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Home My WebLink About9554-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z.1.2.570 .......... Date . .g..u.n.e..2..2 ....................... 19.8.4. THIS CERTIFIES that the building ...a.d.d. %t:.i.o.n...t:9..d.¥~.l.l.~n. g ...................... Location of Property ..... .3.7.5. Igia.v.y.. $.%r.~e~z ................ Q .r.i.e.n.~. ................. House No. Street Hamlet County Tax Map No. I000 Section 2.6. ......... Block .1 .............. Lot ·..1.0. ............ XX XX XX Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated November 17 77 ...................... 19... pursuant to which Building Permit No. 9.5.5..4 .~ ................ dated J~everaher. 3_.7. .............. 197.7., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ....~.d.4~..t.~p.n.s., .t9. ,e. ~x.&s.t.~..n~..d.w..e.~.~.~.n. ~: ........................................ The certificate is issued to Isaac T. Edwards ..................... ?o¥.'& '~;~Dr~7~i,~ ...................... of the aforesaid building. Suffolk County Department of Health Approval ..... N/A, ................................. UNDERWRITERS CERTIFICATE NO. Iq 404705 Rev. 1/81 Building Inspector sOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 9554 Z Date .......................... }]D.$T~....~ .7. .............. 19..7.~... Permission is hereby granted to: T o~z~ ..~to~k.l%u~ .....A/G -..~e.. :~ ~a.z'd,s ............ .............. ~,.~.e~ ................................................... to $~ui.J~...~..~li.~ i~n.. &..~e...a ~.~e.~a~i-on.s .* o~.* ~ ~ ~.t,i~g ,.:~-.i-~ .................. ................... .............................................................................................................. at premises located at ..IJ~.~..~e.~ ............................................................................................... ................................................ 0~ .................................................................................................. pursuant to application dated ........................... J~'~m ....... ~.~. ......... , 19...V.~., and. approved by the Building Inspector. Fee $.'1'-~..,00 ........... 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~ tot 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. B. 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, str. eets, buildings and unusual natural or topograpl~ic 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 3. Copy of certificate of occupancy $1.00 $5.00 Date ........................ New Building .... ?./ Old or Pre-existing Building "~-'~ Vacant Land Locat,on of Property ~75 , .~..¢¢~. ~ //¢" ~ House No. h ~' Street Ham/et Owner or Owners of Property ..~...~,.~~ ..................... County Tax Map No. 1000 Section . ~ ~ . ., Block / Lot,. X~ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No .... Date of Permit Applicant .................................. Health Dept. A~proval ........................ Labor Dept. Approval ........................ f~t.~. ~. ~, 2~'....Planning Board Approval Unde~riters Approval ...................... Request for Temporary Certificate ..................... Final Certificate Fee Submitted $. W.[..' ...................... Construction on above described building and permit meets all applicable codes and regulations. Rev, 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS p~11 BUREAU OF ELECTRICITY ~-- 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT o~y t~e e~ct ' . H l~t ' FIXTIJI~ FIXTt~l~ ~ O~ ~ W~ DIMMERS SERVICE DISC~flNBCT S E R V I C E 1-G.F.I. Sal P~&te Elec. Wlg~Lna Lane Greenpo~t, L.I. llgqq blc. 10~9 R 11 This certificate must not be o~l~red in any manner;, return to the office of t~ by credentials. ~ FOR BUlU)IN~ DIPAJEIMINI'. THIS COPY OF CIRTIFICATI MUST NOT Bi ALTEBID IN aNY MANNER. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Yo Application No..,.~ ....... ~o...~.. ........ 19 , . Permit No ..................................... Disapproved a/c ................... ]~-~'"'~";'~w ........................ ~'~ --s ............. ....................... ............................... ............... ............................. ...... ~'"'~ing Jnspecto~ AFPLICATION FOR BUILD~6 FE~MIT Date ................................................ , 19 ...... 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 o~ 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 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 ir~ buildings for necessary inspections. (Signatu~ 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 ..... .'~....<J://~.~....~..~.~ ............................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name end title of corporate officer) Builder's License No ........ ~....~.. .................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's License No ................................................ Xx~ ~ 1. Location of land on which proposed work will be done. M_ap No.: ................ /..:?.. ...... Lot No....~ .................... Street and Number .......................... .~.'..~.,' ......................................... ~.~..:L-*~,,-.~<~¢,~~..~'-. .................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ....~.4 .................................. ~. ....... ~ ........................................................... b. Intended use and occupancy ..... ~.....~...~..../..~'/.~.'.. ...~ ................................................... 3 Nature of work (check which applicable): New Building'. ................. Addition .........l~... ...... Alteration .............. P, epai r .................. Removal .................. Demolitior. ................... Other Work ..... . .~...~.~ ....................... ~? '/~'~'~ 0 0__~ (Description) 4. Estimated Cost ............................................................ Fee ......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ........................... If garage, number of cars ..... .~ ................................ , ................................................................................................. 6. If basiness, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7, Dimensions of existing structures, iF any: Front ...~.,~...'...~...~.; ........ Rear ....~...~.:...~...i.'. ........... Depth ..,~.'~.,,~.~./~..~.~ Height .....?.~....~...'. ......... Number of Stories ...... A ....................................................................................................... Dimensions of same structure with alterations or additions: Front ...... ........... Rear .....,~.....~"...~.~....~; ..... Depth .....~.~...L.~...~/. ............. Height ......~......~...~ ............ Number of Stories ........ ...~".. ................... 8. Dimensions of entire new construction: Front ...~....~...L .....................Rear ......?....~....~. ............ Depth ....~..~.,( .......... Height .................... Number of Stories ..... ~.. ............................................................................................................ 9. Size of lot': Front ..... ~......~..~....~... .................................... Rear ...... .~....~..?../...~/'. ............. .~..,. Depth ...../..:.5..~:....~, ........... 10. Dote of Purchase ........................................................ Name of Former Owner .~.,.'~_...~ ...................... 7 1 I. Zone or use district in which premises are situated ....~,~w~.z .................................................................................. 12 Does proposed construction violate any zoning law, ordinance or regulation: ...~..~: ....................................... 13. Will lot be regraded .....?'.~". ........... ~Will excess fill be removed from premis, es: ( ) Yes (,J0 No 14. Name of Owner of premises ..~...t.....~..~~~.. .............. Address ...~..~<~....... Phone No. Name of Architect ....... ; ................................. ¥...., .............. Address ................................ Phone No ....................... Nome of Contractor .~ .. " ~ ........ Address ...~....~.~.~..... Phone No. ~..~..,..?.~..~.-.~./ PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions from prcpcrty lines. Give street end block number or description according to deed, and show street names and indicate whether interior or corner Iol. L ~C:¢A'I'E OF NEYV~y,(~, 1S S L~JU~N I ~ Ut- , ............................... Tony Norklun ................................................................................................ being duly sworn, deposes and says that he is the opplicanl (Name,of individual signing controcf) above named. Fie is the .......................... g.o.~..~.r.~.~,..~..o..~.. ............................................................................................................................. (ContractoF, 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 ,~his application; that all statements contained in ibis application are true to ~he best of his knowledge and belief; and tha~ the work wilt be performed in the manner set forth in the application filed therewith. Sworn to before me this day of November 1 .................................................................... , Notary Public, ......................... -. . .~.~.~..~..o...]:.~ .......... County ..................... ' ~ ....i~'[~'~'~'~ ~';; ' ~ ~' '; ~'l~'ii~'~ ~')' ........................... ELIZABETH ANN NB/II.LE ' / '-- NOTARY PUBLIC, State of New Yod, / No. B2-8125850, Suffolk ;l?~rm ~xpires Mar~h 30, 19~..~ APPROV~E~.~ AS NOTED~//~, ' 0 Oifice Of Gordon K. Ahlers, P.E. [J,~' I .. C Razz "Alleratlon of ~hl! J~Cl~lelll except by a Licensed Pr0fes. s/.on~l Engineer, Is Illegal". Secglo0 720g, Subdl,,dslo~ N. 'ff'. Stale Educatlae Law~ Office Of Gordon K. Ahlers, P. E. O~i~e Of :i '~O,i'd'on K, Ahlerl,,p,.E' O~fice Of