The URL can be used to link to this page

Home My WebLink About8827-zNO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . ~tt~l~a~;ex-, A'~e ........ Street Map No..XX ........ Block No. ~X ...... Lot No, XX3; .~%cl~e... ]~.,.5~, ......... conforms substantially to the Application for Building Permit heretofore filed in this office 773333 dated . .~/0~./3/f.~.9/.%/76.., 19 .... , 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 ....Pr~.~.,.t.e., .o/a..e. ,f...a~. ,1~...d.~..1.1..~. Z...w. ~,tk .a.d..d.~.t,%.on~ ................ The certificate is issued to ~ha~.d..I~.e.l~.ak~...J.~ .... [haler ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .~,.R., .............................. UNDERWRITERS CERTIFICATE No..N. ?.R., ...................................... HOUSE NUMBER ...3~D. ..... Street .8~;~,],Wa.t.e.~.&.~. ........................ .......... ....... /' FO~ ~0. ~ TO~'N 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°. 8827 Z Date .......................... ~e~t, .......... ;:J ........ , 19...~.6. Permission is hereby granted to: ...~..~.~.~..~...~.c..~..o.w~.~.~. ............................... Build patio at exlstin~ dweltinE ................................................................ ~- .................................................................................................. ~e- !~*~ ~* 30 Stillwatt. r Ave ..... . .............. ; ............................. g.w~.~.~=~ ..... EJ.,. .......................................................................... to application ;datea ..:...;...; ...... A,I~r......~C~ .................... , 19...~, and approved by the Building Inspector. F~*.!.0...L0...o. ........ ._.. FOILM NO. $ TOWN OF SOUTHOLD , Building Deportment Town Clerks Office $outhold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcahon must be filled in typewriter OR ink, and submitted 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, aha 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 buddings, 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 s~te plan 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 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 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 $§.00 3 Copy of certificate of occupancy $1.00 New B~ilding ................ Addition ....~ .......Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .... ~...Z~.~......~..../-~.Z.~...4....C,~..~..)~.~'~'...z~..y..~....C'...~..~.~.,~.~..(~..Q..¢~ ............................ Owner Or Owners Of Property .... .~J.x..(.C).~'.~.*.~..6~....Z..:/..~...~.~..'V.~..c~..L~..~....~...A. ............................................. Subdivision ................................................................ Lot No ............. Block No ............. House No ........... 3- .... _ Permit No...~..~.~.~...~rDote Of Permit ...~/./~..Applicont ..~Z.~:C(~.~(/~C~.f.f~Z....~..~'. ..... Health ~pt. Approval ............................................ Labor ~pt. Approval ................................................ Unde~rite~ Approval .......... .~G ......................... Planning B~rd Approval Request For Temporaw Ce~ificate ........................................ Fin~ Certificate .........~.~..~ ..................... Fee Submittal $ ....... ~.~.~. ............... Construction on above described building~,perj~it me_ets all applic.able codes ~nd regulations. ............. Sworn to before me this ~/~/' ~ ' "~L '-- .] / TOWN OF SOUTHOLD ..~,~ ~ BUILDING DEPARTMENT ~ ~ ~ TOWN CLERK'S OFFICE ~' ~' ~ ~UTHOLD, ........~ '/-v ~ ...... ~ ........... ' 1~"~": ~----~ Application ............... :: ............. ......... , .... Disapproved a/c ......................................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a This application must be completely f,lled in by typewriter or ,n 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 odlommg 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 apphcatior c. The work covered by this application may not be commenced before ~ssuance of Building Permit. d. Upon approval of this apphcation, the Building Inspector wdl ~ssue a Budding 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 of a Budding Permit pursuant to th Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe, The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors on premises and in buildings for necessary inspections. ~'~; [~'r~'~¥~'r; of' '~pp, ic;~i '(~T 'r~r~'~"i;";' ...... t/~oaress ot appd/cant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde Name of owner of premises ............. ~-.4;/.~..~2...,.J~ll~-.-~..~-.e/:.~...~.X.~...~l.~ .................................................. If apphcant ~s a co~orate, s~gnature of duly authorized officer. (Name and title of corporate officer) Builder's License No ....................................... ..~.-~....~....