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Home My WebLink About6982-z· O~M NO. 4 TOWN OF $OUTHOLD BUn.DING DEPARTMENT Town Clerk'e Ot[ice Southold, N. Y. Certificete Of Occupency THIS CERTIFIES that the building located af . .~J.,. ...... .... ...... .... confo~ subst~ti~y to ~e Applic~on for B~d~g Pe~t he~fo~ ~ ~ t~ o~ dated ..... ~ .~ ........ , ~9.~ p~su~t dat~ ...... ~. ~ ......... , 19 ~, was ~u~, ~d co~o~ ments of the applicable provisions of the law. The occupancy for which ~Ls certificate is issTh~ee~tc e iSrtit~c ~iss~ t d'~to'. ~LJTI,~ .~ ...... ~ .......... (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval . .~. ~..' ............................ UNDERWRITERS CERTIFICATE No.. ~..~/..~.~. ~. ~. ...... . ./~/../~...//. ?./~ ......... HOUSE NUMBER....~. ~7 .~..0.... Street..~ .'. ~.... ~. ~....~ FORWr NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6982 Z Permission is hereby granted to: ~rBe s se~ W~L LLiam .. &he~a.t o~ ..&..W&£e ........................... a!~;t Canyon La . buil~ ~ew private swim~ing pool & fence otc ~ V pursuant to ,ppt~c~tion dated ....................... ~,O.Y ............ ~. .......... , 197..~...., ,nd opproved by the Building Inspector.' Fee $.1. ~..~..0...0. ........ [,.. Building Inspe~ ctor ( WEST l~ f l,' . .. (..~f'~ E E t4 ~ I V~' FORM NO. 6 TOWN OF SOUTHOLD , Building Deportment Town Clerks Office 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 Inspector w,th the following; for new buildings or new use: I. 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 installat,on from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and instal~atlons, 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 property showing all property lines, streets, buildings and unusual naturol or topographic features. 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 in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 -, New BHilding ................ Addition ................ Old or Pre-existing Building ................ Varnant Land .............. Owner Or Owners Of Property ..~.~~..~~ ................................................... Subdivision ........ ~''~ .......................................... to~ NO' '''"~"''''~''' Block NO' '': '~"'~''' Mouse NoT~......~.....O Pea'mit No. ~..~.~.~.....~.. Date Of Permit.~.~...~pplicant ..~...~..-~./.....~....~ Hearth Dept. Approval...... ~'L~ ......................... Labor Dept. Approval ............ ..~...~..~.., ........................ Underwriters Approval .............................................. Planning Board Approval .... ..~..~ ...................... Request For Temporary C~ertificate ........................................ Find Certificate Fee Submitted $ .. !..~ .................... Construction on above described building an~ D~a~t m~ets all apj~Ji~le codes and regulations. Appli .i ..................................... Sworn to before me this ......... o, Notary Public ........... ~/~/~ County provea ........................................ , ...... ~. ............................................ r. .... x / · - - u~sapprovea a/c ................................................. ~ . ..................................... ...................... ....... ............ "' (Building Inspectt APPLICATION FOR BUlL/DING PERMIT INSTRUCTIONS a. This apphcat~on must be completely filled in by typewriter or ~n mk and submitted ~n triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule b. Plot plan show.ny location of lot and of buildings on premises, retat~onsh.p to adjoining premmes or public streets or areas, and gwmg a detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by th~s application may not be commenced before ,ssuance of Building Permit. d. Upon approval of this apphcation, the BuHd~ng inspector will ~ssue a BuHd~ng Permit to the applicant. Such permit shall be kept on the premises avmlable for inspection throughout the work. e. No building shall be occupied or used m 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 Southold, Suffolk County, New York, and other applicable Lows, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The apphcant agrees to comply with all apphcable laws, ordinances, building code, houmng code, and regulations, and to admit authorized inspectors on premises and in buildings for necessaw~Ln~pections. (S~g"" "' n~ature of qpplicant, or name, if a corporation) 4 Urand Gmnyon Lane Goram' N.Y. (Address of applicant) State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. builder Name of owner of prem,ses ..~.illiam...a.'.h~.~.tl .................