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Home My WebLink About10554-z FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. . .2;99~.5. . . . . . , . . , Date..... .!!t~y .49.................. " 19 .~P THIS CERTIFIES that the bUlldmg . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Location of Property ... ?-.4Q9. !3.;I,g9~.~ .FJ.9~P: . . . . . . . . . . . , . . . . . . , . . ~.e,1;;'!:~:t~qJ:.t,. ~ ~ r ~. House No Street Hamlet County Tax Map No. 1000 Section .,' 14.4. . . . .Block .., ~. . . . . , . . . . .Lot . . . . . . .21, . . . . . . . Subdivision. .!!t?:t.1<:J. tW::~ .J:.>?f'~ .r:'r9Ih , , . , .Filed Map No, .. ~P.1. . .Lot No. .... ~~. ~ . ~9. conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . .J~:n).\&U. 21:). , . , 19 .eQpursuant to wluch Building PermIt No. .. ~.q,~~;Z, . . , . . . . . . . . dated. . J.8.Q\t~r.r. ,:;>~, , . .. . . . , . . , , , 19 .~Q, was Issued, and conforms to aU of the requirements of the applicable provisIOns of the law. The occupancy for which this certificate is issued is . . . . . . . . . . . . . . . . . . . . . . OnE). FI31IIUY. P.w<?n.:I,~g. ~.:I, ~:t,l. P.E!1,J,.!,f'. ,!~~:J:;.e.x:~,!:;L!>A. . . . . , . . , . , , . . . . The certificate is issued to .................. .q<?~.4 . J3.Y~~J;' . . . . . . . . . . . . . . . . . , , . . . . . . . . (owner~) of the aforesaid building. Suffolk County Department of Health Approval ....,..... N"/'R; . . . . . . . . . . . . . . . . . . . , . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . , , . . . . . . . N"/.~. . . . . , , . . . . . , . . . . . . . . . . , . . . . ~ ~~ . ,....,......................... ,....... Building Inspector Rev 4/79 , , < j _' "..t .-It \, FORM NO. 2 TOWN OF SOUTHOLD BUILDH-IG DEPARTMENT TOWN CLERK'S OfFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE pREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) o r:. JAw,,;2[3 8() N. 105~4 Z Date ......,..'.."... ,.....................,........,......, 19.... .. Permission is hereby granted to' GOULD ~y DG T<. 6/f(J1?~[ IIrAYI-Orr- ..................................................., .." ........ P.O. i)6X 553 38"JO f)t=LMM\ DR. .................................... .,..,........, ,. ....".., .. .. }-1A rr /71/( ,V 1/95;l... ........,........,....................... . "..' ., '.... ..I,.... , to ......t(t!.~<'i.....,.....,N:..:...€.1!:.!:!..(../..r:.'y.r~. .. c./:ru.f15.......f.!.t:!i?~.7!:....,f7:..~,'~,~/~/,(- .....,........... ,P,."!. ~~............. .f!.! .~. /, ~.~......... i?'-:Y 1:" L..l 1,t:'.6::..,...,..... ....... ................,........,.......... ,. . ~LI{)D 510e:: 1?c C j?()A 0 at premises located at ................................,........... ....,..,......"......... ......,......".................... ... ..... . ..... /...flU7?k-L. /1/'(. ,... ,..................................................................,..,...., ... .1... ....... ......................................'.. ,...... ... .. .y('.........'-!..!!.::....'!.";J...."I....!:!.!:.7!...I.:...I.Jr ,S rA'f:..~, ...p.r.~.'F'..~.~~.'.:..T.I'...FJ..~~~p...~~.,;> Ft-86 / pursuant to application dated ............................,.., ';,1'1:/\/..,~, 19f?..~., ond approved by the Building Inspector. Fee $.......I5..