~ Plumber's License No ................................................. Electrician's License No ............................................. ~~,z~c~ ~,¢/wo~ Othe[, Trade's License No. ~ //~ ~ Location of land on which proposed work will be done. Map No · . ................................. Lot No .............. Street and Number ....... c~/.~....~..~/./-..fc....c~../~..~..~.~..~...~-,..~..ZT..~,Jr(.O..¢.~.~.~ .............................................. Municipality State existing use and occupancy of premmes and intended use and occupancy of proposed construction' a Ex~s~ting use and occupancy ................... ~r~.~!.~..---~...~/./..~....C~m.. ......................................................................... b. Intended use and occupancy ................... ~l~..'/t:../../~ .................................................................................... 3 Nature of work (check which applicable) New Building ................ Addit,on ....... Alteration ............. Repair ............ Removal ............. Demoht~od .............. Other Work .............................. ' (Descr,pt,on) 4 Estimated Cost ............ .'7...,,~.....,~...{?. .............................. Fee ......... ;.~.,/..~... ...................................................... Lto be pa~d on fihng thts apphcahon) 5 If dwelhng, number of dwelhng units .....- ...Number of dwelling units on each floor ...... :::..: ....... ~] If garage, number of cars ~ 6. If l:usiness, commercial or m,xed occupancy, specify nature and extent of each type of use ................... 7 Dimens,ons of exi/st,ng structures, ~f any Front ...... ~.f,)f ........ Rear .,~...~..~!~... ........... Depth ....... .~/'. ~../'.. Hmght ........................ Number of Stones .............. ~. ......................................................................................... D,mens,ons of s,a,n)e structure with alterat,ons or~addmons. Front ......... 4b~...~...'. ............. Rear ...... ~'"~:~ .~. ...... Depfl~ *'/'" Height ~' ~' ......................................... ~...~, ...... 'Number of Stones ........ ..t~. ................. 8 D~mens~ons of entire new construction: Front ........... ~. ..................... Rear ........~(...r: ........... Depth ..... ~../.~ .... Height ...~.. ......... Number of Stories ........................ ./. ...................................................................... 9 Size of lot. Front ~.. X_L~' Rear ............ ~. t(. ...................... Depth ....... ~..~...~......~. ..... 10 Date of Purchase ....... .?:?....C.(...L..~/... ./..~.Z'...~...J. ....... Name of Former Owner ....... ~.. ...... ~...~..,~.~.zf~.z.~;'./¢;~...--__ 1 I. Zone or use distnct in which premises are s~tuated .................................................................................... 12 Does proposed construction wolate any zoning law, ordinance or regulation: .............. .~.,/.L~. .............................. 13 W, ll lot be regraded ...... .~./....~.~.~. ............ Will excess fill be removed from premises: ( ) Yes ,,~ No 14 Name of Owner of remlses! /' ~'' ~ '/ '') ")o:' ~;', Address_.¢.~ ....... J..,~....,.l...f..,~ Phone No .... .~../.../..v..'~{. Name of Architect .............. ;. ............................ Address ................................Phone No ....................... JXlanle of Contractor ........ ; ............ .~..; ..................... Address ..................... ~..f..~Z... Phone No. ,.~...~ ........... ~ PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~stmg or proposed, and re&cate all set-back d,mensions frorr,. property hnes Gwe street and block number or descnpt~on according to deed, and show street names and indicate whether interior or corner lot STA-I'E OF NEW Y/C)Ri~,/, .,~,4,~ ~ S S COUNTY OF .-~n~-d.... -c..~/,('.--Y.....~ .k~'..... $' .... '.':.:...:.[ ....... : ...... (2~....~....~. ...........: ...... ~ .......... '. ~ .... be,ng duly sworn, deposes and says that he ,s the applicon, (Name of individual signing contrac~ above named. He ,s the ........... ~: ...... :..2~ ...... ~:~ ...................................................................................................................... (Contractor, agent, corporate officer, etc ) of sn~d owner or owners, and is duly authorized to perform or have performed the smd work and to make and ill, this application; that all statements contained m thru apphcahon are true to the best of his knowledge and behef, ant that the work wdl be performed m the manner set fo~h in the application filed therewith. Sworn to before me this ................... :.... o, ....... ,,. i /,I ........................ : ..... ................ .............................. ......... DOROTHY ZUKOWSKI Notary Public, State of New Yor~ No. 52 - 4'~9948~, Suffolk Coun~ Term Expires Ma~h 80, 19~