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Home My WebLink About8779-zFO~,~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z7276. ...... Date ............ Oct.. ~ ....... , 19..~.6 THIS CERTIFIES that the building located at . Leeton .DI, ................ Street Map No..n~.. ....... Block No. ..x$. .... Lot No .... ~ ..... ~ORth01;l, ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ Aug .3. , 19 76. pursuant to which Building Pemit No..8~79Z · dated ...... .kug.. h/ ...., 19.7.6., was issued, and conform~ s to ali of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...P.r.i.y.at.e.q.m.e..f..am..~.3,.y...d.w.~.l..1.in.g..wi.t;h ~dd. ~[.t.~0~ (.cl~ck) ............. The certificate is issued to .~hOs.. Q~L~n~ .... 0w~e~ ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N, R, ............... UNDERWRITERS CERTIFICATE No..~:.l? ...................................... HOUSE NUMBE~ .... 89~ .... Street ...~.eg.~o.g..D.~. ......... ..................... FORlt[ NO. 2 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? 8779 Z Permission is hereby granted to: · ~...~...~.....~../..0. ........ ~?.~...~,t.~. .................. .................. ~,e a.~ .~.~..,0.:c1~ ............... at premises located at .~,.e..e..i;.,o..Tt.....D.?..~.y..e. ............................................................................................. ......................................... .~.~.~h~ld ....... N ~.Y.~. .............................................................. ~ ................... pursuant to application dated ......................... ,.~..Zl, [~ ......... .~. ............ 19..~..~..., and approved by the Building Inspector. Fee $.. ~ .~.......0..0. .......... u g spector TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. Th~s application must be filled m typewriter aP, ~nk, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: ]. Final survey of property with accurate location of all buddings,, 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 F~re Underwriters. 4. Commercml 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or ',buildings and "pre-existing" land uses: ]. Accurate survey of property showing all property lines, streets, bbildings 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 dwelhng or land use $5.00 3 Copy of certificate of occupancy $1.00 Dete ...~...?./..~.., .,~'../. :.,3.~. !. ~...?....,~. .......... g , blew Building ................ Addition ........... Old or Pre-existing Building ..... ~ .......... Vacant/and .............. Location Of Property ....... .~...~....~...~.~.~/ ........... ~)..~.:./...~.!....~.~ ............................ ! ............................................... Owner Or Owners Of Property ....... ~....A.r,;~-~.c~r..~ .......... ~?J.~. ......... ~..~../..~';../:ff. ......................................... Subdivision ................................................................ :-- Lot No ............. Block No ............. House No ............ Permit No, ~...~...?.....~.. Date Of Permit .~/~/7....~,...Applicant ......... .~..,~... ~.. .......... j.~...4~.:..~..~...~ ........ Health Dept. Approval ............................................ Labor Dept. Approval I .............................................. / Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificarte ' Fee Submitted $ .,.~...:.~,./~. .................... Construction on above described building and permit meets oil oppl!cable codes and regulations. App lica nt~;..~... ' ..~../-~-~ ........................................................ 7>7 Sworn to before me this Notary Public ........... ~..~..~.../'/.~. County 1~0~,~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. £×omined ...................... 11~. ?Z- APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No....~....?...2..~.. ........... a. Th,s application must be completely fmlled ~n by typewriter or in ink and submitted in triplicate to the Buildin, 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 ad]tuning premises or public streets o areas, and giwng a deta,led description of layout ofproperty must be drawn on the d~agram which is part of th~s application c. The work covered by th,s apphcation may not be commenced before ~ssuance of Building Permit. d. Upon approval of this application, the Building Inspector wdl ~ssue a Building Permit to the applicant. Such permi 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 Occupanc' shall have been granted by the Building Inspector. ~ APPLICATION IS HEREBY MADE to the Building Department for the issuance qf a Building Permit pursuant to th. Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe~ The apphcant agrees to comply with all applicable laws, ordinances, building code, h?using code, and regulations, and t. admit authorized inspectors on premises and ir~ buildings for necessary inspections. (Signa ure or app iganT, or name, it a corporation; ...... ........... .......... (Add,tess of applicant) State whether apphcont is owner, lessee, agent, architect, engineer, general contrac~ror, electrician, plumber or builder ......................................................... ~..