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Home My WebLink About3899-zFO]~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMEN'[ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No...2k..3Z91 ............ Date ........... ~.Sept:elz~ez:.....3.0, ......... , 19.68.. THIS CERTIFIES that the building located at ~a~e~..~..Q£~.~ee. au..A~.e ..... Street Map No......M.a...~..~..~. ....... Block No ....................... Lot No....6,...?~O~,t~l~r..Ne~..~'OZ~k .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........................ ~.....~, ........................ , 19.,6J~. pursuant to which Building Permit No. 38.°~9...~.. dated ............. M..~'.....~.~., ...................... , 19...6J~, 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 ........ . . .a. . . . .o. . .n. .e. .. . y. . , .e,l, ............................................................................................. The certificate is issued to ...~t;[.I~..~.O~.G~.V..~Ch ................ i ........................................................... (owner, lessee or termnt) of the aforesaid building. Health Dept. Approval, SePtember 26, 1968, Robert Vflla .. !-.~ ':.:,~ .,,~ .%, .. ',,: , ., ..... Building Inspector FOEM NO. 2 TOWN OF sOUTHOLD ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD~ N.Y. ~ BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISI~S UNTIL F'ULL COMPLETION OF THE WORK AUTHORIZED) N? 3899 Z vd. ............ : .......... ~,~. ....... .~ .............. , ,~..~.~.. Permission is hereby gronted to: ~.~.o.,.~,~;~.~.~...~. ~..;~.Z.~...,~.'t.~,o..,~l~ ~o ~$~. g~. 9~...~z..~l~a ......................... ~ ................. , ....................................... pursuon{ to opplicotion dqt~d ............................ ~ ............ ~..~?.., ]9;.~., ond opprov~ by tho Building Inspector. Building Inspector, FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF ( ,CCUPANCY Instructions This application must be filled in typewriter OR ink, and submitS:ed in duplicate to the Building Inspec- tor with the following; for new buildings or new use: ;r I. Final survey of property with accurate location of all b~ildin~s, property lines, streets, and unusual natural or topographic featu res. 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 oriEn~lineer responsible for the building, 5. Submit Plann ng Board approval of completed site plan require~nents 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, occupahcy 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, Fees: 1. Certificate of occupancy $§.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date .......................... New Building ...... Old or Pre-existing Building : Vacant Land Location of Property ............... . '~) Street ', Hamlet House No. ~ Owner or Owners of Property..~-~;~.~...~..~c~....~.: .~ ............. County Tax Map No. 1000 Section ...O..~?, .%~. ,?.. '. Block ..... i .......... Lot. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .... .............................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board ~,pproval ...................... Request for Temporary Certificate ..................... Final C~ 'tificate .,, x ~,-- Fee Submitted $ ............................. Construction on above described building and permit meets all applicdble codes and regula, tions, S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH' Date ._~_~,~ ? ~ ?o0~o~ Bldg. Permit No. ~ TO WHOM IT MAY CONCERN: The sewage disposal at ~l~' M¢~/'~t-' -- (Give deed 10c/ation) facilities for a structure located have been inspected by this department and found to be satisfactoryl;, O~mer Diodato Jo f~oskovich l~uilder.-C. A. L~,rzac '~'b~ "~is t r ict Engineer TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Appraved ........................................ , 19 ........ Permit No ............................ Application No.....~.....~'..~...~.. .......... Disapproved a/c ....... ~.....~......~' 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 port of this 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 pursuant to the Building Zone Ordinance of the Town of Southald, 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 wlth all applicable laws, ordinances, building code, housing code, and regulations. (SignatUre of applicant, or nt~e, if a cl~r,a~tion) {Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................... ............................................................................................................................................. Name of owner of premises ..... ~...~...~..~.. ...... ~..-~...~.~..~.../~.../...~...././. ................................................................................ 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.: ..... ...~...~...z.'...~...~.. ................. Lot No.: ....... l~. ............. Number /.~Z.~../'C/"" /~l;,~ D /~/~..~...~.~ ~;~//r~ ~o~/m~ St,est -.d ......................................... ................................. · ................................................ Munici~li~ 2. State existing use and ~cupancy of p~ise~ and intended use and ~cupancy of pr~os~ construction: a Ex st ng use and ~cupancy ........ ~.~..~.~.~..~ ....... .~..~ ......................................................................... b. Intended use and occupancy ................. ~..~...~.......~ .................................................................. ~ ................. ~ 3. Nature of work (check which applicable): New Building................../'/ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ timated cost ..................... Fee ...... ............................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............ Z ............ Number of dwelling units on each floor ..... Z.~ ................ 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 .......'..-w.. ................. Rear ............... ~ ............. Depth ......-.;. ........... Height .......... '..-: ........... Number of Stories .......... ~ ................................................................................................... Dimensions of same structure with alterations or additions: Front .... .~.J: .......................... Rear ......~.. .................... Depth ........... .'7...~ ................ Height ................ ~ ........ Number of Stories ...;..-:~. ........................ 8. Dimensions of entire new construction: Front ....... .'~....~.. .................... Rear ...... ..~....~...~ ........... -"l~/' Depth .....~.. ................ Height .....Z.~.~.....-:'.. Number of Stories .................................................................................................................... 9. Size of lot: Front ....-~..~..~../. ........... Rear ....~...~....~.../. ................... Depth /,~"c~ ~' ]0. Dote of Purchase ..... ~.....c~..~..../.~...~...~.. ................. Name of Former Owner ...~...~...~.~..~ t~'/~~//'~-/ ....... I ..... ..... , ...................... 11. Zone or use &str,ct In wh.ch premises are situated ..... ~.. .......... .~.......G'. ............. ~. ....... ~.~'~x..~/~ .~.~./.. ............... 12. Does proposed construction violate any zoning law, ordinance or regulation? ....~ ................................................ 13. Name of Owner of premises ...~.~......~.,$~.o..~C-..~...Address ../~.~../.~...~..~n......~;.....~/.~.../ZPhone No. ?..~....';..~..-~.~...¢~- Name of Architect ...................................................... Address ............................................ Phone No ..................... ,, .................. Nome of Contractor ...(~'.~.: . ./:...Z..~,...~,......~..~..~.....Address ~..~..~.....~..'<.~.~'~.~.~.....~?.~.~.~..... Phone No'~:..~,.~.~ 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 number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, // (Nome of individual signing ?plication) (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly 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 work will be performed in the manner set fo~h in the application filed therewith. Swo~t%bef~r~ me this ~, ~, , , Nota~ Public, ~~.Z.~~... Coun~ ADELE PAYN~ N~ ~blic, S~te of N~ Y~ Residing in Suffolk