The URL can be used to link to this page

Home My WebLink About10072-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy 8o .... .z,..?.?.,:/.7 .... THIS CERTIFIES that the building ................................................ Location of ~'opetty .~.~..-.~. ..... 7.1~.~. ~.~.~ .~'. .... ?. C.A..-~. ............. ./~..~..~ '. ~'.'f. '.~.. Hou~ No. Steer Hamlet forty T~ Map No. 1000 ~ction / c/~ .Block ~ .~t ~ S~di~sion~?.'. :ff. q...~ ~?~...T~.(r~kl~ ~.~d'Map No. ~q.~...Lot No..~ .......... conforms substantially to the Application for Building Permit heretofore fried in this office dated ............ NOF.. 3./, 197~. pursuant to which Building Permit No../. ('.0.7. ?,..~. · ........ dated .............. D~; C .... /.~.. {. 197.~'. , 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 ......... .. ,q.. Y. ~?.,.~:~. ~ ~ ...... C.~:~ ..... 0). '2/~ .'./ .... ~.~/?.( ! .(~.'.~ ...................... The certificate is issued to tl A/- V£ ~'P,t. ~ ,bt'~ ~w-tq (owner, of the aforesaid building. leI / ~ ~t: ,,~ c'",~ i ~ -.:~ I~n lv~ Suffolk County Department of Health Approval .............. n/. .......................... O~ERWR~ERS CERTIFICATE NO..g(/?.~.. ~./.'.7.~ 5 .~ .'.~... ?./?z/z r... ).'..'! ! ?.-¢.Y.. Building Inspector R~ 4/79 I~OR~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~.EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) , N°- 10072 Z Dote ........ ~ ....... Building Inspector. FORM NO. S TOWN OF SOUTHOLD , Building Depnrtment Town Clerks Office 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 Inspector 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 dispasal--(S-9 farm 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.of 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 la~d use $5.00 3. Copy of certificate of occupancy $1.00 New Building ................ Addition ................ Old or Pre-existing Building..~... .......... Vacant Land .............. Location Of Property ........... ..~....~..~...~. ..................... ~...~..~..~...~..~;./~.., , ti c~..~ . Owner Or Owners Of Propert)y ...~.....~...~.~....d...G...~.~i...J~... :.i~.~.'.' ~ ~ '~C~-J~';,~ i~':~'~"~ ~ ..................................... ................ .o ............. .au,..o ........ Unde~riters Approval ~'~J::~:~:=~JPlanning B~rd Approval ........................................ Request For Tempara~ Ce~ificate ........................................ Find Certificate .......~....... ........................ .......... Construction on above described building a~ermit me~L~/~es and regulations. ................ day of ............................................ (stamp or seal) Notary Public .................................... County THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ! E3 J(~HN STREET, NEW YORK, NEW YORK 10038 ~t~December - oo so N415877 THIS CE;IFIE$ THAT w~ exami~ on a~ fou~ to be in compliance with t~ r~uireme~ts of th~ B~. flXTUfl flXTUlfl ~NOES ~KI~ ~KS OVENS ~ W~ilS EXflAUiT FANS ~RVICE ~N~ ~. ~ Delmar Dr. I,aure~ , L.I. This ~e~ificete musf not ~ elter~ in eny menner~ return to the offke of the ~erd i~ i.~o.ee. I.s~rs met ~ identifi~ by their ~red.ntiek. BUILDING DEPARTMENT. THIS COPY OF CmTmFm~TI MUST NOT BE ALT~ IN ANY MANNiL bus Ele'c. Route 112 Curare, L.I. 11727 certificate must not be altered Jn an}, manner; return to the office of the Board if incorrect. [nspeclors may be identified b7 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. NOTICE OF DISAPPROVAL F,,e No ................................................................. Do,e .............. ~.~.z ....... ~...: ............ , ,9.1:: .... ~ ........ ~~.....~ ................. ~A~ ~A~ ~OTIC~ tha~ your a~p~ica~ion ~te~ ............ ~....~.~r~ .............. , 19 ........ ~Or ~er~it to ~truct ........................................ ~t the ~re~Jses IQcated at ........ ~:~Z ...................... ..~.:/: .... " .. . ........ s,~, , ~:..~....:: .......... ~::~:: ........... FOK~ NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N'OTICE OF DISAPPROVAL F,,e No ................................................................. ~ote ............. ..~:..~... ...... ..'.....: ............ . .... ../........ 'L~,~W~..,~.....~,-,~L ................. ~ ' -- ' "~.. ..:....:..~=~.,.:.z:~. ...... /..,.:...'..:..,.. ..... PLEASE TAKE NOTICE(/that your application doted ............ ..4~..¢~....~..~...~ .............. , 1c) ........ for permit toT,onstruct ........................................ at the premises located ct ....... ~ ...................... ..~.:,..,....~.~..,b~...~.: ........ ~tree,, ~/~-' M~=p ............................. :~..; ~ocr, ............................................................. ~ .............. , ............. ' ,~. :...,~.~i~...A.~.~..~..~Lu~...~.~,.:...~.......-... .......... ~,~:..../~..~, ........... .-. . . .: . . , ~....o...~...,....D~Lr~..~,.:.~...~ :~..~.~..,...~.~...~..,.,?~;...,~:~.., ....... / Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~/~t.. ~OUTHOLD, N.Y. ' Examined .~~..., 19 ........ ~ Application No./~.~ .............. ...... Disapproved a/c .................. .....~:...