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Home My WebLink About4121-zFOllOW ~O~ 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .¥.~.~.t.o..~.&.~..D.~.~.v.e ........ Street Map No ............. Block No ........... Lot No...~/~.t.~Q~..d.,..~I.~W...yo..~.~ ..... ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .tto~e~e~...3.2 ,.., 19.60. pursuant to which Building Permit No..4X2~.. ~. dated .... ~tOv.e~at~...J,2 ,..., 19.68., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. agc.¢~.o.~y. D.U],$~I,i.~q ................... ............................. The certificate is issued to ~aya~o.n¢~. ~.o~taO~J.~. .................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... House ~; 625 FORI~ NO. 2 TOWN OP $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. ~121 Z at premises ioc~areo at ............. .,,. ......................................................................................................... ................... (~.v..?..~..~J ................ ~.~..T;.~:L..~J::.~ ..................................................... Building Inspector. Fee $ ........................ Building Inspector FORM NO, 6 TOWN OF SOUTHOLD J3LJddiog Depar rodent Town Hall Southold, N.Y. 1197 1~, APPLICATION FOR CERTIFICATE OF OCCUPANCY application mu~;t he hlh;d ,J iyjJcwlllel ()1~ ,rd... ,m~l 5LIJ)lllllil'tl III (iJlJ)hCd~¢ tO dlu Building Inspec- ,tWJth the foJJowln(I; for n~:w t~llihJmu.., or Ilew tlt,(~ ',Final suf~ey of properly with ~JC('tll{)[() loc.ilion of all buihJin~ls; prol)elly lil~es, streets, and UnU~I~J Lpproval ot I leutth Dept. at Water supply al:~d sewerage dis~msal.-(S-9 form or equal). )reval of electrical installauoo from Board of Fire Uncl~,rwriters. :Commercial buildmfls, Indusulal buiidinfls, Multiple ResMence~ and similar buildings and installa- tions, a certificate of Code cornphancc from the Arch*Loot or Ef~gineer responsible for the building. alarming Board approval of completed site plan requirements wl~ere applicable. ig buildings (prior to April 1957), Non-co~forminfl uses, or buildings and "pre-existing" Iauses: ~ey of peoperty showing all property lines, ~reets, buildings and unusual natural or ~hic features. ~tement of owner or previous owner as to use, occopancy and condition of buildings. of any housing code or safety inspection of buildings or premises, or other pertinent informa- uired to prepare a certificate. of occupancy ?5.00 / ificate of occupancy on pro existing, dvvci[hl~ ~r MUd "3V of certificate of occupancy $1,00 / Date , . January JO, 1988 ............. Old or P~¢existingRuil,i!~q(× . .)( ..... ~. ~ /V,~('clrlt Land ............ · ¥i¢l;gTia.Rd,, Southold NY (iReydton Heights) -. ......... Owner~ofPropertV Raymond J. Conq~X .................................. Map No. 1000 Section .78 ......... Block . .9 ............ Lot.. ~ ............ ............................... Filed Map No ........... Lot No .............. .......... Date of Permit .......... Applicdnt .Gar. y..F, la.rme.r.O.lsen.,. £$q ........... Approval ........................ Labor Dept. Apprpval ~riters Approval ........................ Plannin~ Board Approval .................. for Tenporary {,erllhc,U(~ .................... } m,d Ce~lllir,~te ................. · ~FORM ,NO. I TOWN OF SOUTHOLD BUILDING D~PARTM~NT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c .............................. ~;;... (Building Inspector) APPLICATI(~N FOR BUILDING PERMIT ~,ate ............. ./..Z..... ~f.~ .... ~0.~.~ 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 l~cation of ~t and ~f buildings o n premises, relationship to adjoining premises or public streets ~r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may r~t be commenced before issuance of Building Permit. d. Upon approval of this applicati.~n, the Building Inspector will issue a Building Permit to the applicant. Such permit shah be kept .~m the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole o~ in part f~r any purl~ose 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 S.authold, Suffolk County, New Y~rk, and other applicable Laws, Ordirmnces .or Regulations, for the construction .of build ings, additions ov alterations, or for removal or demo- lition, as herein described. The applicant agrees to corn ply with all applicable laws, ordinances, building code, housing code, mod regulations. ~ ~~f'~'~i~i'" State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder _ J L;':: L; L .... X > h ;.;' .............................. If applicant is a corporate, signature of duly auth.orize d .officer. (Name and title of corporate officer) 1. Location of land on which proposed work will b e done. Map No ................. Lot No .............. StreetandNumber J~(-- G~-~ F] c'TD]-~g~I~ Z)/~V£z- ~~... ................................................ 2. Sta~e existing use and ~cupancy ~f premises ~ d intended use ~d ~ccupancy of p~s~ ~tmction. a. ~isting use and occup~cy ~/~ ~]~ b. Intended use and ~cup~cy 3. Nature of work (check which applicable): New Building ........ ddition ........ Alteration ........ Repair ......... Removal ........ Demolition ........ Other .V~ork (Describe) ...................... 4. Estimated Cost ....... .L?~.....~..~. ............ ·. Fee .... ~. .......................................... (to be paid ~n filing this application) 5. If dwelling, number of dwelling units .......... Number .of dwelling units on each floor .............. /f garage, number ~yf cars .............. ~..../~..~-- .................................................. 6. If business, commercial ,~r 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 Shyries ..................... 8. Dimensions ,of entire new construction: Frcmt ........ g..~-:.. .... Rear ...... ]....'~.... Depth ~-- TM ' Height ..... ~.'.~.... Number ~f S~ories .......... .~. ................................................. 9. Size of ot: Front ....... Rear .... .... Depth ..... 10. Date of Porchase ............................... Name of Former Owner ............................. 11. Zone or use district in which premises are situated ............ ~.~.'.'....~..~.~..~/..~...~. ~ .7-..].~...~.. ....... 12. Does proposed construction violate any z~ning law, ,ordinance or regulation? ............ ~ .............. 13. Name ~of Owner.of premises . .fi'..~.~..:.,~r~, ,, .~.~..A(.~..0.L.L.¥~ddress ...................... Phone No ............ Name of Architect ............. ~ ............ .~ddress ...................... Phone No ............ Name of Contrac%or ~'~/-]]~/ ~-~t kg)M/~---Address fl~//~! ]~j ?~) Phone No.~.~.~.~.C3~./.~-~ ................................... .... PLOT DIAGRAM Locate clearly and di~inctly all buildings, whether existing o~ 'proposed, and indicate all set-back dimensions from property lines. Give s~eet and block number or de scription according to deed, and show street names and indicate whether interior or corner Lot. STATE OF NEW YORK, )S.S. co NT .............. ....... ~.~t ~ ........ <~ .~ ~.( ~ ............ being duly sworn, ,de~s~ and ~ys ~at he is the appli- (Name of individual signing application) cant above n~ed. He is the ........ ...................... ~'A~, :~i,' ~;' ;~i~e;: ';t~i ...... of said owner Or ~owne~, and is duly autb~ized ~o p~qrm or have pe~ ~e ~id ~k ~d ~ make and file this application; that all statements contained in th is application ~ tree to the bes~ of his knowl~ge and belief; ,and ~at ~e ~k will be p~ in the mann er set fo~ in the application filed ~e~with. Sworn to before me ~is