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Home My WebLink About9847-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of OcCupancy No...Z.~fl.~.~.O ......... Date Octobor 5 19 85 THIS CERTIFIES that the building ~.¢ee88a~y_ Location of Property fi. 7.5..~..u~..~.~.~. ~R.d. & 5~..~.~.m.m.e.~....I,.a.n.e. Southold House No. ' ..... Street ................... fl~r~/'ei County Tax Map No. 1000 Section .... ?.8 ...... Block ...~. ........... Lot...c).':? .0;.... Subdivision .......... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore f'fled in this office dated 9s~7z .... · J.~]~Y. 3. 2. ' ' , ' 9 7.~. pursuant to which Building Permit No ............. ' ........ dated .... J.u,17..~ ~. .... ........... 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 ......... .... Eot. an .accasssry..she.d .................................................. The certificate is issued to. ........................ to~,,~d','~;id~',;r'&/,a;'O ...................... of the aforesaid building. Suffolk County DePartment of Health Approval .. iXl/.A ............... .. UNDERWRITERS CERTIFICATE NO ~/A ' Building Inspector R~. 1/81 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? 9847 z Permission is hereby granted to: ........ ~Tack..~..~L,1,]~a~g ................................. at premises located at .~.~ ~s~nm11,~ ~a~ &'~ S,~ ~e .......................................... ; ................ ~,..~..~.:.~ ............. ~. ....................................... .... r~a..~.:.~te~...r.~..~.4e .......... :: ...... ~....'......:....:: ............... ? ............. ~ ........................ ': p~q~n~~ to application dated ,:~ ...... ;.~..~.~.~; ....... ~ ........ :. ,.., 19..~.~. and approv~ by the '~ '' Building Inspector. ,~ - Fe~ $4~.00..~ ........ ' 1~78-9...10+9 ' ~ng Iispector~/'~ ; ....... ............. ;..;... L..~ .............. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N. Y. Examined ............~..g..~. ........ .J..~. ....... , 19....7...8. Application No ...........,9...8...b¢.~, ............ Approved ............ ~Tij.].~r. ....... .'!.~. ...... , 19...Z8 Permit No ........... ~0.8~.~ .............. Disapproved a/c ...... ~..'..."~r ............. / (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ...... INSTRUCTIONS a. This application must be completely filled in by typewriter o~ 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 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 o 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 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 laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inSPections. //~Signature or applicant, or name, it 9,~,~orporation) ......... .Y... .............................................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................................... . .o... ................................................................................................................................. Name of owner of premises ......... ~/C ......... ~.: ........ ~/~__~ ............................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... ..(~...~.-~...///.44:.~'x~. .......................... Plumber's License No ................................................. Electrician's License No ............................................. //,' Other Trade's License No. · ............................................ . n h Ma No 1. Locatio of land on whic proposed work will be done. P ': .................. t'"' ............... Lot No. · .~=.i...r...... ........ Street and Number ........... ,,~..~..~..~,~..xcT..~,..,....~......~.M.~'/'~..,'D...~.~ ...... ............................................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ...... ..~../~'.~'.~-~.../k~...~..~....~.Ct.Z~.. .................................................................................... b. Intended use and occupancy ........ .~.~..~..~-,~..~4.z='~.. .......... .~..Z~...~z~../~.. 3. Nature of work (check which applicable): New Building' .....~.-... ....... Addition .................. Alteration ............... Repair ................. Removal .................. Demalitior. .................... Other Work ..... ,,a~.'/~...~'~.z~. ............................. ............... ................... %'.?.?. .............. 4. Estimated Cost .......... ,,)..C~..: ......................................... (to be paid on filing this application) 5. If dwelling, number af dwelling units / .Nurnbcr of dwelling units on each floor if garage, nurnber of cars ........................................................................................................................... 6. If basiness, commercial or rmxed occapuncy, sptx.~y,n//ntlh~re and extent~of~ each type of use ............... ~ ; ............ 7. Dimensions of existing structures, if any: Fm,,t ...... ,~... ............. Rear ...,.~.. ...................... Depth .:../~... .......... Height'~'.~.' ........ "_ Number of Stones ................................................................................................ '. .............. Dimensions of same structure with aJlelat~ons or ,~ci4iiio,'lr;. J'lonJ ................................... Rear ............................ Depth ................................Height ............................ z-'Ngmber of SIories ............... r'/' ................ *'~ : 8. Dimensions of entire new constructiom Front ......... -~... ................... Rear ..... ..O.....- ............... Depth ..... ./.. ............... Height ...... --*'.¢,...- ........ Number of Stories ......................................... i ........................................ __ . ~i ......................... / epth ........................ 9. Size of lot: Front .............. ........................... ..... '"t ............................... ]0. Date of Purchase ........................................................Nome of Former Owner ........................................................ 12. Does proposed construction violate ony zoning law, or(hnonce or regulation: .......... ~.~ ....................... 13. Will lot be regraded ...... ~ .......... Will excess fill be removed from premises: ( ) Yes ( 14. Name of ?wner of premises ...~../~.~ ./z~.....................,./T./.- .... .~..~_,~/~ddr~ss ,~....U...~..../~..{..~..~,~.~.... Phone No..~"~..~..~..~'..~..~...~./? Nome of Contractor ..................................................... Address ................................Phone No ....................... PI_O~I DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from and indicate property lines. Give street and block number or description according to deed, and show street names whether interior or corner STATE OF NEW. ~'~17t,/.,~ .~ ~.q q COUNTY~F .. ~~ .... ~~~ ................. be,rig duly sworn, deposes and says that he is the applicanl ~~~(~ame oi individual signing con,act) 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 war,wilt be performed in the manner set forth in the ~pl~cation filed therewith'/ ........................ d~ of ..... ~ ................ T ~9.2~.. ~ ~/~ .. ..... ............................... ~ V ' ( ~ ~ ~ ~/~ (Signature of appl~nt) · FORM NO. 8 TOWN OF~SOUTHOLD Building Depar~men~ ~. ,, ,, . TOwn Hall Southold, ~.~.' 11971 . :: ,,, :, ,~.~ 't ':~' , , APPLICATION FOR CERTIFICATE OFocCUPANOY . , N,~ ~C"~,, '~,~t instructions ' ' ' ~. ~ ~dqn m~st be ~ led in t~;ewrker O~ nk, ~nd sub~[tted in duplicate to th. Bu ..... ~,~ t6r ~i~ th~-fdl[hwine for new bud nQs or new use' - . "IT~ey 6~ property with accurate Iocati~n-~f all buildings, property lines, streets, and n2~ura~ '~oOqraohic,featu res..,_~ 2. Final approval ~7'~ealth Dept, of water supply and sewerage disposd--(S-9 form or equal),- 3- Approval of electrical installation from Board ofLE[,re,-U0d~,~r?te~s.~', ~- ,, 4. Commercial buildings, ~ndustdal buildings, Mu]fi~le"~',ffs~enc'~s~a~ ~ Mj~a~uildin~s ~a~ .installa- tions, ~ cardficate of Code compliance from the Architect or Engineer responsible for the 5uflding. 5. Submit Planning Board approval Of completed site plan requirements where app cable. B; For existihg ~uil,dings {prior to April 1957), Non-conforming uses, 'or buildings and "pre-eXisdng" 1. Accurate ~e¢ f. ~ ' -~ · , ' ' .~ ~ *: ~ ~ ~ " o ~peop,¢rty .sho~q,g ~1t- p~[ogert¥:~ ~es,,,~tegts b, ui'~didgs and"unus0al natbraL or 2. Sworn state~eqt ,of,gwqe~ ocprevious 5~her as t0 use~ocouoa~cv~and c'on'd f nn n¢N,, 3. ~ate of ~ny housm9 cod~ O~ ~?e~y inspection,of, bu,~;l~q~s ~r ,p/em~s~s, pC' o~her pertinen~ nforma- t~on r. equ~red to pr~p'are,~ ce~i'f c~e~-,~ .,~ ~ . : ,~,, ~ ,, ,' ' 1.,Ce~-ifloa~e o¢ occupancy ~':55:~0 -,,, .~, .....z,, , ,, ;¢., ,,,, ~ ,. ~ .¢ 2,~¢erd~ica~e'qf occupancy onpr~-'e~'istin9 dwel cg ~/l~dd Dsc ~/3~/S'5 O0 -" 3, Copy of c~rtlflcate of occupancy $1 O0 ' /~ , ' , . , ' - ,, ",,' D. at ~ ,, New~Budd~gg-.. ,, ........... uIo or ~re-ex~stmg Bu~Idmg(~) ........ ,~= /V,acant Land ..... Property '--' ~-- ' ' ' ' .... Location ..............., , ,: ................... . , , Owner or O;n;rs of Property . :.: ~~ NO lO00~ect~dn ......... :. B!ock EOt.' ........ . PermitNb; ..,'.~..../ Da~eofP~rmt . He Ith D;pt App I pi. App ' ' ' a . rova ...................... ,Labor De roval ..... ' Under¢lriters Approval ........ :,' .Plannih~'Bq~rd ~p~rov~l ,,, .;.;' .;::.¢..':c ;'( ¢ . Request for emporary Certificate ......... '.F, inal Certificate ........ - ......... '.F~e Submhted S ..... , .: ................. Construction on above described building'an i.t'me ts all apg~cab~ades ~d re~uIations. ' Applicant ., ~ FOIL~ HO, ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ............ .9~1/~1' ........... ' Examined ............. J'~. .......~8"'", 19'"'~8 Approved ............. ~T.~ .......~J~ ...... 19....~8 Permit No ............ ¢)8~' ............ Disapproved a/c - -- .... · ....... ................... .......................................................... z (Ui ding Inspector) INSTRUCTIONS a. This application must be completely filled in by typewriter o~ 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 or 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 part for any purpose whatever until o 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~kJ~ 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 buildingf for necessary inspections. ....... ........................... ~-~. C/'~ 7/ ~// (Signature of applicant, or name,(.