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Home My WebLink About10337-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy · Z97.~9 Date ..... November ~ ......... 1979. THIS CERTIFIES that the building ................................................ Location of Property h~sb Ho: ........... 'S'treet Hamlet County Tax Map No, 1000 Section ....1~.5 ..... Block ..... .0.~ ....... Lot ....... Qbe0 ....... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... .J.t~..e.../I.. ....... 19'7..9.. pursuant to which Building Permit No ........ .10~.~ ....... dated ....... ~.~..111~'l~$, .2.. ........... 19.7..9, 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 ......... .... ........................................... Edward H. Schwiebert The certificate is issued to ............ [o'~n'e~~ ................... of the aforesaid building. Suffolk County Department of Health Approval ............ .N/.I~. .......................... UNDERWRITERS CERTIFICATE NO ................... N/.R..,,,, ,,.,, _/ .......... Rev 4/79 FOE~I NO. ~ TOWN OF SOfT,OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, ti. Y. BUILDING P, ERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10337 Z Permission is hereby granted to:~'- / ~C~.~ ........ ~o~.~,~....~/_ ._~.c~..~,. ,. ~- ....... z~..a....~k,~..~.....~ .. ...~,'~Z~...,C'/~,~ x~..;,...~..~ /....,' ,'~ 7 ~o ....£'.~,,~.~.-~.~.c~...~:~...r..~..~~z'c~.;,~.....~.,¢~......./.~.~.o. .z ,c~,~.~x~?:... ~. ...... ~. ~. ........ =x.,~ . .. .q,,o,c ~. . . . .d. . ~..Z. ~. ,gF~ ,z Z ~/. ~.~-~. ....... 7. . /~ or,re m i~es ,oco repot ~[j.~. ~-. . . .. . ~ ~/. .~=~. .~.~ ................................. : ...... ............................................................................................................. ~ .~7-~v'~ ~ ~... ../~..V . Building Inspector. / ~ee *...Za..~ ...... ·~X/4,W,Z..~.,Z,Z_,: ~ ,. , '- / Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions Bo 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 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, 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 Property /(~-~--' /c~,, // ~'~__.~/~._ ,~f~.. .~..~.~.T.~.~.~p~. ................................................... -- House No. ~,_ Street Owner or Owners of Property . ~;7~,,u~./~. ·/~. .... ~. ,.C..~. ~./.~.~ .................. County Tax Map No. 1000 Section .. ~..~..~".. ....... Block .... ~ ..~ ....... Lot...(?. ~ ....... Subdivision ......... ...--'~.. ................... Filed Map No ........... Lotto .............. Permit No.~.~? .~..~...~...~7'Date of Permit (/~,/~ .~...App licant~,-~/~..------------------~'~..~;. ~-~.~.~. ~/~ ~~' ' Health Dept Approval Labor Dept Approval --- Underwriters Approval ~ Planning Board Approval Request for Temporary Certificate ..................... Final Certificate Fee Submitted $... ~ ................... Construction on above describedApplicant.building and..~o .~.~.. ~..~ermit meets all applicable codes and regulations. ........ Rev. 10-10-78 ~ ~7' ~ ? '*' FOI~M NO. 3 ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. NOTICE OF DISAPPROVAL F,e No ................................................................. Dote -J UU ~ ~{~9.~..~ To .... ~..L~~b V SC~w~k- 7S~T ~0~ ~od~b HILL PLEASE TAKE NOTICE that your application date~ .......................... ~.~..~ ...... ~.., for permit to construct ~CC~-~B~ ....................................... at the premises located at .................................... ........................................... {076~ ~ILL OD~.~.~......~l.~rSt~eet ~ Block ~- Lot ................................................ is returned herewith and disapproved on the followlng grounds ..... ~.~.~.~.~ .......... ~.~.~.~ .R~. ~T ........ g.~.~ ........ ~.~.E. ?.L~...~..b ......... t..~......~.. ~......~.8.~..... ~.~..L...~ ..... ~.~.Z.....~ ................ (.g.g.z..~..~ .......... A~c ~E~P.~.~ ...... ~.t.~.E~.}~Le.~. .................. 11971 Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-18013 ? pp"cat o 7· ...... APPLICATION FOR BUILDING PER~IT 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 or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The ~vork 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 Bui/ding 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 promises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ~0~- t~,etmd Iltll ~toad State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . ~t. 1.~.~.?.11..lr:..,5.~.h.?t.?.l~??.~ ................................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder s License No ..... Plumber's License No .......... ,'~ ./ ............ Electrician's License No. · Other Trade's License No ...................... 1. Location of land on which proposed work will be done.}l~tI.l..(l~te*i~. Drt~.e.,..'~te~hold,...?lay .............. House Nnmber Street Hamlet County Tax Map No. I000 Section .../.~.5 ......... Block...~.~. ........ Lot....~?.~. '~' ........ Subdiwsion ................................... Filed Map No. ~ Lot (Name) 2. State existing use and occupancy of premises and intended use and occuponcy of proposed construction: a. Existing use and occupancy . .it.~.~.t..d99.~.i?1 ........................................................ b. Intended use and occupancy .~.?r..a.g?..o.t'..g.a.e.d.?.~. ?.q.u.t .j~.~.a..~..a.n.¢l..~.n~l.l.~. ~.,, ~,'r,~,~.~,~l,~ ............ 1( 12 p; .~n a p~o} survey dated 1/16/G8, a plm~ house ~beut dtfIorent maauf~eturere~ It will ~et ex~eed ten feet in depth oF Attaohed, STATE OF NEW YORK, S.S COiJNTY OF ................. (Name of individual sighing contract) above named. He is the ...... ' ................................................................... : (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d41y authorized to perform or have performed the said work and to make and file this appilcation;.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. Sworn to before me_this, ........ ..... ....... oun,, ~O?^'V "U~H¢, S'.'e e* Uaw York I (Signature of applicant)