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Home My WebLink About8504-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy No..Z~..0~. ...... Date ............. I, Ug... ~0 ..... , 19.76. THIS CERTIFIES that the building located at .. E./$. Id~bess.c~.. 8.t. ....... Street Map No...~x. ......... Block No....~c. ...... Lot No....X~c.....8.o.~..t.h.o.l.d. ............... confoms substantially to the Application for Building Permit heretofore filed in this office dated ........... .A.p.~'~.~.... ~ .6, 19 .~.~. pursuant to which Building Pemit No. 8.~QbrZ.. dated ........... A9r~-~,.. ] 9., 19.~6., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .~ .r.~.v.~.t..e..o.n.e...f.a.m..~.l~..d.¥.e..'.]:~.n.g ..................................... The certificate is issued to . .F.o.~m.d.e.~$. Hc~es..][r~c ....... .~rner .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Ailg .. 211.. ] 9.~.6.. by .BoY:L~LZa ....... UNDERWRITERS CERTIFICATE No.N~0001 .~. ..... Aug.. 2L~...~.S~6 ............... HOUSE NUMBER ...... .~.20. ....Street ...~.a.b.a.s. ~.o..~.t; ..... 5~;1~.~ ............ Building Inspecto~ FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N~ ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8504 Z Date ............................ A.p t~:1:.~.......16 ...... , 19..~6.. Permission is hereby granted to: g~a..~eaee...~ae ..................................... .............. ,L~t,~a;L¢~ .............................................. to ..~ ~ -'Ld..~e~.. ~z~e,.. fa~:Ll.~ ..D~e~l ~£. ................................................................................... at premises located at .~,/~..~01~0-.~$ .............. (~q~C...Z~..~l~...~$~8.~ ............................ .................................................... ~t~lc~....~...~ ........................................................................... pursuant to application dated ........................ ~.~.......1~ .......... , 19~..., and approved by the Building Inspector. Building Inspector 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 disppsal--(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: ]. 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 bu!ldings 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 ............... New Bqilding ..... ..~.... ..... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .... ~/~......../x~....~...~....~.~....,.~..J.~ ~ ........................................................................... Owner Or Owners Of Property ..F...~...~...~.D..~..~,..~. ......L4~../:J.,..~...~...,..j...~.C~,...; ........................................... Subdivision ,/m,,.~.,,,~..~,~.L~(,......~....~.~..~.....~ ....... Lot No ............. Block No ............. House No ............. Permit No. ~.~.D....~..Z,. Date Of PermitY~/~..Z:.-/~-l,.~,,Applicant .~.?....~.../~..!?.....~-...~..;.~.....~.~..,./~...~..~;../..../~'.'..~.,.' .... Health Dept. Approval .~..~...~..,....~...~....J..?..~.~ ....... Labor Dept. Approval ................................................ Underwriters Approval ./~..(d ~......f~.../..~.~....~. ........ Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fino~ Certificate ......................................... Fee Submitted $ .....~..~./)....~.. .................. Construction on above described building an~cl, permit meets cl~lic~able codes and~regulatlans. Applicant ~~.~..~...: - ~~'~7~ ........ ~" ................. .............. d. ....~;~.~7 .......... (stamp or seo')~fr/'~ ~ ~ NEW.YORK BOARD OF FmRE,UNDERWRITERS BUREAU OFf ELECTRICITY iTREET. NEW.,YORK~ NEW YORK 10038 i ii1: ill ,I laC, · ,'~ Waba. sso Street:, S. qutholct, 'r.. I. ~V.... r' } F''-- ~'~ f,u -., . tl1~[~; h% ~u.flXTURES~,J H, . ', ~, I RANGES ,~ ICOOKINGD~K$ I" :rOVENS [DISH WASHERS EXHAUST FANS 1 Smoke Detec$o~ :.. '-ql~ w ~ 1-q. Skw Hot, wate~ hea=e~ ,~ Charles M. Hall, S60 Long Creek Drive, outhold, L,,'!:, 11971 Lic.657E This certificate must~tlot be altered in oily manner;, return to the office of the Board If ~ncorrect. Inspectors may be ~denhfmd by t~ credentials._ FOI~.~ NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ................................... .~..., 19.7....~.i Pernit No. Disopproved o/c .................. ~~~"tZ~ZZ~,~,~--. .............................................................. .......... .......................... ............... ................................. APPLICATION FOR BUILDING PERMIT Applicotion No...~?~.,~,,.,~,. ....... