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Home My WebLink About9039-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z78~7. ...... Date ............ August....1.1.. 19.7.7. THIS CERTIFIES that the building located at . .W/S..Camp..ginenla. Rd... Street Map No. x~ ......... Block No... xx .....Lot No.x. xx... l~latt~tuclc ............... conforms substantially to the Application for Building Permit heretofore filed in t. hi.~ office dated ...........Feb .. 7 .... , 19.7..7. pursuant to which BuDding Permit No. dated .............F.e.l~... ~..., 19. ~.7., was issued, and conforms to an of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is Private..one. £amil~. dwelling. ~ith. addition...¢appr~ved..by. Ild .lppls ) The certificate is issued to .. 1t~...Keh~baum ......... Ownex ......................... (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval ~ ,lq,, ............................... UNDERWRITERS CERTIFICATE No pe~l~ng HOUSE NUMBER ...... .L~80... Street .... ~amt~..l~in~.ola. Bd ....... Building Inspector I~OR~ NO. 6 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 and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Bo~rd 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 Dote ~...(~ ~.. ? .~ New Bt~ilding ................ Addition .....~.. ........ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..... .~..~..../?./.~.......,:~..../...~....~....~..~..~........../~.~.: ........... ../'~,..~..?.i..~..' .................................... Owner Or Owners Of Property ..... ~.:.,.../~...~.~,~'...,~...'~...~.~.../~. ................................................................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. · ~J~ ~ Permit No....~....O...~..~'...?'. Date Of Permit ...z../~../?.,7....,Applicant ..~.......X~.... ............ i.~.....~7...~...q.~...~'......./...~ q Health Dept. Approvol ......... ..~...~..'~..; ........................ Lobor Dept. Approval ................................................ Underwriters Approvol ......... .../~...../~..: .......................... Planning Board Approvol ........................................ Request For Temporary Certificote ........................................ Fincd Certificate .......................................... Fee Submitted $ ............ .~..~..~...~. .............. Construction on above described building and permit meets oil applicable codes and regulations. Applicant .........~..~..~, ..';Y.......~...; ...... ~" '~'~7' ................................. Sworn to before me this '/'/c~///~4'~ _ ....... ./,/.. day of ....~.~...~..../~..~... (stamp or seal) ~ ~/~Or~ / ........ ..... ....... FOR.~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT 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) No. 9039 Z Permission is hereby granted to: at premises located at C/~FI P lvl IN E 0 L/4 T~ O){~:b I~t ~ -TI t "r u~ ~. pursuant to application dated I~ ~' ~ 7 19 7Z and approved by the Butld~ng Inspector. Buildi~'~ Inspector FORM NO. BUILDING DE~RTMENT ~'_-~ · Exomin~ ........................................ , '" Disapproved a/c ............................................................................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter at in ink and submitted in triplicate to the Building Inspector, with 3 sete 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, 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. shall be occupied or used in whole or in part for any purpdse whatever u,nt!l ma Certificate of Occupancy ' the Building Inspector. IS HEREBY /V~DE to the Building Department for the issuance of a Building Permit pursuant to the 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 demoli~tion, 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. ..'. ..... ........ ................ (Signature of alSplicant, Or frame, if a corporation) ................ .......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 'rr j ............... ~'~ ~ ~" ~ ~"~"~" ~'~[~iii~ ......... ~ ~'-~C ~ Builder's Lic~se No ..... ~..~ ........................................~- "' ~ Plumber's Licen~ No Electrician's License No ............................................. ~ Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... S,,e, ,nd N,~ber ..~.~:.~...C~LL~.~.?.~.J.....~.~: ....... ~.~.f~;.~L~:(~ ......... ~,~..~ ..................................... Municipali~ 2. State existing use and occupancy of premises and intended use and ~cu~ncy of proposed construction: a. Exisiting use and occupancy ............................................................................................................................... b. Intended use and occupancy ~ /~ Z~ / )-'/'-//..~/u/ ~'O ~: X /.~ )--/' U ~! /C./~j / ~i ~ 3 Nature of work (check which applicable): New Bui!ding.. ................. Addition ......... Alteration .............. Repair .................. Removal .................. Demolitior. .......... ~z.L ..... Other Work .................................................. · -2~ (Description) 4. Estimated Cost ............... !~......~......O..;~.~......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 basiness, commercial or mixed occupancy, specify nature and extent of each h/pa 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 ..... ../x~....~ ...... Number of Stories .....~. ............................................................................................................. 9. Size of lot: Front .............. : ....... ' .................................... ear .......................................... Depth ................................ 10. Date of Purchase ........................................................Nome of Former Owner ........................................................ I 1. Zone or use district in which premises are situated .................................................................................................... 12. Does proposed construction violate any zoning taw, ordinance or regulation: ........................................................ 13. Will lot be regraded . ......... 4~.~. ..........Will excess fill be removed from premises: ( ) Yes (~) No ]4. Name of Owner of premises ....~.: ............................................. Addre~ ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Nm~e of Contractor ........ I.~C~X.(..~ ..... '~..~.;.~.~ .......... Address /~ ~ ~ Phone No. ~xK PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~ck dimensions fram property lines. Give street and block number or description according to deed, and show street names and indicate ~hether interior or corner lot. t ?TATE OF NEW YORK~;~- / ~ ~¢c COUNTY OF ..%-.-4.?.i..K~...;=.M'.. ...... f'~'~' .......... ~ ................................................... ~ ............................ being duly swam, ~eposes and soys that he is the oppliccn~ (Name of individual signing contract) above named· Fie is the ............................ ]~.1.~.~..~.~ ............................................................................................................................ (Contractor, cgent, corpornte o¢ficer, etc.) o~ said owner or owners, ond is duly authorized to per{arm or have per~ormed the scid work ~nd to ~ke cnd this opplJcution; that oH statements contnined in this opplicction are true to the best o~ his knowledge and belie~; tha~ the work will be per~ormed in fha manner set ~o~h in t~e application flied therewith. Sworn tp hecate me this 7 ZY, f / . . , ' ....................... day o ................~--~ ........ ~,-~ ........... , 19..-Z./ ~ ~ ~ ' ~ ................................. Co,, ...... ' ' .................... ~ ~ i J (Signature of applicant) ELIZABETH ANN APPROVED AS NOTED DATE, ~-/"'~/'~ 7 FEE:__ /~ ~'~ BY: NOTIFY BUILDING DEPARTN~EHT '~T 765-2660 9~ to 4Ph~, ~1~ ,'.~E ~%FILUF~~ - -~. ~* F.~:AL W::EN JOB (' NOT RESPONSI~L~ Ft~;~ OR CONSTEUCTION 5. ALL CONSTRUCTIOtC MUST REQUIREMENt. .~ ~LY, STATE CODE AND TOWN HOUSING CODE & ZONING