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Home My WebLink About9003-z FO~ ~o. ~ TOWN oF SOUTNOI. D BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTH'OLD, N, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 9003 Z Permission is hereby granted to: ............. (~.~ ............................................. ~o ...~..t..z.~...~.e..~....°.~.~....~.t..z.Z ~.~.e..z..z...t.~ ................................................................................ at premises located at ..... .~...O..~.....~.g~. ....... ~..~..o..e...~.....A..o.?...e..~ ....................................................................... ........................................... ~/.~f~.ee~w~yi.~st ............ O~.ie~. ................................................... pursuant to application dated ......................... ~).O~.....'t ................. , 19....~.6, and approved by the Building Inspector. Fee ,..~..e......e.~ .......... (one floor only) FORai NO, 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. ~EI~PORAR~ Certificate Of Occupancy No..~.6~ ..... Date ............. ~.lll~e ..... 2 ...., 19..~.~. THIS CERTIFIES that the building located at . ~e®~ay. ]~as~ ........... Street Map No. I~Z'~.el~./~.e~Bloek No ........... Lot No.. 23....0~:~®lt~..B.o~, ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. Dca .. 1.., 19 .~. pursuant to which Building Permit No..9.00~.. dated ............. l)e.~.., 9.., 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 .. P~l~'al;~ .one..f~,~i3,y..d~c~.].il~g ...................................... The certificate is issued to . .0. ~;~¢~..&..¥~Z'& .1~t~0~ ....... 0¢~rl~ ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . UNDERWRITERS CERTIFICATE No..~..~.~.l~.lg ................................... HOUSE NUMBER ..... 223.0 .... Street.. 0~.~zl~ty..[&~.l; ....... 0l':l.e~t; .......... FORM NO. 6 TOWN OF SOUTHOLD Building Deportment 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 triplicate to the Building Inspector with the following; for new buildings or new use: ]. Final survey of property with accurate location of oil buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage dispcsol--(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 end installations, a certificate of Cocie 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: ]. 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 3. Copy of certificate of occupancy $1.00 $5.00 Date ...~./~.~ ./. 2,7... ...................... New Building ..... ~ ........... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ~//~Z~r~....~'J~,3r.~..~c~,~.. ................ ~.~-.~ ................................................... Owner Or Owners Of Property ..~J..~....",~.....].~,~z~....~...~.-:~ ............................... Subdivision ................................................................ Lot No..~,~... Block No ............. House No ............. Per m it N ~ ~.~-.~ .~ ,~te Of P,e rm it/,.~7~.'/~.~;'.. LA{pp licant ;~-~ - ,~./~.///////~-. · · .~ ................ Health D p. App ov .7.,/~,~/..~..:2. .................... obor Dept. Approvol ................................................ Underwriters Approval .............................................. Plonning Board Approval ........................................ Request For Temporary Certificate ........ ~...~....~... ............ Final Certificate .X ..................................... Fee Submitted $ .....~..~.. ........................... Construction on above described building~,~J~ permit meets all a~plicable codes and regulations. Applicant ~ .~. ~,~.~ ................... ............................................ Sworn to before me! Notary Public ...... ~ (stamp or seal) 3. Nature of work (check which applicable): New Building......~.] .......... Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work .................................................... .~:,oZ,_ ~'-- (Description) 4. Estimated Cost ':...~.l..~..~4Z.~.,..~O. ......................... 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 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 ....... ~Z'..,/, ..................... Rear .....,~.~..Z'.. ............. Depth ...~.~..'~.. ......... Height ...... ./..~., ........ Number of Stories .......... Z..'.~ .................................................................................................. I 9. Size of lot: Front ........... /.~..~....i ............................... Rear ........... J..C~.6.~ ........ ~ ...... .?.. Depth ..... 4'...~ ..................... 10. Date of Purchase ........................................................ Name of Former Owner '. ....................................................... 1 1. 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 ( ) No 14. NQme of Owner of premises f~4~-/~./~/?~..~..k'~'/~'.~.~...~'411K/~.u.~'~/. AddressB4~fl~AY.~.~.6~.X../!~'.. Phon M,,,R/.Z,3.~t Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ~:4L~.~.4/~.4e.~,L~.A./,~-.~'.5 ...... AddressC.'.~:~Cg~-/,c./,D. .......... Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, 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 whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ....... ~...~...~.~¢. ....... ~'~ .......................... .~,.,~.~..~......[/~.....~.~.~..~'.q~ .................................. being duly sworn, deposes and soys that he is the applicam (Name of individual signing contract) above named. He is the ............................................. ~.eJ.e..n..~...~.e..~.....g.9.n..~.~g..~....~ ................................................................................ (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 application; that oil statements contained in this application are true to the best of I~is knowledge and belief; and ti.at the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ............... .~.~...~.. day of ....... .D...e.g.e...~...'.~... .................... , 19...?..~.. Notory Public,. ........................ $,~.,.~0..1~ .......... County ~..~.~Y~-~......~~.~¢~..~',~'..~ .......................... (Signature of applicant) The ~ev~a~ di~po~a~L ' '"' i TO THIS SURVEY iS A VIOLATION OF Lot Z4 ~ ~ ' ~ ' ~eu~&~.~~ j LENDING INSTITUTION LISTED H;REON, AND ~DE~CK VAN TUY~ P. C, LI~ ~N~ ~U~V~O~,~, N. Y. HOLE , , , ,~ , :, ,~, ,, ~ ' ' '"' ' ' ~'~3 OAT~, : Oi~ sv~.s .o. vms ~- -~ . o~ w~ H.S, REP, NO.: ...... ~NO~ OP ~UFFOLK GO. O~. APPROVED: , ,