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Home My WebLink About7091-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnle Of Occupnncy No..Z?~,~ ..... Date .............. .~.p.t...~..8 ..... , 19.~.~.. THIS CERTIFIES that the building located at . .L~ap~t~a. Pa~t. Road ...... Street Map No. ~ ......... Block No. ~ ........ Lot No...XI~ .... .l~.t.t.~.t...u~k...~. :.~:: ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Feb .. 21..., 19. ~. pursuant to which Building Permit No..?0~.~. dated .......... Feb.~IM~y...~,~ 19..~., was issued, and canfoms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .~.~.~..t.e...~.~...ff..~..i.l. lr. d.~.e. 1..1..~..(t~..flo~r.w) ....................... The certificate is issued to .. l[~l~ .&. 0F. tl't~. J[[ai~ .... ~mwrs ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...1~. y., .~7..~. ?~..8. ................... UNDERWRITERS CERTIFICATE No...N.~.l.~.~..~...F..e.~..~.7...~.9.~.9 .................. HOUSE NUMBER ..... .6~ ..... Street ..... L~al~to~. 1~.~ .l]~a~, ................ FORM NO. ~ ~OWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 7091 z Date .............................. ~ ................. , Permission is hereby granted to: ...... .&.~.~...~.q~z~.~ ~..,.~../. ..... ~--~- .~.~..~.~.~.......-...~.....~:... ,or. _~'"-"~'~'" z.~ ...r-~ ........ ~.,=..~..,~o......~X.~,.~.....~.-...e~..,~..~'- v./..~ ............. : ............................ ,-- ...... ,<...::...~--~.. .................................. at premises located at .......~'~....~......~..~.~ .~.~z~.....~./..'.~..../t.~-~.......' ............................... ........................................................ ,z'.'.'.~.,e...z-2-./...~o...~,.., ............. : .............................................. pursuant to application dated .............................. , rov Building Inspector. Fee $, ,/,, · ,.,~.,..'~.. · ~,. FORM NO. 6 TOWN OF SOUTNOLD , Building Deportment' Town Clerks Office Southold, No ¥. 1197] 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 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 New Btlilding ................ Addition ................ Old or Pre-existing Building .....~.... ..... Vacant Land .............. Locat on Of Property ~ ~- .?.~..~..~./~ ~ .~.~. ~,~.~.. /~ ~ O, ~ I *1~1~' ~./~1~ ~. ................... r' .............................. "~ ......... ,* .......................... .~.~r.:f.~ .jo. ~., Owner Or Owners Of Property ..... ..~...~...../t~...el....~'....~.....~.:.~.~13...~ ........ .~.~...~...~....(~..~....~...~.~.~./~ Subdivision ................................................ r'"'"; ....... Lot No ............. Block No ............. Housq No ............. Perm t No~../ ~. t · ~,l ~ ~ r' · ..(~ ....... .~J~ ~2f ~e~rm_,t ..~.....~./..~......Applicant ..... .~..d./~........;:.~.....~..!..~..~....~...~..~. ..... Health Dept. Approval~.....S~..~.~/.~.~. ................. Labor Dept. Approval ...J~;~J~ ..................................... Underwriters Approval ..... ~?/~q ....................... Planning Board Approval ..".~ ............................ Request For Temporary Certificate ........................................ Fined Certificate .....~ .............................. Fee Submitted $ ....5,...~....~.. ................ Construction on above described building~i~,er, m. it- meets all opplicab~ codes and regulations. Applicant ............... ~ ............ Sworn to before me th day of Notary Public .....~.. County (stamp or seal) ~--~//? 7 g N'ot~ry Public in th~ ?ate of N~ Yo~ /r./, Res{dlqg in ~;:ff~,~ County AFFIDAVIT BY EDWARD A. HANUS I will not finish the^rooms in my house located on Lupton, s Point in Mettituck,N.Y., thst are unfinished ss shown in the Building Department's inspection report of March, 1969 until I obtain s building permit to do so. STATE OF NEW YORK) COUNTY OF SUFFOLK)SS Edward A. Hanu.s being duly sworn deposes and ssys that to the best of my knowledge information snd belief ell stetements contained in the above statement a~e true. suscribed snd sworn to befor me this 18th day of March, 1969 Notary Publlc~ MARY E,'~BURNS NO. Notary public in the State of New York Residiqg in Suffolk County qommisson £xuires March 30, S-9 SUFFOLK ~OUl%'~ DEPART~E~ OF ~%L~H TO WfIOM IT FAY CONC'EI~Y: The sewage disposal facilities for a structure located at .N/~J Privste ~.o,~d~ 620' E/O !iarratooka _~toad, . st~tuck, .¥. (Give deed locationl have been inspected by this Department and found to he satisfactory. ... ~.~,~ Di~triot ~ngineer ~a,~.. District Engineer Examined ........................................ , 1 9 ........ FO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ................................. ~ APPLICATION FOR BUILDING PERMIT Date ................................................ , 19 ............ L,~ INSTRUCTIONS 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 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 areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of ~hJs application.',-~ c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this applJcatien, 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 Xi 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 afferations, 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 applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ................................................................................................................................................... .~ 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 ............................................... #~"l~t, ,~¥,11 ll0ll4 1. Location of land on wh~f~:)r~31~c~l~l ~. i~l~No.: ........................................ ~J~l~J~ ................ Street and Number ................................................................................................................................................... Municipality 2. state exist,ng use and occupancy af m, n :: and occupancy of proposed construction: a. Exisiting use and occupancy ""W ............ I1' ................ a ............ ~:/~l'~i~.'~'ii/~'"~"i"~N~i~"~'~il~i~' ..... b. Intended use and occupancy ........................................................................................... ~ .................. 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work jl. jjlj~j~.ii~il~j~ .......... 4. ~t~moted Cost ...... jltllj~..~m..~v.~..t, ffi(~l~.Z;;4iZ.~.~..~.iii.~.~..TAiT.~.~;ii~;B~,,i .................. 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 st~-Uct~re$, if any: Front .~J~.!J~.ll.~l- ............... Rear .~jjl~ ~r.j .................. Depth '~J~l~ ...... ............... Nu er of Stor,es ........ .......................... .'..:......-..... ............................... .-..'.....'.' ............ 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 .... J,~J}~ .......................................... Rear ....... ~Jj~¥~ ...................... Depth:j~;~l~il~,. 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: j~. ................................................... 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, ond indicate oil 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. STATE OF NE~Y~ ~,/' ~ ¢ COUNTY 0~.~/.'~. ...... r~'~ .................................................................................................--~/ being duly sworn, deposes and says that he is the applicam (Name of individual signing controcfl above named. 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 make and file this application; that all statements contained in this application are true 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. Sworn to b~fo~e~e this ~ ~ /' ~ , / ~.~ o~ ~~.... ,~.~ ~: .- /~ ~ / / '~;;;. ~.~,~~, ~:~..~~~ ........ ~~....~...:..L~~ ......... '/ ' J~DITH T. BOK~N (Signature of applicant) Note~ Ru~]ic, State of New York No. 52-034~963 SuffoJk Counl~( ~i~i~ ~ir~ ~rcb 30,