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Home My WebLink About7629-zFOIII~ NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certi icnte Occupnncy THIS CERTIFIES that the building located at . .H?.~&.~.e??. LR.O..a.d .......... Street Map No.}l&?.s.: .p.t.,... Block No ........... Lot No, .~?.8. ...... .C.U.t.?h..o.g~..e....B.,?.: ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... l~.oy....~. .... , 1~.~.. pursuant to which Building Permit No. ?.6..~.9.Z.. dated ....... ~.°.V .... 1.~. ...... , 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 Private olae family dw®liir~g with alteration & addition The certificate is isa' ^d +^Rev° John ,1, By~la® & l~®l~r~r Byrlae ovlaers (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval 1~tt, UNDERWRITERS CERTIFICATE No.. ,N~.~.1.26..8....~.1~..e...~.8...~.??.~. ............... HOUSE NUMBER ....~.3.~.~. ...... Street fly,raters Road Cutchogue Building Inspe FOF,~ NO. :~ TOW'hi OF SOUTHOLD BUILDING DEPARTMENT TOWhi CLERK'S OFFICE SOUTHOLD, hi~. Y. BUILDIhiG I~ERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7629 Z Permission is hereby granted to: T~....~/...,:.....~. ........ ~..~..~.fi .................... ......................................................................... :..~ ~.,~.,~,.?...?....~-: ......... ~.,~.: ............... i ......... .... ~.o...~. ........ ,3....~.~;,. ........ ~.~......~.~. ~,~, ......... ~(~,~.~ ........ ~.:..~.~. ................ pursuant to application dated ............. ~ ........ ~ ]~//~V'~, 1 ~ 6nd <~pproved by the Building Inspector. Fee $...(..~.~....~ ....... Building Inspector TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y. 1197] 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 disposol--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the buliding. 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 natural 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 Date New Building ................ Addition ...~.... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...~./.Z~.~:.(¥2z?:~%.~.~......~...o../)L.~.. .......... .Li:.~¢~'iZ~:~.~.~.,.~..(¥..x;'~. ..................................... Subdivision ..J..L.~:.,:'}:,~..~.~L..~..~. ....... ;i~.9../,.~.!~.Z~..', ........... Lot No..-'~..~.,~., Block No ............. House No.,......2~ Y~/ .... Health Dept. Approval ..... J~..~ ................................ Labor Dept. Approval ..i....,~...~.~ .................................. Underwriters Approval ...~J...~'.)..~..~..-~k ........................ Planning Board Approval ........ ?..?~ ........................ Request For Temporary Certificate ........................................ FinaJ Certificate ...!_~f..;. ................................ Fee Submitted $ ...O...~.~ ........................ Construction on above descrilC~dpplbi:]~itn~./.,.a~!~?~.~et~s~,~aI, L~;~..~..~.~,:nd Sworn to before me this ....... ~..~ da, of ....~...../...~.~. ......... (stamp or se~,~- ~' ....... I~'~ BUiLDiNG DEPARTMENT,~/~.--, Ex ' /~/I l~ / ................ ....... "vt', D =~ ~' ~ J V ~" / ~. / APPLICATI~ FOR BUI~iNG PE~IT~~ ' ~ " ' ~ : .~ - , "-~..:....;.?' .. ' ........ ,,., 1¢..~.~..,. _~:__~ ~~ be comp~ete~y.fdJ~ ~n by ~p~wr,ter o¢,.~i~ an~ in.tr~ ~ ~ Bu ~i~ ,,,~,ur, wKn o ~ OT pl~S, accurate plm plan ~ ~ale. ~ accom~ng to ~h~ule. ~ ~. 0 . ~ x b. Plot ~on ~owing I~otion of lot ond of buildings on pr~mises re er~s, ond gwmg ~ d~tml~ d~c.pt~on of I~out o~pr~e~ must be drown c. ~ wo~ c~r~.by this o~licotion moy n~ b~ commenced before issuonce of Buildi&9 P~rmlt. d. U~n ~1 of ~is op~licotion, ~e Buildin~ Ink.tar will i~ue o Building Permit to th~ ~plico~. ~uch ~rmit~ shol[ be ~pt ~ the praises ~oil~ble for in~tion th~ghout the work..' e. No buildi~ shall b~ ~cupi~ or u~ in whole or in po~ for any pu~ose whoever until shell h~e ~en granted ~ the Buildi~ Ink.tar. APPLI~TION IS HEREBY ~DE to the Building De~ment for the issuance of ~ Buildin~ P~rmit ~u~?t to the ~u ut,~, ~or m~ c~stm~on et uu.mngs, ~iti~s or ~ t~mt ohs, or ~ ~plicon~ ~gr~es to comply with ~11 ~plicob ~. ows, ordinance, building admit out~n~ in~o~ on promises and i~ buddln~s ~r n~e~o~ i~tion~. ~'--' ~" (S gnature of app icant, or ~me, i('~:';~;;i;5 ..... State wh~hJ ~ ~ les.e, agent, amhitect, engineer, general c~tractor, electrician, plumber or huller. Name of owner of premises ~ ~ If applicant is a co~orate, signature of duly authorized officer. ......................... (Name and title of'~"~j~'~ ......... , Builders Lic~ No ................................ (~o Plum~r's License No .................... ~oo=,.~ .......... ~ ~ ~ ~*"~ F~o~4 ~z,~= ~oo~ ~.' ~. ~,,~. ~ ~ ~- ~,~,,~,~,~ ~,, ~. ~... ~.,,o.: ....... ~0.~ ........ t.....: ..... ~o, ~.--.~.Z~ ......... s~,~.~ .,d N,~~...~.~t~g~....~9.~.O,.j.....~,~'A~..,,~.~.~...~..,,~,.M ................ ~3 ~ Municl~li~ 2. State existing use and ~cu~ncy of premises and intended use and ~cu~nc~ of p~ed c~stmction: a. bisiting use a~ ~cupancy ~(.~'~ ,~-~; b. ~,ten~ed use a.d ~c,~ncy ..~RNI~ ~t~, ~.~ . · ................... ~ ................... ~.~ ..................................... ~llllJ~l~ature of work (check which applicable): New Building.. ................. Addition ....... ~1~ .....Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work .............. ', ............................ ~ ........ 4. Estimated Cost ......~.~...]~.. '~'~ $ ~/~,~1~ (Descf~pti~ ..................... Fee ....................................................................... ........... (to be paid on .filing th~ 5. If dwelling, number of dwelling units .......... /. .............. Number of dwelling units on each foot ...',-,&~,; ................ 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 .~J,~....~.... Height ........................ Number of Stories t Dimensions of same structure with alterations or additions: Front ...... ~...~.~ ...................... Rear ............... Depth ........ ~..:~..~ ............ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ .J.~.. ....................... Rear ..... Z~ ................. Depth .....~..~.... ........... Height .................... Number of Stories Rear ...... ~'...~...O ........................ Depth ...,~.d~..~..~ ............ 9. Size of lot: Front ........... J.~..(~...~. ................................ 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 *er regulation: ...... ~/~....~?. ......................................... 13. Will lot be regraded .........../~/~.. ......... Will excess fill be removed from premises: ( ) Yes (3f~ No 14. Name 0f Owner of premises ..fk~ ~..y,..~7~.~:.,~ t .-. ............... Name of Architect .............................................................. Address ................................ .Phone No ....................... Name of Contractor .~.~.~.'..~...~..~..~,.~.~...~...~..0.~.!.~..~.~..~ ....... Address J,~..cl...{.~.~.~..L{!.~.~.~hone No. ~.1.--...~.,,~.1.,~ PLOT DIAGRAM Hu~v?~r~C~t ~V :~ Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines., Give street and block number or descriptio~ according to deed, and show street names and indicate whether interior or corner lot. ~ 7~, COUNTY OF ............. :.; ............ [ ' .................................... , .................... ~ .................................... De.rig duly swern, d~o~s and says t~t he is the applicom (Name of i~ividual signing c~tmc~ above name. He is the ........................................................................................................................................................ (Contrect~, agent, corporate officer, ~c.) of said owner or owners, and is duly aut~rized to perform or have performed the said work and to ~ke and fife this application; t~t al( sta~ments c~toihed i. this ~pplication ~relme.to the best of his knowledge and belief; and thaz the work will ba performed in the manner ~et fo~h in the application filed therewith. Sworn to bef?m me this ................. :.....~' day of ............................................ ~... (Signature of applicant) N~ 52-0344963 Suffoik County/ ~m~ton Expires M~rch 30, iL C 15- APPROVED AS NOTED I~,TE: FEI:: /--~ ?'~ BY y [NOTIF BUILDING DEPAKTMENT 765-2660 9AM TO 4PM FO~ ~D INSPECTIONS: ~. B~FORE BACKFILLING FOUNDA- 'TION OR STAKT FKAMJNG 2. B~OKE COVEKJNG PIPELINE $. ~tNAL WHEN JOB COMFLETED LNOT ~SPONSIBLE FOR DESIGN OR F