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FO~ i~O. Z
TOWN OF~ ~OUT~)~
BUILDING ~PARt~8~'~
TOWH H~LL
SOUTHOLD, N~ Y.~
(THIS PER IT MUST BE KEPT ON, TH.E PRE~IS
COMPLETION OF THE WORK AUTHORIZED)
iS UNTIL'~ULL
Permission is hereby granted to: .-, ~'~
~,~.....~..x~.~./.~.~ ........ .~.~ ........ ~..~.~.~. .................... '...
at premises located at .~.~...~../.~..~...~2..~ ~..- ...... 'i' ............ ('"'"'""~'~ ...........
................................... ~..~.~....,/.,~:.~x;~.~.i.,~.,e.... .......... .~..~J~.~4-
County Tax Map No. 1000 Section .4..z...~".....-,..-i. Block,[..(;
pursuant to application dated .~...~..~.~..-~...:...~..~ ....
Building Inspector.
Fee $ ..............
..... , J9~.; odd approved by the
FORM NO. 6
TOWN OF $OUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
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
natura~ or topographic features.
2. Final approval of Health Dept. of water supply and sewerage disposal-iS-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 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:
~_. Certificate of occupancy $5.00
Certificate of occupancy on pre-existing dwelling or land use
3, Copv of certificate of occupancy $1.00
$5.00
Date . ~..~, .e.b.r:.u.a..~y.,..]..c).8.1. ....
New Building ............. Old or Pre-existing Building . ~ ......... Vacant Land .............
Location of Property ¢~3.~...S.e.c. qo.d. .S.~zT.e.e.~. ,a.n.~ .f~.23.Q~. ~T,a,c.l~$ p~l, .~$~'.e.e~$,..N.e.~..S~.~Lk
House No. Street Hamlet
Owner or Owners of Property . .~b,O~l~..LON~.~i' ............................................
County Tax Map No. 1000 Section .. ~L,1,7. ......... Block ...09 .......... Lot .0~J~ ............
Subdivision ................................. Filed Map No. ~, ......... Lot No ..............
Permit No..10~,~'. Z. Date of Permit ~/.~6/.~[O. ,Applicant .~'~.t,e~ .~,
'~'~zo~a s J~owz-y
Health Dept. Approval ........................ Labor Dept. Approva~ ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ ~,00 ........................
Construction on above described building all applicable codes and regulations,
~p~rmit meets
Rev. 10-10-78
FIELD I~SPECTION
FOUNDATION (2nd)
e
ROUGH FRAME &
PLUMBING
INSULATION PER N.Y.
STATE ENERGY
FINAL
COMMENTS
ADDITIONAL COMMENTS:
Q~UALITY CONTRACTING ON ANY SCALE"
Environment East
PETER R. STOUTENBURGH
310 Akerly Pond Lane
Southold, New York 11971
516-765 -3252
JO' - - '
L~PROVED AS NOTE~D , _~.
NOTiI~y BUILDIN~o ~~
765-1802 9 AM TO 4 PM FOR THE
FOLi.O\^/iNG iNSPECTIONS:
l. FOUNDATION - TWO REQUIRED
FOR, POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSULAT'ON
4, FINAL cONSTRUCTION MuST
BE C''~M?LFTF FOR C O.
ALL CONSTRUCTION SHALL MEET
E UIREMENTS OF THE N.Y.
THE R Q ,
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBkE FOR
~r~D~$1~ ~R CONSTRUCTION ERRORS.
E
E
Ernest Prezioso
JACKsoN
101.9i
STREET
0
~OTE: ia= MONUMENT FOUND
I" 20'
SCALE: =
NOV. II, 1966
DEC. 3, 1966
SURVEY FOR
THOMAS C. F. LOWRY 8~ ANNE LOWRY
NEW SUFFOLK
TOWN OF SOUTHOLD
SUFF. CO, N.Y. GUARANTEED TO:
THOMAS C.F. 8~ ANNE LOWRY
HOME TITLE DIVISION OF CHICAGO
TITLE INSURANCE CO,
PROFESSI~E R AND
LAND SURVEYOR, N.Y.C. LIC. N0,128:45
RIVERHEAD , N.Y.
