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Home My WebLink About8619-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Ot~ice Southold, N. Y. Cerli icnle Occupnncy THIS CERTIFIES that the building located at . R.0,1~., .8/~, ]~a~'~l. ew. Ave Street Map No... xx ....... Block No. y,X ....... Lot No, . X~... l~agg$.i~k...~.,~.o ........ conforms substantially to the Application for Building Permit hereto£ore filed in this office dated ............... &~e.., ~9.76. pursuant to which Building Permit No..~.~. ~9.~.. dated ............ .~e..2 .... , 19. ?.~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .. P~iv~4;e. o~t~. S~.mi:1,7. ~lw$~lir~.. (. $i~'~.~ .£:l.oor) ................. The certificate is issued to . .l~O~:~a. A,. ]g~:i.i~y..~.~ .... .0~,~e:r ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. S~.pt...1.~ ~..1.~.~.~. b~ .~..V.~.~... UNDERWRITERS CERTIFICATE No.. ~l~lt~g ................................... HOUSE NUMBER ... 800 ....... Street.. ~a]r~te~,. A.~.e .... ~'attitilO~ .......... ...... ...... Building Inspector FOEM NO. 2 'tOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE , SOUTH~OLD, N,. Y. BUILDING F,EP, MIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8619 Z Permission is hereby granted to: .... I~.a:c~:~,aa~....~i;i.~.~<..~..z:. ..................................... .................. ~.L:.2,Li~.~.ok ........................................ to ..~,iZ:~...~.~w...o;~..4'.m~a,~..~w,Zft..i~,~ ......... .(.£i~:s.~..£;Lo~a~...oz~.].~.). ............................... at premises located at ...5:L..O.,~J.^...~/.CL.J:Jla~r.V.J.~;~..;kV.~. ............... . ..................................................... ................................................... ~!~..~.~..i..~.~:~ ...... li,.~;;. ...................................................................... pursuant to application dated ............................ ~.,~'.~....,~.....~..i., 19..~., and approved by the Building Inspector. Fee $,.J.,.J.~.5 ....... FORM NO, 6 TOWH 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 dispesal--(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-existin9 dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 ... ...... .................. New Building ..... ..~.... ...... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ................................... Owner Or Owners Of Property ............. /..~..O..~,~'.~.../~.../~,:. ....... ~,.;.,,../.~..~'.,.~...~,.../~../, ........ '..~...L~..~ .................... Subdivision ................................................................ Lot No. ............ Block No ............. House No ............. Perm,t , _Pe m,t .... ............. Health Dept. Approval ........... ~./../..&./.~..~ ............. Labor Dept. Approval Underwriters Approval ....... ~..~,.~,.~./:.,/.,V.,~ .............. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Find Certificate .......................................... Fee Submitted $ ....... :..~..:..?..~ ................ Construction on above described building and permit meets all Opplicable codes and regulations. Applicant ........ ..~..~ ............ ..~./~,.....~ .................................. ......... Z..~day o' ...~.~¢~...~.: (stomp or seal,~> N ota~ Public ........~~Coun, ~/~ ~ SOUTHOLD, N. Y. . . ~ .M~,~_. ~. ,o7~ ~-.~.~.~,~- N~---~....:<:...: ....... :... LXQ~I~Q .../..~ .......... r .............. , .... A- ~ ~ / / ~ _.. -- ~ ~ 1, ~ , 19 ~Perm f No ~..~.~ ........... ~[~/7~ Disapproved a/c .......... ~ ............ ~'"'~7~ ~~ ~:~ ................. ~ ~ ~.