~~ u,~";;::'{~:r -: :;/~~?VK~ r ' Building Inspector ~~.~==-_=_..."".""""_""',...,.,... m,...., ,,-."'...__ <1 Pf-,~ < 'i!. ': i L'L.J:::S p.,PPP\O\fAL I 1 ~ ,',',;. j :~:~ - ':; r[LL , I r. " ",,',":' \'.),::',\<\L~cS [~y ~ :U ," t~ "L/ 1_ J _____ ! t \ oj 1,:,I':~T!:)N !____ c_ t~ " , '"I. 'CII'~)N " i(" . '''I,),Jlt/-~- " ,_1_ ,,\ '-. J" ,\ 1\ ..J'._ I\. j'VI\ ..A..~= r:Yi:.~f_ z __ ___ _"___._ % .;,\~ J, j .1, 1! 4 , ,\ ) N\c<;J _ ~ "2;> f ~ ') '), FORM NO.6 '0 if o.71,\} c' TOWN OF SOUTHOLD '(\,\(J.. Building Department Town Hall Sauthald, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This applieation must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the fallowing; 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 approval of Health Dept. of water supply and sewerage dispasal-(S-9 form or equal). 3. Approval of electrical installation from Board af Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Cade 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: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural ar tapograph ic featu res. 2. Sworn statement of owner or previous owner as to use, OCcuPancy and canditian of buildings. 3. Date of any housing code or safety inspection af buildings or premises, or other pertinent infarma- tion required to prepare a certificate. C. Fees: 1. Certificate af occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy af certificate of occupancy $1.00 Date.. . 5. ~ .2.~.: &.',;J. . . . . . . . . New Building. . . . . . . . . . . . . Old or Pre-existing Building .., v.. . .. Vacant Land ............. Lacation of PrapertY .. :J...'l:O.IP.. .$"1'.b.e.,~. . R.I.. ... . .. . . .fJ:u*.T.[4T v...JL. .. . .. .. House No. Street Hamlet Owner or Owners of P raperty . G.O .1..-\.. .I.d. . . :R. y .cl~ X. . . . . . . . . .. . . . . . . . .. . . . . . . . . . . . . Cou nty T ax Map No. 1000 Sectior .... /. y-. if. . . . .. Block .. . . . . . ./. . . . .. Lot.... d. /. . . . . . . . Subdivisionro.p,.It.,t.<i-~.-k f6.+:v.k .fV.1'e. .~1~. .Filed Map No. .5:r.tl./.... .Lot No. .. if f. . t. .'t.7 Permit No. 10. ..s- 5 .~.4fate of Permit /)z1fj$'!. .Applicant . .~~.Q ."':7-<'. fI.TA.y)9!2... . . . . . Health Dept. Appraval . . . . . . . . . . . . . . . . . . . . . . . . Labor Dept. Approval ........................ Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . .Planning Board Approval ........ . . . . . . . . . . . . . . Request far Temparary Certificate. . . . . . . . . . . . . . . . . . . . .Final Certificate. . . .. . . . . . . . . . . . . . . . . . . Fee Submitted $ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Construction on above described building and permit meets all applicable codes and regulatians. Rev 10-10-78 Applicant /~.1I. .~~....... t,'~:'7- i9~~ !i ~9 J,}70 U%L -# /!? ,3-7 !Ju~#' //H~ .~ i . ~,i1 ' , A :,t" ; ,A, ! _'.1\ ~'_"_~-;;_~<'O.'~' , . ".,."., "W"",.- ...,~~,,_i'o''''''''''_ _ '..,." ",,",.-., ~m~, _,_'__._~"" '....,.." .""~"~'_~"'-"""""""""""~""''';''''''''''---'''''''''''^'''''-'-"""",'"~",,",--,,.,,,,~,~,," _) L> ,.'- !?!~.,0.no?~~~~.~:!T.. =*!~~'f3if}.~ ~:' ~~~k:3~:~~~.~_ '/' '- . 