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Home My WebLink About7944-zFOIE~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z6888 ...... Date ............ P.~l~...l? ...... , 19.7.{~. THIS CERTIFIES that the b~ld~g located at L~t~le. Pe~on~e. Bay. ~.. Strut Map No. ~ ~. ~. F~k No .......... Lot No,2~1.7..2~2 .... qB~.. ~.,~. conforms subst~ti~ly to the Application for Building Permit heretofore ffl~ M this office dated ...... ~..20..., 19 7~ p~suant to which Building Pemit No. ~2.. dated ....... ~.. ~.., 197~., was issued, ~d co~orms to aH of the req~e- ments of the applicable provisio~ of ~e law. The occupancy for which t~s ce~ificate is ~ssued ~ . ~i~. ~e .f~ly. ¢~ll~g .wi~ additio~ ................... The ce~ificate is issued to .. ~illi~ .Ho~e~ ... ~ ......................... (owner, lessee~or ten,t) of ~e ~ores~d building. Suffolk Co~ty Department of He~ Approval ~,R, .............................. UNDER~ITERS CERTIFICA~ No.. P~q~. .................................. HOUSE ~MBER ... ~.~0 .... Street . Litt~ .Pe~nie. ~y. ~ .............. ......... / .... FO~M NO. ~ TO~N OF $OUTHOLD BUILDING DEP~TMENT TO~ CLARK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE Pi~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 794 Z Permission is hereby granted to: ge~-.~t~e~,..-..~/~-.,;~..~o~-st_~._t~i ................ ............ ~touth~:txl' ............................................ to ~d..~..~dt.~f~a.. ~-.~e..-~t e.~:e %1~.. ~n.-~ ~-i-~:t~..~wet.~.X~ .................. at premises located at te~3~...sL~..~...~+~....~l~j~.~...p~,...~e~ ...................................................... ............................................. &i.~t -~e .- ~e e]~Eilo~¥-..R ee ¢I- ........... ~es.,.-. l~b.- ¢~,t~ehogt~e .... pursuant to application dated ................... ~a~'.....~O ................... , 19.~..., end approved by the Building Inspector. Fee $.~.~:,.CO. .......... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall 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 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 dlsposal-(S-9 form or e~luat). 3. Approval of electrical installation from ~oard Ol ~re unuurwnLu~. 4. Commercial buildings, Industrial buildings, Multiple Residences and mmilar buddings and installa- tions, a certificate of Code complmnce from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. Bo For exmtlng buddings (prior to Aprd 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topogr apb ~c featu res. 2. Sworn statement of owner or previous owner as to use occupancy and condition of buddings. 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 dwelhng or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ...q.a.n.u.a~y..:2Q,. ~_.9.E}$ .... Location of Property ...~.i.t.~.:l:e...P.e. qo..n.~.q . .B.~ .R. 9.a.d.,' .~.a,s.s.a..u..P.o.~.,..C..u.t,c.h.o. 9'.u.e.~' . .N:.Y.. House No, Street Hamlet Owner or Owners of Property . ~..o.~.s.~...~.~.~ .M.i.~..&...C.~.~.~..m!..~.c: .......................... County Tax Map No. 1000 Section ...~ .~.1 ......... Block., . .~.4. ........ Lot...~.4, ........... Po±nt Health Dept. Approval ........................ Labor Dept. Approval ........................ Underw'mters Approval ....................... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..... .X ................. · ,o FeeSubmltted$ ~ ..... I....~. - Construction on above described bu lid mg and ~ meets alj-al;~diicab!~, co¢e¢ and regulations. Apphcan "' Rev 10-10-78 / J Mix & Cream, Inc. FORM NO. 6 TOWN OF SOUTHOLD , Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This applicotion must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector w~th the following, for new buildings or new use: 1. Final survey of property w~th accurate location of oil buddings, property lines, streets, aha unusual natural or topographic features. 2 Final approval of Heolth 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 mstollatlons, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-ex~stmg" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual naturol or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and cond~hon of buildings 3 Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare o 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 $1.00 [~te ...... .~. ~..~,J.2.~. ......................... New BHilding ................ Addition ....~.~.... Old or Pre-existing Building ................Vacant Land .............. Location Of Property ..... }T~9§.....~..~ ......... Ln.t~..~Tn,,..2./4!..&2/4~ ..... T-~.t.t&*.~.e,c.C~.:L~,.J,S~/'...~L ................... Owner Or Owners Of Property ...~..~..Z.~ft~,..~.q~'~.~ ................................................................................. Subdwision ................................................................ Lot No ............. Block No ............. House No ............ Permit No .7.~.~P,,~ ..... Date Of Permitl~.Y...:~.0.J.7.~i...Applicant ...... ~.¢.9~L~...$..,~,g,e,r. .............................. Health Dept. Approval ..... ..~....~ .......................... Labor Dept. Approval ......... /~.,!.I..~.. .......................... Underwriters Approval ...~..~.....~....~. ..................... Planning Board Approval ...~...]..[.~--~ / Request For Temporary Certificate ........................................ Final Certificate .......~ ............................. Fee Submitted $ .... ~ ........................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ......................................................................................................... Sworn to before me this ~ ........ ........ ....... Notary Public ....... ~../~/~.. ..... County (stamp or seal)~ ~f.~,/O ~00 * ~'' FORM NO. 1 TOWN OF SOUTHOLD ¢~//7~" ~ ~r~---~ ~, ~ _ ~/~ Tow. ~um.o~, ~. Y. ~~ ~~/~ ~~ -..2 .... - Ex. mined 19~.~ ~ppJic~tion No..{...~....{...~. ............ ................. ....... Disapproved a/c .......................... ~ Date ...................... ~!.8:.