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Home My WebLink About10057-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No..7.,9.'~?.~. .......... Date ................. ,t~¢~.~?,~.-[;. 9 ....... 197.9. THIS CERTIFIES that the building ................................................ Location of Property .'[0".~.0..~a J.~..~¥'.v~.~x¢. R.(1 ~. &..C.0~7 ~y..(~:q~.eJ~ .I .~d-~ ....... House No. Street Ham/et County Tax Map No. 1000 Section . .0~[[3 ....... Block . .6. ............ Lot . .'I.L~ ............. Subdivision...~2X .......................... Filed .Map No.. 2; ..... Lot No... ~[ .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... December..'1 ..... ,19.723 pursuant to which Building Permit No .... .I 0.0..5",~. ¢: .......... dated ......... I/)~c eraba~. ~ ....... 19.78, 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 ......... ................ Lvaoce. one. ............................... C,.O.~ p, ........... The certificate is issued to ................... .~:[124[s..'[ita. ty. (owner, of the aforesaid building. Suffolk County Department of Health Approval 8.-~0 .-.1./+2, . 8,/B/79,..Ftobe~.'b./~. :~.J.]_.l~.. UNDERWRITERS CERTIFICATE NO .......... ~.e~n/t~qg ............................... Rev 4/79 Building Inspector TOWN OF SOUTHOLD 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 AUTHORIZED) N? 10057 Z Permission is hereby granted to: ......... .~,.~z..~,~...4,;.~.,.~. c%~. ...zo. :z~..~.,~...k~.x ~. ............ · ..~.~.'..-:~.~.~-.~...r.-~.--~..: ................ .... C..~.z~.~;z7../.~.~?~`."..~.~.~.~:z.~..~.~...~.c:z~.~ ..~.~"~r~.~ ' at premises located a'r.~-/('.~ ....... z~ ....... ............................................................................................................. ..-T....~,~. <~. ~//.~.~ .LD......-z. ..... pursuant to application dated . /. /. /. /. /. /.. /~./~,'~f.~,~.,~ ...... g ........ , 19..7.~., and approved by the Building Inspector. ~ ,..~:...~ ..... ' I~ilding Inspector ~ ..... 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 a~l property lines, streets, buildings and unusua~ 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. 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 .... ~./. °.h.~ .............. New Building ............. Old.or Pre-existing Building ............ Vacant Land Location of Property/~o..~s~ .N~...~....~--.~...~,..~.-~. ?.~ .~./'~/Z~.~.< ~'~'' · ' ............. Owner or Owners of Property ...... ~ .~' .......................... County Tax Map No. 1000 Section .... ? ~ ....... Block .... ~. ..... .... Lot../..~. ......... Subdivision ................................. Filed Map No ........... Lot No .............. pe m,t No../. Date of Perm,t . Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described bu lid lng and p~e~,~,/~.d~es and/re_gu lati,,~. Applicant /....~..~, ..~.....~....'~.~. ~~ .......... Memorandum from .... BUILDING INSPECTOR'S OFFICE TOWN OF $OUTROLD TOWN H^LL, SOVTHOL~, N. Y. 11971 765-1802 TOWN I-1F ~OUTHOLD DFFICE DF BUILDING INSPECTOR TOWN r. LERK~S OFFICE: SOUTHGLD, N, Yo 11971 TEL. 7~5-~66D FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...~F~:,~.......4~... .............. , 19Z .... Application ./.~O-~ Approved .~-....~.. ................ , l~Permit No...Z~.~.'.~.~........~... No .................. ~ ......... Disapproved. a/c ....................... ~...~ ......... APPLICATION FOR BUILDING PERMIT 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 o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, 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. ' ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................... ........................... . ...... Name of owner of premises ..~_.~.....~.(~..~ ~,~..~...~t. ,.C..~.' ,..~..~......~', .... i i, iii,' ............ iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii If applicant~porate, sig~/gtur~o/dulyauthor~j~d off icer. (Name and title of corporate officer) Builder's License No ..................................................... Electrician's License No...~../~...~.4'~....~........~...Z...~...C/=~ Other Trade's License No ............................................... Location of land on which, proposed work will be done. Map No.: ........................................ Lot No .............. Street and Number ~ . .~./.?..~ . .~....C~_,a/~...~.~et~ ~L~ (.~'~ t~.~,..~ ~~ ..... ...................... L/ ....................... '~' ..... ~/~,'j~ ....... M~';'i~ipality ....... State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .~.,r~.C,./~X~,/ 3. Nature of work (check which applicable): New Building ..... '.~... ........ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work .................................................... ./ ~,=5"- (Description) 4. Estimated Cost ......../'g-~ ~.~.~.,.~.,~.,.~ ........................ lee .... (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 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 ............................ Number of Stories ................................ 8. Dimensions of eptire new construction: Front ....... ......... Rear ........... Depth ...~.~..Z'.... ......... Height ....../~.'~...'. ..... Number of Stories ..... f-,~.~ ................................................................................................. Size of lot' Front itl!....~:..?.. ............... Rear ..... /..~....~.....~T.. ....... ~ ...... Depth../...'~....).:..~'.~.. .............. 9.10. 'Date of PLrchase iiiii~,..../..~..'.~...~- ................... Nome of Former Owner ..~....0.~.~.jj~.. ...................... 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 ( ~ 14, Name of Owner of premises .................................................... Address ................................ Phone No ....................... Name of Architect ....-~.. ....... :~ ............... · ............. , .......... Address ..................... ~ ........ Phone bio ....................... Name of Contractor .~.....P'..~...~...~.-.~ ~.~.~.~.~ ~.... Add~rff~-~..~{....~..:...~..~..~hon~e%.~..J'..~ Locate clearly end 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 I~'3R~K,~ ~ c c COUNTY OF :~...~.~-~,..z. '4~' ...... f" ........................ '.~..~..~..........~.,..~..~.~.....~..,'.~, ..... being duly s,w, or,, deposes and says that he is the applicam (Name of individual signing contracf) 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 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. Swam to before me this ~ . .......... Noto Pub,c,. ................... County ......... f ....... ,.:........,. ............................. Tr!rrll Explrc,~ M;~lch 30, 19~L,~' Suffolk County Department~of Healt~:Se~fVic~ " f~ ~pproval of Cons~ruction Only Apprpved':~. . The water supply and ~ewa~e disposa~"sys~ema~ for th!S~ ~esidence will cdmfoTM to the ards of the Suff61k County Dept. of Health F P,,ONT 'f ~pH^LY E L E"VAT 0 N EL EVA T I ON APPROVED,AS ~NOTED ' NOTIFY BUILDIt4G-DEPA AT L REQUIREMENTS OF N.Y, STATE CODE rAND TOWN HOUSING CODE & ZONING L L W' A"i'f 0 As ?l-t/~ ,EA K i 0 N APPROVED A~ NOTED NOTIFY BUILDING DEPARTMENT AT 765-2660 9AM to 4PM FOR REQ. UIR- ED INSPECTIONS= ~. BEFORE BACKFILLING FOUNDA- TION OR START FRAMING 2. FRAMING INSPECTION 3. BEFORE COVERING PIPES OF ANY ~ND 4. FINAl. WHEN JOB COMPLIED NOT R~SPONSIBLE FOR D~IGN OE CONSTRUCTION 5. ALL CONSTRUCTION MU~ REQUIREMENT5 OF N.Y. ~ATE CODE AND TOWN HOUSING CODE & ZONING Y ,.I FOU ktl)kTlON PLAN,, ¢ 1 C~ t...-' Ct-, CZ) T'-I ooN Pk. O ILA Ft ~ :E C YiO'N· LL FT EL L'V" A"t" i 0 N L FO u ki D: A T i :(t N -"i v V o YEI:K G ~., GL-, 0 ct_. Ck.* T-L'OON LAN E~"~ I to' C0N C', .,~",!o" K I l)C~. pc, cF.- ~SLO ct~, ~ALL PLUPIBIN~ blAGKAFi CKOS5 ¥C (TiON. oL P., G H T ION '