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and t~tle of corporate officer) Builder's License No .................................................... Plumber's bcense No ................................................. Electrician's L~cense No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposedwork wiJI,beJJona MalmNo-k .......... (......~. ....... ,¢~ .......... Lot No ..... Street and Number ..................~.~.~.'..~.....C~.~.<.~..: .................. Municlp~l}~y 2. State ex~sting use and occupancy of pre, m~ses and intended use and occupancy'of proposed construction: a. Exisit~ng use and occupancy ...qlg.~.-?f~.~lBj,.1,y....~J.w..~..1.~..n.g~ ................................ ~.... ...... . ..... ...........,........,...... -b. Intended use and occupanc¥ to in'stall 15 x 30' gunite swimming pool .~.'"Nature of work (check which applicable). New Build~ng .x, Addition Alteration ~. Rel~ir .................. Removal .................. Demoht~on .................... Other Work .................................. (Description) 4. Estimated Cost ....... .2..,..9...0..0.. ...................................... Fee .......... .]:..5.:.....+....~.~..:....~.e..?..?.e. ............................ (to be prod on filing this apphcat~on) 5 If dwelling, number of dwelling units ........................... Number of dwelhng umts on each floor ....................... If garage, number of cars .......................................................................................................................... 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ................ 7 Dimensions of existmg structures, if any: Front .......................... Rear ................................ Depth ............. Height ........................ Number of Stories ...................................................................................................... D~mensions of same structure with alterations ar add~tions. Front ....................................Rear ..................... Depth ................................ Height .......................... Number of Stories ................................ 8. Dimensions of ent, re new construction: Front ..~ ...x....3...0..~ ................ Rear ............................ Depth ......... Height .................... Number of Stories ... :j,.t3....g~..qg~f] ................................................ 9. Size of lot' Front 100~ Rear 100' Depth' 170 '~ 1'59' 10. Date of Purchase ...................................................... Name of Former Owner ................................................ 11 Zone or use dmtrict in which premmes are situated ....................................................................................... 12. Does proposed construchon violate any zonmg law, ordinance or regulation, no 13. Wdl lot be regraded ............g..o. ............ Will excess fill be removed [~)r~j]s/e~_: DriVe ) No 14 Name of Owner of prem,ses ..~.~.]k.~..i.~....m.....~..h..~..~.~.o...~. ........... Address ...A..~..s..~G..m.D..m.~..q~.e., Phone No ....................... ............................................... 4 Grand Can on Nome of A~h~+~+~taster ~ools ....................... Address .......................... Y..... P~di~e No.C9.~.~ ............. Name of Contractor ~!~.s.~..e..~....?...o.o..~.s. .............................. Addres~ ..G...~.~.q..d......C..~.~..o...~.. ~bt~e No ..... ..C..o.~.~...m. ..... PLOT DIAGRAM Locate clearly and distmctly all buddmgs, whether ex,sting or proposed, and red,cate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and ind~cale whether interior or corner lot STATE OF NEW~ YORK, COUNTY OF ..~.gF. ED.L~ ............. ~°'~ ......................... .~...o..b...~..e..s...s..e..~ ........................................... being duly sworn, deposes and says that he ~s the opphconl (Name of indw~duol s~gnmg contracf) above named. He ~s the c~on~'ao~o~' ........................................................... (Contractor, agent, corporate officer, etc.) of so~d owner or owners, and is duly authorized to perform or have performed the said work and to make and fde this application; that all statements contained m thru application are true to the best of his knowledge and beLie~, -m.C that the work will be performed in the manner set forth m the apphcat~on filed therewith Sworn to b~ore me this( .%: 19...~ ..... Notary PubI~c, . .......... .._>~.~..~..'r~...~ ...... County ................................................ (Signature of applicont) CAROL CARROL~ t, OTARY PUBLIC, Stale at Ne~, Y~rk N0. 52q5C1567 ~ommlssmn