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Home My WebLink About10855-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Cerli icate Occupancy No. 7 'I0~58 Date Jnnuary 2~, 19 81 THIS CERTIFIES that the budding ............................................... LocaUon of Property .. ?79.Q.5..S.qu..n.dy.i.e..w..A.v. 9.n.u.e., .......... ~.gu.~.h. ql..d,..N..Y... ...... House No. Street Ham/et County Tax Map No. 1000 Section . . .OS.~. ..... Block .... .07 ......... Lot ..... .0.0.5. Q.0.~ ... Subdivision .............................. Filed Map No ......... Lot No .............. conforms substantially to the Applicahon for Building Permit heretofore filed in this office dated ...~.u. gt~..8~. ?.9., ..... , 19 .8.0. pursuant to Much Budding Permit No... ? 9.8.5.5.. ~ ........... dated . .S..ep.~.e.m..'9.e?...5 ............. 19 .8.0., 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 ......... .............. ................................. The certificate is issued to .... Tt%o.I~. I~,..a.n. Cl. ~¢rl..l~N.e.lT~..e¥ ........................ (owner, ~o77~¢~ of the aforesaid building. Suffolk County Department of Health Approval ...... .C).-.~0 .-~... 3/.! ~ [.83..RO.b.e.~. ~:. A..¥:tlla UNDERWRITERS CERTIFICATE NO... P. endlng ...................................... Building Inspector Rev 4179 FOR~ ~:NO. 2 TOW~ oF $OUT~HO~,~ BUILDING DEPARTMENT TOwN HALL SOUTH'OED, N. Y. e [LDING P,£1U~IY ~ (THIS PER/~IT MUST BE KEpT ON THE PIPElinES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? ~o~5~ z Date ~...~:~.~..~/~. ~'-', Permission is hereby granted to: n ?--) / I / , ~ ....... ~.z......~7~......~~.~c -/~ ~, ............ ~ ........ E~......~.. ~ ...... ......... ............. ~ ~ .~ ~ ...... Lot No ~oun~ lox ~ep ~o. iuuu ~ec~on ..~..~.-~ ........ .. ~ ..... -~? ....... ~ .................. ~ ~. and approved by the ~ pursuant to app caton dated ..... ~ ......... , 19 ~uiJdlng Inspector. Fee $....f ................... ~ Inspector FO~ NO, 6 TOWN OF $O~THOLD ~ Building Depar~ment Town Clerks Office Southold, H. 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 oil buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal--(S-g form 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: ]. 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: ]. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ............. iN .................................................................................. z ~ ................. Owner Or Owners Of Property .... /...~..~.2 ......~/.~....~.../.~.C.' ......... Subdivision (,U~T~-S'Pc¢ k/ ............ House No ............. ................................................................ Lot No/..~,Cfl~...~. Block No. Permit No /.9~.~....~..... Date Of Permit ...~./...~./~...Applicant ~', /~</~-/-~/ '.~.~u'J /iV' Health Dept. Approval ].././.~..l...~...J. ....................... Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ............. 7~ ................... Request For Temporary Certificate ........................................ Final Certificate ............ ~ .......................... Fee Submitted $ ........ .,-~..'.~.~ .................. Construction on above described building and per.mit meets all a~.plicable codes gnd regulations. Apphcant .............................................................. Sworn to before me this ................ day of ............................................ Notary Public .................................... County FIELD INSPECT I(~¥ DATE COMMENTS ~o~o~ (~)~ INS~ATION P~ N.Y. STATE EN~GY CODE (Building Inspector) FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765~1B03 Application No../.~..~..'~..~. -- ....... APPLICATION FOR BUILDING PERMIT / Date ...~/..°3'.~11 .......... 19 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 t6 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, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) /! '~ 5-' ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises /"~/~ /~ 'J~ " (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of co'rate officer) Builder's License No ....... /.~. ............... Plumber's License No ..... ./.~?./.~...t:? ........... Electrician's License No.../)~. "~ 2 2 ~ ~ / Other Trade s License No ..................... Location of land on which proposed work will be done ............ ~.?.?./././?..~¥.. ~ ~ ..... ~:Ufq.~q.~.. ........ .............................................. House Number Street Hamlet County Tax Map No. 1000 Section ..... ?~.~ ........ Block ......:~ ......... Lot .~. '~' ~ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Ex]sting use and occupancy ....... b. Intended use and occupancy .... / 3. Natureofwork(checkwhichapplicable):NewBuilding..........~ Addition.......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4 Estimated Cost fl! ~'o0 ooo ~ oo : (to be paid on filing this application) 5. If dwelling, number of dwelling finits ............... Number of dwelling units on each floor ................ If garage, number of cars ..... ' ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... .~., Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ...... ~.l ....... Rear .... rJ.I ......... Depth .-~ ~ ......... Height ............... Number of Stories .... J .t[~-v ............................ ,,. ................ 9. ' ~z.~,o Rear .( ..... :Z...G..5': ......... Depth .. ~ ?.o. ............... S~ze of lot: Front ....................... 10. Date of Purchase . ~.q. ......................... Name of Former Owner ............................. 11. Zone or use district in which premises are situated .... /~'.: ............................................. ~to 12. Does proposed construction violate any zoning law, ordinance or regulation: .../. ............................ 13. Will lot be regraded ...... .t¥.? .................. Will excess fill be removed from premises: Yes No 14. Nmne of Owner of premises . ~. !.~.c..~/qR.lI/V ...... Address ...~..q .o.v. !~?..~.O. .....Phone No Name of Architect ' Address Phone No Name of Contractor . i~ '. R.~.t.H~ ~...~J'.o?.~ ...... Address t~o}~.q-~ ~/....~! .~.r.T., Phone No..2.~. ~-.,. ~.~. ?..,~... PLOT DIAGRAM Locate clearly and distinctly all 'buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block lumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF N~W ~DRK.~, COUNTY .... Jl/~..*..~..~..-~.m.~. .... ?. :... ~ ~ .% ~.~. ............ being duly sworn, deposes and says that he is the applic~t (Name of individual signing contract) above named. Heis the ........ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e ~d file this application; that ail statements cont~ned ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed in the m~n{r set fo~h in the application filed therewith. Sworn to before me this ........... ...... Nota~ Public, . ................. ~. County ~ ~ ~ /~ ~ ' ,' ZABETH ANN NEVtLL~ (S~g ature of ap hc~t) I ~o. 52 8125850, Suffolk Cou~ " m Term Expires March 30, 19~ \ ~' Om ~< 9z ~ 0 0 0 8 ?40 '~'