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Home My WebLink About7131-zF~RM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certi[icate O[ Occupancy No. Z769~ ..... Date ~til~e- · '3 ..... , 19. THIS CERTIFIES that the building located at . DOgWoo~ .~. ........... Street Map No..~ ......... Block No...~ ...... Lot No, ~.. ' So~tho~d ' ' ~','~; ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... -Ma~...2~.., 19.~. pursuant to which Building Pe~it No. ~'31Z' ' dated .............. ~..~, 19.~., was issued, and conforms to ~1 of the require- ments of the applicable provisions of the law. The occUp~cy for which this certificate is issued is 'Pri~te' ~e' f~ily 'dwel~ '(fl~st~~ ~Oo~' 'O~y 'e0~I~t~') .... The certificate is issued to . ~anle2. P~- -~gan .... ~e~ .......................... (bwner, lessee or ten~t) of the aforesaid building. Suffolk County Department of Health Approval ...N,R., ...... : ...................... UNDERWRITERS CERTIFICATE No.. ~3~9~] .... . -IpF.. 28..$977 .............. HOUSE NUMBER . ~ ......... Street .. 'Bo~ood~ '~e ........ ~OUt~OX~ ........ . ............... ~B~ilding I~tor FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMEI'4'! TOWN CLERK'S OFFICE $OUTHO/D, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~.EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 7131 Z Permission is hereby granted to: Daniel ~', ~. ~q~Ir;~' ~. ~e~an ....... to ~uild an adc:it,.on on existing; c~..'el;~i~:~ at premises located at ......... .Q.~;~..~.~D.O~ .~...[..~....~II~I.~LeW...~.~.~...,~ .................. ......................................... ~Q~ ............. ,.,~., ................................................................................. pursuant to application dated ........................ ~[~.~ .......... ~.~..-,;....,~ 19.~.,., and approved by the Building Inspector. Building Inspector FOR~I NO. 6 TOWN OF $OUTHOLD~ Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and s~bmitted 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 installation from Board of Fire Underwr ters 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from t~e Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plah requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-ex/sting" land uses: 1. Accurate survey of property showing all property I nes/ 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 $$.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 ' New Building ................ Addition .....x..x. ........ Old or Pre-existing Building ...,~ ....... Vacant Land .............. Location Of Property ~.o~wood Lane (~$80) offf t(e~o, ys' t~oad~ So~bhold Subdivision ................................................................ Lot No ............. Block No ............. House No ............. 3-?~'7]i Applicant Dar~fe]. a~.d Msry Rega~ Permit No. ZJ.L.~.._~ ....... Date Of Permit .=....:.:. ..................................... :...; .................................. Health Dept. Approval ............................................ Labor ~pt[ Approval ................................................ Underwriters Approval ....~,,.~..~ ....................... ¢ .......... rlannmg ~rd Approval ........................................ Request ~or Temporary Ce~ifJcate ........................................ Final CerfJfJccte ,.,.~ ................................. Fee Submitted $ ...... $~...00. .................. : Construction on above described bui,ding and permit~ meetly,__ -~al~p~able_c~es and regulations. Applicant ............ Z..~....~....~ .................. ~ ............................ Sworn to before me this r:~. ~ [~ ~/ ~ ~/'4 --, ........ ~.~ ..... day of ............................. .J....~ ..... (stamp or seal) /~ No, 2 ~-58397~3 ~. ~u~ified m Kmgs County ~ :~ BUILDING DEPARTMEN'F"~,,,~.. c~,~ ~ ~ ~ · row~ c~R~'s omc~ ~L~/ ~ ~ ~ ~ ~ ,," ~UTHOLD, N.Y. ~ o~~ ~ ~ ~ o ........................................ . ................................ Di~ppmv~ o/c ...~ ........ ~ ........... ~ ............. ~ ........... ~ ....... ~ ...... ~ ... ~ ~ . . ........................ ...... d h?- / ,~ __'-*~ ; / INSTRU~I*S Date ........ ~~..~..~....., 19..~*..~ a. This application mu~ ~ completely fill~ in by ~pewriter o~ in ink and s~mi~ in triplicate to ~e Ink,tar, with 3 se~ of pl~, accurate p~ plan to ~ale. F~ acco~ing to ~hedule. b. Plot plan showing I~ation of lot and of buildings on premises, relationship to adjoining premises or public stree~ o~ areas, and giving a detailed description of I~out ofpr~e~ must be drawn on the diagram which is ~ of this applicati~.~ c; The work covered by this a~lication may not be commenced before issuance of Building Permit. d.' Upon approval of this application, ~e Building Ins~tor will issue a Building Permit to the applicant. Such permit. shall be kept on t~e premises available for insp~tion thr~gh~t the work. e. No building shall be ~cupi~ or used in whole or in pa~ for any pu~ose whoever until a Ce~ificate of ~cu~n~ ' shall h~e been gmnt~ by the Building In~ector. APPLICATION IS HEREBY ~DE to the Building Department for the issuance of a Building Permit pumuant to the~ Building Zone Ordinance of the Town of ~uthold, Suffolk Count, New York, a~-other applicable L~s, O~inanc~ or Regulations, for the constru~ion of buildings, oddities or alterations, or for m~l or demolition, as herein described. ~e applicant agrees to comply with all applicable laws, o~inances, buildi~ C~, h~si~ c~e, a~ ~ulaflons, a~ to admit authorized ins~ctom ~ premiss and in buildings for n~essa~ i~tions. ~ '--~ / ~; ~ ..................... --(~-'-""'-~,~';i';~;~ ............................. State whet -~i ~nt i ~, lo,se~, ~ent, ~mhit~ct, en~ineer, oener~l contractor, electrician, plumb*r or buil~r. ................................................................. :: .......................................................... ..................