~.~..~...)c.~..~ F.¢...~. ................................................................................................ Nome of owner of premises ..... ..~...~...q...~....~..~ ......... ~/~...~. ..... t~..~.~.~,~...~.. ..................... t .................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate~ o.~fficer) 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 Lot No. Y Street and Number ...~.,....~....~.?..0...¥. ....... ~...?.../...O....,~, ................................... ! ...................................................... Municipality Stale existing use and occupancy of premises and re:ended use and occupaniy of proposed construction' ............ ........ _, .............. _.I ...................................... a Exisiting use and occupancy JL[.- ~/~ ~]/~'~ ...,~.....~.....~..~ ........... '"'..' ..... / 3. Nature of work (check which applicable). New Budding ........... Addmon .................Alteration ........... Repmr ................ Removal ............. Demohhor ................ Other Work ..~ .~,C, ~ .................... 4 Estimated Cost ....... ./..~...~.~.~..f....~...~ ........................... Fee / ~--~._C~ ' (Descr,ption) (to be pa~d on ,fihng this apphcahon) 5 If dwelling, number of dwelhng units ......................... Number of dwelhng umts on each floor ........................ If garage, number of cars ........................................................................... ; ............................................... 6. If business, commercial or m~xed occupancy, specify nature and extent of each type of use ...................... 7 Dimensions of existing structures, if any. Front ..... ~/"..~.. .......... Rear ....... .~....~. ............... Depth ....~......~.,.. Height ........................ Number of Stones ....... ~ ............................................................................................ Dimensions of same structure with alterat,ons or addmons Front ....... ...~........~.. ............... Rear ...~......~. .... Depth .......... .~....'~... .......... Height ....................... Number of Stones ............................ 8 Dimensions of entire new construct,on: Front ...... .~ ~:~ .......... ; ........ Rear ...... ...~....~... .......... Depth ...~......~ ......... Height .................... Number of Stones ............................................. ~ ......................................................... 9. Size of lot. Front ...... ~..~2.1~.../. ................................. Rear ..... j..~...~. ......................... Depth .......~-...~....---~.. ................ 10 Date of Purchase ................................................ Name of Former Owner ..................................................... 1 1. Zone or use &strict in which premises are situated ................................................................................... 12 Does proposed construchon violate any zoning law, ordinance or regulation ...... . .ji~......O. .............................. 13 Wdl lot be regraded ....... ..~...0 ............ Wdl exces~ fill be removed from premises. (~) Yes ( ) No 14. Name of Owner of prem,ses ..~.~..0.~3../~..~ ..... (~.~.1 .~..~.. ......... Address .~...~.~...z~....~/....~...~.... Phone No ....................... Name of Architect ...................................................... Address ................................ Phone No ....................... Name of Contractor .~Z~-~...J'...~...~/....~D¢/.~. J~O...u~. ~ J~..f .... Address ................................ Phone No..)....~.~..~..'7.J...~....~'. PLOT DIAGRAM Locate clearly and d~shnctly all buddings, whether ex~stmg or proposed, and re&cote all set-back dimensions from property hnes. Gwe street and block number or description according to deed, and show street names and in&cate whether interior or corner lot ! STATE OF NEW YORK, I S S COUNTY OF ........... ~t~'G]-]~..f ' .............................. ~¢~ge~'i..~:~l.~r,J_ ................. being duly sworn, deposes and says that he Is the applicant (Name of individual s~gning contrac¢) , above named He is the ........................................................... .C~OD.~Z'.ft. I3.1~O.~ ............................. : .............................................. (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and is duly authorized to perform or have performed th~ said work and to make and this application; that all statements contained in thls apphcahon are true to the b~st of h~s knowledge and belief, an~ tha~ the work will be performed m the manner set forth m the opphcahon filed therewith. Sworn to before me th~s : ........... LF.~ ..... dayof ............... Notary Public, . ........................... ~kl,~,~.g.~.~ ...... County ... ................... FLIZABETH ANN b~E¥1LI.£ I%~,TA~'Y PUBLIC, Stmte of New York Ne 52 8125850, Sui~,Jli~