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Home My WebLink About8936-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Ot~ice $outhold, N. Y. Certificnte Of Occupency No Z?~'00 Date ;an 28 1~.7... THIS CERTIFIES that the building located at Sot%nd View Road Street Map No. 0r~g. bX. ek No ........... Lot No conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... 0'~...~g..., 1~.. p~suant to which Building Permit No.~... dated ............ 99~...28..., 19~P.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is . P~lvate one family dwell~g with addition & Alteration issued ~s The certificate is issued to Joseph D~].o~ (owner, lessee or ten.t) of the aforesaid building. Suffolk County Department of Health Approval .~t .............................. UNDERWRITERS CERTIFICATE No. N3~1996 Jan2 ~ 't 977 HOUSE NUMBER ~ Street ,~o.~,(', Viow Road 0rien~ TOWN OF SOUTHOLD BUILDING DEPART/v~ENT TOWN GLERK'S OFFICE SOUTNOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8936 Z Permission is hereby granted to: at premises located et ................. - .................................................. Lo-'~ ~-/ ~ OiY~ uC '~" ~'ttE SbA pursuant to application dated ................................... ~.(..Z.....,,~.~ 197.E., and approved by the Building Inspector, Fee $..],,/. ................ Building Inspector TOWN OF $OUTHGLD Building Delm~tment Town Clerks Office Southold, H. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions Sw~ to before me this ............. Notary Public ~.~.~~.... County A. This application must be filled in typewriter OR ink, and submitted in triplicate 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 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 Building .................... Old or Pre-existing Building ,,.~ .............. Vacant Land ............................ Owner Or Owners Of Property .~.4~/~,~........~...~ .............................. , ............................................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval ,../.~,~,,~,,,~,,,~,.~ ........................ Planning Board Approval ........................................ R~-~_?st--F--o~m~,orary Certificate ..., .{.~.... ............................. Final Cediflcote ............................. Fee Submitted $'~- Construction on above described building and permit meets oil aPPlicable codes and regulations. 3. Nafur~'o~"work (check which applicable): New Building.. ................. Addition ......~ .......... Alteration .....~.~..',. ~ Repair .................. - Removal .................. Demolitior ..................... Other Work .................................................... (Description) 4. Estimated Cost ..~ ,9~.~[~,O.O .................................. Fee .................................................. ........................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ Jf 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 ....~.~...~. ..................... /iDepth ..,5.~.] ........... l-leight .......... .2...~..'. ....... Number of Stories ........... .2. ................................................................ : .................................. Dimensions of same structure with alterations or additions: Front .......... 2~ ..................... Rear ....... ;~O ................ Depth ........... ~-./~ ................ Height ...... .3.~.!.~!! .......... Number of Stories ....-[ ........................... 8. Dimensions of entire new construction: Front ............ ;~0. ................... Rear ..... 2,6 .................. Depth ..,..?.5. .............. Height ].2' 6" Number of Stories .................... ~ ........................................................ ~ ...................................... 9. Size of lot: Front ............................... ']0D.~ ................ Rear ........ ']O~D.~ ......................... De'pth ... 26,~,..~8 ........... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated .......................... .A.. ........................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ................. ,~ .................................. 13. Will lot be regraded . ........................... Wilt excess fill be removed from premises: ( ) Yes (x) No Soundview ~d. 14.' Nome of Owner of premises ...~.o..fl.e.~..~.....~..o...o,.]-...e.~.. ................. Address0~.~,[;' .................. Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor .C-.e. Qr~e...Ah'l.e. rA ........................... AddressCP%..T,a. .................. Phone No.?..]..LI:..,,5.Q.~.Q .... PLOT DIAGRAM C toho u.e, New York t_ocote clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions from property lines. Give street and block number or description according to deed, and show street.names and indicate whether interior or corner lot. STATE OF NEW YORK, ~c S COUNTY OF '"'"~tl~'~ ......... ~'~' .................................... ~l~lt~..~l~i',ll~l~ ....................... being duly sworn, deposes and says that he is the applJcam (Name of individual signing contract0 above named. He is the ......................................................... a~el3~...~o~..~13~.l:~i~3t, l~J¢ ....................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this o~plication; that oil statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .......... ',~,1~"' day of ............ (~¢1~111~ ............... , 19...~. Notary Public, . ........................... IBtl,££~.k ........ County (Signature of applicant) ago ~'/a FEE~ '[5' '!'°-°: BY NOTIFY BUILD[~iG, DEPARTMENT AT 765-1660 9AM '[O 4PM FOP, AEQUI~- ED tNSPECTIOMS: 1, BEFORE BACKFILLING FOUNDA- TION OA 5T~AT FAAMI~G , 2, BEFOAE COVEAING PIPELINE '~ 3. FINAL WHeN lOB COMPLETED I I L