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Home My WebLink About7872-z}'OIE~ NO, · TOWN OF SOUTItOLD BUll.DING DEPARTMENT Town Clerk's Office Southolcl, lq. Y. Certificate Of Occupancy No..Z79.6.g. ..... Date .......... .~.~. p....3 ........., 19.7.6. THIS CERTIFIES that the building located at Bay. ]taYen. _l~u_~_e ......... Street Map No..l~y .~.~¥01~.. Block No ........... Lot No, .~.. ~$~9~ .. N~ q ........... conforms substantia~y to the Application for Building Permit heretofore f~ ~ this office dated ............. ~..~., 1~. ~ p~suant to which Building Permit No...~8~ dated ........ ~ ..... ~ ..., 1O.~., was issued, and conforms to ~1 of the req~ merits of the applicable pro~sions of the law. The oeeupane7 for which this ee~ifieate is The certificate is issued to . .A~ea..g,. [~ ...... ~ ............................ (owner, lessee or ten,t) of the Moresaid building. S~olk Co~ty Department of Health Approv~ ...... ~*~ ......................... HOUSE NU~ER . .~60 ......... Street ...~[ .~YPP..~P ....................... Bffild~g Inspector ( TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTNORIZED) N? 7872 Z Permission is hereby granted to: ............ ,?~eu. thz.~]~. ......................................... to ..~i..15~..a.n..~d~i.tic~..<~n..~x&s~iz~. d~e.~..1.~g. ........................................................... at premises located at ............ L~t..,,~.9. ...... :B~,yh~,xre~ ....................................................................... ....................... ' ....................................... Ba.y.h~zen...L~e .......... S~u.th~:Ld. ..................................... pursuant to application dated ........................... }.[ay.....J ................ 19...~., and approved by the Building Inspector. Fee $..1.5,~.Q0 ........... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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. Bo For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusum 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. Fees: 1. Certificate of occupancy $5,00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Addition to building Date . .A,~..~.i.1..3..0 :..1.9..8.1 ........ :l~;]~f~ ....~ ......... Old or Pre-ex~sting Building ............Vacant Land ............. Location of Property . .5.6..0..B.a.~'..H.a.v.e..n..L.a.n..el..S.o..u.tho. 1..d ................................ House No. Street Ham/et Owner or Owners of Property . .A.C,l.~.e.s.. ~..~.~..a~..e??...~.~.~.~. .................................. County Tax Map No. 1000 Section .. ?.8. .......... Block .... .~. ......... Lot...2.~. ........... Subd,vision...B.a.~'..I-I.a.v.e..n..a.t...S.o.u.t.h..o.l.d. ..... Filed Map No..2..9.1.0. .... Lot no .... .2.9 ........ Permit No ........... Date of Permit .......... Applicant . .Ag.~.e.s...~.~z..~.~.e.~...~.A~ .~ ......... Health Dept, Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... F ' ' 1.00 ee Su bm ~tted $ ............................... Construction on above desar bed build ng ~n~mms~l ~pli~es 8nd reguls~ions, Applicant .~~~ ~ ~ ~~ ................ Rudolp~ru~, ~orney for Agnes Elizabeth Hart Rev 10-10-78 FO~ NO. 6 TOWN OF SOUTHOLD ~ Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcahon must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: I. Final survey of property with accurate location of all buildings, property hnes, 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 hnes, 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 inspechon 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 D~te ................... ~ ............ ~ ............... New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..... .............. ......................................... Owner Or Owners Of Property .... ./~..~..,LJ...,~..~ ..... .~¢.,.~.../..~....~....P9,.c.c.~[ ..... ..~.1.,~....~,..~. ............................................ Subdivision ................................................................ Lot No. ~ 7 Block No. House No ................... t4T-C~ 'FTV/~c~ ~,~c. ~' ~ Permit No. ~7...~.. ~'~ Date Of Permit ...~./././~..~....Applicant ../.(¢. ........................................ :/~.~. .......... ~. /--/~r~ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ....~...'. ............................... Fee Submitted $ .......~:. ........................ Construction on above described budding an~ p)e~rnit r/neet~_,~ll a ~j~plicable codes and regulations. Applicant ....... J~-C,~,.~u,-~....~.~b.~..%..~ ................................................ Sworn to before m,e~this day of No~~ounty FORM NO. I - TOWN souT,o . TOWN CLERK'S OFFICE ~UTHObD, N. [xomined ................... l ¢~.~... ....................................... ............ Application No...2 .~..~ .~......~r~... .......... INSTRUCTIONS a This application must be completely filled m 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 or areas, and g~ving a detailed description of layout of property must be drawn on the diagram which is port 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 or demolition, as hereto described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and tc admit authorized inspectors on premises and in buildings for necessary inspections. / ~ ~ ..... ................... (S~gnature af apj~.licant, or no. me, if a corporation) ..... .............................. State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ................ ........ ............................................................................. Nome of owner of premises .......... ~'T~...~......~...~.. ......... .,.~'..,.~..! ..~..~..~.?~... ..... /.~....~...~:',Z',. ............................... If appJfC~nI ,s o co. rporatq~,)sign, ature of duly authorized officer. (Name and title of corporate officer) Builder's License No ......... ..~....L~....~ ....... ...~.'~.,~=.,. ............... Plumber's bcense No ................................................. Electrician's License No ....... .c./...~;.....~..~.....~j..~ .............. Other Trade's License No ............................................... ~ c~' ~l. Locahon of land on which proposed work will be done. M~p No . ! ~ Lot No. Street and Number ..... .~.~ ...... ~L.~~......~..~..?.~ ........................ ..~..L~...~..-~..~.~7..,g....~...~'~ ...................... Municipality State ex.sting use and occupancy of premises and intended use and occupancy of proposed construchon: a Exisiting use and occupancy ........................ ?..)..-~.. ~-:--~ ~-~'~ b Intended use and occupancy ~'-"~ i ~ %~ ~ c.:.~-- 3 Nature of work (check which apphcable) New Bu,ld,ng ........... Addition ...... ~ ..... Alteration . . Repair ................. Removal ................ Demoht,or ................. Other Work ~..~...?..~?...~...~.~..~........~....~....c:z...~m... .... ~ ,~. -~-~ f ~-_ ~ (Description) 4 Estimated Cost ............. ./...~:.....~.~..~ ....~.. ......................... Fee .................................................................................. (to be pozd on fihng th~s apphcahon) 5 If dwelling, number of dwelhng umts .......... ..;~... ......... Number of dwelhng units on each floor ........ ..~..~ ............. If garage, number of cars ..................................................................................................................................... 6. If business, commercial or m~xed occupancy, speofy~ nature and extent of eac~type of use ........................ 7 D,mens,ons of exist,rig structures, if any' Front ........ .~.....'.~.. .......... Rear .............~ ............... Depth .... ..2r..~.~.. ...... Height ....... L.O.. ........... Number of Stones .................................................... , ....................................... , .............. D,mens~ons of same~_structure with alterations or addmons: Front ........... .~.(~....~.. ............... Rear ..... ..~...~. ......... Depth ............ .~..b. ...........He,ght ........... .J...O ..... Number of Stories ........ 1 ..................... 8 D,mens~ons of ent,re new construct,on' Front ........... ! ..~'/..Z...°...' ........ Rear ..........!...~....f...-.?..'.'. Depth ........ ! '~-- '~" Height ...... LO...~.:.~.r Number of Stones .............. [ .............................................................................................. 9 S,ze of lot. Front ........... L.~.,...~.......'.O..../. .............. Rear .......... ./..2:.....~...:.?....~ .......... Depth ...... .)..~.~.,.~?...t. ...... 10 Date of Purchase .................................................... Name of Former Owner ........................................................ 11. Zone or use district in which premzses are s~tuated .................................................................................. 12 Does proposed construction wolote any zoning law, ordinance or regulahon: 13 WHI lot be regraded ........ .Z:.?...-~:. .......... Will excess fill be removed from premises: (.) Yes ('<) No 14 Name of Owner of prem,ses ...../~..~....'Z...~..~. ..... ..~..~..f~zT. ................. Address . .~...~.Z....~...P?.?..~.../...~..LPhone No ....................... Name of Architect ........................................ Address ........... Phone No ....................... Name of Contractor ~.~...~.~.,¥.~._....t./...-~.~.~.~ .t~r....../--~c_ Address ............................... Phone No. P LOT D I AG RAM ~u u~-;¢ u u ,x Locate clearly and distinctly all buildings, whether ex~stmg or proposed, and red,cate all set-back dimensions from property hnes G~ve street and block number or description according to deed, and show street names and in&cote whether interior or corner lot /_- STATE OF NEVv' Y~RKj/../ ~ ~ COUNTY OF ..p.~~ f ~ ~ being duly sworn, deposes and says that he is the apphcam (Name of indiwdual signing contracf) above named He ~s the ..................................................................................................................................................................... (Contractor, agent, corporate officer, etc ) of said owner or owners, and Is duly authorized to per{orm or k~a performed the said work and to ~ke and this apphcation, that all statements contained m this apphcation are true to t~e ~st~f k~s knowledge and behe{, tha~ the work ~dl be performed in the manner set fo~k m t~e applicon filed Sworn to before me th~s / ~/ ~ V I/ ........ IA Y ........ ................................... (Signature of abplicant) ~DITH T BOKEN Not6~ ~Lhc, St~a e~ Ne~ York No 52-0~24~63 Suffolk County