'E.I"..D 1,,,sPECn9.v ~1.D-~f;::: COI,-/L.VI c:.ldT5 ...... I,~ ~ I :tr; I 'F.c>w"'" OATI 0 ,v. I sT II ! ~ . . I" -/1 \I . I //"J~' ,;../1',. N ! i ~ #.A' It{ 7i<_ ~?/ '" ~ ~~~,-' j~ ! f:: I C1 " Z t::.E. ' ! -I '-\ I 2 rt-' ~~ , . \:t--t: 2.0LJ c;:; H FRAlv,\t::.. Ii . ~ D <1 ?L u N (3 I N G I 1 ~ '0 ~~ I ~ ~ i : w. oJ I i I';; I 1'-1 S U LA T I 0 t--:l I 7[) ,/-J.y, -srA ~ I! b E 1'-' EE. r2. G\ v Co Dc.. I --.-.--. I I . ... ..' _,_._ r !.__ . ~ <} i..___ i , I-~------ --------.---- F" i 1'-1 A L.... i I! _~______h ~~ ~ I ! - ,~ '., " ,. ~~ A;') D I TI d tV ALe 0 "-/l I\/'\ = fJTS'- m._' .... --.. .., ..... n' ~ Ti1 (3-vJjv_ ~) .__..___._._.... ..,_ _ . 1J - -- ._~ ---------~ . ~ ~ ,..\-J .-- ~ '\; 7.t ~--, ".\,C "---;ERMlT"71:.1(:'~;[)[:'; APPP<O.;;t._, . ~ TG ;1,:::,'v',.OVE [):'C:-:;S riLL -- _.fiillM..,-"i\C1V:C .EJ1EMJlilS.J3L_ 1-- . 1-- t-~Gr'-'\I2!~G LO'f____. _.. ~ I [)[\IV;,Wi\ Y CON ~ml.lCi ION ,. =--..'1--- '--'--'- ----I--. C.,,:h t) ,) " .1 ) ,'. J. I ,~ OTHER \.._. . .. j ," . ,,_, "1. ,~ " , fORM NO.1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ~ r Q-iJ Application No. /~~..f. y. . . . . Examined. . . . , . , . . . :2:-,.,19. . . A""",", . ~>C~19 2<j"=,, N'/O ,rs: '( 7 Disapprovedah . .~".,., ....,.,..".. .....................,..,.....,..~...~,k% . .. ...P.-:.. .. ... ............ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ~.1..Jf.. .. .., 191!.O 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 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 buildmgs for necessary inspections. 1?O. Box 553J1,~7fw1~,;i:~~;;;~,i;;) . . . .3.f14. JJl.d.1i1.P.-1.Ifl.t. .1JJ~.'NJ /lrs:J, (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician. plumber or builder, . .. .. . .. . .. fr\ )'}:-:; .".!.1. . . .~~..,..........,...................,................., Name of owner of premises .. .j:J.~. .~0:-:'."...........,...............,..."...,..... (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. . .7,0. t:. #, I.. . . . , I. w~;:qO(ti'h'ro'9.d~9'kwillk~...... ~,?(,...................... H~~~~ N~I~be; . . , , ' , . . . , . . . ~re~t . . . . . . . . . . . . . . . . . . ,/h. ~ '77?j, ,llof.'..s~~ County Tax Map No. 1000 Section .... ,/ ':f. t. . . . . .. Block ,.....1., , . . . . . . .. Lot...~./",........ Subdivision. ' .I1.A7rI. Tr!( I<'. ' , Pfr. If.!<. , . . . ~~.~~led Map No. . $'.C!.(. . . , . .. Lot .'f8:t. 'I{' . . (Name) 2, State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . . . .~. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy ..... ~. . . . . . . . . . . . . . . . - . . . . . . , . . , . , , . . . . . . . . . . . . , . , . , , i ''" c j .\<4. ^,:;z ud 1i ~~" ., i ,.. 3. Nature of work (eheck which apI1licable): New Building. . . . . . . . . . Addition. . . . . . . . .. Alteration .. .~. . Repair .............. Removal . . . . . , . . , . . . .. Demolition .............. Other Work. . . . . . . . . . . . . . . , ' i ~ ~ (Description) 4. Estimated Cost. . . . .r;.:?-tJ. P. r. . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . (~ . . . . . . ~ . . . . . . . . . . . . . . . . . . . . . , (to be paid on filing this application) 5. If dwelling, number of dwelling Jnits . . . . . . ./. . . . .. Number of dwelling units on each floor. . 