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Home My WebLink About8930-zFO~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPAHTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z7~.6.~. ...... "Date ............. ~..1~. y.....6 ...... , 19.~.~.. THIS CERTIFIES that the building located at . ~a.llg~.e..z..D.~?~ .v.e~ .R..o.~9..I,..a Street Map No.. ~ ........ Block No... :~ ..... Lot No, ...:~.....~.~..~.~.~.~..~.~.k...g. ?.~.~. ....... conforms substantially to the Application for Building Permit heretofore filed in this office 3973Z datedT/2~/6.8...~)..e.~..~.~ ..... , 19.7.6. pursuant to which Building Permit No. -8930Z. dated ............ .0.~.~... 2.1..., 197.~. ., 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~..v.a.~.e..a.o.c.e.~..~.o~'.~...( .~.~.o.l~..a.g?.)..b.~.~.~.d.!n..g.. ?.~;.h. ??d.d.~?.$.o..B ........... The certificate is issued to . I,;t, ll~...D, ah~,~'~g~. $ ...... .0..wng.~ ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approvall~,B., ................................. UNDERWRITERS CERTIFICATE No. }t,R, .................... HOUSE NUMBER .... 260. ~..ROse..I~8 ........ ~a~g~,.~ll*k ............. Building Inspector TOWN OF SGUTHOLD BUILDING DEPARTMENT TOWN GLERK'$ OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8930 Z Permission is hereby granted to: Clarenc.~.. Item......~ ./.C.. Lila.. Da~u~e r. ............... ......... 53.....~.......P.~.~.k..~.v.~ ~.....RQck.vllle...Centre at premises located at ....~.../..~.....~.~.~.~.~.,~..]~.~,~.*~.e ................................................................................ ................................................... ~.~.~.u..o...k. ....................................................................................... pursuant to application dated ......................... ..0.9..~..-..~...~9. ...... , 19..~.~.., and approved by the Building Inspector. Fee $..'J..O.~. ~.~ .......... Building~spect°r/ ', 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 disposal--(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 installations, o 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 end "pre-existing" land uses: 1. Accurate survey rof property showing all property line~, 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 Date Y .~ ~ .......... ~ ..... /. ....... ~ ............ New B~ilding ................ Addition[~..~..~'4~OId or Pre-existing Building ................ Vacant Lend .............. Location Of Property ....... /~........~.~.~....~.~.~.~....,j~...~.j....~ ...... ..f~...~.~..~..~..(2..C../..(.. ........................................ Owner Or Owners Of Property ..... .~...!.~.~.... I~..~IL~.~.J.~...~.~:~..I~. .................................................................. Subd'"v,s,on . Lot .... ... Bilk ~o....~ ....... House No ............ /, ~ ~.~.,, ,~--.~ Permit No. Dote Of Permit ..Jl. hApplicont ...~.{.~.~....~.~.,.5.(.~.'..~. ............... Health Dept. Approwl ..........................~ ................. Labor ~t. A~mval .... ~'- ~ ~ Underwriters Approval .................... ~;...~.; ............. Planning B~rd Approval ~ ~ Request For Temporaw Ce~ificote ........................................ Final Ce~ificote Fee Submitted $ .................................... Construction on above described building and~ermit meets all applicabl~ codes and regulations. Applicant ..~..... ~..~ ......~....~ ~..C.~ ............................... Sworn ~,~efore me' ,~,~)~ L) ~ ..~/~,_ .......... of .... //77 .~~ ........::~1..~1:~ (stamp or s~. /~/, ~ot~ Public FOUM NO. 1 TOWN OF SOUTHOLD BUILDING Dt:PARTA4i:NT ~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. INSTRUCTIONS Application No ............. 0 Date O.e.~.~ab.~. _18., ....................... 19..7..~. ..... a. This application must be completely filled in by typewriter or~ in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plgt plan to scale. Fee according to schedule. b. Plot plan showing Iqcation of Iht aqd of buildings on premises, relationship to 6djoining premises ar public streets o; areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. 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 a 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 th~ 'Building Zone Ordinance of the Town of Southald, Suffolk County, New York, and other applicable Laws, Ordinances oF Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described~ ,The applicant agrees to comply with all applicable lows, ordinances, building code, housing code, and regulations, and to ".~dmit authorized inspectors on premises and in buildings for neces~nsped, ions. ~..~. ..O,... ....... ...~... ~..~... ~.~' ..~....;~. ...... (Signature of applicant, or name, if a corporc~ion) ..... ............................. (Address of applicant) 53 No. Park Ave., Rockville Centre: N.Y. Store whether applicant is owner, lessee, agent, architect, engineer, general contractor, eJectrician, plumber or builder. ...................................................................... ................................................................................................................. Name of owner of premises ....... .