~ ......... ..2..0....., ] 9..Z~... INSTRUCTIONS a Th~s application must be completely filled ~n by typewriter or in ink and submitted ~n triplicate to the Buildi~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing Iocatton of lot and of buddings on premises, relationship to adjoining premises or public streets areas, and giwng a detaded description of layout of property must be drawn on the diagram which is part of th~s applicatic c The work covered by thru application may not be commenced before issuance of Building Permit. d Upon approval of this application, the Building Inspector wdl issue a Budding Permit to the applicant. Such pern shall be kept on the premises available for inspection throughout the work. e. No budding shall be occupied or used m whole or in part for any purpose whatever until a Certificate of Occupan shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuance of a Budding Permit pursuant to t Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describ, The apphcant agrees to comply w~th all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. Ge orge Bauer (Signature of applicant, or name, if a corporation) T ........... S.outb_o. lcl_....I~ .... A .............................................. (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build .......................................................... .b.~$.l~.~.~. ................................................................................................................. Name of owner of premises ..~±~l~.Z~s.t~r~ ................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No.....G.:.....~.~..~..e...r. .............................. Plumber's License No ...... ..~.~...~.fLQ~, ..................... Electrician's License No ........~.~9,~.~ ..................... Other Trade's License No ............................................... 1 Location of land on which proposed work will be done. Mop No ......... ~.~.~.~...~.~ ...... Lot No. Street and Number .... ~,.$.~e...R.e~.c~.±a...~,~..~oa,~ ...............Cu,taho.g.~e ............................................. Municipality 2 SCate existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exis~ting use and occupancy .... ~.,~..e.-'i..~,~J~ ............................................................................................ b, Intended use and occupancy ........... .~.,.~,.~.,.e,..~.,~..~...~.. ~...~(~,~,,ffL, DD. ............................................................. 3. Nalure of work (check which applicable) New Budding ........... Addition ...:~-~.,~: ...... Alteration ....:Y-_.2C~,. Repair .............. Removal ............... Demolibor. ................. Other Work ........................................... (Description) 4 Estimated Cost ....... .2...~.~..0...0..0.......+.. ......................... Fee ..1...~.%C)...0. ...................................................................... (to be paid on filing th~s apphcat~on) 5 If dwelling, number of dwelhng units ....... g.~.~ .......... Number of dwelhng units on each floor ....................... If garage, number of cars ....................................................................................................................... 6. If business, commercial or mixed occupancy, speofy nature and extent of each type of use ....................... 7 Dimensions of ex~st~ng structures, if any' Front ....................... Rear ................................ Depth ................... Height ........................ Number of Stones ...................................................................................................... D~mens~ons of same structure with alterations or addmons Front .................................... Rear ..................... Depth ............................... Height .....................Number of Stories ............................... 8 Dimens,ons of entire new construction' Front ...2.~'. ............................ Rear ........ .1.5 ............... Depth .br..C}.../..2..3 ... Height ................ Number of Stories ...... .O.~..9. ..................................................................................... 9 S,ze of lot Front ....1..~.~.. ............................................. Rear ........... .1..5..8. ....................... Depth ...~3.LJ'.../'.....~.c).O... 10 Date of Purchase ................................................. Name of Former Owner ...................................................... 1 1 Zone or use district in which premises are s~tuated . ?..~..?....d.~.s...~. ...................................................................... 12 Does proposed construcbon violate any zoning law, or&nonce or regulation ........... ..~..O.. ...................................... 13 Wdl lot be regraded ....:p...O. .................... Wdl excess fill be removed from premises: ( ) Yes ( ) No 14 Name of Owner of premises ....~.~..~...~.o.~.~.~..~.i~. .................. Address .....C...-g,.~.o...~..o..[.'g...e. ....... Phone No .................... Name of Architect .............................................. Address ................................ Phone No .................... Name of Contractor .Ge.Q ....... ]~1.1.e.:~ ..................... Address ..~D.~I..I;~C~,TL(;], ........... Phone No .................... PLOT DIAGRAM Locate clearly and dmtmctly all buddings, whether ex~sting or proposed, and re&cate all set-back dimensions fro property hnes G~ve street and block number or description according to deed, and show street names and in&ca whether intoner or corner lot See attached plans STATE OF NEW YORK, [ ¢ ~ COUNTY OF .... ~uf£olk ........... ................................ G~o..~az~er. ................................. being duly sworn, deposes and says that he ~s the apphca (Name of md~wdual s~gning contract) above named He ~s the ...................................... ~.l.~.e.Z' ....................................................................................................... (Contractor, agent, corporate officer, etc) of said owner or owners, and ~s duty authorized to perform or have performed the sa~d work and to make and f~ this apphcat~on, that all statements contained ~n this apphcohon are true to the best of his knowledge and belief; t~a~thew, or. kwil/be..p, erformed in the manner set forth m the appl,catipg filed therewith ~worn to betore metros .............. ....... ; ........... ............... , (/ ................. ~' 14~f(ry Publm (tale of f~low York No, .52-03449/~3 S,~ffotk Counl.~