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Home My WebLink About8503-zFORM NO. 4 TOWN OF $OUTItOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certi icnte O[ Occupnncy No.. Z.8.930 ..... Date . February. ..... 14 .......... , 19.7.8. THIS CERTIFIES that the building located at .310. .Al.v. ah~ s..Lan~ ........ Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...April .... 12 ...... , 19..7.6 pursuant to which Building Permit No..8.5.0.$~.. dated ...Apt. il ..... 16 ......., 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 ...... Accessory .Building ............................................ The certificate is issued to ...... ~.±lli~m. Ii....~lc~f. ee ............................. ( owner,~xe~xt~]~lt~ of the aforesaid building. -- Suffolk County Department of Health Approval ...... N/R .......................... UNDERWRITERS CERTIFICATE No ................ 1~3~.8.~63 ..................... HOUSE NUMBER .. 3.10 ........ Street .... Alvah.'.s. L~ne ....................... ........................................... CUt~kc~gu~-.,..N · ~Y ...................... Building Inspector FOI~M NO. ~ 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) 8503 Z Date ...................... ~,~It ,~,~ ....... .1~ .......... , 19~... Permission is hereby granted to: .;::L~.L~.am ..~9....~.e...e. ....................... i ................... .................. Cutcha~u~ ........................................ ~o .~.~ll,~ ..a~ ..~ ~Ldit lo~...~rz ..e xiat l~g.. ac caaao r.~.. hull~ir~ ...(.G~r a~e ~ ................. et premises ~ocate~ at ~.V.~..~I~ .................................................................................................... ....................................................... ~mte.h~ue....N...¥.: ..................................................................... pursuant to application dated ...................... A~:~:J.l......~q ........... , 1~...., and approved by the Building Inspector. Fee ~.~.~ ............. FOF~ NO, $ TOWN OF $OUTHOLD , Building Department Town Clerks Office Southoid, 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 disposol--(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 t957), 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 staYement 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: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or Jand use $5.00 3. Copy of certificate Of occupancy $1.00 Da te .. ~.J..~.~. ~. ~. ~..Y..... !..ct.,. !. ~ i?..z. .... New Building ................ Addition ...~.. .......... Old or Pre-existing Building ..~.x~ ........ Vacant Land .............. Location Of Property ..... '.3.~.!.?......~.~.~.!~!.~...J'..~...~..~...~.....~...~..?..c...,~.°..?...~..~.L....l~..;.~.~. ................................... Owner Or Owners Of Property ..~,,,.t,~k.,t.~..~.,,,!..~..;..J:,..,.?,,..°,,,~,..t.~,. ........ :.....~-..C....~...F.~:~ ................................ .--- ~ ,o.. Subdivision ................................................................ Lot No.......~-': ..... Block No ............. House No ...... .................... q/ / ~/~ c .... ~..:.~.~.!.~.~.._~::.~.~.~ .......... Permit No. ~0 [~. Date Of Permit .................... ~pp.cant Health Dept. Approval .... ,.~..;...~.. .............................. Labor Dept. Approval ~/ ' ~ Underwriters Approval ..~......~.~...~...~...~...iLi~ ................ Planning Board Approval Request For Temporary Certificate ........................................ Find Certificate ...... .~.. ................................ Fee Submitted $ ...~... .............................. Construct Jan above on described building and permit meets all applicable codes and regulations. App,,cant Sworn to before me this ................ doy of ............................................ Notary Public .................................... County (stamp or sea!) · '~ rYORK BOARD OF-FIRE UNDERWRITERS :-~ '~'~i~,' :" .?'":-'b.....~,,,am;.~,c~re~,~.-.,V~.s:~n~-~ . . Cu*chogue, L.I.. .... AW.G B.J. Electric Co. Stillwater Ave. Cutchogue, L.I. 11935 Llco 505 certificate must not be altered in any manner;, return to the office of the Board if incorrect. Inspectors may be identified by l~OgM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ...... , , om,ned " " ........ ........... Approved ........................................ , Application Disapproved a/c ...................................... .............................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building ~' o. 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 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 port for any purpose whatever until a Certificate of Occupancy shell have been granted by the Building Inspector. APPL CAT ON S HEREBY MADE to tlne Building Department for the issuance of a Building Permit pursuant to the Building Zone Ord nonce 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 ir~ buildings for necessary inSpections. "~-" (Signature of applicant, or name,,~f a corporation) (~ ~ T'c H oC.~C- F~.? I t cl~- (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........ ~:~ .................. Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... .~ .....~... 1. Location of land on which proposed work will be done. Map No.: ...... · ..................... kot No ................ Street and Number ....~..j..~.........~..~..ff...~..l-).~...~..~.~.~ .................. ..~..?..~..c..~?.~..9...~...c~ .............................................. Municipolity 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Exisiting use and occupancy ........ ~ ........................... ~ ~ ~ ........... .............................. Intended use and occupancy ................... ex,~ ..... .~. .......... ~ 3. Nature of work (check which applicable): New Building'. ................. Addition ...~.?...r..~..~:~.... Alteration ................ Repair .................. Removal .................. DemoHtio~ .................... Other Work ................................................ . .... · ~ (Description) 4. Estimated Cost .......................................... 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 ............................ Depth 7. Dimensions of existing structures, if any: Front ......~...~....'~... ........... Rear ...... ~..~....~..,~. .................................. Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ,...~..~..~...~.. ................... Rear ..... .,~..~...~..~.. .......... Depth ..~.[[ ........................ Height ............................ Number of Stories .........I ...................... 8. Dimensions of entire new construction: Front ......... I;.~..~..~ ................ Rear ......... .~.~.~.~...*..... Depth ..... ..~...~....~..~.~ .... I-[eight .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ....... ~.~.~ .......................................... Rear ......... I...o...~. ......................... Depth ....... I.~-~..~ ............... 10. Date of Purchase ...... %..~.~...~ ....................................... Name of Former Owner ...~.~£~.l,.~....~.~...~,.~f~... ............ 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 (~') No 14. Name of Owner of premises ..~,~.~,.~w~....~.,...~....J~.~.l~C... Address ~.~..~.¢r~ .%.~, .... . Phone No."/.~..~.:..~.?..~..~ Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ 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 Iol. STATE OF NEW~-~E)RK~'-~- ~_, ~cc ,1., CO~N-~¥ o~,.~..~Z~..~.~...,,...Z,;,;;G~~ .......... .~ ....................................................... ~ .................... ~~"Z~~ ............... ~eing duly sworn, deposes and says that he is the applicon, (Name of individual signing ~tracf~ [ above named. ~ ~ He ds the ............................................................. , .................. .j ............................................................................................... (Contractor, agent, ~rporate officer, etc.) of said owner o~ owners, and is duly authorize~ to perfor~or have performed the said work and to make and file this appl~ication), that all statements contained ~n this app~cation are true to the besf of his knowledge and belief; and fhat fhe work ~ilJ be performe~ Jn fhe manner s~t fo~h Jn~e application filed therewith. Sworn to befgfe me this , '~ ~ ~,/ .... I..~.~: ..... ~a~ o~ ..~...~.L .......................... ~ 1~4. - - ~. ,./ ~ . z ~o,a~ ~,~,,c.. ......................... ~.~.LL co,,~ ~........~~..~Y~~.., ........................ ~ ~ ~ )~ )/ (Signature of operant) ~0. 52-8}25850, Suff01~ CoU~ ~ ~rm Expires Ms,ch 30, lg~ ~