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Home My WebLink About10056-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N.Y. Certificate Of Occupancy No..296.1G .......... Date ................... Allgtl~qt. 2 .... 19.79 THIS CERTIFIES that the building ................................................ Location of Property ......... 5920 ........... I~lcl&axl. geck. Lgxle ...... PeOOllJ. C...--.- House No. Street Hamlet County Tax Map No, i 000 Section ... 09.8 ..... Bloc]< . .5 ............ Lot .., 1'~ ............ Subdivision.. ([~±no:c). ROs e~.~erg ......... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... De.eerabe~..~l..., 19.7. Spursuant to which Building Permit No... ']0Q56. Z ........... dated ............. Dec.embex'..5... 19.7.8, 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 ......... .................... a, .private. orse. family, dwell&rig ......................... The certificate is issued to ..... Johrl. &..Alan. Ee~),.~ ...................... of the aforesaid building. Suffolk County Department of Health Approval 8.-.~O .-.'1.~./~, .Miay.. 'JTa..1979.,..Eob:e~.t.A...Villa UNDERWRITERS CERTIFICATE NO ......... ~5'10J .................................. Building Inspector Rev 4/79 FOI~M NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK ^UTHORIZED) N.o 10056 Z Permission is hereby granted to: ~-/w~P~&~w~t /,~'~'~, ~ ,-~f~ Cr'~;:J,)' ............ ....................... pursuant to application dated ........ ,,.~/..~...(..~..~.~..~...~......~. ........ , lC2 ........ , and approved by the Building Inspector. Building Inspector FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. T~PORAR¥ Certi[icate O[ Occupancy No ....Z. 95~.~. ........ Date ....... .~.a~.. 25. ................. 19.79 THIS CERTIFIES that the building ................................................ Location of Property ,... ~gR0...~d;t.a~. NO.~.Ig .~¢ .................. PeDDleD ...... ~ou~ No, ' Street Hamlet County Tax Map No. 1000 Section ...~ ..... Block .. '... ~ ......... Lot ...... .1.~ ........ Subdivision ~O~). · ~b~g ......... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated D~O~D~'... · ~ ....... ,19 ~ pursuant to w~ch Building Pe~it No... ]005fiZ ............ dated · .De~ember.... 5 ............ 19 7~, was issued, and conforms to aH of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ............ ~;Y~9. ~$. ~;;Y. ~;~.~ .................................... ~e ceaificate is issued to ............ ~. of the aforesaid building. Suffolk County Department of Health Approval ...... P~n~g ........................... / UNDERWRITERS CERTIFICATE NO .............. Pe~g-- .............. ..fi/ .......... / Buildi~ Inspector Rev4/79 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 featu res. 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, streets, buildings and unusual natural or topographic featu res. 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 $5.00 3. Copy of certificate of occupancy $1.00 New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property. ~ .... .~.~, .-~....~.~..0 .' · ./~..../~/..~..~.~.~. · .~...'~?. .......... ~.~..C..~. ...... House No. J Street Ham/et Owner or Owners of Property County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Perm,t No../. ....... Date of Perm,t... .7 .... App,,cant ............... . . ..... ' Health Dept. Approval,~.~. ~.~,-..~/,~,A~..Labor Dept. Approval .... L~.~.., ........ '. .... Underwrite, Approval .'-~'..; ................... Planning Board Approval..~/. ~//.~: ............. Request for Temporary Certificate .... ~. .............. Final Certificate ....................... Fee Submitted $. ~-~----~ Construction on above described building, and permit_meets~f~ ~all applicables/~'~'._~.cF'des and regu~ Apphcant ~~'.. ~ .... '-~/~,~ ................ ,,v.,,.,o.,, , FORM NO. 6 TOWN OF $OUTHOLD 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 featu res. 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 peoperty showing all property lines, streets, buildings and unusual natural o~ 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 Date .... ~,/~/).~ .............. New Building .... ~.. ...... Old or Pre-existing Building ............ Vacant Land ............. Location of P rope rty....~.: .~/.. ?./.~'~. ?.~..~'.~/~.,',~. x2...~..~.~../~..../~/z. ....... ~..~?.c.~.'~.,.~ ~ ........ House No. Street Hamlet Owner or Owners of Property ...~.£! .~.'~., '.~?..9/....f~. ?.~..C.~.. ~.L.-/./? ............................ County Tax Map No. 1000 Section ............... Block .............. Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. PermitNo ,~/'//)~'~' g'' ...... ~.,..Applicant..~..~.~.~/.] .... .~...;...~...,~..'.. .......... Date of Permit h.~ .AL~., .~.~.''/° '~ g~ Health Dept. Approva,-~.~. ~7/~. ~..~..~.~..Labor Dept. Approval ...... .~././~..~. .......... Underwriters Approval...~....~. ?..~.-.~.-- .C?..(/ ...... Planning Board Approval .. ~.//~-~ .......... Request for Temporary Certificate ..................... Final Certificate .. V~. .................. Fee Submitted $ ............................. Construction on above described building.,/'~.~and permit meets all app_~i/~a,.,~!: codes~~:and regulations. nt .,~... ¢.~Y..~: ............ .... ............. THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 N435101 THIS CE~IFIES THAT in the follotving locution; [] Bnserne~t [] Ist Fi. [] 2nd FI. ~ectlon Block Lot ~vmexaminedon ~,?