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name end title of corporat~o~)cL~er) Builder's License No .................... ~.,..:..~) ....................... Plumber's,License No ................. ~.~ ................. Electricians License NO ............ ~....;....~....~-,.. / c~ o o - Other Trede's License No..' '~'"....~...~..~...~....~...~..~.-...~..-.~.~. e ~' ~ 1. Location of land on which proposed work will be done. Map No.: ~. ......................................Lot No ......................... Street and Number '"'~"'~'"~'"'"~/~'~' '~</'~'~'"~'"'"'"/~"/~"~'"'"~"'"~'"~"'?'"~'"~"/"~-~"~ / <' /~ ............................ 'J~i~i~Ji~ ....... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy . .. ..'~,.,./-~...,.~7~....../~..,.~'...~ .......................................... b. Intended use and occupancy ............ .-~.~.~'~.~. ........................................................................................ property lines. Give street and block number or description according to deed, and show street whether interior or corner lot. Nature of work (check which applicable): New Building ~.. ............... Addition .~ ........ Alteration ......... Repair .................. Removal .................. Demolition. ................... Other Work ....................... ~ .............................. . ~ (Description) ................................................. 4. Estimated Cost ~.~.:~..~¢...~.../.. ....... ~..~*. ............. Fee ........................................ (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 t~/pe of use ............................ ........ 7. Dimensions of existing structures, if any: Front ....~.... ................... Rear ....... ,~.~.. ................ Depth :Height ....... ./.~.../. ........ Number of Stories ....... / ......................................................................... i ............................... Di~nensions of same structure with alterations or additions: Front ....................................Rea~ ............................ Depth ........ ./.~..../. ........... ;.. Height ........... ./..~..../. ....... Number of Stories ..... ./ ........................ 8. Dimensions of entire new construction: Front ...... . .~.~. ......................... Rear ........... .~..~.. .......... Depth ...."~ Height .....~.~. ......... Number of Stories ......... ./. .......................................................................................................... 9. Size of lot: Front ............ ./..~..~.. ................................ Rear .......... /...~....O.. .................... Depth ............................... 10. Dote of Purchase ../--~'.~.Z:~. ........ ............... Name of Former Owner 11. Zone or use district in--which premises are situated ........ ,~..~..,<..~.~.~' .~Z..~..(..',~.~. ................... "/i ............................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ......... ~ ...................................... 13. Will Jot be regraded .../~'..~. ............. ~... Will~')excess fill be removed from premises:,, ,,~( ) Yes 14. Name of Owner of premises .~.~.~'~..' .~'../.. ...... /~/....~'~..~.....~(....... Address/~-.~./....~'...~....,.-~.....4~...~,ep~ No. ,..~. ~'..9/...~.../...z?..-~. Name of Architect .............................................................. Address ................................ PhOne No ....................... Name of Contractor ............................................................ Address ................................ Pho~ No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-ix ck dimensions from names and indicate COUNTY OF . .~,~¢'-~ff'...~ ...... ......... ~ ............ ,~...~...-~...'...'~,..~. ..................................................... be!ng duly sworn, d~oses and says t~t h, is the applicon, (Name ~ i~ivid~l signing contrac~ above name. He is the ................................................................................................................................................................................. (Contractor, agar, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work a~ to ~ke and file this application; that all ~atements'cont~ned Jn this application are t~e to the be~ of his knowledge and belief; and that the work will ~ performed in the manner set fo~h in the application fil~ t~r~th. .S...~..T..t..~.~.~.~ ~tho~ ....~...~....~.~....., 1~.~ . . ~.. {$i~n~["~pl,~a~[)" ' .............. ....... ........................... JUDITH T. BOKEN No 52-0344963 Suffolk Cou~ Commission Expire~ March 30, 19.L~. THE NEW YORK BOARD OF FtRE:'U'N Dan Re~a~. ~8~ [~m-w~od Lane, .~outho]d, L. I. Peter PogovJa /~'/ {' ,lain r4d. ,,, J