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Home My WebLink About7363-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Ot~ice Southold, N. Y. Certificate Of Occupancy No. Z8.931 ...... Date .Fahr~r~ ...... lb~ ......... , 19.7.8. THIS CERTIFIES that the building located at . .].~7~, Beebe..Dl~l~,~ ....... Street Map No...32~0 ..... Block No ........... Lot No....].0 ............................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ... June. 27. .......... , 19.7)+. pursuant to which Bui]ding Permit No. 7~6.3... dated ...J.~e..27 ............ , 19.7.~.., 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 .... ON~ ,FAM. IL~. ~WELL~N~ ............................................. The certificate is issued to ...... P, olTal.d..C, ar~ .................................... ( o w n er ~ ~ ~. Z~ ~A'~ ~ of the aforesaid building. Suffolk County Department of Health Approval ..... N~.R ........................... UNDERWRITERS CERTIFICATE No .............. .N./.R ........................... HOUSE NUMBER...].~75 ....... Street....B.e.e.l~...D.r,$.V,e .......................... ......................................... .c.~;~ .h.o.g~. e. ~. ~,¥.. ..................... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7363 Z Permission is hereby granted to: to .. ~,;L¢ ..~'~..~.4~,.1;.$,or~ ..o~...e,~,~ .~.~,~ ..~ ~ag .............................................................. at premises Iocoted ot ..l~;.:20.....HO~S~...{3~tt~ ............................................................................... .......................................... · Beebe..I~&v~ ........... ~te.hc~me ......................................................... pursuant to application doted .......................... ~,gl~..~,~. ............ , 19..'~h', and approved by the Building Inspector. Fee $.']..~. ~....Q~ ......... r FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions Aa This application must be filled in typewriter OR ink, and submitted in triplicate 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 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 building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 19.57), Non-conforming uses, or buildings and "pre-existing" land uses: I. 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. 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 ............ ..~.~..:~T....~........'.~.~ .. :Z.~ f) New Building .................... Old or Pre-existing Building ~ Vacant Land Location Of Property ~..~..E~'~ 'Jill .~: t V/~ Owner Or ~ners Of Propedy .... ~ ~ .~. ~ ............ ~.~.~.....: ........................................... Su~ivision .......... .~..~.~2~. ................ ~/.~.~(.~....Lot No.............~0 Block No. ~............ House No ............. Permit No..~.~.~.~Z Date Of Permit ................ ~..Ap~cant ........ .~.~..~,~ ........ f.~.~ ............ Health Dept. Approval .....................~..~ ............. Labor ~pt. Approval ........ .~..~. .............................. Underwriters Approval .............................................. Planning Board Approval Request For Tempora~ Ce~ificate Final Certificate Fee Submitted $ .......... Construction on above described building and permit meets all applicable codes and regulations. App,ca., ................ Sworn to before me this ................ day of "~'"'~.'.?./..~.?.C~.,~ ....... (stomp or seal) .,A Nota~ Publ,c .......... ~ ........ County ~ . ,~ ~' W FF~:N,A~Ei'TE BROWN '~~ ~ ~ ~ ~D/ NOT/,J , kt .. (', ~;~d-~ cf Now York ~ ,, ', ' .o k Counfy C~m~,,.,~,. ~,,;,~ March 30, 1~79 /TFT Examined : APPUGATION FOR BUILDING PERMIT INSTRUCTIONS (Signature of applicant, or name, if a corporation) Beebe 9rive C~tehogue (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises Do~a~d C&'~"d If applicant is a corporate, signature of duly authorized officer. a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Buildir~ nspector, with 3 ~e~ ~ plans, accurate plat plan to male. Fee according to schedule. b. Pict plan showing location of lot and of buildings on premises, relationship to adjoining premises or public ~'rasts o; areas, a~nd givi .riga detoi..~ ..~. ripti .o~. of layout ofproperty must be drawn on the diagm ~m which is pa~t of this a~plicattor~ c. , ne wor~ co, rea I>y m~ appllcahon may not be commenced before issuance of Building Pe~mit. / d. beUk~t:~opraval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall on the premises available for inspection throughout ~he work. e. hNO building shall be occupied or used in whole or in part for any purpose whatever until a Ceffificate of Occupancy shall ave been granted by the Building Inspector. APPLICATION IS HEREBY M~DE to the Building Department for the issuance of a Buildi_~ Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other d~iicable Lav~, ~ or R~egulati..ons, for the construction of buildings, additions or alterations, or for removal or demofltlan~ as hereifl de~ribed. the applicant agrees to comply with all applicable laws, ordinances, building code, housing cads, ~ regulations, and to admit authorized inspectors on premises and in buildlng~ for necessary inspections. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................ Other Trade's License No ................... 1. I0 on which prpposed work will be done. Map No.: Moose Cove Lot No. ~ ............. Location of land Street and Number ....... ..~..e..e...~..e.....~...~..~..?..e. .......... ~.~..~...h..O.~ ................................................................................... /.~' 7 ~ Mts'gclpallty State existing use and occupancy of premises and intended use and occupancy of propc~ construction: a. Exisiting use and occupancy ..... 0,1~t~],~ ......................................................................................................... b. Intended use and occupancy .......... .~.~ ....... ~.~..~...~.....~..~..~...~..~...~..O...~. ...................................................................... '3~' Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ............ r~ Repair .................. Removal .................. Demolition .................... Other Work ................................................ ...... (Description) (to be paid on filing this application) S. If dwelling, number of dwelling units ....... .g...~..? .............. 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 ..~J~. ............................ Rear ........ ~.~ ............... Depth .J]~L.....~' ....... Height .................... Number of Stories ....~lJ,e. ............................................................. : ............................................. 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 ..~..~...e...~.~.~.~. ............................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............... ..~..g.. ................................... 13. Will lot be regraded ...~.9. .................... Will excess fill be removed from premises: ( ) Yes ( ) N° Name of Architect .............................................................. Address ....................... , ........ Phone No ....................... Name of Contractor ......... ~...~,..e. .......................................... Address ..................... '..~ ........ Phone No ....................... PLOT DIAGRAM 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 description according to deed, 'and show street names and indicate whether interior or corner lot. STATE OF NEW~YO~I~,,_ COUNTY OF .... .~....~....~. ,O.,..~. ........... .~ ................................... ~)~iil~d..J~l~l~ .......................... ~.....being duly sworn, deposes and soys that he is the applicanl (Name of individual signing contracf) above named. He is the 0~tl~er - J)l~l. ldez' (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this application; that all statements contained in this application ore 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 before me this g pp' JUDITH T. BOKEN Notary Public, Stale o~ New Yo~k N0.52~03.44963 Suffolk Counl~J~'~ COmmi~ion Expire* March 80, 19.~.~