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Home My WebLink About6655-zNO. ~ TOWN OF SOUTHOI.D BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z63~ .1 .. Date ~iaralary. 2th 19..75 THIS CERTIFIES that the building located at · R,(~,W. Map No. ~ .... Block No. ~ . Lot No.~. ~ttl~ck.. E.X. .... confo~s substantiMly to the Application for Building Permit heretofore filed in this office dated "' Jure ] 2 19.~3. pursuit to which B~lding Permit No. 66%%Z dated ~e -~2 , 19.7~' was issued, ~d conforms to M1 of the require- ments of the applicable provisions of the law. The occupancy for which this certificate issued is Private. one -famil. y .dwelling. with. additi~ ........... The certificate is issued to Ous~w · ~rtra... ~er ........... (owner, lessee or ten~t) of the ~oresaid building. Suffolk County Department of Health Approval .N,R, ... UNDERWRITERS CERTIFICATE No. ~. ]~38'' 'NOV' 2~ i97) ................... HOUSE NUMBER ...bi 20 Street . ~.o~wa~r. ,Read. ...................... / ' B~ld~nspecto~ FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEFARTJ~ENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERJ~iT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 6655 Z Date .......................... ..~...~Q....e. ........ .1..2.. ....... , 19~.,,~.... t Permission is hereby granted to: austav Bartra ...... 122.~...-~ ..... Bmea.~a.t .m.. ~oad. ........... ............... ~m.~ J*i~¢k ......................................... to ...LLliL~...~L.ad~.i.tlon ..... {.&1;..t~,~.b.e. ft...gaI.ag.~..). ..... on..e,~sJ~Lt~..cL~zelltzzg ............ at premises located at ..... ~.,,,r.~.....]~/~..~_,~ _aka,' a.t~z'...~42.a~ ..................................................... ................................................. .~.:~..t..t..& ,t. ~......~.L...7..'. ............................................................................ pursuant to application dated ........................d~'~.e. ....... ~..~. .......... , 19..~.~..., and approved by the Building In%oector. Fee $1.~'.,..0..0.. ............ Buildin~} Inspector o o I ~; ~--4-~-~ f'~ , , Z !11 FO~ NO. 6 TO~H OF $OUTHOLD ~nildiny Dnlmt~m~nt Town Clerks Office Southold, N, ¥. 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 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 mstallahon from Board of F,re Underwriters. 4. Commercial buildings, Industrial buildings, Mulhple Residences and similar buildings and installations, a certificate of Code comphance 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 buddings and "pre-existing" 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 condihan of buildings. 3. Date of any housing code or safety inspechon 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 3. Copy of certificate of occupancy $1.00 $5.00 ..... ............ New Building .................... O~ld or Pre-existing Building; ........................... Vacant Land ............................ Location Of Property ,,.,~..(~.~.~./.~kV..~.~...~,,,......--/~,,~. ............. (~; ............ .~. ............ ~....~ ................. O ner Or O ners Of Property .... ..... ...................... Subdivision ................................................................ Lot No ............. Block No ............. House No...~....Z'..~..~ Permit No..~".~.~.~;Z~.. Date Of Permit .~7)../,~,,,7...~.Applicant ..~.~..~.'.J...?.~...~..-~.....~...~:.Z..~ ................... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .....~...,~...c..~..~?.~..~..~....~.. ............... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ ~n~ ........ '-~ Certificate ~ ....................................... Fee Submitted $ .......~.f.:..~ ................ Construction on above described building and pe.r~it meets all applicable codes and regulations. Apphcant ......... Sworn to before me this ~,~ 5 ....c~..~..R~.. day of ....'~.~,~... ~ .............. Notary Public ~..,-~G~..~'~-. County (stamp or seal) M~JOR]E D NO. 5~ 8730350 Qu]hfied m Sulh_,ik County Conim~lol~ ~p~res March ~, l~OILlf NO. 1 TOWN OF $OUTNOLD BUILDING DEPART/~ENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. 19.?...~ Permit No..~....~...~,~.,°~ .... BU,L.,NG PERM,T Date .......... . .~.,....'T.:3...t..~. ............... , 19..~....~.. INSTRUCTIONS a This application must be completely filled ~n by typewriter or in ink and submitted in triplicate to the Buildin Inspector, with 3 sets of plans, accurate plot plan to scale. Fee accordmg to schedule. b. Plot plan showing location of lot and of buddings on premises, relationship to adloinmg premmses or public streets, areas, and giving a detaded description of layout of property must be drawn on the d~agram which is part of this applicatio, c. Zhe work covered by this application may not be commenced before ~ssuance of Bulldmg Permm d. Upon approval of this application, the Building Inspector wdl ~ssue a Buddmg Permit to the apphcant. Such perm shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or m pa rt for any purpose whatever until a Certificate of Occupan, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Bulldmg Permit pursuant to tk Building Zone Ordmance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances, Regulations, for the construction of buildmgs, additions or alterations, or for removal or demolition, as herein describe, The applicant agrees to comply w~th all apphcable laws, ordinances, building code, housing code, and regulations, and I admit authorized inspectors on premises and in buildings for necessary inspections. (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engmeer, general contractor, electrician, plumber or builde Name of owner of premises ........ ...~...~.~...*~...~..~....~....'~...~....~. .................................................................................... If apphcant 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 Zrade's License No ............................................... Location of land on which .p~roposed work will be done,;,....~, ~;;~.. · /] .~. ~-...........~:~.tF... · .-..,~/,?, ,,~,,,, ~.~ ...~. ~...,...... Mop No · ~ ...... ~r-l_ot lx~ ~/~k Street and Number ...l~:..~..:..C,~..: ....... ~.~..~ ...... 7m,~...~:.~C:..~c....'~..'"K~f'.¥".'..../..~.~.~...~...~..~.,cfk.'."~..-TT..'''''''''' Municipality State existing use and occupancy of pjLemises and intended use and occupancy of proposed construction' a. Exisiting use and occupancy ..~.~...~...~.~..~;.]__ · .......... ~......~.._..;f.... occupancy ..........~ k~.K~ ........ ~[~....., ..C~ :....~. ~. [,. ~f~'~' Y"'~ "''~Z~-' (~ .q..~-~, ............................... b Intended and use 3. Nature of work (check which applicable) New Budding .................. Addmon ....~..~....~. ...... Alteration Repair .................. Removal .................. Demolition .................... Other Work ............................................... 4. Estimated Cost ......... ...~....~....~....O.. .............................. Fee / ~ ~ (Description) (to be prod on filing th~s applicahon) 5 If dwelling, number of dwelling units ............................ Number of dwelling 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 existing structures, if any: Front ..... .~..~....~....7~... ........ Rear ...... ~.~...F-T..?. ............ Depth .?x...~..~...TT: .... He,ght .J..~..?..~...~...P~..~...KNumber of Stories /..~.?~.~....~......~..~.~..~.../~..~--~dT. ............................ Dimens,ons of same structure with alteratic~'~ ~ ~,tions Front ...i]i~.~.'.' ~; ~ .~." ......... Depth ....... '.~.~. ................... Height J~....F'.~.~..P.P.P~....~..:..Number of Stories .../. '.~.Rr.~...TJz..~..:S;...A'.J..7- 8. Dimensions of ent,re new construction: Front ..... ,~,.O...F....7~.. ................ Rear .....~.O...?...7:... .......... Depth .~.....~.~.. Height /4....~'...?.... Number of Stones ... ~ ............................................... 9 S,ze of lot Front ....... ./...ff...O...?....77 ................................. Rear../..~..O....~....7~... .................... Depth.~....c~...~...~..~..P..P...e:~..]q.: 10 Date of Purchase .,~.~.~..../.~.Z...J..~...~....~7... Name of Former Owner .'~..~...~.f..~......~-...~..~...~...~...~. ........ 1 1. Zone or use district in which premises are s~tuated . .../~...~..~..~/...-C.../--d...~...~.. ........................................................ 12. Does proposed construchon violate any zoning law, ordinance or regutahon 13. W, II lot be regraded ..... ./~....o. ................ W, II excess f,II be removed from t)rem,ses' ( ~i),Yes (~x<~, No 14. Name of Owner of premises ....~.A<..~..~..'~.?.......~...~..A:...77.A...'9. ........... Address/~.~?T..z7..7....~..c..<, ........... Phone No.,~.~z..~..~...O...~... Name of Architect ................................................. Address ................................Phone No ...................... Name of Contractor ........................................................... Address ................................Phone No ...................... PLOT DIAGRAM Locate clearly and d~st~nctly all buddings, whether ex~¢hng or proposed, and red,cate all set-back d~mens~ons fron property lines. Give street and block number or description according to deed, and show street names and indicat. whether interior or corner lot STATE OF NEW,~YOR]~ COUNTY OF ..~..~j/tL.~..Z.. ........................................................................................~" being duly sworn, deposes ~nd soys that he is the ~pphc~n (N~m~f indlwdu~l s~gning contract) ~bove n~med He ,s the ...................................... ~~~ ................................................................................... (Contractor, agent, corporate officer, etc ) of said owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to m~ke ~nd fd th~s application; that all statements contained m th~s applicahon are true to the best of h~s knowledge and belief, an, thru the work will be performed m the manner set forth m the application filed therewith Sworn to before me this ................. .... Notary Pubhc, .~.~.g.~. ~County ............... ..................... TE~RJ ~E NOTARY PUBL~O, State 0J [Jew Yo~k Quaht~e~