The URL can be used to link to this page

Home My WebLink About8770-zNO. 4 TOWN OF SOUTHOLD BUTLI~ING DEPARTMENT Town Gle~k's Offlee Southold, N. Y. Certificate Of OCcupancy No..Z.7.~.l ...... Date ............. Se~2...2? ....., 19. THIS CERTIFIES that the building located at . L~laa..Lane ...............Street Map No. N.~ S~. ~. Fla~. Block No ........... Lot No, . [at. 10.~... ¢ ~t c hogue .......... conforms substantially to the Application for Building Permit heretofore fried in ~hi.~ office dated .............Ju2y....30 19.~. pursuant to which Building Permit No.. dat~l ............J..u.l~...~.0.., 19..7.6., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which th~.~ certificate is .iasued is ... Pr.~vat~. garage .................................................... The certificate is issued to . Jehn -Geeel. le ...... Y~rnel- ............................ of the afbresaid building. Suffolk C~unty Department of Health Approval (owner, lessee or tenant) ~;.R~ ............................... UNDERWRITERS CERTIFICATE No. ~I~. R ....................................... HOUSE NUMBER ...... 1~?.~ .... Street ... L&~ac. Lane ........................... Building Inspector I~OB31 NO. ~ TOWN OF $OUTI'IOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~,F_J~ISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8770 Z Permission is hereby granted to: ..... gha~..~t s.....~C...Johr~..Gasele .......... to ..... ~...~....e..~.~..o.~....o.~....e...x..s..s..~....a.~.e..U~.~; ........................................................... at premises located at ..~,~.~..~Q~..~ ......... .JJa~j~,...~'~,;~ns ......................................................... ............................................. ~ ~ La,..c.....z,..~.~..~. ......... .c.~1;.~j~ ............................................................ pursuant to application dated ........................... ~T~J~.~. ....... .~ ....... , 19...~, and approved by the Building Inspector. Fee $.].2.t.g.~. ........... Building Inspector FORM 1~0. 6 TOWN OF $OUTHOLD , Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPAINCY In~tmctionl A. This application must be filled ~n typewriter OR ink, and submitted ir~ 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 Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences,. and similar buildings end installations, a certificate of Code compliance from the ArchitecJt 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 ]957), 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 '~ Rte ..... New B~ilding ................ AdditioR ..~ .........Old or Pre-existing Building ..... ~ .......... Vacant Land Underwriters Approval ..~.~....-~ .~..., .......... Planning Board Approval Request For Temporary Certificate ........................................ Final Certific( Fee Submitted $ ...~...:....~....~.. ............... Construction on above described building and permi~ meets all applicable Sworn to before me thi~ ...... day of ..... (sro Notary Public ...... ~//~-C:. County codes a._~ regulations. TOWN OF SOUTHOLD ~ BUILDING DE,I),.ARTMENT ~-., " TOWN CLERKS OFFICE ~-- UT.OLD, N.Y. Examined ....... -~..-~...-.-, 19....~...: Application ~pproved ....,.~........~.!..i.....Z..~......, ] .~.....~.., Permit No. ~...Z..?...~..~ ....... APPLICATION FOR BUILDING PERMIT °ate INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises relationship to adjo n ng premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram 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 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, and other app icable Laws, Ordinances Regulations, for the construction of buildings, additions or alteration.s, or for removal or demo tion, as herein described. 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) ~ddress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ......... sC.. ..~ ....l.'PT~ ..................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Other Trade's License ~/o ....... /..~... ................................ o o and on wh ch proposed work w be done Mop No ./.- .~....-~.. Lot Locat' n f ' ' · / //~" Street and Number ............... '.....~./.'~.~.~. ...... ....~......~.....~r .................................................... ~./-¢//~-~.~...~.lk,.-~ ....... Muni~pality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy . ~. ~..~..!~:.Jz .~. .............................................................. b. Intended use and occupancy .~...,/,~..~. ........ ...~ ............ ~ .................................... 3. Nature of work (check which applicable): New Building-. ................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work ................................................... (Description) 4. Estimated Cost ~..~.~.........c) ...... .. ............... ..... ...... Fee .J..~Z..~ ....................................................................... (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, spefi~y,_~ature and extent of e~%,h type of use ............ ::~f';"lr .... 7. Dimensions of existing structures, if any: Front ...... . .~..~ ............... Rear ...... .~..~... ................... Depth ..~....~.. ..... Height .....~;...~'... ........... Number of Stories ....................................................... ~ ............................................ .f ........... Dimensions of sane structure with alterations or additions: Front ..... ~/...~.. ..................... Rear ...~.....Z~.. ............... Depth ...'.A-.,.~....~ .................. Height ~...~'......~../...7-.-'...~..Number of Stones ..... .~... ...................... , / . · / , 8. Dimensions of e~ntire new construction: Front ..... ./...?.- ...................... Rear ....... ~...Z ............. Depth .,,~-,~ ............... Height ....?..~-. ........ Number~.~of Stories ......... ~. ..................................... ,-~--;-, ? ...................................................... ~ ............ 9. Size of lot: Front ...... ~.,~/...~.'.......~. ............................... Rear ....... .7...~.... .......................... Depth ....~F:r~..~ ................ 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: ........................................................ 13. Will lot be regroded ......~.~...~. ............. Will excess fill be removed from pr. emises: ( ~*l~s ( ) No 14. Nome of Owner of premis/es .'.~..~.~:..~..~..~.~.:(.~.2~'.~......~..~.~..¢1.'¢... Address ....~(..i~./.~.¢.,~t.~z.t~,.... Phone No. Name of Architect ......... +~ ............................. ~ .............. Address ................................ Phone No. Nome of Contractor ...~1~.~......~....~ .......... Address ...~.0..~0~.~.~.... Phon~ No..~.~..x...~o.~.~ 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 YORK, ~ S S COUNTY OF ..... x~ ...................... ~ ' ~ ...............~~ ~..~...~ ...................... be'rig duly sworn, deposes and says that he is the applicam .~~ individual signing contracf) above named· //? ~ _~ He is the · ~.~.....~J ....................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ahd is duly authorized to perform or have performed the said work and to ~ke 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 perfor~d in, he manner set fo~h Jn the application filed therewith. Sworn~eforezt~7 [ , l, 19 g ~ ...... .... .............................. " ..... ~ /r// (Si~noture o{ opplicont) Neta~ P~Iic in the Sta~ of N~ York No, 52-8996350 Residing in Suffolk Coun~ ~ CommJssi~ Expires March 30, 19