9. . . . . . . . . . . . If garage, number of cars .....;..... .;. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial ormixedioccupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front. . . . .J. tf . . . . . . . Rear . .::/';" .k, . . . . . .. Depth. iJ.1 . . . . . . . . . . . Height ............... Number of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure wi1ih alterations or additions: Front ... .!.LJ. . . . . . . . . .. Rear . :?: ;'.' (,., . . . . . . . . . . . Depth. . . . . . '11 . . . . . . . . . . . i . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories. . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new constrljction: Front. . . . . . . . . . . . . " Rear . . . . . . . . . . . . . . . Depth ............... ~eight ............... Num ?J~r of Stories . . . . . . . . . . . . . . . .,. . . . . . . . . . . . . . . . . . . . . . . ~ '/ . . . . . . . . . . . . . . 9. Size oflot: Front...... ,/.00.;.......... Rear.....I. t'.~............~ '\~~" 10. Date of Purchase ....../9.;3.~................ Name of Fonner Owner ,fl'" . '0'" :.. . 'ff"'"'' :-.-.... . . II. Zone or use district in which preinises are situated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction viol~te any zoning law, ordinance or regulation: .. da. . . . . . . . . . . ';./:' . . . . . . . . . 13. Will lot be regraded ...,'. '1,' .y. ~.;5. . .. . .... . . .. Will excess fill ~e removed from premises: Y Yes No 14. Name of Owner ofpremlses~.~... Address ~..... Phone No. J,. 9lf:-:-.I//ltJ.? Name of Architect .. Jdl'J~) . . . . . . . . . . . . . . . . Address .. . . :..:,..; :..;,..:..: . 'J: . . . . . Phone No. .. . . . . . . . . . . . . . Name of Contractor ., ~-- (f 1#. r~y',.... Address 7J:J~..... Phone No.?1'.8,.1-gS'eJ... PLOT DIAGRAM Locate clearly and distinctly all ibuildings, 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 StFret names and indicate whether interior or corner lot. , ' / If If I _ _ - ~ / j . ~ ~ j.. 3- SO \0 ~W(I<YJo!l/ (0 I J i ',~- I ~ . 17"t./~)- ~l/~ I ~ , ~ I (-........ i 1 z.. '-:J . /(! c,e\\""-' \ '> .;'I\1'\~ _ (" / I C"ct ~4.' '-1 \ I 11, \ ! - ---- - --+~J - - ~-I : ~ 17 ' STATE OF NEW YORK, ~S ~ S 'hee.. Rd /(){) COUNTY OF .y.t(T~o.~/~.... .' ''1 ~ . . . . . . . ~. .m.. . ;Ja,.t&tt)(?.,.. . . . . . . . . . . . . .. being duly sworn, deposes and says that he is the applieant (Name of individual sifning contract) above named. : 4'" . ~! ,I" He is the. . . . . . . . . . . . . . . . . . . . . .i. . . . . . . . . . ~.~ ~.C:-.~"':':.~. . . . . . . . . . . . . . . . . . . . . . . . . .'. .. .. . . . . . . . . . . . . , (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfonned the said work and to make and file this application; that all statements cont*ined in this application are true to the best of his knowledge and belief; and that the work wi11 be perfonned in the manner set forth in the application filed therewith. Sworn' to before me this ' .... .f.f-,-~.~ ~1)J.<<(J.f;-v......., 19!? Not~~............. .,............ ,?'(I.f. County ~ LINDA F. KOWAISI<r : " ~ ~ NOTARY punt IC, State of New. York . .. .. ~... . . .1 (). ~ . No, !;2-4524771 I QU3Jitl0c1 III SUfl0/k County : CommiSSIon L p!roS Milra/l.:;O 19aO , , ' ,