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Home My WebLink About8880-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~. ?.h~. ?. ..... Date ............ THIS CERTIFIES that the building located at .... M.a..in..R. oa.d ............. Street Map No..x~.. . Block No.....X~X.... Lot No, ....~f~X. .... .l~.~.i..~.u~..k....N.:Y.: ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated . Se. pi....2.1. , 19 7.6. pursuant to which Building Permit No..8..8.8..0~.. dated .... .Se.~; 21. , 19~.(5.., was issued, and conforms to ali of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . ~.~.i.v. ate. on9 .f.a..~.i.~.y.d.w.e.l..!i.ng..~.i.~.h. '];he certificate is issued to .L..ou~.s.e .~.!..lso. n. ...... 0~ne.~ ........................ (owner, lessee or tenant) .of the aforesaid building. Suffolk County Department of Health Approval I~..,R, ......................... UNDERWRITERS CERTIFICATE No. N :.R., ...................................... HOUSE NUMBER ... 9.2~ .... Street ...M.a.i..n..R. qa..d ......... F.~..t.l;.t.~..ug.k' ......... Building Inspector FO~ NO. Z TOWN OF SOUTHOLD BUILDING DEFARTMENT 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? 8880 Z Date ................... ~t~; .......21 ................ 19...76. Permission is hereby granted to: ..... .~.o....~....s..e....~!~ ~.o..~ ........................................... ............. ..~.. ~,rz..L~ .............. . .~...t,.t. ~..~.~.~.k ......... to Build new accessor~ s.~or..a.g.e., .b..q~..d...~DE ...................... ............................................................... \ . . ~/~ ............................., i'"'~"'"''' i_~ at premises located ~t .......J~/.J~..~-_O_..~Qa~ .............................................. ' '~' ......... ' i'"; ............. - ; .......... ~4~ . ......................................... .~ ............... Mattitu~k ...... ~,.~., ......................... :::.: .................. ~ ............... and~\gppro?d by the Building Inspector. Fee ,..i...0..,..0..0.. .......... Building Insp~ec~o~ FOF,-~ NO, 6 TOWN OF $OUTHOLD , Building Deimrtment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCGUFANCY Instructions A, This application 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, unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposalw(S.9 farm or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial 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: 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 ....... New B~ilding ................ Addition ................ Old or Pre-existing Building ................ Vacant Lard .............. Location Of Property .......................... ..~,...~..!..../~... .......... .(?..~.,.~...,-~,. ......... ~,...,,,/~.,.,,~,..,,'~,/,.,/...-~,,.~.,,C;.,.,,~. ................. Owner Or Owners Of Property .......... .,Z:...O....~.../..,~....~,.-. ............ !.?..!.,/?..~,o.....~,.. ...................................................... Subdivision ....................................... ~ ...................... Lot No ............. Block No ............. House No ............ · S't:'~'T:~ (q'l(' ,~ outs c.~ ¢~ ~o~,/ Permit No ..~..~....'~...-."'" Date Of Perm,t ............ [ ....... Applicant .................................................................. Health Dept. Approval ........ ,../~'....~...~. .......................... Labor Dept. Approval Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ 5 ~ Construction on above described building and permit meets all applicabl,e codes and regulations. Applicont ......................................... Sworn to before me this ................ day of ......................................... ~,. Notar~ Public ................ ../..~. ...... County FO_UM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date .......................................... , 19 ......... a This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi, 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 adjoining premises or pubhc streets areas, and giwng a detmled description of layout of property must be drawn on the diagram which is part of this applicatio c. The work covered by this apphcation may not be commenced before issuance of Building Permm d Upon approval of this application, the Building Inspector w~ll issue o Bu~ldtng Permit to the applicant. Such pern shall be kept on the premises available for inspection throughout the work. e. No budding shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan, 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 ti Budding Zone Ordinance of the Town of $outhold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as harem describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and i~ buildings for necessary inspections. ~ignature of applicant, or name, if a corporation) ........ .................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bu.ld~ Name of owner of premises ~ L~)O [_~C~' L~ If applicant is a corporate, s~gnature of duly authorized officer. (Name and title of corporate officer) Builder's bcense No ................ ~ ......... Plumber's Lmcense No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... ~x/ ~' Location of land on which proposed work will be done ~xzp_l~.....,~ ..... .~ ............... Lot No ........... ..~....~. St, eat and Number .... ~ ..... .~......~... ..... ~.~--.-~.....'...~.. ............ ~ ................................. Municipality State ex,sting use and occupancy of premi~ an.d~*ended use and occupancy of proposed construction' Exisitmg use and occupancy Ji~(.xA~~}. o .................~. ~-.~..~'./ .................................................................... occupancy ......................." .~. .......... ...~. ~...~......~..~ .~.~ ~.'~-- ~'~'~/~ ................. b. Intended and use / 3. Nature of work (check which applicable). New Budding......~ ............ Addmon .................. Alteration ............ Repair .................. Removal .................. Demolmor. ................. Other Work .................................................. (Description) 4 Estimated Cost ~ Fee (to be pa~d on filing th,s apphcat,on) 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 Dunens,ons of existing structures, if any: Front ......................... Rear ................................Depth ................. Height ........................ Number of Stories ............................................................................................................ Dmnensions of same structure with alterations or addmons' Front .................................... Rear ................. Depth ................................Height ...........................Number of Stories ................................ 8 Dimensions of entire new construction: Front ......... ~ .................. Rear ...~....... .............. Depth ....~..~. ......... Height .................... Number of Stories ................. ~ ........................................................................... 9. S~ze of lot' Front ...................................................... Rear .......................................... Depth ............................. 10. Date of Purchase ...................................................... Nome of~orm~/' Owner ...................................................... 11. Zone or use district in which premises are situated ..... /q[, ...... ~ ...................... ~"',7~'~ ................................... 12 Does proposed construction violate any zoning law, ord,nance or regulation: .... . .,/~........cZ. ...................................... 13 W~ll lot be regraded --/~.~ (-') ~ Will exce s fill be removed from prem' (~ ~/Y~ ( ) No 14 Iqan,e of Owner of pre~i~'2~ .~.....~.. }~~.... Address ...~e~...~.....~....~-~. P~°ne No ..................... Nome of Architect .......................................................... Address ................................ Phone No ..................... Name of Contractor ...... ~ ...................... Address ................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~sting or proposed, and indicate all set-back dimensions fro, property lines. Gwe street and block number or descr~phon according to deed, and show street names and ind~ca whether i,~terior or corner lot STATE OF NEW YORK, ~ COUNTY OF ....... ..~..~..~.~..~..~.. ..... f S.S ............................ T,O~J.~l.e...~J~.~[l~. ................................... being duly sworn, deposes and says that he is the apphca. (Name of individual signing contract) above named. He ~s the ........................................... ~.~1~,,~ .............................................................................................................. (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and is duly authorized to perform or have performed the said work and to make ~nd fi this application; that all statements contained in this application are true to the best of his knowledge and belief; or that the work will be performed in the manner set forth in the apphcation filed therewith. Sworn to before me this ........ ~.~,,.~ ...... day of .... .S.l~.e,~]3(~:[' .................. , 19..?.6. ~_~_ ~ ~ . / Noto ........................ .......... County ...... ..... .............. ~:,~, ~ ~ (Signature of applicant) ELIZaBETh! ,~NN N[VILLE I