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Home My WebLink About8514-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building inspector Town Hall Southold, N.Y. Certificate Of Occupancy No... Z..1.0392 ....... Date .... Feh~.uar.y.. 18~ .............. ,19 8.1. THIS CERTIFIES that the building ................................................ Location of Property .... h,~ ,3 ~3..4'~, ,..P.e¢o~.c. Bay. · Bl.v.d., .... La. urel.,..I~, 2/ ......... House No. Street Hamlet County Tax Map No. i000 Section ...1.2,8 ...... Block .... 0.2 ....... Lot .. P.1.9 ........... Subdivision ............................... Filed Map No ....... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... a. .8.~ ........ , 197..6. pursuant to which Building Permit No...851 .4..7. ............ dated ...... /~p.~.~, l. 2.0 ............ 19. '/6, 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 ......... ................. .~,~c e $ '~x~r:;~..( .U. t; l ~. J..t i~/: )..~.P, l ~ ~.1 :Lr~F~ ............................. The certificate is issued to ....... Floyd. E.,. · ant[ .Lo g.g. ie. F.,..Jon~s .................. (owner, l~,~t:, l,t~e,t~J_, of the aforesaid building. Suffolk County Department of Health Approval .. ~{ J.[q .................................... UNDERWRITERS CERTIFICATE NO... M//~ ............................................ Rev. 1/81 Building Inspector FORM NO. ~ TOWN 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? 8514 Z Date .................... A,~I.....~O .............. , 19...~ Permission is hereby granted to: ~ ~o~.d..~.. t.o~ti~..~.o~ ~ ................................. ........... ~m~i.tuck ............................................... ~o .~,uild...r,~,~..acce~s~.y...CutiL~,t¥.)...bu£:td.;~;m§ ............................................................... ~t premises located ct ..,~....,~e~(~l~,e...~[..,}3.t.¥d .................................................................... .......................................................... .~.~ ,t.,~.t..u..~ .k......~:!... ! ... .................................................................. pursuant to application dated ............................ A.p~£1...8 ........... , 19..~.6.., and approved by the Building Inspector. Fee ~.Q.,,..O..~. ............ ~u~lld!o Inspector FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instruotions 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 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 sur~ev ofp,j~6perty 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. 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 ,o,,., ,z ....... Date . New Bu Iding ... ~ .,..._.... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ~..~..~:.../¢~:'~.~.¢.../~'..~.~....~...~'.O.... .......... ~,,~2.~z../~'~-~,. ,//. ' Street HaM/et Owner or Owners o f ~ , .~.'~.~ y~c? ~,... ~'./. ZO.'J~'. ~.~,. <~,~,~'. .................. County Tax Map No. 1000 Section ,. ~.Z..~ ........ Block ....~)..~. ........ Lot....O./. ~. ........ Subdivision .......... ~ ............ ~. · ./ .... Filed Map NO .... ~-: ..... Lot No.....---", ........ Permit No..~'¢~'/.~. ~.. Date of,,,~,<lr,lZ4..Applicant ,/~/~. ~.~ .......... Health Dept. Approval...~/~ .............. Labor Dept. Approval ...*/~, ............. Unde~riters Approval .~ ..................... Planning Board Approval .~.". ............. Reque~ for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ . .~ ...................... Construction on above described building a, ndDermit meets aU app~cable codes, and Rev, 10-1o-7e FORM TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'$ OFFICE SOUTHOLD, N. Y. £xomined ....................................... 19 ..... ( ' ' g I~pe~tor) APPLICATION FOR BUILDING I~£RMIT Dote ._? ........ INSTRUCTIONS This application must be completely filled in by typewriter o~ in ir~k and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot pJan 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 ~'~,'~ 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 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 f~r demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to L~) admit authorized inspectors on premises and in buildings for necessary inSpections. (Signature of applicant, or r~ne, if a corporation) (Address of applicant) State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ............. ~..~. ......... ~--~.../.~ ...... ~..~i ........................................................ 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 Trode's License No ............................................... 1. Location of land on which proposed wo~ will be done. ,~ap No.: ..~.. ............ '~'~'~Ty'"'"~'-~'~ .............. Street and Number ~ /..:~.C~.~' ~ / ~' ~...4..~ ~.. ....... ~.(..& .L/.~.. . j..~. '.~. .~.~.~ ............ ¥ .... 'z .......................................... M' n o p ty ' 2.State existing use and occupancy of p,.remises an~ intended use and occupancy:of proposed constr~tion: o. b. 'ntended use and occupancy ........................ 3. Nature ~ v~ork (check which applicable): New Building'. ................. /(dclitio~ .................. Alteration ............... Repair .................. Removal .................. Demolitio~ .................... Other Work ......................................... 4. Estimated Cost .............. Z. ..Fee ......... .'....~ ....................................................... ~'~tpczTTJ~ be paid on filing this application) 5. If dwelling, number of dwelliag 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 ............................ Nu_,m, ber of Stories ................................ 8. Dimension~ oI entire ne~ construction: Front ......... ./..O'fS ..................... Rear ............................ Depth ..~ ............. '~, Y/-~ / Height~.Y~.7...~.L ~umber of Stories 9. Size of 10t: From ........................................................ 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 ................................ Phons 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 ~vhether interior or corner lot. / /~ ~0 / STATE OF NEW,,YORK.~ ~ I c c COUNTY OF ...~.~..~..f.-".O.~.~.......f~'~ ........ :~.'~.~.J..~.. ....... ~......~.~ .................................. being duly sworn, deposes and says that~he is the (Name of individual signing contracf) above named. SHe is the ...:J~.~.~.~ .......................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of sold 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 tha~ the work will be performed in the manner set foffh in the application filed therewith. Sworn to before me this~ ~~ ~ ........... [.~.. do~ of ..... .~.~.[ ......................... , 19.~.~. Nota~ ~u~ ......... ~g~~ ............ Coun~ ................................... Notar7 Public, Sgageof Now No. 62-8~21(~2~, SuffolkCoun~7 Commission Exgirea March30, 19~