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Home My WebLink About9243-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z14008 DateNovember 18 85 THIS CERTIFIES that the building .... .A.d.d. ~..t .z p.n. .................................. Location of Property ..... 6. ~ ~ 5.0....M.aAn...R .o.a.d. .............. .S. qu..t .lap. i.d. ............... House No. Street Hamlet County Tax Map No. 1000 Section . . ~ .~ ........ Block ...... ~. ........ Lot ......... .7 ....... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... M. ,ay..6. .......... ,197.7, pursuant to which Building Permit No .... 9.2.4. .3.Z ............. dated ..... HaY..12 ................ 19.7. ?, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is ~ssued is ......... ..... .~.d.d.. o..n.t.o..e..x.~.s.t. ~..n~..~.u..~.Z.d.~. n..~.. ........................................... The certificate is issued to ...... ~ I~ ~iA.N.D.Q..C.l~ P. F..A ...................................... (owner, ~6~ ~ ~,~ X X X X of the aforesaid building. Suffolk County Department of Health Approval ......... .N/.A. ............................. UNDERWRITERS CERTIFICATE NO ................. .N.1.9.4. .7.2? ......................... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOL~, N. Y. BUILDIN~ FERMIT (THIS PERMIT MUST BE KEPT ON ~HE PREMISES UNTIL FULL C(~MPLETION OF THE WORK AUTHC~RIZED) ,~ N9 9243 Z Permission is hereby granted to: ..7~ ...... 3~.~.~..~.~.~. ......... ~.~.~.e...:...(~ ~ ~' -) ......................................................... · ): ........................ ;...: .......................... .~....~ .......... :....;....::.: ................ at premises locoted ot .......... ..~...,~..!...~....~......'~.,.O,~....'.~...~ ....... .~...O..?..~....l~,:~ ~.~.,.. ............ ~eU~P~ to ~p~.li~ion d~ ..: ..... ~....~ ....... ~ .~:.,, ..... ~ 19~:, ~ ~pnmv~ by.the Building In~tor. ~ -_ ,~ ... ~ Fee ......................... 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 m ~ 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 survey of pz"operty 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 New Building ............. Old or Pre-existing Buil~ling Location of Property .... .0.~ (~ ..... ~! .~....~. House No. $15.00 .... ......... ..... .~. ..... Vacant/--Land ............. ~] ,1~ Street Ham/et Owner or Owners of Property ...t,_j~j~.~,J..~./'~ ~'-' ...~~ ............................ County Tax Map No. 1000 Section ... ~ ....... Block ..... ~2. ........ Lot ..... .¢7 ......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No..~, .~.~.~..~... Date of Permit .......... Applicant... ~..1~.. , ~ ......... Health Dept. Approval ........................ Labor Dept. Approval ........................ 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 ~ .~_~ ~.~:~..-r .... ~ , .~c~ Examined Approved TOWN OF SOUTHOLD/''~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c .................... .........~._ .._..~......_..._~ ........ ..................................................................... ....... 3F' 'P ...... ................... ...................... (Budding Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This apphcation must be completely filled in by typewriter or in ,nk and submitted in triplicate to the Buildi Inspector, w~th 3 sets af plans, accurate plot plan to scale. Fee according to schedule. b Plot plan showing location of lot and of bu,ldmgs 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 ~s part af this applicati, c. The work covered by this apphcation may not be commenced before ~ssuonce of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such pert shall be kept on the premises available for inspection throughout the work. e No budding shall be occupied or used in 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 Building Department for the issuance of a Building PermE pursuant to t Building 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 applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and iN buildings for necessary inspections. "Z~ ~- f; V_TM ........... ............... (Address of applicant) ~/' ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build ......................... .......................................................................................................................................... Name of owner of premises ............ ..~.~ ................................................................................................ '~f apphcant is a corporate, s~gnature of duly authorized officer. (Name and title of corporate officer) Builder's, License No ................. .,~....,~. ..................... Plumbers L~cense No ...................... ~:~..~ .................. Electrician's License No ................ .~'.,-..~... ..... ..,L~.. ......... Other Trade's License No ............................................... Locat,on of land on which proposed work will be done. Map No ...... .'~....~....-~......_. .............. Lot No.. (..0.....'~...!...!. Street and Number .................................... ...~.......~... ....... . .C~.~?.~ ......................... ..~..~.~. ................................ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction' a Exisit,ng use and occupancy .... ..~.'~.~.~. ...... ~.~..~ .. ,.r~/~......~...~...~. ........ ..~....~....~...~ .~. I.~....~.. ......................... b Intended use and occupancy ...~..~...~...~....~...~ .... .'~1~.......~..~.,~..I.~..I.?~..l~........O.~/~.~.~....t',.J.~..~.. ........................ 3 Nature of work (check which opphcoble). New Building ................. Addmon .... ....~¢E~... .... Alteration ........... Repair .................. Removal ................ Demohhor. ................. Other Work ............................................... 4 Estimated Cost ................................... Fe ........ ..~.~.. ........................................................................ (to be prod on filing th~s application) 5. If dwelling, number of dwelhng umts ............................ Number of dwelling units on each floor ........................ If garage, number of cars ................................................................................................................................. 6. If business, commercial or m~xed occupancy, specify nature and extent of each type of use ........................ 7. Dimensions of ex~stmg structures, if any: Front ........................... Rear ................................Depth .................... Hmght ........................ Number of Stones ................. ./.. ........................................................................................ D~rnensions of same structure with alterations or additions' Front .................................... Rear .................... Depth ................................Hmght ......................... Number of Stories ....... ./.. ..................... 8 Dimensions of entire new construction: Front ................................... Rear ............................ Depth .................... Hmght .................... Number of Stories ...................................... 9 S~ze of lot' Front ........................................................ Rear .......................................... Depth ............................ 10. Date of Purchase ....................................................... Nome of Former Owner ..................................................... 11. Zone or use district m which premises are situated .... ~:~"'~ . 12 Does proposed construction violate any zoning Iow, '°rd'inonce"°r"regulati°n'""'"'.~...~'"'""""'"'.'"'"'""".'.'-" "---"" -'""'"'"'"' '"""-;'T'"'"'""'"' '"'"'""" ' ' ..... 13. WdJ lot be regroded .......... .~.._...o. ......... Will excess fill be removed from premises: ( ) Yes (/~ No 14. Name of Owner of premises .~f/~L?.~....~....~....~.A..~.~../] .................. Address ~.~/.~..[.~..~?....~..~/.( Phone No.'t...~..?..':..~..~...~ Name of Architect .................................................... Address ................................Phone No .................... Nome of Contractor ...................................................... Address ................................Phone No .................... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~sting or proposed, and in&cote all set-back d~mensions fro property lines Gwe street and block number or description according to deed, and show street names and in&ca whether interior or corner lot ~])PROVED AS i'I.DTT~D DATE. 2 F ....... -'' ' AND TOWN STATE OF NEW YORK, ~",// ~. c S COUNTY OF ............... k...~l_ ..... ....................... ~ .~..¢).......~... ....... .~..~.... ~...~... ............... be,ng (Nome of indwiduol s~gnmg contracO above named duly sworn, deposes and soys that he ~s the opphcc He ,s the ... (2,.¥],/~'~, (Contractor, agent, corporate officer, etc ) of smd owner or owners, and is duly authorized to perform or have performed the said work and to make and thru oppI~cat~on; that all statements contained in this apphcotion are true to the best of h~s knowledge and behef; thor the work wdl be performed in the manner set forth in the application filed therewith Sworn to before me this ~S Not~r~ ~ublic, . ......... ~.~ .......................... ~.....x.J.~ ~oun~ ....................................... ~ ,TAqY I IjBLIC, Slate of New % 52 812505q, Suflolk Coun~ ~rm x rp F p~ s M~rch 30, lg~ FORM NO, 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ...... Permit No ..... D,sapproved a/c ............................. .~. ............................................................ / (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or' in ink and subm,tted in triplicate to the Buildi, Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b Plot plan showing Iocahon of lot and of buddings on premises, relationship to adjmning premmes or public streets areas, and giving a detailed description of layout of property must be drawn on the dmgram whmh ~s part of th~s applicatio c. The work covered by th~s application may not be commenced before ~ssuance of Building Permit. d. Upon approval of this application, the Building Inspector will msue a Building Permit to the apphcant. Such pern 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 Occupan, 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 tl Building 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 describe The applicant agrees to comply w~th all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and ir~ buildings for necessary~/~n~~ ........ i~i'~JJ'~-r'~;F'~'l~ii'~nt, or nome~"i~"~"~:~'~l~i~'i ..... ............. . ....... (A~ldr~s£,dFs. pp I icant) State whether applicant is owner, lessee, agent, architect, engineer, gener~E~ontca~ct~'r, eleqtfi~a.n, ~ build~ ....................................................... /,~ .~........~.....~....f~ ....................................... 7~6.5..~f;~9..9~.? ~,.t r~..~ ~,.~/~ · ¥. ~.~:.... C.~..~, ~, ......... Name of owner of premises ~,~, ..~....O ~ ED ........................................................ · ~; - li$~. F..~R ,_.. · ~. ;",;',::,' ................. ~....: ............. If applicant ~s a corporate, signature of duly authorized officer. (Name and title of corporate of/fic/er~ Builder's License No .................. ~:...~:'.-.~ ................. Plumber's License No .............. ~ ............................ Electrician's bcense No ...... ~ ....... ~...: ........ NOT R[SPL;'?;~;: : OR COHSTRU~i b~'~ ~UI~M[NTS CF 'LY. AND TOWN HOUSING COD~ & Other Trode's License No ............................................... '~' ~- Locat,on of land on which proposed work w,II be done. Map No.' ......... ...~..~..,.?~... ........ Lot No /'~) ~/- /// Street and Number ....................~..~...J..~...~. ........... ...~....~;~.. ................................................................................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction' a Exisit,ng use and occupancy ..........................~..~...~..~..~...'-.. ...... ~ b Intended use and occupancy ........................ ...'~.....~. ' ..~T.. ...... ..~..~. ...... .c~.. ~../...~..~ ......... ~~.. 3. Nature of work (check which applicable) New Building .................. Addition .................. Alteration ............ Repair ................. Removal .................. Demolihon ............. Other Work ................................................ (Description) (to be paid on filing th,s application) 5. If 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. D~mens~ons of existing structures, if any: Front ........................... Rear ................................ Depth .................. Height ........................ Number of Stories ................. ./. ....................................................................................... D~mens~ons of same structure with olterahons or addmons: Front .................................... Rear ...................... Depth ............................... Height ....................... Number of Stories ................................ 8 D~mensions of ent,re new construction. Front .................................. Rear ............................ Depth .................. Height .................... Number of Stories ..................................................................................................... 9. S~ze of lot Front ........................................................ Rear .......................................... Depth .............................. 10. Date of Purchase ...................................................... Name of Former Owner ...................................................... 11. Zone or use distnct in which premises are situated ................. 12 Does proposed construct,on violate any zonmg law, ord,nance or regulation: ....... ~.~ ............ '..'"'"'"'"'"'.'.""" 13. Will lot be regraded ...........~....o. ............ Will excess fill be removed from premises: ( ) Yes ~,) No 14 Name of Owner of premises ....~....~..~..~....0.?...~.~ ............. Address .?..?..l~.ff~.....~....c'~.~.L.¢.. Phone No.~.~..~'~....~..}~..~.... Name of Architect ......................................................... Address ................................ Phone No ..................... Name of Contractor ........................................................ Address ................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether existing or proposed, and indicate all set-back dimensions fro, property hnes Gwe street and block number or description according to deed, and show street names and ind~ca, whether interior or corner lot ................ ~..~. ....................................................... being duly sworn, deposes and says that he is the apphca: (Name of ind~wdual signing contracO above named He ,s the .................. ...~..~/..~..~ .................................................................................................................................... (Contractor, agent, corporate officer, etc ) of said owner or owners, and ~s duly authorized to perform or have performed the said work and to make and this application; that all statements contained in this apphcahon are true to the best of his knowledge and belief; ar that the work wdl be performed in the manner set forth m the apphcation filed therewith. Sworn to before me this ./...~.. ~,) 7-/ ................. of .......................... .... ........ ........................... ...... ......................... ~ of NoW ~oT~/ ~m Exp~es M~ch 30,