The URL can be used to link to this page

Home My WebLink About7438-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES .tl~t the building ............................. , ................... 283.~. Hsrbor Lane/250 Oak Street ....C~..t.9.hp.A~..e., Location of Property ~ Wo~ ..................... ~ ............ Ham/st County Tax Map No. 1000 Section ....1~.~ ..... Block .... .0.'1. ........ Lot... O~.l..~. ~,~?,.. ~. Subdivision..]~tg~e~3~. ~p.J,g]p.tp. ............ Filed Map No...0~..Lot No.93..~l~'O~t. 98 conforms suhtantially to the Application for Buildin~ Permit her~ofo~e filed in this office dated ....... .J..u/.~...2.5. ...... 1977.. pursuant to which Building Permit No .... .7./%~.~. · ........... dated .... .J..ul. ~'..2.5. ............... 19 .~.4., w~ issued, and conforms to all of the requbements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ..................... The certificate is issued to ............ ~Q~)p,--'TI; .DP~..q0~;L. ............................. of the aforesaid building. Suffolk County Department 'of Health Approval ................. N,/R ..................... UNDERWRITERS CERTIFICATE NO ......................... .N .,~. ..................... ~ ON THE I~EMISES UNTIL FULL AUTHORIZED) at premises located at ~o..bnl..z).~j,~ .........~.t~et't~...H.e~..~'lt~ ......................................................... ................................. ~,qmen,..,l,~ .. ~,.. O. ak... 6.~ ................ C~.~eheg~e ............................................. pur~Jant tO application dated ................... ~t..].~f ......... ~ ............ , 19...~14,, and opproved by the Building Imoectoe. Fee $.$I~-G~ ........... IUILDING DIFARTMINT TOWN CLIRK'S OFFICE ............... ' ..... ,rm,t No. 7_-- Disapproved a/c .......................................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT ,.S RUCT,ONS a..This .a.,ppl. icot. ion .mu, st be comp!etel, y ill!ed in by .~/p.ewriter o~, .in ink and submitted in triplicate to the Buildi_ng~ ~nspecror, w~rn 3 se~ or pzans, accurate plot plan to scale. ~-ee accor&ng to schedule. ~ ~ b. Plot plan showing location of lot and of buildings on premises, r'elationshiD to odio n na oremises or oubllc str~-~4r~r~ · , and g v ng o detaded descnpt,on of layout ofproperty must be drawn on the d agrom 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 Permit to the applicant. Such permit ~ 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 Certificate of Occupancy shall have been granted by the Building Inspoctor. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the iuild!n.g. Zon,e O~inance of the T,o?.,o,f. Southold,. Suffolk Cou.n. ty, New York, and other applicable Laws, Ord nonces or ~gu~an,o. ns, .zor me construct!on o.r. Du~mng.s., addihons or alterations, or for removal or demolition, as herein described. · oppncanr agrees to comply w~th an appncable laws, ordnances, bud ng code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. Robert J. Deroski (Signature of applicant, or name, if a corporation) Oak a Harbor La Cutchogue (Address of applicant) State whether applicant is owner, lessee, agent, arch!tect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .~9.~.e. T4~...~..*....]:)...e. ro~ki 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 ............................................... - 1. Location of land on which proposed work will be done. Map No.: Eugene Hfs Lot No.9..3..-..~.8.. Street and Number H~.~ ..~...~.q .~. 0...8~_ ~t OLztcho · 2~% ~-~_~ ' ' Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exislting use and occupancy ~'e'I].:LD~ ~.th ezi~t:J.D.g &oce$$or,~r b].c].~ b. Intended use and occupancy sa~e ~tb. relocated &eey bld~ & ney ~¢¢y b:lctg v~th E~t~re ~reenho~$e add, n. Nature of work (check which applicable): New Building.....3~r, ......... Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ..~l'e..;ez;[s,t..l~l.~.. ............. (Description) 4. Estimated Cost ............... ~...~... ........................... Fee ...~.0.. .................................................................................. (to be paid on filing this application) , O'nO 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 ....2..L[- ........................... Rear ......... ~. ............. Depth ....~. ............... Height .................... Number of Stories ....O,~ ............................................................................................................. 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: ....... ~O ............................................ 13. Will lot be regroded ....ta~ .................. Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ....... ~.l~.~.~'.lp....~..~...~.ff~.~;~... Address .q13,~g~g&l),l~ .......... Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ........................ same Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGEAM 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..,YQEK.. I ¢ ¢ COUNTY OF ....~.~.~...o[...1~:.. ............. ~.-,.-.,, ........................ .~...o..b..e..?..~....~.......~..~?..9.~J~...~ ................................ being duly sworn, deposes and says that he is the applicam (Name of individual signing contracf) above named. He is the .................................... gW33eZL.ff...hU.t I cl.P,,~ ......................................................................................................... (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. Sworn to before me this ~. ~/~ ~,e .................. ..2..~.. day of .................................. , 19...~...~.. ' Notary Public, .................................................... County ...~.. ~ ~ .~'....~.....~ ................... ~ ' (~tJ~6ture of applicant) FORM NO. 6 TOWN OF SOUTHOLD' Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions Ao Bo 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 features, i 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. 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, occu~)anc¥ 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 New Building . ~ ......... Old or Pre-existing Building ....... Vacant Land Ho. No. Owner or Owners of Property .~ ~.~ County Tax Map No, 1000 Section ..~.~..~. ....... Block ... ~. I ........ Lot. Health Dopt ~pproval kabor Dept ~ppmval ~ ................. Hnde~Hters Approval ........................ Plann~n~ Board Approval .................... ~equost for Temporarg Certificate ..................... Final Cortificate ............. Feo Submitted $. ..q9 ....................... Construction on above described building and permit meets all appl!cable codes and regulations. App,icant ......... ................ ......... Rev. 10-10-78 FORM NO. 6 TOWN OF $OUTHOLD 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 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 Underw~riters. 4, Commercial buildings, Industrial buildings, Multiple Residehces and similar buildings and installa- tions, a certificate of Code compliance from the Architect dr 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, sti'eets, buildings and unusual natural or topographic features. ~ 2. Sworn statement of owner or previous owner as to use, occup'ancy 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. C. Fees: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.0O Date ,,~..~....~... ?..~, .'?, ~ ?... ............. Vacant Land ............. New Building .. ~ ....... Old or Pre-existing Building Location of Property 2. Owner or Owners of P;:~S:rt/~;°' ~..~....~.....o~.'.'~ '/...~...'... ~ir~ County Tax Map No. 1000 Section . ./. ~:~ .~' ........ Block ~,~=~'-~.,..~. ~'... Lot..~--2~..1. ~..~. ,,~. Permit No..7 'z'~' ~J'zDate of Permit X' X.~.' Z~.Applicant. ~-~ .~.~ .... O,-~"i.~'~.~. r... Health Dept. Approval ...... -~. ................. Labor Dept. ~pproval Underwriters Approval ........................ Planning Boar~l Approval Request for Temporary Certificate ..................... Final Certificate ... ~ .............. Fee Submitted $ ~.' .O.§ ............ : .......... Construction on above described building and permit meets all applicable codes and regulations. Applicant ~...~.'.~.~'..¥?.~ ........................ Rev. 10-10-78