~/ ................................. ~ .............. ........................... ::z . ................. ........... ; ................... APPLICATION FOR BUILDING PERMIT ...... .................... INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 sete 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 or 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. (Signature bf ~.cant, oi; game, if a c~or~ion) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ........................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ............,~ ......................... · ~, J Plumber s bcense No ........ .,.-.). ...................... ?:,.) ...... 7//i~ //?d/d/ --/<~z ~) - ~ - Electrician's, License No. j~. '~. · . Other Trade s License No ...................................... ~. ...... Locotion of )ond on which proposed work+wil) be do~)~e. Mop No.: ............. ?.,.....[....... ...... ¥... Lot No....,..4.~)q ................ Street and Number ..~..\i..~.]....~...)...~...~.~...-~...~..S.....~.....~. ....... (~...~...~:.~..'...t~c...~.i~.,.d.:~: .................................... ~ - / Nun cipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .....-~......~....,,~,..~..G...~.%....!?,..o..~...~,.. ............................................................................ ~ ~ ¢ ~,, i' -~L '~'-'~ b. Intended use and occupancy ..,...'~..~..,,'T,......°...~...~....'~......:,0...I.'-..~...: ........................................................................... 3. Nature of work (check which applicable): New Building.. ................. Addition ...~ ......... Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work .................................................... o o (Description) ~ \ c~o o.°.-~ ~':o o . , 4. Estimoted Cast ............................................................ Fee ...... i (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ Number of dwelling units on each floor ..... ~ .............. If garage, number ef cars .................. ~ ................................................................................................................ 6. f business commercial or mixed occupancy, specify nature and extent of each type of use ..~.~.~.( ............ 7. Dimensions of existing structures, if any: Front ..... ~.~ .............. Rear ..~.~. ..................... Depth ..~.~..,~ ..... - Hmght~ ................. Number of Storms ....... ~ ........................................ r'~ ......................................... c'r ............... D,mens[on~ of~sa~e structure with alteration~r additions: Front ..... ~.~.} ..................... Rear ..J~..~. ................. Depth ...A.~....~. ............... HeightG~..}~.....m..Number of Stories ...~..~..~ .................. 8. Dimensions of~ntire new construction: Fr~ ant ....~.~ ....................... Rear..,.~..~ ................ Depth .A~;..~ ........ He ght ~...~). ..... Number of Star es ...~g..~ ...................................................................................................... · . ~ O 9. S~ze of lot. Front .............. ~...O. ................................ Rear ............................ ~ ........Depth ...[.~ ....................... 10. Date of Purchase :)~.J..L~ ................................. Name of Forme~ O~er ~]..,~..~.~.~.~ .......................... 11. Zone or use district in which premises are situated ..........~~...~.[~.~..~,..[.~ ........................... t2, Does proposed constructi~te any zoning law, ordinance or regulation: ..~.~..~.~ ....................................... 13. Will lot be regraded ...~.,..~ ................ Will excess fill be removed from p~mises: ( ) Yes ( ) No 14. Name of Owner of premises ~.~.~.ff..E....~.~..~fl~.~ddre~ ~.~..~.~.~.~hone No. ~.~.J.~.~.~.~ Name of Architect ~.~ ~? . ' ~ Addre~.~.~'~.~J~. .... Phone No ................. of ..E.g..if .............................................. ddre,, ................................ ..on. No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~ck 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 YOR~,- ) /,- I¢¢ COUNTY~OF ...*~....q.x./.Z.~..~'.~.c......f "~ ............. :..t.....~, ........... ~-~ ............ ~.z ........ ~ ........ ~ ............... emg duly sworn, deposes and says that he is the applicam (Name of individual signing contrac~ 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 applfcat~on are true to the best of his knowledge and belief; and thor the work will be performed in the manner set fo~h in the application filed therewith. ~ Sworn to before me this , ~ ~ / / ~ /' ........ .......... o, ...... . ,'/.. RICHARD BO~S~ ~" -- ~--~' ~ ......(Si~t~f/0f applicant) ~OTRRY pUBLIC, State of HOW York ~ fi./] ~-'~ t . ~ Qualified ia Suffolk Conn~ ~ ~ J ~ { J ~omml~slon Expires March 30,19') 7 ~00 9~ 99 TITLE NO. 07-8.5392 R£v,s,o.s YOUNG & YOUNG 23/977 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK SURVEY FOR: HARVEY M. dORDAN ~ DOROTHY H. JORDAN LOT NO99,'~MENDED MAP OFMATTI TUCK PARK ~ ~ LAUREL ~~ ~ GUaRaNTEED TITLE DIVIS(ON TOW~ o~ ' SOUTHOLD' ~.,. ,..~,,~' '- APP*OV*g ~, NOTED NOT[FY ~U~LD~NG D~.ENT AT 765-~o~ f'~.M fo 4PM FOR REQUIR. "*~*~"~ 4. F,,~A_ WNEN JO~ COf~LPLETED NOT RESPO~:S~LE FO~ DESIGN S. ALL CONSTAUC?~ON ~,UST ~EET