~ corporation) ~'~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.~,q ...................... .0... ./. >,..':..R. .............................................. Name of owner of premises ....,~..'--~../~Z~..Z/~ .......... ~ .........~.~./././~...~.t~/.~... ................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .................. ..~...~...¢~'../..~/.~:..~,,,, ........... Plumber's License Electrician's License No ............................................. / 6 o O .-~- '7 ~- ~' -- / 0' q~- ~ ) Other Trade s License No .................................................. ~ ~/ ~ 1. Location of land on which proposed work wil~l be done. Map No.: ....... ...~....~.......'~.....~... .......... Lot No...:..~ ...... ~ Street and Number .............. ..'~...~.~...~.~..~-....~.-. ....... ~ ....... ~.~.Z~.z~./...Z~'.......~-..~.. ............................................. ~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...................~/...~:...~..~....~...,..Z~...~.... ............................................................. b. Intended use and occupancy .................. ~.'.~..~.Z~....~..J .~........~/~"~....,...~z ,~ ......... / ............. , / 3. Nature of work (check which applicable): New Betiding ................. Additior{ ...............~:.. Alteration ................ Repair .................. Removal .................. Demolitior, .................... Other Work ......-d.....~.. ~'..~.. ........................ (Description) 4. Estimated Cost ..... '~....~,.-.<~.:.....~....~.. ............................. Fee ...~.~,.,/...~..,.....~...O. ................................................................... (to be paid on filing this application) 5. Jf dwelling, number of dwelling units ......................... Number of dwelling units on each floor ............................ If garage, number of L,u~ ..................................................................................................................... 6. If business, cormnercJal or ~,~xe~:l oc,,upa~c>,, spec~Iy nr~ure and extent of each type of use ............................ 7., Dimensions of exislin,g shuclutes, J[ any: I-~o.t ......................... Rear ................................Depth .................... Height ........................ Number of Stories ........................................................................................................ Dimensions of same stmctare with al~erat~o~ts o,- ~c[didoa~,' J;nm~ .................................... Rem' , .......................... Depth ............................... Height .......................... J'-iumhcr o]' SJorJes ................................ 8. Dirnensioasof entire newcor, struction: Fron, ........ ,~- ~. Rear ~.../. .................................. Depth ..... .7.- ............... Height ................ Number af Stories ............................................................................................ 9. Size of lot: From ......... ./,.~ ......................... Iz~, . ,,~ ........... Depth ./.,.~ ........... 10. Date of uPsU~'Cdhi:~:r~ ....................................................... ~.04~,..~ ...................................................... 1 1. Zone or ct in which premises are situated ......................................................... i2, Does proposed construction violat~Ding law, ord,n(mce or regulation: .... ,¢~....~.......'~ ................................... 13. Will lot be regroded, ....... ~ ....... Will excess fill be removed from premises: ( ) Yes ( ~ 14. Narne of Owner of premises ...~'.z~,~.:..../~'.:.../.~../~'-.4~-~-~..~'?/Address ..~.)./~.Z~.2.~..'o..~.~.~ Phone No. Nome or Architect . ................................................. Address ................................ Phone No ....................... Nome of Contractor .............................................. A,dchess ................................ Phone No ....................... Pi.LYF DIA(3RAM Locate clearly and distinctly ail 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 STATE OF NEW YOP, I~, COUNT~ OF ........ ,.:.....: ...... :...~.~~ (Name of individual signing coniiacf) ,bei~,lj duly sworn, deposes and says that he is the applicam above named. -- Ne is the ..................................... (Contractar, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perfom~ or hove performed the said work and to make and file this application; that all statements contained in this application are true fo the best of his knowledge and belief; and that the work will be performed in the manner set forth in the ?pplication filed therewith. Sworn to befc~re me this ...,' ..................... ',.. day of .................. ....,.,............,. ..... ............................... ..... . ....... ' .....~. (Signature of applis~'nt)