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Home My WebLink About8928-zFOItM NO. 4, TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupency THIS CERTIFIES that the building located at Flee.t .lleek. Road. Map No. ~ ......... Block No.. ~ ...... Lot No, -~X..CU~hO~.. N.,~, ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. QC~...20, 197g.. pursuant to which Building Permit No.. dated ............... 0e~...2~, 19~., was issued, ~d conforms to ~1 of the requff~ merits of the applicable provisions of the law. The occupancy for which this ce~ificate is The certificate is issued to .g~9~ .&. ~$1e. Ethel .... ~er~ ................. (owner, lessee or ten~t) of the aforesaid building. Suffolk County Department of Health Approval ~...~3...~77~..bY. ~*. Villa ..... UNDERWRITERS CERTIFICATE No. ~ ..... ~..~. ~,~ .................. HOUSE NUMBER ..... ~.~0 .... Street .. ~q~. A~. (F~e~. ~.e~k. Rd). C~aho~e Building Inspeeto~ BUILDING FERI~',IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8928 Z Permission is hereby granted to: c~...u.~.~.~.~.~.c..~...n.~.~t.r.~..~.c..~..~..~.~/`c~.`~...~....~..t.~t~e! & wt~e ................... · ~,0 .... ~ ·...B./ely~t~..P~ %h ....... Belden to ~m.~.,l~,. ~e,a., o~e...z?~./,ty...d~e t.Z...~ ...................................................................................... at premises located at ..WZS..~.eq,~sh...~e.,.../,Fle~t,..31k..]l~t) .................................................. .................................................. .~.c.h.o~z~. ....... I~,;~, ........................................................................ pursuant to application dated ......................01~.t~ ....... ~.O .............. , 19,,,~,(},, and approved by the First £1oor on~y Building Inspector. Fee $....Jt'.~..= ~.0 ......... ,THE NEW YORK BOARD OF,EIRI , ,i, ~, ,. , ~ March 10,~, =~ =~ 'SERVICE 'D SCONNECT - ' ;5 Dennis Boyd : Sterling Rd. Cutchogue, N.Y. credenliaJs. TOWN OF $OUTHOLD , Building Depu~tment Town Clerks Office Southold, N. Y. T1971 APPLICATION FOR CERTIFIGATE 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, 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 buildings, AAultiple 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. I~. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey*of property showing oil 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 o 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 Date ......................... ............ New Buildlng...,.***........~' Addition ...***,*******.. Old or Pre*existing Building ................ Vacant Land .............. Location Of Property .......... f.~....u~',..~.,~.~.~.....,~.~ .......... .(~...~.~..~'~..~...~...~.~...; .................. Owner Or Owners Of Property ...~.~..~'...~...~.~....~..,~.....~-. /~.¢~,Z~/.~.~...: .~.Z. ...................... Subdivision ................................................................ Lot No. ............ Block No ............. House No ............. Permit No..~...~.~..~..,~ Dote Of Permit..C~...~../~.~/.~.~./,'.~Applioant ...~..~'.,~..~'~.~.'.~'.~'~'.~.~/-~..~...L~..~-~.... ...... Health Dept. Approvo ..~..Z..~...~./...?..~.. Labor Dept. Approval ......................................... ( Underwriters Approval ...~'.. .................. .5 ........ ~'.~./7~Plann.ng Board Approval Request For Temporary Certificate ........................................ Final Certificate ......... ~ ........................... Fee Submitted $ .....~.'j...~.....~... ............... Applicant · · ...~.~..~.~.,,~...,,-~-.~;~r~..~ .......................................... Sworn to before me this ....... . .~.~... day of ...~....~.~...~...~.. ....... ,stamp or seal, ~~0( Nota~ Public ...... ~ Coun~ TOWN OF SOUTHOLD ~z /~_ ........................................ ' ............................................ A~ Disapproved a/c .................... ~ ...................... ~ ..................... ~ ~t~d~ ...................................................................... ~.._~~ ............ ~~ _ APPLICATION FOR BUILDING PERMIT . INSTRUCTIONS ~. This appiicat~on must be completely filled in by typewriter or in ink and submitted in triplicate to the BuilSing Inspector, wit~ 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, an giving a detailed description of layout of property must be drawn on diagram which is part of this aoghcation. 