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL,: 765-1803
Examined .~ ~.O~Y)...~ ~..., 19o~.9.
/
Approved ~.c/.~.. ?.~.
Disapproved a/c ......... ~.~ ......... ~-~ .........
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
Application No. ~'~' ff'~' '~'7 ......
Date .... .~./~-~ 3 .~. .......19~.
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 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, ordinanc,~g code, hqfi'~ .¢ode~ an~regulations, and to
admit authorizedinspectors on premises and in buildings for nec~sarg.hn~tiogt~. ~U--~-~'~J__~' /Q
.........
· (Mailing address o f applican'F~
'
State whether applicant is owner, lessee, agent, architect, engin~t~,~~electrician, plumber or builder.
(~/;~n' ;~3,~x roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No ..... ~../. ~r. ...............
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
Location of land on which proposed work wil$ be done...,./,/,-.~. ~...,~,, .....................................
House Number ~treet ~ ~- X ...... Ha~'l~i ....................
County Tax Map No. 1000 Section ...... ...... mock ....... ......... Lot ..... ........
Subdivision ................................. Filed Map No ............... Lot ...............
(Name)
State existing use and occupancy of premises and intended use and occupancy 0f proposed constructior~
a. Existing use and occupancy ..................................................
b. Intended use and occupancy ..
4. Estimated Cost .................................... Fee
(to be paid on filing this application)
5. IF dwelling, number of dwelling units ............... Number of dwelling units on each floor ................
II garage, number of cars .....,...~ ................................................................
6. I~ business, commercial or mixed occup~cy, specify nature and extent of each type of use .....................
7. D~enSions of exittiog stmctur6s, if any: Front ...... ~.~ .~... Rear ..... ~. ~ .... Depth... ,~. ~ .--.
Height ..... ~.~ ...... Number of Sto~es ..... ~ .............. ~ ............................. -- '~"'
Dimensions q~ structure w!th alterations or add~ons: Front .. ~..~. ......... Rear .... ~ .~. ........
Depth ..... ~.~ ............. HeiSt ..... ~ ............... Number of Stories ..... ~ ..............
8. Dimensions of eBtire new construction: Front .... ~.~., .... Rear .... ~.~ ...... Depth .... ~ ~ .......
Height .... ~. ....... ~ Number of Stones ............ ,...,..~., ~ .................... ~ .~ ........
9. Szze of Itt. ~to~t ...................... Rear ...................... e~t ....................
~0. D~te of ?utc~se ........... ; .................. Na~of Fo~et, Owlet ......... r>~ ...................
...... ::;r;:~;::t;:~ ............................. ~.(. ..........
111'2. ~ ::; ;;;S;s ~s Z:ts ;::~h~:;;:s , ordinaf~o~ a~ ~:1 .~ ....... ' .......... ' ....
13. Will lot be regraded ........ j ..... ~ ............. Will exces~ fill be r~mov~ro~ premises: Yes No
14. Nme of Owner of ~emises . .~,..~. ~ ~ r:~. Address .. ~.~.. ~ ~TPst ./mqhone No ................
Nme of Archztect, ............................ Address . .~ ......... , ...... Phone No..
Nme of Contractor . .~ .~;~'h ~ Address .. ~:*. t. ~.., Phone No..~. ~.~
PLOT DIAGRAM
Locate clearly and distinctl,y ali 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 NEWt'~'0RK,
COUN ~~'~ '--' '-T~..~i~&~~ being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract) F/
above named.
,
He is the ...... ~ .............. ; ...........................
ontractor, agent, corportite officer; cfc:
of said owner or owners, and is drily 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
wor~ will be performed in the man,er set forth in the application filed therewith.
Sworn to before me this
............. :day f.: ....
No~?ublic,., ,..-., ....