HomeMy WebLinkAboutVloutely, GeorgeNO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No. Z 3.503 Date Oc~t~bor 23 19_62.
THIS CERTIFIES that the building located at '~'~'Ma'J.~"RIS~'~'"BIt~J"III~'AOIt ........ Street
Map No ....................... Block No ......,~j~ ......... Lot No ......... ,~j .......................................................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.................... ~pt~JlJJ~Z:..~l ................. , 19...6.1. pursuant to which Building Permit No ........... JJ~.
dated ......... f~Oji4:Oad:lO~..l:J ................ , 19....6,~, 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 .......Goordj~...V~:M~t.~l,Jr,...o¥.lt~z' .........................................................
(owner, lessee or tenant)
of the aforesaid building.
Building Inspector
TOWN OF $OUTHOLD
Multiple Residence Law Permit
PERMIT NO~,j~? ~Jl~ ~ 19 ~ APPUCATION NO. 1il'?
LOCATION J~ J~ JJlDJ~ ~ !(11~t !1.~'.
Application having been made on ~JltdllJJll~ ~3 · 19 ~ , for · permff
covering construction on ~ Ilil~:J.t~,~l t~ JJ IIz~r~31~ ij.l.t:J.jl'le J'll:J.(JtJJllt lbl~:J4J~l~
Jnew, altered, or converted}
multiple residence building, by or in behal~ of
application having been examined and recommended for approval on J~JllJr, iJJll~ ~
is hereby iss.ed for the performance o~ the ~ (It~ll~J;~l.1.)
(archi+ecf~r~l. strucfurat, mechanical, etc.)
work described in the above numbered appI;catlon and any accompanying plans and specifice+ions.
If no work is performed within one year from +he time of ifs issuance, this PERMIT shall expire by limitation.
, for a dwelling Ioce+ed as above sta+ed, and the said
, 19~kj' , a PERMIT
Approved SI~~lllllEl~e X,~ 19 6,1.
E~f~rcemen+ Officer L
FORM NO.I
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
×am,neo ....... ..................... .. ........
Approved ..................... ~.. ?... .............. 19 ........ Permit No ...............................
.......
........................ i~L'i]~'i~"i~;~;;;;;f .............................
////f / '/?
Application No .............................
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building
Inspector.
b. Plot plan showing location of lot and of buildings on premises, relationship to odioining 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 location.
c. The work coYered 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 progress of the work.
e. No building shall be occupied or used in whole or in part far 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 o 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 a Iterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances and regulations.
.........
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ...... ~O3~.~ll......~.341M~.~.a~. ........................................................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
1. Location of land on which proposed work will be done. Map No: ....~ ................................ Lot No: ...~ .........
Street and Number ...~.....~¢llJL~.~.O~t¢~.....~l;...l~',t,ol~ ...............................................................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
Tourist & Board~n~ hotme
a. Existing use and occupancy .......... ~ .................................................................................................................
" " ~ ~ addition
b. ~te~e~ ~e ~d ~c~ponc~ ................................................................................................................................
TOWN OF SOUTHOLD
APPLICATION FOR BUILDING PERMIT PURSUANT
TO MULTIPLE RESIDENCE LAW
Altered or Converted Multiple Residence Building
APPLICATION NO. //'/7 ~ /..~
House Number
Height: ~ '~
Street
Dis+ance from Nearest Corner
(I) Type of Occuloancy of Building
to be altered or converted
(2) Type of Consfruction ~--'~.--"~- ~
(Permanent, Transient, or Private)
(3) Use and Occupancy after Alteration
or Conversion ~'--~-~-~'-
(4) A new C of O (will) (will not) be required
(Fireproof or Non-fireproof)
Story
(include EXISTING OCCUPANCY PROPOSED OCCUPANCY
Cellar &
Basement) Persons to be
Ap~s. Rooms Apts. Rooms Accammodated
CorB
First
Second
Third
Fourth
Fifth
Sixth
Seventh
TOTAL
(5) State generally in what manner the Building will be altered or converted
(6] Estimated Cost of Alteration or Conversion
(7) Is Appllcat[on made fo remove violations? If yes,: State Violation Number
(8) State what disposition will be made of waste and sewage
(Public sewer, private sewer, cesspool, etc.)
Page I
STATE OF NEW YORK
COUNTY OF SUFFOLK
being duly sworn, deposes and says: That he
in the C~y of('(<~' ?~A~ in the State of
he is making th;s
application for the approval of
(Architectural, structural, mechanical, etc.)
plans end specificefions herew;~h submitted and made part hereof, and that to the best of his knowledge and belief,
the work or construction will be carried out in compliance with such plans end specifications, and thet it will conform
to all appllceble provisions of the laws governing multiple residence construction.