~ ~ ~ (B~pector) ~? - .............. ......................... ..... a. This appI cation must be completely filled in by ~p~writer o¢ in in~ and submitte~ in triplicate to th~ Building~ Inspector, with 3 set~ of plans, accurate plot plan to ~al~. F~ according to schedule. b. Plot plan showing Ioc~tion af lot and of buildings on premises, relationship to adjoining premises or public streets oreas, and giving a detailed description of layout ofprop~rW ~ust be drawn on the diagram which is pa~ of this application. work covered by this applicalion may not b~ commenced before issuance of Building Permit. c.d.Upon approval o{ this application, the Building Insp,ctor will issue a Building Permit to the applicant. Suc~ permi Th~ /~ shall be ~ept on t~ premises available ~or inspection tHrougHout t~ Work. e. No building shall be occupied or us~ in whole or in part for a~y purpose what~ver until a Ce~ificate o~ ~cupanc~ sh~ll have been granted by the Building Inspector. APPLICATION 15 HEREBY MADE to the Building Department for ~he issuanc~ of a Building Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, N~w York, and other applicable Laws, Ordinances or Regulations, lot the constru~ion al buildings, additions or alterations, or for removal or demolition~ os herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings ~or n~essa~ in~eclions. (~ignature of applicant, or name, i~ a ~orporat (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. N~m. o~ o~.~ o~ ~.~ ....... ~..r~.m..a.~L....~......~.e...~.6.-~.....;..Y....~ ............................................. applicant is a corporate, signature of duly authorized officer. ............ . ............ (Name and title of corpo/ate officer) Builder's License No ..... C~..?..~ ....~.... Piumber's License No .... ~,~..: .............................. Electr,c:ans License No. .~ ..................................... Other Trade's License No ............................................... ~ r~' Location of land on which proposed work will be done. Mop No.: ................................ : ................................ Lot No ~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended us~ ~nd occupancy .............................. ,-- ................... : ........................................................................... ~/ ~'/~ t ~0~ APPROVAL O~ CONS~UOTIO~ ONLY ' I. k 7' . s I / .¢/X~. . : , "' .: -~ ~~L~ ~/ water sup~y & s~age dis~sal s~- W.~-,, , ' tO t~ ~ ' ~ ~ ~ ~ addd~on lo this su~ tems for this r(~ de.~ w ~nform ~ ~ : ~ ~. 7~09 of the'Ne " ' ' e aR - ~ - : ~ w York Stole Educat,on Law. ~tan~ar~s of the Su~olk 60unt~ 0 p - ' ~P~s of tki~su ma no ' . ' ~ ~ . ~ ~ ' ~ p t beadng he I,:nd su~eyo~s i~e ~:~ (~ . ~ ,~ne,eon, an~ I~ Ih. as,ign~, of ,h~ lend,n, n, ~ - ,)~ ~ sub~uent ~wpers SURVEY FOR · / Unaut~rized o,~ratlen or addlti~ to thi~ su~ey i, a violati~ Cbp~ of ~is su~ ~p ~ ~.ng the land su~eyo~s ink~ S~l ~ em~ss~ ~1 ~hall n~ ~ comideted ,~ be o valid copy person fbr whom the su~ey is prepared, and ~ his behalf to the title company, governmental agency and lending institution her~, and to the a~ of the lending institute. G~mnt~ or ¢e~if~at~s am ~ ~fmobJe to ~dil~nal institutions NORMAN,Il. REI L L AT MATT/TUCK TOWN OF $OUTHOLD SUFFOC Y , JULY 14, 1976 ApPRC~VED AS NOTED DATII ~ ~ (~7~ NOTifY BUILDING D£PARTMENT AT ,N&,~,660 ~M TO 4PM FOR RE~UIR- ~ ~ ~I~NG ~UNOA- 4." coN~¢~r~ KITCHEN ' LIVING ROOP? &~.'~ I~' ~'¢"_ FO'r ER VANITY BA TH R-C'OM HAS, TER BUlL f) EJ L'S FLOOR PLAN T PATIO t ----~ I UNEXCAVATE D ..................... ~' .................................... ~ ................... : ............ ~'" t:'.'~= :' '11- '" ,'i RAG E 4" LONE. RE TF REIN FORFu;' CONCRETE PORCH bNEXCAVATE FLOOR D 3Y' GRADE - - ASPHALT ~ ...... STUCCO SA ND - - 12 CO LI RSES- 8* 16 BLOCK WATERFROOF-TO POURED GRADE g'T~P