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Home My WebLink About7652-zTO~ OF $OUTHOLD BU~qG DEPART]fl~NT Tov~ Cl~k'~ O~ie~ $omhold, N. Y. Certificate Of Occupancy Map No... ~.~..88. ..... Block Bio ........... Lot No ........~ ........................ conforms substantially to the Application for Blllldlng Permit heretofore filed in ~t~ office dated .. D. ece~.er.. ~. ...... , 19.7./~. pursuant to which Building Permit No .... 7~52.Z dated .. D. ece~her.. 5. ....... ,19.7./~, was issued, and conforms to all of the requ/re- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ....... Achiition. ~o. l~riva~e. 0~ ~amil~. D~alling .................. The ce~i_'(icate is issued to ..... .Wayne .&. Ka~fl. aen. I)trpatm'is ..................... (owner, 1~ of the a/oresaid buildi,,~. Suffolk County Department of Health Approval .......... ~/.R. ...................... U~TOE~WRrrERS CE~T~CATE ~o ......... .~ .~L~..~. ........................... HOUSe. Z~a~Ea .. ?.7.5 ........ Street ...... .C.~.e..aFAr...~.~' .A.v.e. .................... ............................................ .S .o.u~ .ho..~,...~ .¥.or~ .............. County Tax l~nber 1000-070-08-0D7 BuiM!~g Tm.~:~tor FOB,M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7652 Z Permissio~ is hereby granted to: at premises located at ..~4~t...~.~....,~&~,~',~e1~..~.~Z~l; ........................................................................ .......................................... .(~Le~.. JL~ ...... ~m~t~o3~....~i,.~ ............................................. pursuant to application dated ................ ~11 ....... ~ ...................... , 19~k..., and approved by the Building Inspector. Building FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall 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 Inspec- tor 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 featu res. 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 similar buildings and installa- tions, 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 peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 informa- tion required to prepare a certificate. 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 Date .... /./! .~./.-7. ?. ............ New Building ............. Old or Pre-existing Building ~ Vacant Land Location of Property .~.~...~'...~.,, ,c~,,'.~.. ~.~..[..,..~". ~.~..~,' ,/~, ,/~ .... .~,, ~'~c~, ,77.~.~..~ ......... House No. Street Ham/et Owner or Owners of Property .~.~?~...&...E...~...~....~..~..~.0...~..../~. e~P~¢¢~;.~ County Tax Map No. 1000 Section ............... Block ............... Lot ................ ... ¢ -j- Subd~ws~on ........... ¢. ,/¢ ................. Map No ....... ~ ..... Lot No ............... Permit No. ~¢.~.... Date of Permit .~.-~;7~Applicant ,',~,~¢~¢~ .......... Health Dept. Approval ........................ Labor Dept./IApprova ........................ U nde~riters Approval . .~ ~ ............... Planning Board Approval Request for Temporary Ce~ificate ..................... Final Certificate ....................... Fee Submitted $ .~ ~ ~ ....................... Con,ruction on above de~ribed building and p~it mee~ aJ~ap~ble codes and regulations. Applicant..~.. ~(/~. ~ ............................ R~. 10-10-78 ~O ~ ~3q i LOT- I0 , LOT-It I5 , M.'"/6'Z~'~' W. - I~I.D~ '.4 ~-uUr=TT L~,. (_. L r-.. ,& 12. V I ~ ',,v ":", SOUTHOLD, N. Y. ' ~ ~ ~ ' INSTRUCTIONS ~. o. This aPPlication must be completely filled in by typewriter ~ in ink and submitted in triplicate .to the Buildlng.~' Inspector, With 3 ~ets of plons~ accurate plot plan to scal~ Fee eccordin~ to schedule. ~. b. Plot plan showing location Of lot and of buildings on premises, relationship tO adjoining premises or p~lic streets ol~ areas, and givinga detailed description of layout ofprcq3erty must be drawn on the diagram which is pert of th~s ~PPlicotion?,- c. The work covered by this application rnoy not be commenced before isstmnce of Building Permit. d~ U~ approval of this application, the Building Inspector will issue o Building Permit to the applicant. Such permit L-%, shall be kept on the premises available for inspection throughout the work. . ~'~ e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificat~ of Occupancyr 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~ ann 9t~her applicable Laws, Ordinances or Regulations, for the construction of buildings, additions ~)r alterations; or' for r~mo~bi er demolitian, as herein descrilL~ecl. The applicant agrees to comply with all applicable laws, ordinances, building code, hOUSing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) t/.,aarees o? applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................ ........................................................................................................ If/.~,,~..-,~ -.zaPpJ~ant..is a c°rp°p~'te' sigDefure of duly authorized officer. .... ...... ~lum~r% kic*n~ ~o ................................................. fil~tricion% Lic~n~ ~o ............................................. ~h~r Trade% kic~n~ ~o ............................................... 1. k~ation of lond on which p~d rk will be dOn~. Mop ~o.: .~~ ............. 2. Stat~ ~xi~ting us~ and ~cu~ncy o~ pr~ml,es ond ~ntended use and ~cu~ncy o. ~isiting us~ ~ ~cu~n~ ............ d.~/~,...~~ ........................................................... ..................... · ......................... . ........ ............. b. Intended u~ ond ~cu~ncV f' . Nature of work (check which applicable): New Building .................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ..................................................... ~ ~ (Description) 4. Estimated Cost ............ ..~.~.,.~.~.. ........................... Fee ..t~,,~....:..: .......................................................... (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 .o?.~._~9/ Height ...... /..'~... / Number of Stories / .. 7'-"'"' .... Dimensions o,f. sa~rne structure with alterations or additions: Front ............ ,_~..~...~. ........... Rear ..~".,~.../. Depth ....... .G.~,.Z~ .......... Height ............................ Number of Stories ................................ 8. Dimensiop, s of entire new construct on Front ../.. ~. Rear ........ ../..t ........... Depth ..~.....~... ............ Heigh/,~',,~,... Number of Stories ....... ./, ..................................................... : ..................................................... 9. Size of lot: Front ................./...~../..-..~'. ........................... Rear ,~'..~:~./..,.~. Dep~ ...o~.....O..O.., 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 I. Zone or use district in which premises are situated ........ ~.~..~.?'..~..~ ...................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ,,~...~....i ..................................... 13. Will lot be regraded ...... ....~.....O.. ........... Will excess fill be removed from premises: ( ) Yes ~'~o 14. Name of Owner of premises ,~..~'..z~...'~.~...~...~...'~..~~Address ~.~..~.~'.~.. ...... Phone No...., ................. Name of Architect .............................................................. Address ................................ Phone No. Name of Contractor ~/...,~.'.......,~..~...,~....~......./.,4~ ........ Address ..~..~..'~.~..~.' ...... Phone No..~'.~'..,~...~..~...,,f~....~' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from whether property interior lines. Give or corner street lot. and block number or description according to deed, and show street names and indicate COUNTY OF -.~.7~/..~ ......... .... (.i,~..me of ind .v~ idU~,..~,.,g,~:,. -,:~..4,:?,~ ......... sworn, above named. He is 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 id this application are true to the best of hi--ledge and belief; and th. ar the work will be performed i,D.~e manner set forth in the application filed therewith. / } ' SWam to before me this Notary Public, ............. .~,,'~"-~"/~,~--.~ u n t~ ...".::~2~:~:~:~:~:~...~ ../~../:...,~.~/..~'..~.....~'~...~..~'~'~T,......: .................................... ~'-" ,~/ ~/ (Signature oyopplicont) APPROVED AS NOTED ¸1,