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Home My WebLink About8890-zFO~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, BI. Y. Certificate Of Occupancy No.2[~.330 ....... Date .... ~cto. ber 2~ ............ , 1976.. THIS CERTIFIES that the building located at . ~[/.$. hain. l~ad, .......... Street Map No..~43[ .... Block No. Y,-~,~ ..... Lot No, . J~X ........................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .. Septembel'..~0~. · , 19.?/6. pursuant to which Building Permit No. ~90Z. · dated . Septemhe=..~Ot .... , 1976.., was issued, and conforms to all of the req~]ire- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is .. ~ .¢az'..garm~e .... Aeeo~s~ry bu~.l~llng ........................... The certificate is issued to . .,T. t~r~ .Si~oieh- -;~r, ............................... ~ ( owner, l~z~t) of the aforesaid building. Suffolk County Department of Health Approval ~/.R ........................ UNDERWRITERS CERTIFICATE No. ~29~.]21~ ................................... ]lOUSE NUMBER ~.6815;. .. Street .~4~iu .Road, .. ~qouthaid,. ~..Y .......... Building Inspector FOBM ~TO. 2 TOWN OF SOUTHOLD BUILDING DEP,~,RTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE' PREMISES UNTIL FULL COMPLETION OF THE WORK AL_UT?ORIZED) N? 8890 Z Permission is hereby granted to: ~m; '~ ~:~' .... ~' ~' ~" - ~ ..... -q~.~- ~0 .... , 19..~.0.., and approved by the ~z,~?fx_, gu~suant tc~ ,appycanon aatea ........ : ................ v'~'"'~, ......... FOI~M NO. 6 TOWN OF $OUTHOLD , Building Department Town Clerks Office Sou*hold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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, and unusual natural or topographic features. 2.Final approval of Health Dept. of water supply and sewerage disposa! ~ (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 and installations, a certificate of Co~e compliance from the Architect or Engineer responsible for the building. 5.Submit Planmng 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 / _ .... ./..' ./... ............. B, I /' Owner Or Owners Of Su, bdivJsion ..... ./..(~ .................................................... ~- Block J~o ............ House Health Dept. Approval ............................................ Labor Dept. Approval ............................................... Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificate .......................................... Fee Submitted $ .................................... Construction on above described building,~ p~;t ~; ;l~,~ap~p~b~ode~r regulations. Applicant ... ,4~:~. ~..~. · ~ ~ .~.. · ~'. h ......................... Sworn to before me this ~- - / - Rr~ ~/~ Notary Public .................................... County //~O/~,/~ ,,,~?./ /,Iv, Z EA3, I SLA.¢} Dr:.n lZi :~GN'JW,~ N"¢ THE -NEW'YORK BOARD *OF FIRE -UNDERWRITERS *' BUREAU OF EL~T~IGI~FY --~T $~ ~HN ~ET, NEW YO~ ~W YORK I00~8 '"'"' ~u us~ ~,,...~-,~ ..... ~*~ ~lSa2~ N 297124 CERTI~THAT 6, 1976 THI~ John SimiCiC, Hain ~., Southotd, t..I, TOWN OF SOUTHOLD (,.~'. (,,~....... TOWN CLERK'S OFFICE ~OUTHOLD, N, Y. Examined ..... ~...L.~.~ ...... 19"'~'"~"r'-)/ ~*~-- Applicat,on No. ~..~ ........... ~pr~ed ............ ~.: ......... .~.~ ........ , 19.~?.. Permit No. ~....~,.~...~ ...... ~ ui ~in~ mspec~¢r~ ...... , INSTRUCTIONS a This applicat,on must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi, Inspector, with 3 set~ 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 detailed description of layout ofproperty must be drawn on the d~agram which is part of this apphcatio 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 pern 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 Occupan. shall haw.~ been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances 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 taws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and ir~ buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of appl leant)/~ 7'7- / 'T'u c State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build~ .............................. ................................................................................................................................. Name of owner of pram,sas ............... ~...~.Z~.....~...~ ................................................................................................. I f/?1~, c. lnt I~. c~o~. ~ ~or.a~te~, ;~gn~. of du~ authorized off lcer. ....... ........ (Name and t,tle of copbrote officer) Builders Lic~se No .............. ..~LM: .............................. Plumber's License No ............................................ ~ .... Electrician's License No ............................................. Other Trade's License No ............................................... ~ 1 COC~i~n O{ I~nd on which pr~ose~or~ withe don~ M~p~o ............... ~..~ ............... kot ~o ....... [ .............. ........... ........................................... Municipali~ 2. State emstmg use and occupancy of premises and in*ended use and occupancy of propased construction' a Ex,siting use and occupancy ..................................................................................................................... / - 3. Naiure of work (check which apphcable). New Building ................ Addition .................. Alteration .............. Repair .................. Removal .................. Demolmor. .................... Other Work .................................................. (Description) 4 Estimated Cost .........../.h ....~....~....C)... ?...O....O.. ................. Fee (to be paid on filing this apphcat~on) 5 If dwelling, number of dwelhng units ........................... Number of dwelhng units on each floor ....................... If garage, number of cars ...................... /......~?:rC~. ......................................................................................... 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ......................... 7 Dimensions of ex;sting structures, Jf any' Front ....................... Rear ................................ Depth ................. Height ........................ Number of Stones .......................................................................................................... Dm~ensions of same structure with alterations or addmons: Front .................................... Rear ...................... Depth ................................ Height ........................... Number of Storms ................................ 8. Dmnensions of ent,re new construction: Front ...... o~.~....~.../~.. ............ Rear ....... ~...O...~....'~.. ..... Depth ...,~...,~....~...7~. Height .....~....~.~...~... Number of Stories .................... .~. ~...C~. ....................................... 9 S,ze of lot. Front .... /../.2,...~....~......~...~.. .................... Rear ...... /...~...O.. ...... ..~.....'~... ......... Depth ....~...~....~.....?....~..~. 10. Date of Purchase ........ .~.....'~.....~.~....-;....~.~.... ................. Name of Former Owner ...................................................... 1 1 Zone or use district in which premises are situated .............................................................................................. 12 Does proposed construction violate any zoning law, ordinance or regulation ....... .~.O... ......................................... 13 Will lot be regraded ............................ Will excess fLII be removed from premises: ( ) )'es (4-"Y No 14 Name of Owner of prem,se~.f~.~.~f,.~.~;. Address ....~.~Phone No.~..~'...~.T..?.Z.~.., Name of Arch,teat ................~ ................................ Address ii~]]]i]i Phone No. Ncme of Contractor ........... .,~/w~-.~ ..................... Address Phone No. PLOT DIAGRAM Locate clearly and d,stlnctly all buildings, whether existing or proposed, and mndmcate all set-back dimensmons fro, property Ihnes Gwe street and block number or description according to deed, and show street names and indlcal whether interior or corner lot STATE CF NEW Y~:~./~,~iL,/~ ~ c S COUNTY OF .... ~...f ~' ................. .~...~.~..~..~..~...~..m..~.~...z...~..~.. .......................................... be,rig duly sworn, d~oses and says that he is the apphca (Name of indiwdual signing contracO above ~ ~.~. named He ~s the ....................................... ~~ ......................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and ~s duly authorized to perform or have performed the said work and to make and f~ this application; that all statements contained m this apphcation are true to the best of his knowledge and behef, that the work will be performed in the manner set fo~h m the apphcatiog filed the~th. Sworn to before me this ~ /. / /~ , / / .............. ....... ....... .... , ... /i Y · /// ~' - , x ( ~ ~)~ ' ~ - / J (S,gnature of applicant) ELIZABETH ANN N~VI~ ~ / ~ARY PUBLIC Stat~ cf Ne~