(SIF=N HERE) , Owner
Sworn to before me, this day of , 19
If application is to be executed by someone other then owner, acting in his behalf, thCer'followlng additional inform-
etlon should be supplied:
Owner's Name Address ~
(If a corporation, g~ve full name and address of et least two officers)
(SIC~N HERE)
Sworn to before me, this
day of
, Applicant
, 19
Notary Public or Commissioner of Deeds
FOR OFFICE USE ONLY
Examined and Recommended
for approval on
.~pproved on
19
19.
Superlntendent.
Work commenced on
19 Date Completed 19
I HEREBY CERTIFY that the above report is true in every respect and that the work indicated has been done
in the manner required by law and Rules and Regulations of this Department.
Signed
Page 2
Original for Municipal Building Department
STATEMENT OF REGISTRY
To be filed in duplicate with the municipal building department or local enforcement agency
by every owner of a multiple dwelling, as defined in subdivision 33 of section 4 of the
Multiple Residence Law.
Within 30 days after the filing of this statement, the municipal building department or en-
forcement agency is required by section 300, Multiple Residence Law, to file a duplicate
copy hereof with the State Building Code Commission, 1740 Broadway, New York 19, N. V.
i. Location of multiple dwelling:
Street and number ..~..¥..~..~....~... J~k~J P~....~. '
(a) . ..
(b) Muncpa ty ..'~..~.g..~...~.. '"~'~';'i ~;~ "~i ..............
2. Description:
(a) Type of construction .....~....][~I.L~..~. J..~...(~..~.......'~......~.....~.....~...../~....~ ....................
(b) Height of building, including number of stories .~..~.~.Lk...~..~../..L~?..~..~.......~...~...~.~
(c) Type of heat ng fac t es /~,../~.~ .~..~..~.~..~.~.~.~.--,4~..¢~..~. ~/,~.~, ~'./hl/~ ~'~
(d) Number of apartments ...~......~tJ~j~...~k....~...~...~..~.~'./~..~...~,.~
(e) Number of v ng rooms ...... ~)..~...E. ...... ..: ............................................................
(f) Number of kitchenettes ......~..J./~. ..........................................................................
(g) Number of bathrooms .....J~...~...~....l~ ......................................................................
(h) Number of water closets ...~...I...~.....~.. ....................................................................
(i) Number of occupants for which building was designed or intended to be occupied
or used ..~_...~. ............................ , ........................................................................
3. Age of
(a)
(b)
multiple dwelling:
Date when constructed ....../~.....~...~..U.~......~....~....~..~....~....~) ...................
Dates of substantial additions, alterations or modifications of dwelling, with
brief description thereof ....................................................................................
(c) If now under construction, state when construction commenced and anticipated
date of completion '
4. Use:
Describe the principal use made, or, in the case of buildings under construction, to
be made, of the multiple dwelling (such as apartment house, hotel, apartment hotel,
lodging house, boarding house, school, convalescent, old age or nursing home, pri-
vate dwelling two or more stories in height with five or more boarders, roomers or
lodgers, or other classification of multiple dwelling including those specified in sec-
tion 33, Multiple Residence Law).
.... ~.e~(...c,.~.~:..c_y..../~.....~c...T..~.~ ..u...s:...~.. ~.......s.
.... ......... ,./.,,. ................. '... .......... ! .......................................... ZZZZZL
.'~ ~U~./',~ ~f'/.,.,.~ , 195 ('~
/ (Name of
.~ZT-~ ~.~.~
................ ~X~;~";~"~;~""~'"~(' .....
~ STATEMEN~OF [ILIN~.~ -- --
Fed wth the ~~ ~.'~ ~.Z~ f t
~ ' ........... ~[,~i~;'g~L~L' ~"~'~Z~f' ~¥~ ........................ one
.~-~.~q~.~~<..~[-- ~'on the
..... .......
- ~S~nat~e and ~si~ation ~ Offi~al with
whom Sta~ment of ~t~ wa~)
/
Original for Municipal Building Department
STATEMENT OF REGISTRY
To be filed in duplicate with the municipal building department or local enforcement agency by every
owner of a multiple dwelling, as defined in subdivision 33 of section 4 of the Multiple Residence Law.
Within 30 days after the filing of this statement, the municipal building department or enforcement agency
is required by section 300, Multiple Residence Law. to file a duplicate copy hereof with the Sta~e Build-
ing Cede Commission, 1740 Broadway. New York 19, New York.