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink end submitted in triplicate to the Building Inspector, wJtl~ 3 sets of plans, eccurate 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 or arees, end~ giving a detailed description of layout of property must be drawn on diagram which is part of this application. c. The work couered 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 ~n 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 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 coostruction 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. ...~.?..~..~..~>..~.~..$.....~s.:~..¢...~ ........ i.i.V..¢...:.... (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 ...~...%.~.....~,.r~.~..~.~ ...... .(.~.~.;~..~..C.....L../~/..~...: ........................................................................ If ap. olic~t is a corporate,.sign, a, ture of duly authorized officer. ...... ........ ............. ' ~Name and title of corFff3rate officer) ~der'~ L~cense No....~,.,~ ............................................. Plumber's License No ......................................................... ~/~- ~.2 Electrician's License No ..................................................... ~. Other Trade's License No ................................................... .('~... /~. 1. Location of land on which proposed work will be done. MapNo ..................................... Lot No.z .................. _ Streeta.d Number ...... ...... ...... ............. - Municipality 2.State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................................................................................................................... b. Intended use and occupancy ...O...t~J~,....-~....~...~...!...L,..~.......~...u~....~..~..{,..I.~.~.. .......................................................... 3. Nature of work (check which applicable): New Building ................. Addition ..................... Alteratibn.:...: ......... Repair ......................... Removal ......................... Demolition ........................ Other Work (Description) "O o O .... ~........ .......................................................................... 4. Estimated Cost ....~..~ .................................. Fee (to be paid on filing this application) FZoo ~ 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 occul~ancv, 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 e~ptire new construction: Front ....... .~.~. ............ Rear ..... .~....~. ................ Depth ..~../"~.. ...................... Height /..~. . ~ Number of Stor es ~. $...~.~ ..~...~.. . . 9. Size of lot: Front .....~....O../. ......................... Rear ..... /.~.~. ............................ Depth ...~..~. ........................................ 10. Date of Purchase ...~ .~.~./-..,............/q ).~....... Name of Former Owner ....~...)..c....~....~...~..?. .................................................. 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law. ordinance or regulation: ...../~/-.~. ................................................ 13. W lot be regraded ....... ~'.~. ...................... Will excess fill be removed from premises: [ ] Yes [~ No · ' o,.,~,- ,,~ ~,,/ ' - 3'/0 . 14. Name of Owner of premises .iF.. ........... .c~.~i~5; ...... ~.~. ........... ~ .......... ~..: ............................ 7..~..~.....~. ....................... (Address) ~. ~ (Phone No.) Name of Architect ..................................................................................................................................................... (Addres~ (Phone No.) Name of Contractor . ~...' ........ ~./.-~.(Z~....~.~ .......... ~.?.?.../..../~.~../':.~?. ...... Z~....Y..; ................... (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 wheth- er interior or corner lot. Svv '-f . STATE OFNEWYORK, ~-~ , ~ ) COUNTY O~ ....... .,~.~.-~..~_,L~ ................ I ss ...~...~/,. ......... /.~..~ .................. being duly sworn, deposes and says that he is the applicant above named. H. ~ ~ ........................................................ .~..~.~.~.~..~.~. ............................................................................................................. (Co~Zractor, ~e~t, corporate oS~cet, of sa~d owner or owners, and is dWy authorized to ~rform or have performed the said work and to make and file this application; that statements contained in this application are true to the best of his knowWdge and belief; and that the work will be performed in the set forth in the application filed therewith, ......... ............. ............... , . Not~v fie~r~?.,~;n..p~..~p~....~.....~.~Lt% Co~t~ ........................ :~...~.~ .............................. ~ ~~ {Signature of apphc~u ,! · o=.~J~U.t~f ~OUN~¥ HEALTH DEP]%RT/~ENF The Sewage d~spo~al an~ water ~DDIF facil~tf~s for this location have bee~ ~0 bo satiSfac%o~. L ........ t,,,