~...~.~. ............................... , 19...~.]. The premises to which this ORDER TO REMEDY VIOLATION refers are situated at .... ~....~.?..~..~.°...~.~..~....~..A~.~..~....~.°.~.~.°.~.~, .......... County of Suffolk, New York. Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law may constitute an offense punishable by fine or imprisonment or both. Building I nspecto~:-.~c FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall 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 Inspec- tor 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 featu res. 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 installa- tions, 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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 informa- tion required to prepare a certificate. 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 $5.00 New Building .... ~ .... Old or Pre-existing B,uilding ............ Vacant Land ............. Owner or Owners of Property ...~..~.~ ....................... County Tax Map No. 1000 Section .. ~..? ........ Block .. ~..~. ........ Lot.. ~../..~ ........ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .... ~ ............. Fee Submitted $..~.,.~'...~ ..................... Construction on above described'building an~l~ermit meets a)~pplicable codes and regulations. , ' Applicant /~...~. .............. ~.~, .i~.)..~; Rev. 10-10-78 54 PF.C~ -- ! t