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Home My WebLink About8895-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy No. 769~.g. ...... Date ............. g..~t~..e..~ ........ , 19. THIS CERTIFIES that the building located at .8~8. I01~ilaRQad ............. Street xx Lot No.xl~x 0~iela~ }IoYo Map No....xX. ........ Block No ....................... ~ .................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............... 0.~..~.. pr, lO..7.6, pursuant to which Building Permit No..8..8.9..~.. dated 0e~; }t- 1976 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 ...P.~i. Ya~e. a~.~.~ s. ~9.~.y.. b.u.l.!d .~.g..w.i.~. l~..~.~.~, o .i~A~. ( ~.~;~b~,.e. ). ............ The certificate is issued to . .D.~Y.l.d...&..~.~8~.e..~. ..... ~eI'.lt ............ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval 1~?.~ ................................ UNDERWRITERS CERTIFICATE No... ~33.~.~.~. ..... .~lay... ~... ~ 97.~. ............. HOUSE NUMBER ...... ).8.~.0.0.. Street . .Yl.~.i?,...~p.~... Ox*i.e.~.~; ................. TOWN 'OF BUILDING 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? 8895 Z Permission is hereby granted to: .... .~..~ ...uT..e.~ .~...e...~.:...~.~a~r~e.~. .............. .............. ~-~..~o~d ............................................ Orient Fo .....~:.a.~.z..~.. ~ .o.~..e. ~.~..o.~..( .~.~.~.b. ;ko. L.l~.~;1,c~ ~ .....~.. ~.en~ ~ ............................................... at premises located at .,~/.~..~,~O..~O~ ........................................................................................... .................................................. 0.~.~ ....... ~L ................................................................................ pursuant to application doted .......................... .~.~.~.......~. ................ 1c)..~.6., and approved by the Building Inspector. Fee $ Building Inspector TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, 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 dispasal--(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 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), Nan-conforming uses, or buildings end "pre-existing" land uses: 1. Accurate survey.of property showing all property lines, streets, buildings end 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 $5.00 3. Copy of certificate of occupancy $1.00 New Bqilding .....~...~ ....... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Property .....¢....~........'~...~.~.....~...~.. ................... "~P ~/P ~~........~.....~.-~2- _..: ........ Location Of ~ner Or ~ners Of Prope~y . ~ ~ Subdivision ................................................................ Lot No ............. ~MBI°ck ~o .............House No ............. Health Dept. Approval ............................................ Labor ~pt. Approval ................................................. Unde~riters Approval .......................................... Planning B~rd Approval ........................................ Request For Temporaw Cedificate ........................................ FinQI Certificate ~ Fee Submitted '~ Construction on obove described building and porm~meot~ ~ .9~c~ble c~ ~nd ~ulotion~. Applicant ............. . .......................... Sworn to b~fore m~ thi~ ....... ...... ~oto~ Pu~~ ......... Coun~ THE NEW YORK BOARD OF Fire UNDERWRITERS dp(' .. ' , ~- ' ' BUREAU OF ELECTRICITY ~ I ~Y~ 27,'~]1~.77 ' I ~5 JOHN STREET, NEW YORk, NEW YORK 10'038 913575 DaZe Application No. on file ' ' : ' N 339264 : e~'" David .Bra~He~',.tocaiion; .:[] BasemeniS/Sieem MainFi; ~]Rd'' (Back 250 Ft .').. Orient. L. I. tt. e a_llowing 1st 2nd Fl. Section alock Lot vasexaminedon May 19~: 1977 - ;].I at~dfoundtobeincomptlaacewithtaerequire,neatsof;hlsBoard. Theodore-R Orient, N. y'..ui '11957 . , - ~ I: 'Li'c;:~608E This certificate ~sf not be mitered in any manner; return to the office of the B~ard if [ncor['ect. I~sl~ectors may be GENERAL MANAGER credentials. Disapproved a/c .................................................................... APPLICATION FOR BUILDING PERMIT TOWN OF SOUT. ?_ BUILDING DE,P,A. RTM,'~I L~ TOWN CLERK $ OFFICE ×am,ned ........................................ App,,ca,on ......... ............................................... rmit No ................................. INSTRUCTIONS This application completely filled in by typewriter o~ in ink and submitted in triplicate to the Building~ must be 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 public streets or areas, and giving a detoffed description of layout ofproperty must be drown on the diagram which is part of this opplicetion. 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 o 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 applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for remova or demo ition, as herein descr bed. The applicant agrees to comply with all applicable laws, ordinances, building code,~hous ng code, and regulations, and to~ admit authorized inspectors on premises and in, buildings for necessary iys~pectior~ 4 J- ,~ ......... i'"g' ~" ;~ o~"~'p~ii~c~r~I ~r '~'~'~"i~"~"~';l~'~';~'~i~i ........ ..... ...... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... i..~.~...C~.'g..~.~..~'......[.~....~....~.i.'~....¢~...~...~..~...~..~.:....~...Z.~...~....~...~....k~.. ................................. applicant is a corporate, signature of duty authorized officer. (Name and title of corporate officer) Builder's License No .......... .?...'~ ................... Plumber's License No ................................................. Electrician's License No ....................................... ' ...... Other Trade's: License No ............................................... k/.~ . 1. Location of land on which~pr, oposed work will be don~ Map No ......................... Lot No ~(x Street and Number ...... ,5~,'5..~..._[..~ ~..~.~ ..~..& ~ .......................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .....~...~...~...~...ca.~ .~.' ............................................................ .......~..~. ..... b. Intended use and occupancy ~v~ '~- ~\ LocQte clearly and distinctly all buildings, whether existing property lines. Give street and block number or description ac whether interior or corner lot. 3. Nature of work (check which applicable): New Building......~.....-.. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 3r o ..................................................................... 4 Estimated Cost ............................................................ Fee (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, specify nature end extent of ea%h type of use ............................ 7. Dimensions of existing structures, if any: Front .......~....'. ..... Rear ........ ~ .............. Depth ....~ ..... Height ...... ~.~.'... Number of Stories ..... ~ ...................................................................................................... Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... 4.Z ...................... Rear.....4.~ ................ Depth ..,6,~ ................ I?' 16" Height .................... Number of Stories ....... ~. ............................................................................................................. 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ..... .~.~..~.~...../...~..,./..~.?'...~.. .............. Name of Former Owner ..~_.1~,.~.(~-~¢,~,~-..9..~. .............. 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 regraded . ......... ,~..0. .......... Will excess fill be removed from premises: ( ) Ye~ ( ) No 14. Name of Owner of premises~'~ffm:.~...N:...~.~.~.~.~.~:,..~..~...~..~..~...~. Address~?.~,.~...~.~.../~..~:~...~hone'/ No.4~...~.~'.~..~ .... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM and indicate all set-back dimensions frorn 'cind ~how street narfl~ indicate ?i .......................................................................... (Nome of individuQl signing contr~cf) above named. He is the ........................................................ ..] ............. ~ ............................... ~ ................................................................ (Contractor, agent, corpor~t~, etc.) of said owner or owners, and is duly authorized to perform or ..~ve performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge one,belief; and tha~ the work will be performed in the manner set fo~h in the application filed therewith. Sworn t~ me this _ ........... ....... .......... .................. ~ ...... {IIOlTH T BOK[N/~(~( ' (Signature o appucant)~ Ope,,, At~te -'~w~ F~o,~','- ./