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Home My WebLink About8597-zFOR!VI NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy ~.7~.8.~. Date AIXg l~ 19 76 no ...... ........... THIS CERTIFIES ~ha~ ~he building located a~ .. ~. ~h~,. 9~ ......... Street Map No...~ ..... Block No. ~. ....... Lot No..~ ..... ~.~$~RQ~.. ~.~ ~ ...... conforms substantially to the Application Eor Building Permit heretofore filed in this office dated .......... ~ .~ ~ ..... , 197~.. pursuant to which Building Permit No.. ~. dated .......... ~.. ?~ ..... , 19~.~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...~?. ~. ~ ~V?;~ ......................... The certificate is issued to J.a¢O~. ~.. ~.$.p~..~hOp~o.~ .... ~ ............ (owner, lessee or ten,t) of the aforesaid building. Suffolk County Department of Health Approval ~g.. ~.. ~ 9~.. ~ .8~. ~ ..... USDSaWm~as CSa~I~CA~S No.~7~8~ ...... ~V¢.. ~... ~77.~ ................ HOUSE NUMBER ... ~0 ....... Street..~r~¢¢~.~ .~. ~r.*.~ .~.).... ~ttituek ............. ................................... .......... ........ Building Inspector FOKM NO. ~ TOWN O~ $~TNO~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8597 Z Permission is hereby granted to:" at premises located at P~rsuant to application ~Jated 8uilding Inspector. : : ' / · Fee ..; ....... TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 Job # 1809 AFPLIGATION FOR GERTIFIGATE OF OCGUI)ANGY Instructions A. This application must be filled in typewriter OR ink, (]nd 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 oil buildings, property lines, streets, and unusual natural or topographic features, 2. Final approval of Health Dept. of water supply and sewerage disposol--(S-0 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, /V~ultiple Residences and similar buildings (]nd 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 1057), Nan-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 os to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premise~, or other pertinent formation required to prepare o certificate. C. Fees: I. 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 August 18~ 1976 New Building ..~ ........ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .... .~./..S.....B.~.e.~..k~...a.~.e.~...R..o.,~..d.,~....~....~..t..i..~..u.,c.~ .................................................................... Owner Or Owners Of Property ........ ..~....~)~:...B,..u~.',,]:.d..~...g....g.o.....~....~..n..c.... ................................................................ Subdivision ..~.o.~...S..u..b.......l..0..3. .................................. Lot No ............. Block No ............. House No......8.,5..0,.. Permit No ..... ,8.5...9..7. ........ Date Of Permit .5./.l..9./,7..6....,..Applicant ..~...B...u~.'..l..d,.i,.n.g...C..o....g..~n.c.... .................. Health Dept, Approval ........ ,6,,,S,,Q,8,.7. .......................... Labor Dept. Approval ................................................ Underwriters Approval ....~..~..~..~...~...~. ................... Planning Board ApprOval ........................................ Request For Temporary Certificate ........................................ Finctl Certificate ....... ./~.... ......................... Fee Submitted $ .....5..:.0..0.. ....................... Construction on above described building and permit meets all applicable codes and regulations. pplican ..... r ............. ~ .................. ~.~,.,..:....;;..;....d.,~.~.,~ ......~ ................... ....... o' / ~worn ,o Before me ,ms ~( ........ ............ -- Nota~ Public Suffolk~ ~ ~ ~ ~ ~ARY AXELROD .................................... ~ounty ~ ~/ ~ ~ NOTARY PUBLIC, State of New York ~)~ /~ No, 30-0119340, Nassau County / ~ //~ / Cert. filed in Suffolk County / ~ / ' / ' Te~m Expires March 30, 1977 BUILDING DEPARTMENT~ TOWN CLERK'S OFFICE Disapproved a/c ..~.~.:;::~..~.~ ............... ~~ ........ ..................................................................................... ........ ..................... ~ ~Buildino Inspector) ~ APFLICATION FOR BUILDING FERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter at 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 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. 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 o 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. ..... ............................................... (Signature of applicant, or name, if a corporation) 5040 Express Drive South, Ror~on~com~, N.Y. .............................................................................. ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................................................. ~.~.~ ................................................................................................... Name of owner of premises~..~..O..°..b....~....~...e..~.~...?..b..~.O..~.,e. .................................................................................................... If applicant i~Jorporate, signg~e of du~a~on'zed~f~i~r.// ...... ......... · ~.., (,Kla.?: title 'o, co/porate o",cer, Builders Lice, Hse No ................ ~J,{~L .............................. Plumber's License No ............ .4...0...~..i~ .......................... Electrician's License No ........ .~.~..8..-..~. .......................... ~.(~. ?~b/Z~~ () Other Zrade's bicense No ............................................... 1. Location of land on which proposed work will be done. Map No.: .......... '-~?x;4~'~-'............ ......... ~L~ ..JdJ ....... Lot No Street and Number ........... Llz~;b~.!~..i~a~l..(~m.e~a~te~...Ro~) ......................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................... ~ .................................................................................... b. Intended use and occupancy ............. ~..~tf]~..~%~ ...................................................................... 3~ Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work ................................................... oe-~j (Description) 4. Estimated Cost ........... .~.~}(~lf~(:~ ............................ 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 .......... ~6.!.8!~, ................ Rear ............................ Depth ....3~.~.6!! .......... Height .................... Number of Stories .................. .O.~':t~ .............................................................................................. 9. Size of lot: Front . ........ ;1,.~.!..,~%'~ .......................... Rear .......................................... Depth ........ $3.0.t ................ 10. Date of Purchase ....................... ..:~..~'~..5. ...................... Name of Former Owner ..C~le~.~t..1[~l~l,..l~li.~.~-O ...... 11. Zone or use district in which premises ore situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............... ~Q .................................... 13. Will lot be regraded' . ........................... Will excess fill be removed from premises: ( ) Y~e~ ., ( ), No, 14. qame of Owner of premises .~.f~..e~...b...~....~_~.~.~9.~.Q.. Address:l~l~r':~..~.'l~)..[~.~... Phone No ....................... Name of Architect ..... ~l~.t~;J,~..~..X;l,~'f.t, ........................... Address ,],:~.~,~if~...~..~:t,., I:~oen~ne~l~¢~...~.."..~Z..*. .......... Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM L.ocate 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 '~.~,~,~ ( ¢ c COUNTY OF ...... ~ ~.~.'.~..~.. ............ ~'~ .................. .~.~.~....~..,~...~..~. ................................................. being duly sworn, deposes and soys that he is the opphcom (Nome of individual signing contract) obove homed. He is the .................................. ~.~.~.~. .................................................................................................................................... (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/~n this application ore true to the best of his knowledge and belief; and that the work will be performed in the mon~er/~/et forth in the application filed therewith. Sworn to before me t~i~ /~ // ~ ............ etary Public, ........ ...... ........ ...................................... No, 30-0119340, Nassau County [ l /. ~-U~(~T'r DEPARTMENT OF HEALTH SERVICES t ~I~R'~OYAL OF CONSTRUCTION ONLY FAR EAST BO 1926 LINCOLN AVENUE ~OLBROOK, NEW YORK 117~ ' U. au~h~ 0 F ¢ ized'alt~ration, or a~di~i0n to this survey is a violation of Section 7209 of the New York State Educat on Law. ~t~l~i ~tvey Map .at beartng the land surveyor s tn~ce~ seal or ernb~ssed seal shall ~tet be considered to be a ~;~c~py (~U~rantees'lni~ioat~d h~reon shall run only to the person for, whom fhe survey is prepaYed~ an~ on h s be. te T~t[e.~orkpany~ (~o~ernmental Agency-and Lending Institution list~:d hereon, and to the Asslgne,es ~ the Let~d. ti~6s ~rg~ees are not transferable to addttt0nal Institutions or subse~uen~ owners. WEISENBACHER & SCHNEPF, I LAND SURVEYORS ® LAND PLANNERS 7 MONTAUK HWY. WEST SAYVILLE, N. ¥. LiC, NO, 361~ lIC, NO, 446 0 r U~aut~ed ~erqtion or addition ~o this survey is a v~Qlation of Section 7209 of thee New York State Education Map no? bearing the land surveyor ~ inked seal or embody'ed sea~ ehall, not be ~onsldered ta6e '~6~y;?Gua~ntees ihdicated hereon shah run only to the pe~s~ for wh~m fhe survey is prepared, a~d on his t~he ~it]~G~mpaqy,~G~v*rnmenta~ gen~y and Lending {nstitut~on listed ~qreon; a~d to t~e Ass~g~e,es ~f the Lend WEISENBACHER & SCHNEPF, I LAND SURVEYORS · LAND PLANNERS 7 MONTAUK HWY. WEST SAYVILLE, N. ¥. revisions issued plans, elevations A~ Nose~v appr date development house type I emmy building company, mc. smotrich & Platt..,, architect,s '305 .east 45 ' ' . th,~st, new york.~ n.y i,: '~ ' r' platt 19~4 '1 .[ revisions notes , u issued · elevations, sections P umbng diagram ,deve opment house type I. for emmy building compony, inc.. smofrich & platt, architects , LI dotal, -' 305 east 45th sl; ,new,~yorl%:' n:y. ,.copyright Q by smatrich ~. ;'s.,~ 2¢ t'.k'- ?'¢?, / i i- c-~- revisions -TAU I;* ~'/~ notes issued note: , alternate foundation plans, details scale A~ N~ appr w~¢ date m-~-?a' job /-~,tc~- development house type I,for emmy building company, inc, Smotrich, Platt & Buttrick, Architects/Planners 12 East 44th Street, NeW York, New York