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Home My WebLink About10332-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Date ................. 4u..ly..1.~ ........ 198.4. THIS CERTIFIES that the building ......... ~gr.o. Ur~rJ. gqo. ~. ........................ Location of Property .......7:qO ................ ~40 ¥.e.c.~.~ ~ .~..I~ Br3.e ......... g .a.~.[~ g..u.c.k.... ~ouse ~vo. Street Hamlet ,County Tax Map No. 1000 Section ... ] p.0. ..... Block ..... .0.3 ........Lot...(~9.7 ........... Subdivision...~g J,.t;.R~,r~..~ I:g.~.qQ ......... Filed Map No..~.6..8.2...Lot No....3~.. ........ conforms substantially to the Application for Building Permit heretofore fried in this office dated .....J.~ ~-¥..2~ ...... .., 19 .7.~ pursuant to which Building Permit No. 1 0332Z.... .. . dated .... .J.q ~y. ,3.~ ................ 19 .8.4., 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 ......... ...... i~g~.~uo~..~;[mmJ, og. ~.qg~-..~./. ~'~p.c.~..eB.c.~ 9 ~.u?.o. s ......................... The certificate is issued to ............... Gg.O.RG~. ~,..AbLC.~ .gbP.~.q .................... (owner, levee or tenant) of the aforesaid building, Suffolk County Department of Health Approval ............... I~ ./g ........................ UNDERWRITERS CERTIFICATE NO .................... ~l.~.q ~ ~5.5. ..................... Building Inspector Rev. 1181 FORM NO, 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'$ OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMtT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10332 Z Permission is hereby granted to: ........ ~...z...~.~...~.~..~...~.~.~. -..~-. - ~.~.~.~..~.~.~:~.,.~ ~._...~...~, ~ ~__ ~=G~ ,,~,,,,,.~ ~c~ ............. ~ ........ ~~,~.~ ~.......~c.,,~~ .................... ., ........................................ ~ .... ....................... ~ ................. : ......... ~ ................................................................ ~: Buildin~ Inspoctor. .... .... FORM NO. 6 TOWN OF SOUTHOLD Buildlng Department Town Hall ,~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted-~TA~catc 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 approva~ 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 or topographic featu res. 2. Sworn statement of owner or previous owner asto use, occupancy and condition of buildSngs. 3. Date of ~,ly 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 land use 3. Copy of certificate of occupancy $1.00 --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date ........... /' New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Lo=t,= of Hou~ No. Street Ham/et County Tax Map No. 1000 Section . Subdivisio,~A~.~ ~ .~.r~_R~ /. /. ...... Filed Map'No ......... .~N~ ~.7--., ....... ~O. S. ~ ~. Date of Permit7/~ ~7.~ .Applicant ~''~ .~~ Perm it No. Health Dept. Approval ........................ Labor Dept. Approval ........................ Unde~riters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .. ~ .................. Fee Submitted $...~ ................... d per_mit pplic~l d re ulations, Construction on above described building an meets all a e codes an g Applicant ~ ..................... Rev. 10-10-78 // /~0~,~ NO. ! YOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E ommed ....................... , ^pp,icot,oo . DisopproYe~4/c ..... ' :~::~ .'.~:....zT:.....' ~'. .................. =. ................. ..o./. .................. · ............ ..... ~Bu~lding Inspector) Dote ............................... , 19 . ,. 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 thiF 6p'p'lidotio"h'. 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 per*~it 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 YoJJ~ and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or~ r~moval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, bpil'ding ,¢Jode, housing co~nd regulations, and to admit authorized inspectors on premises and in buildings for necess~-y insp/e'~:~ ~/~..,._,,~ . ~ (Address of applicant) State whether applicant ~lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ......... ~...~~: ....... l..~.~...E..q4~7 .~.....~..(-4...Z:/..L2.~'....'~.~...4'...6..~...~J. ............ 'ized officer.' If applicant is a corporate, signature of duly authorized off'c . (Name and title of corporate officer) Plumber's License No ........ ~_~......[..-~ ........................ Electrician's License No .... ¥~....~J..~.......~. ................ Other Trade's License No ............................................... ~_/~//~,~. ~ ~(~h Location of land on which proposed work ~ill begone. Map No...~..~...~..!.... Lot No_.,,.~.~ .............. Street and Number ....~::l~.~.....~.~........~....:~. ............................. ~r4¢~,~ ..... Municipality b. Intended use and occupono/ .........................~ ................... ;.~ .................................................... 3 Nature o, work (check which 'applicable) New Building ................ Addition Repair ................. Removal '. ................. Demolmor. ................... Other War< ~/ C ~ (Description) Estimated Cost ............ ~...,<~ ..................................... ee ...... i (to be pa~d on filing this apphcahon) 5. If dwelling, number of dwelling units ............ [ .............. Number of dwelHng units on each floor ......................... l{ fl~ro~e, number o{ cots ...... ~ .............................................................................................................................. & I~ business, commorciol or ~ixed occupdncy, specify noture opd extont o~ e~ch type o{ use ........................ 7. Dimensions of ex,sting structuFes, if any: Front ...... ~.~ ........... Rear ..~....~ ............... Depth .~.~..~ Height ........................ Numb,~r of Stories ............................................................................................................... D~mensiohs of same structureJ with allerations or aSdihons: Front ....................................Rear ......................... D~pth .............................. : .... H[eight ; .......................... Number of Stories ................................ 8. Dn~ens~ons of entire new construct on Front .................................... Rear ............................ Depth ....................... Neight .................... Numberl of Stories ................................................ :......~ ............................................................ 9. Size of lot. Front ..... Z~.~ ...................................... ar ....... ~ .............. z~.... D?~h .~f.~ ................. ':' ,~7 ~ Name of Former Owner ..~....~~ ............ 10. Date of Purchase ~ ..]~. .................... 11. Zon~ or use district in which ~remlses are situated ................................................................................................ 12. Doesl proposed construction viblate any zoning law, ordinance or regulation: ...... ~.~ ................................. ....~ ..... Will ex~ fill be removed from premises: ~es 13. I~t be regraded premises of of ....... ..... g.ocate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck dimensions from '. property lines. Gwe street and bkck number or description according to deed, and show street names and indicate whether interior or comer.Jot. ½, STATE OF, NEVV( ~'vORI~,,~ .~z.~l ~ ~ ~ COUNTY .............. ~~...~ .............. ~,....X~ ................ be,ng duly sworn, Is . z ~ - .~ ' deposes and says th~( he the applicant (Name of individual sigoing contra~ above named. : He is the ........................ r~,~...,.~ ~ ,, . ¢ j (C/ntractor, agent, corporate officer, etc,) of said ow?r or owners and s du~y authorized to perform br have performed the said work and to make and file t~ s application; that ail statements contained in this applicahon are true to the best of his knowledge and belief; and . that the w6rk will be performed in t~e manner set foffh in the application fi ed therewith. Swam to before me this , ~ Not~ ~um~c, · .................. ~ ........... ~~coun~ ~' ........ T'"" ~"~;¢~;2~" " ~"~%." T ~"'~"W ~ '~ff /Y ~ F / ~ T '1~ ' ., /g / - t~lgnoture or app canT) ILIZAB~H ANN ~IL~ / , ' ~ ~BLIC, star.of ~ York '