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Home My WebLink About2802-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLEP, K'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ...... ~...;~33~. ........ Date ............................. ~T~J~t,U&~.~...1,~..., 19..6~. THIS CERTIFIES that the building located at ~/~.J~....~t4..'g.~.~..~'~e..~k...~r,~;..,~... Street Map No....~X ............. Block No ........... ~ .......Lot No .... ~..~ ......... ~.~[~41...[~.,.~..., ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...................................... ~'~Xle...,.~8 ........ , 19..~. pursuant to which Building Permit No...~.80~..~ dated .......................... ~1~1,~ ....... ~8 ........ , 19.~..~..., was issued, and conforms to all of the requirements of the applicable provisions of the I(~w, The occupancy for which this certificate is issued is ........ ..~.t.Y.~.C..:e....o.~.~..~ftr~il~..d,~'e.l,~;.L~ .............................................................................................. The certificate is issued to ...~T4~eI~,..D.!.A~I~ ........ ; .......... ~e~'. ..........i....~ .............................. ~owner, lessee or tenanT) of the aforesaid building. N.D. Approval August 26, 196% by R. Villa ....... ....... ....................... Building Inspector ! FORM NO, 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2802 Z Permission is hereby granted to: .T~me m..l).~At~.'uet~ ............................................. ....... · eu~h~l.d ..................................................... to ....,Bu:L;La..ae~..ea~..£aa.~.l¥...~,~t.~.~l~ .................................................................................. at premises located at ....~.~....~o~/13.~..&~e..&..~;hr.t,..~ .................................................................. ..................... : ............................. ~.u~;hold~.....l/.X. ........................................................................... pursuant to application dated ............................. ~TL1F~ ....... ~ ...........19..6~., and approved by the Building Inspector Fee $*10,.QO ............ Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.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 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 features. 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. 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 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. C. 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 $5.0O Date . .~.gD.e. ,3,.:~ ,. ,L.9.8. 0 ......... New Building ............. Old or Pre-existing Building ...Z ........ Vacant Land ............. Location of Property .. 7 ~.8.0..$Qp~.~¥,~.e.~..A. ¥.e~.u.e. , ,S.o.q~.o.l.~. c , .~...~.; ...................... House No. Street Hamlet Owner or Owners of Property . . .Z.a.m.e.s., .V.,..~.:..D. ~.A, .~g.~.s.~..a..a.~.~..A.~.~e..1.a..A.~.~..D. ~,A..ucj,~.s,t..a., . County Tax Map No. 1000 Section . . .5.~) .......... Block ..... 9. ......... Lot .... ];7. .......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant ...~,~.[,q.~..[:[.-..~..~.u.e.~. ,...~.s.c~; ..... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate . .X..~c. ,o~)¥.) ............. Fee Submitted $...~.,.0..0 ...................... Construction on above described building en~//~~~d/,r~u~ltions. RudOlph H. B~/uer, attorffey for D'Augus~c~ Rev. 10-10-78 SCHD SUFFOLK COU~Y DEPARTMENT OF HEALTH TO ',~0M IT MAY CONCERN: The sewage disposal facilities for a structure located at (Giv~ deed locationJ ~ have been inspected by this Department and ~,~'~nd to be satmsfactory.. ~ Dist..it ~ I~ri~ine or District Engineer POI~,M NO. I 't~OWN OF SOUTHOLD BUILDING DEPARTMENT T~OWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....... ...... , 19 ~ Approved " 19 ........ Permit No. C:~ O ~ ~ Disapproved a/c ...... ______'/(" .,~./....~....-~-..:z~,. ........ ~-.~.......~.....~ ..~.,, .... (Building Insppctor) 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 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 thb application. 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 progress of 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 puCsuant 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 and regulations. James D 'Augusta (Signature of applicant, or name, if a corporation) Southol8 N.Y. (Address of applicant) Stale whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................................... q.~r....-....'D~u~ ~.d e,z'. ...................................................................................................................... Nome of owner of premises ..... ~.a.~.~.~...D.~..A.~,6.u...s..~.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.: ..... ,,~f~7-~ .................. L.. Lot No.: .X~....x...x; ............... Street and Number ..,S/.,~.,.,.S,ou~d,.:?.ft.c~w...A.v.e.....~...E/~..~x.%..[f~.oact~ ....... ,$.o~:b~alf] ................... Municipality 2. State existing use and occupancy of premises and intended use an-d occupahcy of proposed construction: a. Existing use and occupancy Vacant lot b. ~ntended use and occupancy ..... .0..~..~..~.~..~.~.]r,Y.....d.~f.~..:]:.]r.t..~..~. ............................................. 3. Nahrre of work (check which applicable): New Bujldin.g ..,~,~ ..... Addition .................. Alteration ............... Repc Jr .................. Removal .................. Demolition .................. Other Work (Describe) ..................................... 4. Estir ~ated Cost ........ .1..~...O..O.g...?../.}..~ ............................ Fee ..~0^.Qf). ...................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ g..~..e. ............. Number of dwelling units on each floor ......................... If g~rage, number of cars ....................... f 6. If b~usiness, commercial or mixed occupancy, specify nature and extent of each type of use ........................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Heir, hr ........................ Number of Stories .............................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ......................... Depih ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ....,.~.~ .......................... Rear ........ ~8 ............... Depth ..... 2.~/...~0... Height .................... Number of Stories ....QBe ....................................................................................................... 9. Sizelof lot: Front ............ ,~,0D. ........ Rear ........ ~'LDO .................. Depth ....~.02./...'103 ......... 10. Dat~J of Purchase .................. ~,9.~2 ............................. Name of Former Owner .................................................... 11. Zon~ or use district in which premises are situated .......... t[A.u...c].~.~.-b .................................................................... 12. Does~ proposed construct on vio ate any Ton ng aw, ordinance or regulation? .... ~) ........................................ 13. Nan~e of Owner of premises ...~..~...m.~.~...~.!.~,.g,g.g,8.~.A..Address ........ ~$.c)~J:,Ig.Q~L~I ................. Phone No ................. Name of Architect ...................................................... Address ............................................ Phone No ................ Nar~e of Contractor .................. ~Ame ........................ Address ............................................ Phone No ................ PLOT DIAGRAM L.ocat~clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr, property I!Jqes. Give street and block number or description according to deed, and show street names and indic~ whether interior or corner lot. STATE OFi NEW YORK, '( COUNTY OF .... ~,g~.~].~ ........... ~ S.S. ................. i ........ ~gJ?i~,~...D.!.~!.~,.g.~.~ ................................. ~being duly sworn, deposes and says that he is the apptic '.(Name of individual signing application) above na~ed. He is the ....................g~z~e~...,,...b~.~. ........................................................................................... (Contractor, agent, corporate officer, etc.) of said ortner or owners, and is duly authorized to perform or have performed the said work and to make and this opplic~tion; that oil statements contained in this application are true to the best of his knowledge and belief; that the w~)rk will be performed in the manner set forth in the application filed therewith. Sworn to blefore me this ................ ~....2..q~ day of .............. Z. lt~,e ..................... , 19.~.~.. Nota,¥ ..... I ~/ NOTARY PUBLIO, ~ow ','or~ ~o. 52.3233120 Su[foJk Cou t~ ~erm Expires ~arch 30, Jg~ (Sig of apl