,. Lacetion of mu ,p,, dw.,li
(at Street and number ~~..z~
(b) Municipality ~~
2. De~.r;ption:
(at Type of'censtruchon'
i¢~/ype of hoatlng facilities-
Numbm. ,o~rl~mattes
(g) Number of bafhroams
(h) Number of water closet~
(it Number of occup~ts for which building was designed or ~ntended fo be ~cupied or used
3. Age of multiple dwelling:
Date when constructed ~
(o)
(bt Dates of substantial additions, alterations or modifications of dwelling, with brief descrip-
tion thereof ~
(ct If now under construction, state when construction commenced and anticipated date of
completion
Use:
Describe the principal use made, or, in the case of buildings under construction, to be made,
of the multiple dwelling (such as apartment house, hotel, apartment hotel, lodging house, board-
ing house, school, convalescent, old age or nursing home, private dwelling two or more stories
in height with five or more boarders, roomers .er lodgers, or other classification of multiple
dwelllng including those specified ~ sectioe 4, subdivision 33, Multiple Residence Law): -
Original for Municipal Building Department
STATEMENT OF REGISTRY
To be filed in duplicate with the municipal building department or local enforcement agency by every
owner of a multiple dwelling, as defined in subdivision 33 of section 4 of the Multiple Residence Law.
Within 30 days after the filing of this statement, the municipal building department or enforcement agency
is required by section 300. Multiple Residence Law. to file a duplicate copy hereof with the State Build-
ing Code Commission. 1740 Broadway. New York 19. New York.
of multiple dwelling:
(a) Street and number
(b) Municipality ~
2. Descrlpfion:
(a) Type of construcfic~n ___~ -~..
(b) Height of building, including number of stories __
(e) Number of living rooms
(f) Number of Idtcheneffes
(g) Number of bathrooms
(h) Number of water closets
Number of occupants for;~· building was designed or intended to be occupied or used
3. Age of multiple dwelling:
(a} Date when constructed
(b)
Dates of substantial additions, alterations or modifications of dwelling, with brief descrip-
tion thereof
(c) If now under construction, state when construction commenced and anticipated date of
completion
Describe the principal use made, or, in the case of buildings under construct;on, to be made,
of the multiple dwelfing (such as apartment house, hotel, apartment hotel, lodging house, board-
ing house, school, convalescent, old age-.m` nursing home. private dwelling two or more stories
in-height with five or more boarders, roamers or lodgers, or other classification of multiple
dwelling including those specified in so. Ion 4, subdivision 33, Multiple Residence Law):
~New York
STATEMENT ~1: FILINO
(Sign~ure and Designation of Officlal~fh who~
Statement of Reglsf~ was ~led)
Original for Municipal Building Department
STATEMENT OF REGISTRY
To be filed in duplicate with the municipal building department or local enforcement agency
by every owner of a multiple dwelling, as defined in subdivision 33 of section 4 of the
Multiple Residence Law.
Within 30 days after the filing of this statement, the municipal building department or en-
forcement agency is required by section 300, Multiple Residence Law, to file o duplicate
copy hereof with the State Building Code Commission, 1740 Broadway, New York !9, N. Y.
1. Location of multiple dwelling: . . .
(a) Street and number ....~.O..~[~.....~'.~....~.......L~.~..~;z.~.~.....M,~-..~.......L..I......~...Y
(b) Municipality ..... .~.~./.~,/..~J. ~..~. ........ /:~. ~ .:..... ~.~...... y. ~.: .~/~. .....................
2. Description:
(a) Type of construction ..... .F..~.~, ................................................................ ~,, ~s~,'~
(b) Height of building, including ,number of stories ~,...~...F..f...~...~.~f.:.....~....~../...~..4ce~J- ~P
(c) Type of heating facilities ....~./~../-...../'/.~..~......¢?,<(-~......(~ .~...'~...~.f~..../~/~ "/~,41~)/J
(d) Number of apor mens .,~. ...... f:~,/ ....... i~....~....~.~.~/.,~ ................
(e) Number of living rooms ....~..,:t'b~_ ........................................................................
(f) Number of kitchenettes .... ../.~...~r' ........................................................................
(g) Number of bathrooms ....F.~...~,:~ .......................................................................
(h) Number of water closets ....~.-.../,~ ......................................................................
(i) Number of occupants for which building was designed or intended to be occupied
or used .... ~..O. ........................... . .......................................................................
3. Age of multiple dwelling:
(a) Date when constructed ..~........~....~?...~.....~..~..~, ,,9/ .......................
(b) Dates of substantial additions, alterations or modifications of dwelling, with
brief description thereof ...................................................................................
(c) If now under construction, state when construction commenced and anticipated
date of completion ....................... ~. ..................................................................
4. Use:
Describe the principal use made, or, in the case of buildings under construction, to
be made, of the multiple dwelling (such as apartment house, hotel, apartment hotel,
lodging house, boarding house, school, convalescent, old age or nursing home, pri-
vate dwelling two or more stories in height with five or more boarders, roomers or
lodgers, or other classification of multiple dwelling including those specified in sec-
tion 33, Multiple Residence Law).
.. ......... ...... .
£.. ......
(Name of Owner)
STATEMENT OF FILING
Filed with the ............................................................................................................ of the
(Bufld~n~ Depar~men~ or Other Er~forcement Agency)
................................................................ on the ..................................................... 195 ......
(Name of Municipality) (Date of Filing)
(Signature and Designation o~ Official with
whom Statement of Registry was ~L!.ed)