HomeMy WebLinkAbout8992-zNO, 4
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificnte Of Occupnncy
No. Z78~) ...... Date ............... AUgUSt...~t~., lg.
THIS CERTIFIES that the building located at Capt..l~.eld..Dr~.v® ......... Street
Map No. Capt' K~Edd' F~°ck No ........... Lot No, .1.11~ ....... l~tt~tuck. · .I~,Y~ ....
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ............ Nov' 22 '" 19. ~(~. pursuant to which Building Permit No.
dated ......... Deg...2 ....... , 19.76, was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is ...Pl'~,va.2e · one · l'ami].y, dwet[.:[ng .....................................
The certificate is issued to .. t~rl~le.~. -. P~i:LOs ..... 0wne~ .........................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval .. - Ju~y. · .~l. -$~. · -by. R,
UNDERWRITERS CERTIFICATE No ..... N3~ ...... AUg..~...~' ...........
HOUSE NUMBER ........ ~60 · · Street ..... Cap2-lii. ~d · 9rive ...... P~2tiiuek. ·
Building Inspector
~om~t ~.0. ~:
T°W OF
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 8992 Z
Dote ......................... .~.O..q ....... ~ ............. , 19.~7.~..
Permission is hereby granted to:
Cad,~a~. ,~ o~'~.~.t .h;~ ~...../~,/~-..- .k]~,~tt~&. ..~alios
......... 1'""~et'r~'l" ~d ............ 8o~zt h'gmp't on'"
to ..~r, iLd.,~ea~.., o~e,..ta~Z~b~;,,,~,~.,.i~ ....................................................................................
at premises located at .[LO~..~4,~ ....... ~a~..~.¢0.'~....~-~.t~ ...................................................................
............................................... (~p 4."~'J:&d'-'&"tt~i~ t'"~:z .......... ~at:t i't;uu'k ..................................
pursuant to application dated .......................~Ia~......$~. ............... , 19..~6., and approved by the
Building Inspector.
Fee $~3.,.~:.0. ............
',,,,~: ~:, :~.~THE NEW YORK, BOARD,,~OF FIEF iil~nFr~WPIT~i~q
~;. ' ; ;~[ ~ ; ? ~ F ; 85 JOHN ~R~E~' ~E~ORK'N W' ' ' ~ ,;;,~;, , r,'. ,, ..
..~. .... ~:= ~¢d~ ?~1~s ,~ ~w%~or.,:~gp~ ~ K~dd :Rd..: ~ ~Iniet~ ~d.~. Mattituck, L.I.
FOlt~ NOo 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
$outhold, N. Y.
-F~ I,~ -P 0 ~-- P ~ ~
Certi~icnte O~ Occupnncy
No..7_.~ 71l .$.~t.,, rate ................ .-4..~..~.x., .~..-1., ~977..
THIS CERTIFIES that the building located at .~..D.O....C/{~.- .7...Vi D.b....-~..~.~.. Street
Map No... t..'8.~. ~.. Block No ........... Lot No .... ./.g.~ .........................
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ......... ~....~..D~.., 19.7.~.. pursuant to which Building Permit No..~.? ?..~. ?
dated ......... .~)~C. .... .~...., 19.~,~.., 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 ./~...~..I.V. PtT.~...~)1~.£.. iZ .B.~{ .I .Ly...~..6H..~.L. L/.N...dry.. ....................
The certificate is issued to . ~...M..~. ~.~..~. ~ ..... .?.~..L.I ?..~. ........................
(owner, ~t)
of the aforesaid building.
~F~ b-.5o-o~o~. ,gu~7 2~. ~07'7
Suffolk County Department of Health Approval .~ ................... .~ ....? ....., ..
U~D~,aWRIT~.RS CERTImCAT~ ~o .......... i~.l.x! j3.,..~...r..,w. ..................
HOUSE NUMBER .... .,~i. ~.. Street ..... .~.~[~.T .... .15. !?? .... .~. :.~..~ 3./!S. ......
................................................ ~/.~...m. !-' !..T..u..c. !? ............
.......
Building Inspector
· OEM NO. S
TOWN OF SOUTHOLD
, Building Department
Town Clerks Office
Southold, N. ¥. 11971
APPLIGATiON FOR ¢£RTIFICATE 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
unusuaJ natural or topographic features.
2. Final approval of Health Dept. of water supply and sewerage disposals(S-9 form or equoI).
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 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 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 Building ~ Addition Old or Pre-existing Building Vacant Land -
Location Of Property 5> C~ c) C/~' ' ~.../.>.?.
Owner Or Owners Of Property .....~.'/?.'.7..~;(.~.i~.~.~. ......... ~ .z..~...~...~.~. .............................................
Subdivision ~TAI i'q I~l~ ~_~;~/~ TI S I~ No. ,.~.~:~..... Block No ............. House N~..... ........
................................................................... /,-' _
Permit No. ,.~...:.~...~..-Z Date Of Permit:. .Applicant ~z~ l_,, .% ~
................................... ....
