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Home My WebLink About6638-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~.]. .. Date .... THIS CERTIFIES that the building located at Nor.t~ .~a Dl~.~o. Street Map No.0r. ient by F~ock No. II . .Lot No..~1. 0r. ie.nt N,Y, conforms substantially to the Application for Building Permit heretofore filed in this off~ce dated ~mae 6 ., 19 73 pursuant to which Building Permit No. dated . . . Jtme . 6 , 19 ?_~ , 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 Px'lv.at.o..{.a.qe.o.s.~o.~..Ir.)...l~t.../:n.~..~.ll.g P..o~..~. ........................ Anthony Deilae~ano (owner, lessee or tenant) The certificate is issued to of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No. ttOUS[!NUMBER .]70 .. Street ..... N,Ro. ............ 099591 ~.~ue. 2? 1973 .. .N.o~.th 8.e~t .D. rtve .......... Building I n,,pcctol FO~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'$ OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 6638 Z Permission is hereby granted to: ......... An~hoU~..I)e~a~tano .............................. ...~ ........... 2~3~....l~.ento~..~ ........................ ..................... ~.~g..m~ ........ ~,:~... .............................. -t~stall new private Swimming pool & fence at premises located at ...~..o,..~...~. ....... ~..1......' ........ .O..?..~..e..~.!...b..y....~,h...e.....S..e..~ ............................................ ....................................... .~..o~....s..e.~..~.~,t...*..e. ........ ..0.~,¢..e.~. ........................................................... pursuant to application dated ..................... ~.1),~ .......... ~ ............. , 19..~7~., and approved by the Building Inspector. Fee $:$-~.g0 ............ PERMIT INCLUDES APPI~OVAL TO P. EMOVE EXCESS FILL FROM ABOVE PREMISES BY/ REGRADtNG LOT DRIVEWAY CONSTRUCTION CESSPOOL CONS fRUCTION CELLAR CONSTRUCTION OTHER ~ fy_ Z~OI~M NO. $ TOWN OF $OUTHOLD Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR :nk, and submitted in duplicate to the Budding Inspector 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 simdar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-exmting" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condihon of buildings. 3. Date of any housing code or safety inspechon of buildings or premises, or other pertinent in- formation required to prepare a cerhficate. ¢. Fees: 1. Certihcate 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 5~d_ ,~t~ g Date ........ ~Z~. ~... ~ .0.~.. ~.9.7' ~. .............. Pool New Build,nc .................... Old or Pre-existing Building ............................ Vacant Land ........................... Location Of Property ~r~t~h~e~D~r~;~e~9~L`~z~e~!~a:~t~~e~a~t~ .............. Owner Or Owners Of Property ...... J~O,~b,O~,Y...~,-~...~X~.~3f~ ............................................................................ Subdivision ........ ~[~,~..R .............................................. Lot No .... .~.~.. .... Block No ............. House No ............. Permit No..~2~.~.~. ..... Date Of Permit .~/~/...~......Applicant ..~.~9~Y.....Dg.....g.~.~9.°. ............................ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval ~.0.,9.,9..~.~. ............................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ..../... ................................... Fee Submitted $ ,~.~..0..0. ........................... Sworn to before me ~l~is/q ...... /..Z)... day of .................. Not'cry Public ......~ ............................. County Construction on above described building and permit meets all applicable codes and regulations. Applicant ..... .~.;. . . :~. ................................... (stamp or seal) ~/~..~ FOBBf NO. 1 ~ TOWN CLrr~,IC'S OFFICK SOUTHOLD, N. Y. proved , Perm,t No .............. Disapproved a/c ............................................................................................. .................... ........................... ~Building I n.~l'or) APPLICATION FOR IUILDIN~ PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o¢ in ir~. and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. (~) b. Plot plan showing location of lot and of buildings an premises, relationship to adjoining premises or public streets of areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram which is part 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 Perm t to the applicant. Such permit(' shall be kept on the premises avai ab e for inspection throughout the work. e. No building shall be eccupJed or used in whole or in pa rt 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 ~Build!n.g. Zon,e O.r.dinance. of .t. he T,o?.,o,f. Southol.d.,~ Suffolk .Co?.ty, New York, and other applicable Laws, Ord nonces or ~hegaulat~.o. ns, .tor me construction o.t. ~u~alng.s., additions or alterations, or for removal or demolition, as herein described. ~ · applicant agrees to comply w~th al~ applmable laws, Ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ~gn~ icant, or name, if a corporation) ............................... ................... /. ............. ........... (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) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed w~rk will I~ don[ Map No.: .......~.... ........................ Lot ~1o..2.l ................. Street and Number ..~~.~...~ii ........ i .............. ; ............. '. ............... ~.~ .............. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .............................. ., ...... 3. Nature of work (check which applicable): New 'B,iilding., ............... Addition .................. Alteratic~ .. . Repair Removal Demo ition ... Other Work~14/l~/'4~l..~'..~. 4. Estimated ~o~ .o..;..: ............................................ ~ ....... ~ee .......................................................................................... (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 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 Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ....................... Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ............:...... ..................................... Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ................................................ ~ ....... ,.: ......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: i~.0. i ................................................ 13. Will lot be regraded ......~...O. .................. Will excess fill be removed from premises: (~ Yes ( ) No N ......... ~.. ....... 14. Name of Owner of premises ..~.~....~..(~..~./af~/'....O. ..... ,~ ~..~ ~h/~' Ph~.-..~.../.-~ Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exi~tinn or pronOsed and indicate all set-back dimens~ property hnes. G~ve street and block number or descr ption according to deed, and show street names and' indicate whether interior or comer lot. /'/0 o$6 /.or 71 iot Poet. Io ~ 2-, STATE OF NEW_ YQRK, tSS COUNTY OF ...~.~..~-~.\~. ........... J' ' ~...~.~:~'~'~"~ ~ t ..~. ,.~.~.~..~..~...~....~ be ng duly sworn, deposes and says that he is the applicant ............... CN ividugl 'ii'gig; ................. above named. He is the ............. ~..~....k:~.......~.....~.. ......................................................... -.. .......................... ~; ...................................................... (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 thor the work will be performed in the manner set forth in the application filed therewith. Swam to ]~efore me this .......... · ~. .......... .gdXay of ..... ....--~...~ ....................... ] 9.~. Notary Public, -~;9:~.~~ ....... County 1.~ .. - ~gnature of applicant) .......... TERRI LEE EL.AK NOTARY PUBLIC, State of New Y~rk , NO. 5;N~!~8295