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Home My WebLink About9507-zFOR~ NO. ~ TOWN OF SOUTttOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerfi[icate O[ Occupancy z £2: No ............. Date ............................ , 19 .... TYIIS CERTIFIES that the building located at ............................ Street Map No ............. Block No ........... Lot No .................................. conforms substantiallvot~t° t~ t)Applic/a~on for Building Permit heretofore filed in thisc~.gO.7 Z-°ffice dated ........... (~:.ff...;; ~.., 19 ~7. pursuant to which Building Permit No ......... dated ....................... , 19 ...., was issued, and conforms to all of the require- ments of th/~ applicable provisions of the law. The occupancy for which this certificate is issued is ................................ .~J ~.' .er) e~.t)... F ~. e0.~ ..................... T~e ee~i~ioa~e i8 issued $o ................................. , ~ _ .......... (owner, lessee o~ o~ ~e a~oresaid b~Hdi~[. Sn~olk Connty Departman~ of Health Approval .................................... D~D~RWR~T~RS C~TIFIC~T~ No. ~(<, ~ ~ ...... L~t.~" ' '~'~;~ ............................... HOgS~ ~MB~R .............. Street ...f. ~.~y.~; ~:.if ........................... Building Inspector :Town o~ sOut,o~" BUILDING DEeARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~.EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9507 Z Date ......................... Oe..~. .......... 2.0 ........... 19...e~. Permission is hereby granted to: ~&L~,.£a~..~,..~J;b.,~l~e.~a:~cL ..................... .................. ~.~, ~;.t~,~.t~ua k ........................................ to ...~::~-'L~.. ,~r...o~u...~a~L~,~'.. ~L~;Lz~g .................................................................................. at premises located at ..... ~/~ ....... ~,~:a.~:....,~.~, .................................................................................. ...................................................... (.L~ ~.~:a-~....14..) · ... ~la.t t .1.tuek.....l~ ,~., ....................................... pursuant to application dated ............................ ~).C:.,~.....~°.0 ........... , 19....~.~, ond opproved by the Building Inspector. Fee $..2,~og,0 .......... ! Buildihg [ spector J FOBM NO. S TOWN OF SOUTHOLD Building Dep~menf Town Clerks Office Southold, N. ¥. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructioms A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector with the following; for new buildings or' new use: 1. Final survey of property with accurate location of all bui,ldings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage dispasol--(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 aT 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 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 3. Copy of certificate of occupancy $1.00 $5.00 New Building ....... ~ ..... Old or Pre-existing Building ............................ Vacant Land ............................ · oca,,on of property ......... ...... Owner Or Owners Of Property ....... ..~.~?./~..~.~.~Z..~....~?~..~...~..~/..~.~..~..`f~.`.%~...~./..`~....~.~.~.... .................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. / Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval ...............~ ................... Planniing Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ............. ~ ............... Fee Submitted $ ......... ...~.. ...................... Construction on above describedApplicantbUilding .......... and~/____~...~~~ ../;~..../.....permit meets all app~cable codes and regulations.,~ ........ Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) ~THE NEW YORE BOARD 'OF FIRE' 0~DERWR]TER .BUREAU OF ELEC;TRICIT¥ ~,.,~ ~ ~s, ~9~a .,,.,,~,,~,,, ...... ~,,~88s N 3?6086 THI~ CERTIFIES ~HAT Willl~ Schonewald~ Bray Avenue albo Delve Wells Road~ Laurel~ ~,~ ,~..f,,u,,,~,,~ ~,,,..u,,,,~ ~ m,., ........ , ~" ~, ~.'n ~ ~,,,~ ~'~..Outside .... ~' , "; ~ J -7 ~ 161 26 18 , 16 : I ~ 1 12.2 i ~ I I 2 ~ F 1 i00 CB x I 1 1-GFCI 1-Smoke Detector Motol-s: 1~1/2 HoPo R V I C E ~*,, · ...... ~v,d ~ OO~"*UT"*tSi Of Ju~ Richard Go Relyea /' Delmar Drlve~ PoOo BOX 372 i / Laure!~ LoIo 119~8 Lic. #21~8-E ~N~: -×~,-~/~_~ ~.~, ~ ._ Town OF sOU~O~ ~,/~/~- ~'/~ ~ TOWN C~ERK'S OFFICE ~, Examined .........~'.~:...~ ......... 19~.~. Application No. ........................................ , Disapproved a/c ............... ~.~~~.~:~X ....... ~" ........................................................................... .............. ....... ............................ (Buildin~ Inspector) ~"~¢~'"'"~fi "~'" APPLICATION FOR BUILDING PERMIT INSTRUCTIONS completely filled in by typewriter o~ in in.k and submitted in triplicate This application be Inspector, with 3 set~ of plans, accurate plot plan to ~ale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets 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 pa rt for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment 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 lows, ordinances, building c~e, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ............ ....... (Si~noture of *pplicont, or name, i{ o corporotion) ... z... (Address or oppHcont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................... ................... . .............. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ......... ~ ............. Other Trade's License No ............................................... 1. Location of ' ' and on which proposed work will be)done. Mop No, .......................................Lot No ............... Street and Number /.~:.~?.~..~....~.zfi'..~:. ~:7.~..~..~.~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ..~.(~?.~;4~"..~.., ./. Z-.-~.,,.,~~/ ;.Z2.~.~./.~.~7. ......................................... . .. b. Intended use and occupancy ............. .~-~. ............ 3. 'Ncture of work (check which applicable): New ~uilding ....... ~... Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 4. Estimated Cost ...... .~.....c~....~.~....~..~..~. .............................. Fee (to be paid on filing this application) ,5. tf dwelling, number of dwelling 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 ............................ Nurnber of Stories ................................ 8. Dimensions of entire new construction: Front ............ .~...'~..; ................ Rear ........ r~.¢~ ............ Depth ......~...~... ............ Height ....... .Z'.¢~....(... Number of Stories ./. 9. Size of lot: Front .............. ...~..,,~f'. .................................. Rear .............. '~.~, ..................... Depth ..... ~....~'....~...( ............ ]0. Dote of Purchase .......... .Z~,.,~,,'~,i.".~,. ............................... Name of Former Owner ....................................................... 1 1. 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. ',lame of Owner of pram sas .,~../.,~./~...~...~.~..C.~...~.../~..~..4~.. Address ..~.. ,~..~...~...~../..~?..4'.~..~../..."~}~on/~No. ,~..~..~..T..~../...~...,~. Name of Architect ..................... ~..4~",~z~. ........................... Address ................................ Phone, No ....................... Name of Contractor .................. . .~.Z~..¢~.¢ .......................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorn property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATF OF NEW Y~)RK, COUNTY OF'~:~,?~..... [ (Name of individuol signing controc~) above homed. He is the rporate officer, etc.) ..... of said 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 that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ..... -,~..~...'~.. day of/..~...Z',~.~ .................. , 19~7../~... ~,z~.~~~ (Signature of applicant) 'NOTARY PUBLIC, Sta~'~ of New YorJ< ~ SUFF, CO. DEPi'. O I~A. LTH S~..I~V I , , NTOFI NT ~// ~ ~A~R SUPPLY' AND SEWAGE ~v,/, ~'/ ~ D~N~ WI~ CONFORM ~ TH~ H, $. REF, ~.: 7 I STAN~R~ OF SUFFOLK CO. DEPT, - ;.,,:-, . ,;.,