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Home My WebLink About7499-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Occupnncy No. z6199 ....... Date ............ Nov .... ~- ...... , lO .7.~. THIS CERTIFIES that the building located at ~itt].~ -Nec.k .&. ~-lson .I~ Street Map No ............. Block No ........... Lot No. Outeho~e...N,Y., .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... A~g' ' 26' '" 19.?~. pursuant to which Building Permit No..71~9.9Z. dated ............ Aug.. ~G-', 19..71., was issued, and confoms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is Private. -aoes.ssery .(storage.). build.lng ............................. The certificate is issued to .Pau~ .&. ~/ancla..Bend& ..... owner ~ ...................... of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) · . N.,R, ............................. UNDERWRITERS CERTIFICATE No. N.*Ro ........................................ HOUSE NUMBER ..... '~9~0 .... Street .. -I,~ti~l.e · Neok. ltoa~l .................... ~ Wilson Rd Building Inspector FORM' NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7499 Z Date .................................. .AM,~t ..~1 ! 9.~l~f... Permission is hereby granted to: .~.~..~..&..~t, ..................................... ............. ~.t..,.~.,..~... ............................................. ~o .J~l~ct..ne~..aecas~z~..hut~ding ...................................................................................... at premises located at ...... Z~t:t,l~..~e~l;..Ra~l~L.&..t/L~.l ~g~..~ ............................................. ; ..................................................... ~l.t~Qh.Q IGI ......... ~.~'.~ ................................................................. pursuant to application dated ..........................A13~....26 ............. , 19..~., and approved by the Building Inspector. Fee $...1~).,~. ......... TOWN OF soirrHou) lUll.DINe DE~AIITMINT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ............................................................................................ APPLICATION FOR BUILDING I~ERMIT ,, INSTRUCTIONS ,O* , This 'a~lication must be c~pletely fill~ in ~ ~ewrJter ~ in ~r,~3 ~ of plans, accurate pl~ plan ~ ~~c~ b. P~t p~a~ ~ I~=tion ef lot and of buddies ~ premix, relationship to ~joining premiss or ~blic str~or areas, and givJ~ a detail~ d~riptJ~ of Ioy~ of~e~ must be drawn on t~iagmm which is ~ of ~is ~1 cati~ c. ~e work c~ered by ~is a~llcation may n~ ~ comme~ ~ ~e of Bu.ld~ Pe~t. d. Upon approval of this ~plicoti~, ~e Buildi~ I~tor wJJl issue a Building Pe~it to the applicant. Such ~rmit shall ~ ~t ~ ~e premi~ ~ailable for in~ti~ ~h~ the ~rk. e. No building s~ll ~ ~cupi~ or u~ in whole or in pa ~ for any pu~e ~atever until a ~ifJca~ of ~cu~nw shall have ~en gmn~ by ~e ~ilding Ink,tar. APPLICATION IS HEREBY ~DE to the Buildi~ ~ment for ~e i~ua~e of a Buildi~ Pe~it pu~nt to the Building Zone Ordinan~ of t~ T~ of ~ut~ d, Suffo k C~n~, N~ Y0~nd ~her ~pli~e ~gulmi~ns, fo,~~i~of buildi~, a~i~ or al~i~s, 0r for /ge app.cant agr~s to c~ply wi~ all a~licabl~, ma~ Duir~ admit au~oriz~ ~o~ ~ premiss and in ~i~ for ~w~ions. .... .=... ... _ . · .... , r State whether ap;Ii'antis owner, le,ee, agen~,ginee~.~ general contractor, electrician, plumber o; builder. Name of owner of premises ............ ~L ......... . .~...~..~..~....~JA ............................................................................... If applicant is a corporate, signature of duly authorized officer. (NomejJ~l title of corporate office Builder's License No ................................................. Plumber's Lice~.se No ............................................... Electrician's LiCense No ............................ = ................ Other Trade Locatiqn of~la~l b~ done. ~Map No.: ..~..,Lot6No ......................... Street a.d State existJng use and ~cu~ncy of ~~ntended use and ~cu~ncy of pried ¢on~mction: a. ~isJting use a~ ~cuponcy .....~~:..~ ............. ~.....k ............................. ~ ........................ ~.....~ ......................... ' nten~ and ~cu nc ~. u~ ~ y ................. .~.....~..~F. ~ .................................................................................. 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolitian .................... Other Work .................................................... *'~) t~ " I ~) ~ (Description) 4. Estimated Cost ............................................................ tee ......................................................................................... (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 ................................ Heighl~ ............................ N,gl~,r~er~of Stories ............. .j~..j, ........ 8. Dimensions of erjtire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of_Stor ese ...... ~ t 40 ~ ~ .................. J* ~ ................. 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 ......................................................... ~'O .................................... 12. Does proposed construction~io,~late any zoning law, ordinance or regulation: ................................. 1.3. Will lot be regraded ................... ~Wil excess~f~ll..~l~/emoved from premises: ( ) Yes 14. Name of Owner of premises .................................................... aaress ................................ Phone i,~o ....................... Name of Architect .................... ~*~1[_' 'l'"~ ...................... 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 ane india, me whether interior or corner lot. STATE OF NE.~¥I~I~ .~j~ JSS J COUNTY O~.~........J · dep~llljl~ says being duly ........... ............ 7';'"";'".'"';?:"-*~'"'~'.'"':" I'" "'~.'t'*¢....'.". ............. ,' "~'N'dm~ df ,nd,v,~ual s,gm~ ~ntra¢~ ' sworn, applicam above ~clrned. He is the .......................................................................................... ~. .................................................................................... (Contractor, ag~ent, corporate officer, of said owner oF owners~ and is duly authorized to perform or have performed the said work and'to make and file this -application; fhat all stc:tements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the application filed therewitt~ Sworn to be~ me this ~ ~ ~ ........ ....... ,,*..Z¢ Notary P u b I i~..~./..;. ~..~y .................... ~ ~......~.. ~ ...'b~..~ ................ ~nt) FORM NO. 6 TOWN OF SOUTHOLD 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 ond 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-ex'st'rig 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 ........... .~.~...V...:....!.! ....... !.~..-/...~ New Building.... ........ ~.... Addition ................ Old or Pre-e~k?ing Building ................ Vacant Land .~ ............ Location Of Property L-,'~.~L~ ~,~ {~,..~ ~ ,.I /~o-,I ~)~ ......................................... ,. ....................... ~.....~..~.~.....~...~....~.t) ........ ...'~.....L .%L'1' Owner Or Owners Of Pro-art,, ~J~ .~/~ ~ .~ A ~J ~- ~ U ~ Subdivision ................................................................ Lot No ............. Block No ............. House No , _ Permit No..'7.....~.~..~...i.~... Date Of Permit ~:.~,~,'~L~ Applicant ~.~ ..................... Health Dept. Approval ............ ..~..J..~. ....................... Labor Dept. Approval ......... ..~.]..~ ............................... Underwriters Approval ................~...l..~.. ...................... Planning Board Approval .............. 1..~. ..................... Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ ......... ..~..:..0..~. .............. Construction on above described building anc~j me~ca~ble ~e; and regulations. Applicant .............. ...'~. ~...,.~_¢~, ................................. Sworn to before me this Notary Public ..... +~'7~Z~.~. ~ (stamp or ~ ~J~, ~ 0