~y ~ 197~) andfoundtobeincomplianCewiththerequirementsofthlsBoard. NXTUR! L~CEPTA I IT HE I RXTUR~S 1 12. I 30 SERVICE IgSCOflNE~T NO. OF . S METER ~ 200 CB qoto~/~ 1-F~ hp ]-Smoke DeBeetor ],-;~.5kw Ho~ ~/la~er Heater R I C A, W.G. NO, O~ HI.lEG A, W, G* 310 2-. 75, 3-.SKw EXHAUST FANS 1 1/o Ruland Elect~l~ Co. P.O. i~ox I~t3 ~attltuc~, ,,.~, 11952 Lic.2~2E This certificate must not be altered in any mannerr return to the office of the Board if incorrect. Inspectors may be identified by thei~d:redenlials. .............................................. --____~__--~----~, TOWN OF' ~rlUTHOLD OFFICE DF BUILDINI3 INSPECTOR TOWN OLERK'S OFFIOE E~OUTHOLD, N. Y. 119'71 ,TEL. FO~ NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....'~...~,.......~.... ........... , 19~.~. Approved ............ , Permit No. ...... Disapproved a?c ....................... ~...~.~ ...... ~....._.5;~ ............................ (Buildin~ ~l~'ector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No.../.~..~.' ...... ~;,' ............... Date .................................... , 19 ........ o. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the i~uilding 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 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 port for any purpose whatever until o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY /V~/kDE 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 in buildings for necessary inspections. (Signature of applJ~cant, or nome, if o Corporation)' " .............. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................... . ., ... ..........._.-... .... o, Il: applicant is~or~oorote, sig~l,~autho,rized offic~,~. ~~and title of corporate officer) Builder's License No ..................................................... Plumber's License No. Electrician's License No .... Other Trode's License No ............................................... 1. Location of land on which proposed work. will be done. Map No.:~.~..<..~...~./..~./~.....~..i~---~No ......................... Street and Number ....~..~.~...~...~'/.~...../~...~.9/..'~...~......'g~'.J~..~'-~.~/~....~('/,~44'-. .-~..-,.: ........ -~..~".~ .......................... /.~ )-~4'1,,~ I~').-,Z, ' Municipality 2. State existing use and occupancy of premises ond~d use and occupancy of proposed construction: a. Exisiting use and occupancy ......... ..,~..c.~_~.~,.~ ............................................ ........................................................ b. Intended use and occupancy ...................................... ~ ........................ '"7 ...................................................... 3. Nature of work (check which applicable): New Building ..... ~ ..... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work ...................................................... ~ 7~ ~,~"- 0~5'- {Description) (to be paid on filing this application) 5. If dwelling, number of dweliing units ..... ~ ........ Number of dwelling units on each floor ............................ If garage, number of cars ....o~..~ .................................................................................................................. 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 some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ ' Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... ~.,,,~.! ...................... Rear ....~'~'../. .............. Depth .~L./ ................ Height ...:..../..~. ...... Number of ?aries,, ....... ~')!~ ............................................................................. , ............... 9. S ze of ot: Front .. ........... ..................... Rear ...... ....... .,,..... Depth .............. 10. Date of Purchase ....... ~;;a,f~ ....................... Name of Former Own~.*.~.~...e~,Z,~::~.f,~Z...f~'~'* ~/~ .......................... 11. 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 , 1 4. Name of Owner of premises~z~?.u.'..~.r~.;~.~.-.:.j .................. Address ~...~rcC?~Z~..~...,.v.~ ...... Phone lXlO.. ..................... Name of Architect ...... ~.: ....... -. .............................................. Address ................................ Phone No ....................... Name of Contractor ................................... Address ./.~..,l~..~..~,.~....~f^ .... mane ixlo ....................... PLOT DIAGRAM rJ Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~q~RK .... [ ~ c COUNTY ~ .x:,~./,~.,.... )' -~.-~ ~Ja *'/'/~ ~ b in deooses, and says that he is the applicant ................ ~.~...,...~-~.)~....~... ....... ~..ZI/.I~..~.. .............................. . e g duly sworn, . (Nome of individual signing contract) above named. ~' He is the ............. ..'~..~.~..~..~ ......................................................................... (Contractor, 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 this application; that ali statements contained in this application ore true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this Nora 'y yublic, ......................... ',.j..~,t,,z..c~/,A,.. ~coun~y ~,,: .......... :~-: ............................................................. ,---x ~ ,,-'-~,~x ~ // (Signature of applicant) (/ NOTAI~Y Pill-~1 lC, SLate of Ilew Yoi~l~ T.;,,, t-:~'.'- r,,',~,~l, A~,ROVEo ~ NOTED 'At, iD ~T OV',~ t'l, ti t FILL f ,J - F.O U .kl I) Aa-lO Ri PLAN ,~' Pc~Rc~ M R Ll.. I.O F- oCF~OSS SCC,T