~...I...~,.....~..A..~.][~.~I'.(~ ........................................................................................................... If applicant is a corporate, signature of duly authorized officer. Tax description ~ School District #9-Town South~ (Name and title of corporate officer) old~ North of Mat~ituck Builder's License No ................. ,,N,O,.~,,,E. .......................... Plumber's License No, " Electrician's License No ............................................. Other Trade's License No. N x Naugles Drive E x Davison ~ s x P. Klymko /~o~ W x Lindsay-Suglia Location of land on which proposed work will be done. Map No.: ...... ..N..O...N.E. ........................ Lot No....~Q~T.~ ........... Street and Number ~.q..#...l~.~l~g~,.~..l~r,J,~.e,...i,,~..~.~,~.~b.eg...~.~.). .............. ~9,.¢.t,;~$.~1.c.:(¢ ................ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .....O..t...~..];..J...t.~.....~..t...o.~..~.~.e.. ........................................................................................ b. Intended use and occupancy ....U..t...i..1..~.t..y.....S...t..o...~.?...g..e.....~.../..~....~...~/'n ........................................................... 3. Nature of work (check which applicable): New Building'. ................. Addition ......~ ......... Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work .................................................... ? (Description) 4. Estimated Cost .......... ~..5...0..0..:..0..0. .................................. Fee ..Z ..................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling unitsU~.t..~v~e, lZl.£ng..Number of dwelling units on each floor ............................ if garage, number of cars ~O. ~?,7~,F~e. .............................................. utz~zty 6. If business, commercial or mixed occupancy, specify nature and extent of each b/pe of use .~,.~.O.~.~J~f~ .......... 7, Dimensions of existing structures, if any: Front .....1.~....f..t..~ .......... Rear ....... ~..2....:¢..1[;,, ............ Depth .....8...;[.~ ...... Height ......9.....f...t..: ....... Number of Stories 1 .... .......... Dimensions of same structure with alterations or additions:,'F~ont ....... ..2..0.....f..t;.: ............... Rear ....,2.,q...z"...t..: .......... Depth ...... .8....~..t..~ .............. Height ....~.,.3.....~., ......... ¢.Number of Stories ........ ~[ ...................... 8 8. Dimensions of entire new construction: Front .............. ~.~;.* ............... Rear ........ ~..;¢.~ ........... Depth ....... f~...~.t:., ...... I-[eight ..... .1..3,....~..~,:. Number of Stories 1 ............................................ 9. Size of lot: Front ..... ~.0,0...;['.~ ..................................... Rear ...... .1..O...O....~.,t.,: .................... Depth ,...3...]...4....~..t..: ............. ~0. Date of Purchase ...A..p..r..,~.l.....5..~...1.,9...7,.~ ...................... Name of Former Owner ...~Z~.eS...~.Q],.],~?~ ................. 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 . ......N~3 ................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ..LJ,,l~..JQab, lSzH~r. ................ Address .9./...o...~.^~.o.~9.~.~,.. Phone No. Name of Architect ...................... .N...O.~.E.. .............................. A~53..,.N..:....P..~,,k..A..v..e..: Phone No ....................... Rockville Centre,NY Name of Contractor .................... .N.,.O..N..E.. .............................. ~ ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorn property lines. Give street and block number or description according to deed, and show street names and indicate , whether interior or corner Io~. STATE OF NEW~ ¥O,..,R,~, ,~ ~ ¢ S CO N ¥ .......... .......................... ~ ............................. ~ ................................. = duly sworn, deposes ~nd says that he is the ~ppHcam (Name of individual (signing contract) ~bove n~ed.. ............. ~ ~ . .. He is the ......... ~ ................ (Contr*ctor, o~ont, corpor~to officer, otc.) of s~id owner or owners, ond is duly ~uthorized to perform or have por~brmed tho s~id work ond to m~ko and file this opplic~tion~ that ~11 statements contained in this ~pplicotion oro true to tho best of his knowlodOo ond that the work w~l~ be porformod in tho m~nner sot fo~h in the op~lic6tio~iled thorowith. Sworn to b~e me this ~ / ~ / ) ~ / ~ ~ ~U~IT~ r ~OKEN~) ~/ [~ignarure ot oppHcant~ N.~tJ~L E-~ DRIVE' W/LL I,4t~I ,I~ ,ZltVtV,4 ~£T TE'AtI~ORF APPROVED AS NOTED DATE: d-'x~"l' /_ ~ ~ '/,,---'~ FEE;,~Y~.~'--_...~/.~ B~..,.~..~ B~ ~/. NOT~FY BUILDING DEPARTMENT r55.2669 9AM TO 4PM FO~ REQL4~- 3z-O~.E BACKFILLING FCUNDA- : ;ON C?~ bTART FRA~,, lNG L, ~fxO&.: COVEEING PIPLLIN~ ~ FIFM, L WHEN JOB COMPLETED '7