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Home My WebLink About4504-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. ...... Date ......... 00~;ol~e~..17, ...... , 19.75 THIS CERTIFIES that the building located at .M~.IJ..¢l'a~k. Dr~.~.~ ....... Street Map No...XJE ....... Block No ..... ~t..Lot No..2..8ola~;hol{l .................. . ~,,,~-'~on~orms~,-~ ~, ~'~'~ substantially to the Application for Building Permit heretofore filed in this office ~ ~'~'~ed ........ 0~.~obel'. lift., 191~9. pursuant to which Building Permit No....~'~.OltZ dated ........ 0~.~obex'. ll~t.., 19..6~ was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ... Pr~.gata .oz~e. fa~l~..~1~.1.~ ..................................... The certificate is issued to .. Jola~ .It~¥~1a$ ....... o~ea~ ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .~.; .R? .............................. UNDERWRITERS CERTIFICATE No .... ll.~l. ......................................... HOUSE N UM B E R....1~ ...... Street .... lgJ.t.11 .CI'IIII,~. l)l~[.X;~ .......................... Building Inspector I~OP~I NO. ~ TOWN OF $OUTHOLD BUILDING DEPART~AENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL~ COMPLETION OF THE WORK AUTHORIZED) N? ~504 Z Permission is hereby granted to: at premises located at ........................ ~--~1~tt~ .~.[~i~l~ ............................................................. , ........................................ ~l.if,be~l~l. ......... 11,~.-.-~ ............................................................. ;. pursuan¢ to appli,cation,'dated ........................... ~ ........ '.jl~ ........... , 19.~,., and approved by the Building Inspector. Building Inspector Th~s appi~catmon must be fzllad ~n by t]~ewr~tar 0R ~ and subm~ccec co the bu~!d~ng ~nspector w~eh the foi!owmng: for new ou~!dmng or new use. i F~nal su~ze¥ of proper:7 wzth accurate location of al! bu~!~ngs, prooerz7 !~nes, s%reens, tnd unusual ~aturai or %Dpograp~&c feaeures. 2. F~nal Approval from Kea!sh Dope. of w-ater supp!7 and sewera~e-n~sposal(S-9 fo?m). 3. Approval of e£ectrmcal ~nstalia[~on from Board of Fire Unde~r~cers. 4. S~orn sta~emen2 from plumoer cerz~fy~_ng that the solder used ~n sysna~ conna~ns less than 2/!0 of 1% leac. 5. Commerc~a! ou=!dL~g, ~ndustr~at building, mu!ciple residences ant sxm~iar ou~!d~ngs an~-~nstallations, a cer~mf~cate of Code Compi~ance from architect or engineer responsible for the bumld&ng. 6. Summit Planning Board Approval of completed site plan requcrements. For exm~tmng bu~ld~-n§s (prmor co Apr~! 9, 1957) non-conformmng eses, or bu~idzngs and "pre-exmst~ng" !and uses: I. Accurate survey of property snowzng ail property l~nes, streets, bu~!d~ng ant unusual natural or topographic features. 2. A properly completea appl~catmon ann a consent to inspect s~ned by ~he appi~canz. If a Cartmf~caea of Occupancy ~s den~ed, the ~u&Id~ng Inspector snail scene ehe Co Eees ~. Certificate of Occupancy - New ~well~ng ~2~.00, A~d~c~ons ~o dwei!~g ~25.00, A_!carat&ons eo dwelling 325.00, Swimming pool 325.00, Accessory ou~!dmng Add&tmons ~o accesso~/ bui!dmng 325.00. Businesses $50.00. 2. Certmf~cate of Occupancy on Pre-&x~st~_n~ 3um!d~n2 - SlO0.O0 3. Copy of Cart~f~cama of Occupancy - .25¢ ~. UpaaZed Cerrzfmca~e of Occupancy - $50.00 5. Temporary Cartmficate of Occupancy - Resmdentiai $i5.00, Commercial $15.00 Disapproved a/c .............................................................................................. APPLICATIOH FOR BUILDING PER~rT ................ ............... , ..... INSTRU~DIONS 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 gi~ing a detailed description of layout of property must be drawn on the diagram which is port of thie application. ~. The-work covered by this application may not be commenced before issuance of BuilclJng 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 ir~pection throughout the progress of the work. e, No building shall he 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 Deportment 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 app cant agrees to comp y w th a app cab · aws, ordinances building code, housing code, and regular ans. - ...... ...... ........................ (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................... ............................................................................................................................... Name of owner of premises ..~r~x..L?..~.. .............. ~ ............................................................................................ 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 Ng.: ........................................ Lot Nc~: ...... ~.~ ............... Street and Numbe~,. /~..~g~.~. ~ . ~ ............ 2. State existing use and occupancy of premises'~:md-'l/ft~-nded use and occupancy of proposed construction: a. Existing use and occupancy ......... ~ .................................................................................... b. Intended use and occupancy ..... ~ .................................................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Re,oval .................. Demolition .................. Other Work (Describe) .............~ .......................... 4. Estimated Cost ........... ..~......~...~....O..?..........o~... ............ Fee. , (to be paid on filing this application) 5. 'If dwelling, number of dwelling units ........ ] ................. Number of dwelling units on each floor ............................ If garage, number of cars ' 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions cjf~xisting structures, if any: Front ....~.~... ................ Rear .....~.~.....~... ............ Depth .~...4 .......... ,.. Height ...... ..~...~...I ......... Number of Stories .......... ~ ........................................... Dimensions of same structure with a.lterations or additions: Front ....... ~.....~...../...~.../.~ ........... Rear ,/~ ~-/~" Depth ...... .~...~.!.~?..~ .......... Height ........... ~.~. ........... Number of Stories ...... J. ........................ 8. Dimensions of entire new construction: Front ~...~.. !. .......... Rear ~c~'..~../ Depth ...J....'?. .............. Height .....1.~. ......... Number of Stories ................................................................. , .................................................... 9. Size of lot Front ..J.~,~'..Y ....... Rear Jo~.. .... Depth ] ~.. 4 [ ~ (~ 10. Date of Purchase ..~..~. ......... J..~.l..J[..~...~..~ ........... Name of Former"~v~'i...ii~i~ii~..il.h...~..~...~.. ....................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction v[olote any zoning law, ordinance o£ r, elgulation? ....~.~ .......... ; ............................. 13. Name of Owner of premises~-Jl.(9.....~.~ ...... Address J~J~!.~,L...~.L~.~..~ .............. Phone No'-/~'.-....~...O...°(..~' Name of Architect ................................. ~ .................... Address ............ ~ ............................... Phone No ..................... Name of Contractc~.J~L~.~.~tS.......~.t..[~..q ........... I~S' Addres~.~.~.~.~..~ .................... Phone No.~.~.~..'..~.~.~. ~ PLOT D AGRA, Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimen ; property lines. Give street and block number or description accordir~g to deed, and show street names and indic"~:~e, whether interior or corner lot. STATE OF NEW'IYQRK,# I e e COUNTY_gF~ ............ .:$"~,' .............. c~..~.gJ.CI.JT~ .......... ~..I..P~.~..~J...h?...~. ........................ being duly sworn, deposes and says that he is the applicant (Name of individual signing app~cation) above named. He ~s the ................................... ....~........~... ................................................. (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 tothe best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the application' filed therewith. Swam to before me this ' , ................ · _day of ..~...~ ....... ~ ...................... , 19..~..? .,.~J~..~.,, .(") /', ~_'n//~, -~ · t Pu' .'il. .......... .............. I~10 ary b c~-~li~.J~l~'ll~.l~.J. JlfJ~ ......... Countyof:~ (Signature of applicant) ............ ELIZABETH ANN NEVILLE ~¢0TARY PUBLIC, State of New York No. 52-8]25850, Suffolk County Term Expires March 30, iL