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 the premises avadable for inspection throughout the work. e. No building shall be occupied o¢ u~Sd in'whole or in part for any purpose what~ve'r until a Certificate of Occupancy shall have bee granted by the ~ilding Inspector. APPLICATION I~ HEREBY MADE to the Building Dep. artment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffotk County, New York, and other applicable Laws, OrdinanOes or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply w~th all applicabte laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections~,_~ (Signature o( a~plicant, or name, if a cor~oration~ {A~ress of ~plic~nt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · .. .. . .. Name of owner of premises ~ , ~ , - ~ If applicant is a corporate, signature of duly auth~orized officer. ............. . . ,e. . . . ./¢,. ,. ........... (~ame and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: .................... Lot No ............................................. Street and Number ./....~..~.~'.?..~.~! ...~...~.. ~ ~.~./,.. ........................................ ..~.~,.,..~f-.....~.,'.-~,.~../~,~.~..i .............. w~un c pal tV 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . ~,~....:.:...~ .................................................................................................. b. Intended use and occupancy ........ ./......~/~..~.~......¢~.....~.~...~'~(./.././.:~.~. ...................................................... ,3., ~ature of work (check which applicable): New Building ........ ~..~..... ...... Addition ..................... Alteration..., .......... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated ~;ost ......................... ~.../. ................ Fee ............................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units.................f 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. 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 ...... ~....~.. ......... Rear ....~.~.'..~.. ............. Depth ...~....~.. ..................... Height ......... ~....i ............. : ................... Number of Stories ........ ~ ........................................................................... 9. Size of lot: Front ...~../~"~ . Rear ..... //...,~.~ ............................. ~ ............................... Depth ....~.~.. ......................................... Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. 12. 13. 14. Zone or use district in which premises are situated ..................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation: ........ ~.~. ........................................... Will lot be regraded ..................................... Wi)l excess fill be removed from premises: [ ] Yes [~'No Name of Architect .................................................................................................................... .~._~....'.__..~....~}..../...'~..... (Address) , (Phone No.) ~ Name of Contractor .~.~.~...~n~:~:~.~.~.~..~.~./~..~..:~..~ ..~.~ -- ' (Address) '-- ' (Phone ~ PLOT DIAGRAM '. Locate clearly and distinctly all b~il~lings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner Int. STATE OF NEW YORK, ) SS ~i COUNTY OF ...................................................... ) .......... · ~,..~..,~~ ................................ being duly sworn, deposes and says that he is the applicant above named. / (.~ame of individual signing contract) jt ' ~ ' ....... ............ ..................................................................... of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all ,;tatements contained in this application are true to the best of his knowledge arid belief; and that the work will be performed in the manne~ set forth in the application filed therewith. Nn,ary ¢~blic ...................................................................... County .... ~~~ ................................. / (Signature of applicant) , ~N FO~: 10 APPLICANT: ADDRESS TEL ..... NOTE: · -'MOIVUMgNT R£:V'I~IONEt UNAUTHORIZED ALTERATION OR A(~ITION TO THIS ~[JRVEY IS A V~OLATION OF ~ECTION T209 OF THE NEW YORK STATE EDUCATION [_AW COPIES OF THIS SURVEY MAP NOT B£ARtNG YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W, YOUNG FOR: KENNETH C, ETZEI ~ LUCILLE M, ETZEL ~ CUTCHOGUE oF SOUTHO£D SUFFOLK CO., N.Y. GUARANTEED TO: SOUTH OLD SAVhV~S BAI¢~¢ TIT~ INSUf~AfVC~ CO C. E; LUCILLE M. £TZ~L 998