Hea*th ept. Approval Dapt. Approva ............ .......................
Underwriters Approval .............................. ..,.;::>..,..,Planning Board Approval ....... .,~./..!~ .......................
Request For Temporary Certificate ........................................ Fin~ Certificate ..........................................
Fee Submitted ...... :..:. ...................
Construction on above described building and permit meets all applicabJ, e cedes and regulations.
~) ~ C~'~ -//
Apphcant ...... ;~..... :~-.Z.:....~..~.~.i ........ ~' .~.... .........................................
................ day of ............................................ (stamp or seal)
Nota~ Public .................................... Coun~ ~c~ /~ ~ O
· 'O~ ~Oo ].
TOWN OF SOUTHOLD
BUILDING DEPARTMIrNT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Ye
Exam,ned ......... ..... ..........
Approved ...........tsp~t..C.....~ ...... , 19.Z.~. Permit No..~..~.Z...~....~ ....
D,sapprovod.% .. ................................................................ I ........
(Buil~ng Inspector)
APPLICATION FOR BUILDING PERMIT
Date ........ ................
INSTRUCTIONS
0. This application must be completely filled in by typewriter o¢ in ink and submitted in triplicate to the Building
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 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 o 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 hove 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 removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in buildings for necessary inspections.
wi 1 .. /,;,
/ (Address of applicant) / ~ . .~/~
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or b~Jl~.~.
Name o¢ owner of premises. , .......................%; ............... :.; ...... '...=-. ....................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
/' / .~ </,.. /':'
Plumbegs License No., ................. ,~, ............................
Electrician's License No. '~.d...¢:..¢d ...... ,T. ......
Other Trade's License No .................................................
1. Location of land on which proposed work will be done. Map No.: ~.,,...~...;: ........................ Lot No....;z..z.~ ...........
Municipali~
2. Slate existing use and occupancy o¢ premises and intended use and occupancy o¢ proposed construction:
o. Exisiting use and occupancy
b. intended use and occupancy ................... ~ ........... .................................. :..~, ............ <.....~*...:.....; ......... ;-4 .............
I
3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ...............
Repair .................. Removal .................. Demolitior ..................... Other Work ...................................................
(Description)
4. Estimated Cost ..;..L.)~-.J.,..LL?..'CZ...:: ............................. Fee .........................................................................................
(Io be paid on filing this application)
'~)t / L~ , .... : ........................
5. If dwelling, number of dwelling units ............ :....~ ........ Numbcr al dwelling units on each floor
If garage, number of cars ? 1'/ ~' ~ /' z~, /, / ~ ~ '
6. If business, commercial or mixed eccupQncy, specify nature and extent of each type of use ............................
7. Dimensions of existing sh'uctures, if tiny: Front ............................ Rear ................................Depth ....................
Height ........................ Number of Sfor~es .............................................................................................................
Dimensions of same structure with alterations or addttions: F~ont .................................... Rear ............................
Depth ................................Height ............................Number of Slories ............. , ...................
8/" Dimensions of entire new construction: Fron~ ~ ~ Rear ............................ Depth
Height .... :~:t.~..~'~/,.. Numbe~ of Stories //" /' ~' ~:/~
9. Size of lob Front / ~J ~ ' [Le~n' / ' ~ Depth /
10. Date of Purchase ................ : ....................................... Name at Former Owner ':...C.&.~.~..r.:;t..:._~:...'..:..:.'..:..::..:.
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 ............................ Will excess fill be removed from premises: ( ~Yes ( ) N~
14. Name of Owner of premises .:-,:zz,~z'.z,/.a~..;,,..Z.¢'.'.~:.: ................. Address L....~....~.~..J;(.:.....~.~ Phone No; .~:. ...........
Name of A~d~itect ..... ~(.....~,Z.~..~.C::.:'.; ........................... Address'~..t~ ............. "':...:.:.:,- Phone No.'C:.':..:.~.::.::.Z(
~/ ~ , / ' ...
Nome of Contractor ~ /'/ , 4 . ,,.::....-:.,..,~, .~c ....... ~,, /; / /) ; , . /,,,.
.......................... z~adress ....: ........................... Phone No .......................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether exisling or proposed, and indicate all set-~ck dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate
whetlner interior or corner lot
STATE OF NEW YORI(
COUNTY O~
............................... ~.~.~..~.9~.~a.~ ..................... beh~g d,,ly sworn, deposes and soys tb~t he is the applicon,
(Name of individual signing contracf)
above named.
He is the ~n~
(Contractor, agent, corporato officer, etc.)
of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file
this application; that all, statements contained in ibis application are true ~o the bes~ of his knowledge and belief; and
that the work ~ill be performed in the manner set fo~h in the applicgtiop.filed therewith.
Swo n b fo e me q y/ . ,
..........................
· Suffolk , 'o r ~..
Nota~ Pubhc, . ............................................... C u ~ ................................................................................... ) ...........
~{~2 ' /~ ~ '~ z~ /7 (Signature of applicant)