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Home My WebLink About7289-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.g. 1.3~5.1 ........... Date . ?l.a.r..c.h..~.3. ...................... 19 .8.5. THIS CERTIFIES that the building../~ C ~.eA ~ 9 r2t. . gl" .e.e.z~ l~ p.u.s.e. ........... ~ .......... Location of Property ..... 6..0).5..~..n.d./.a.n...N.e.c.k., Lane ?econic House No. Street Hamlet County Tax Map No. 1000 Section .. ~.5. ....... Block . ...6 ........... Lot ..... 1.(~ .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore ~ed in this office dated ...... H~. 3.1 ........ ,19~z~. pursuant to which Buildins Permit No...7.2..8 ~.Z .............. dated .... I~ y..3.1. ................. 197.~., was issued, and conforms to all of the requffements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ·..~C¢~.~ 9ry..g~.e.~t3 ~.~ ..................................................... The certificate is issued to ....... An~e. C)~-~e ~ ........................................ (owner, ~ ~Xt,~IX of the aforesaid building. Suffolk County Department of Health Approval ........ .~/.R. .............................. UNDERWRITERS CERTIFICATE NO ................ ~./.A. .............................. Building Inspector Rev. 1/81 1~0~ NO. ~ TO~N O~ SOUTHOLD 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? 7289 Z Date ...................... ......... Permission is hereby granted to~-~ , ...... .G..~.....~......~ ............... ,o ..J.3...~.L.~..D. ............ ~. ........ o.. ~ .... ~ .................. x. .......................... Building Inspector. Fe. *l.g..~. ...... Disapproved a/c ...................................................... ............................. ................... APPLIC*TION FO" "UILDING PERMIT Dote ............................................. , ~..t ......... 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 Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance~'~l ilding Permit pursuant to the ~Build!ng Zone Ordinance of the Town of Southold, Suffolk County, New York, o~d other PR icable Laws, Ordinances or Kegulations, for the construction of buildings, additions or alterations, or for re)floval or cj ~{~li~t~n, as herein described. The applicant agrees to comply with all applicable laws, ordinances, bui ding j~ode, housj~; ~_e~, arid regtJJations, and to admit authorized inspectors on premises and in buildings for necessary Inq:/~n~//// ' ( S igl~,at u re ~pl~i'i'~ nt~"o~. -~.~.~..i~..~.. ~:,~i~ · .~ ..... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~.....~.../-~....¥.....~.. O/'~ C~ ~'-/~' ................................................................... 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 ......................... .......... .............. - Street and Number ............................................. ~ ..................................... ~ ................................ /~0)~' ~vD/~x ~/£c~, L,~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ............................................... (~. ............................ b. Intended and occupancy ............................................................ L..: ............................... ~;-J. ................. ~m'3--Nature of work (check which applicable): New Building. ................. Addition Alteration Repair .................. Removal .................. Demolition .................... Other Work ...................................................... (Description) 4. ,imated ca, ...... ............... 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 ............................ 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 ...................... .~.. ......... Rear ............................ Depth ...../..~ ......... Height ....... ~ ......... Number of Stories ................... ./. ................................................................................................ 9. Size of lot: Front ............ ./....~...~ ................................. Rear ............ .~..,.~.......~. ............... Depth .......... ..~....~..,?. .......... 10. Date of Purchase ........................ .?...~.'~....~.. ...... ..~...~.. ...... Name of Former Owner ..... ...~.........~'....~.'~..l~...!..~...~...../~....~. .......... 11. Zone or use district in which premises are situated .................... ...~....&..~...~..,/....F~... .......................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................... ..~.....C/.. ........................... 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ~No 14. Name of Owner of premises .................................................... Address ......~.....~....~.....L.-~.. .......... .Phone ..................... /. 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 comer lot. STATE OF NEW YORK, t c c COUNTY OF ................................ ...................................................................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contracf) above named. He is the .............................. ..~....V~.....I~......~..~ .................................................................................................................. (Contractor, agent, corporate officer, etc.) ~,~.---~ of said owner or owners, and is duly authorized to perform or have performed~h~e said ~vo~ a_nd to make and file this application; that all statements contained in this application are true to,th'e best of ~jX"~ledge and belief; end thor the work will be performed in the manner set forth in the application filgd' therewith.~/'/ Sworn to before me this ~ ................................................... ....... Nota Pub,c,. ................................................... ........... L/,,~/,/(Signature of applicant) FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall · ~outhold, 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 features. 2. Final approval of Health Dept. of water supply and sewerage disposai-(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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accu,rate 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 i,nforma- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land 3. Copy of certificate of occupancy $1.00 use --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date ...~['Cb. 6,. :~985 .......... (ADDIT[0N ON EXiSTiNG ACCESSORY BUILDING New Building ..... ~. ...... Old or Pre-existing Building ............ Vacant Land ............. 6015 Location of Property . ;(J~X ~. J-ndi. an .Neck .La~e ............ P. ec0o i c,, ~¥ .................. J 1958 House No. Street Hamlet Owner or Owners of Property ... ~P. Fle .O].$eD .[: -- , -: ..... = .... ~,Q ....................... County Tax Map No. 1000 Section ...... 86 ....... Block ...'I'~. ......... Lot...~. .......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Apl Request for Temporary Certificate ..................... Final C/~/ / Fee Submitted $ .5...0.0. ........................ / / Construction on above described building and permit mee~ Applicant ....... .-. d ,O. z ER 0LSEN, ESQ. BOX 706 -' CUTCf'IOGUE,~I:.I., N.Y. 11935