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Home My WebLink About8502-zTOWN OF $OUTHOLD BIJ~ J~ING DEPAR~.NT Town Clerk's Office Southold, N. Y. Certificete Of Occupancy No..Z.. ?.0!~! .... Date .............. l~y...?.1 ...... , 19.7..6.. THIS CEBTIFIES that the buJ]cling located at . ~oun~v~Le~. ~tve ........... Street Map No.. zX ........ Block No...z~ ..... Lot No, YJ(.. 5.o. Bl~.o~.d....I~.,?-.~: ........... conforms substantially to the Application for Building Permit heretofore filed in ~hi.~ office 8 02Z dated ~r I~.., 19~.~. pursuant to which Bui!ding Permit No. A~' 1 ~ 1976 dated .......... AuC~..~ .~ ......, SS, was issued, and conforms to all of the require- ments of the applicable prov~ions of the law. The occupancy for which this certificate is The certificate is issued to ... l~i. char. d. ~le3.oh~one. &..t~,~Ce ..... i.vne~ts ............ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval I~....tl.o. ............................... UNDEBWRITEI~S CEBTIFICATE No. p.e.n.d.~..n.~ .................................... HOUSE N-LTiU. BEB ... 1 .I+.R~.0 ..... Street ..... Sound. ¥£ev. Ave ..... Sou.thold. ..... FOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8502 Z Permission is hereby granted to: .................. ~tt~Ltuclc ....................................... ~o ..~$~l..&~.~l.~.%~n..~z~..e~$~t.~..g;. ~l~e~$~ ............................................................ at premises located at ...... ~o~tllcl...I/4~e~e..A.~,e .................................................................................... .................................................... ~o~th~0.....~,~Y, ........................................................................... pursuont to application dated ..................... ~.~:L'L.....I~- ............. ]9...7~., and approved by the Building Inspector. Fee $...~,.~.OJO ......... FOKM 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 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-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 New Building ................ Addition .~ ...... Old or Pre-existing Building ................ Vacant Land .............. Locot,on of Property ...... ....... ..... Owner Or Owners Of Property ~.z~/~`~........~....~z~.~.~....~..~!.~.~.~`~E~..~d..~...~./.~`/~.~./..~.~/~.~....~....c~ ' ' 0 ........ Subdivision ................................................................ Lot No....~. .....Block No ............. House No.Z.~...~.~O Permit No...~,~...~..~...~...~.. Date Of Permit .~/C/2.~...Applicant ...~.~.Z..~..2/?.l~/.....~.~.~......E/~..~.~....J..(- Health Dept. Approval ............................................ Labor Dopt~ Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Find Certificate ~ .............................. Fee Submitted $ .....~.~.~ ............ Construction on above described building and permit meets all applicable codes and regulations. Applicant..,~.~ ~ '. ....... ............................. Sworn to before me this ..... .......... (stamp or,co,) Z?¢ Notary Public .... Count~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E am,ned ......... ~proved .................... CJ ....... ~...[~..., ,~&. Permit No. ~..~..~:..~......~.... Disapproved a/c ....... ~ (~uildi~ In~p~tor) ' Application No...~..~.~..~ ........... APPLICATION FOR BUILDING PERMIT ...... ......................... Date ~ " //'~ , INSTRUCTIONS a. This application must be completely filled in by typewriter o~ 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 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 o~ 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 a 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 inspectlons. (Signature df ~Cpl~licant, or name, Fda cor~oor~i,~n) -- - ...... ........... / (Address of applicant) State whether applicant is ownerz lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... .~...~2:~...~.,..~.~...,~..~..4~0...¢.....~.~..~...~....~..~.~.~,.~.../~/:c'Z'~.?~. ........................ 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 workwill be done. Map No.: ..... ~ '~'~.~..~.../..~..-.- ................. LatoNa.....~: ................ Street and Number ...... ./...~..~.'..~ ....... ~..f~"~.. ~..~.~.~......¢~...~..: ...............,~~.~ ..................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ....... ~.~Z,~.~ ............................................................................................... b. Intended use and occupancy ...... ~.~K/~.j ........ ~,...~*.-q..~~.:..~:~-r~..,./ ................................... 3. Nature of work (check which applicable): New Building'. ................. Addition .~.... Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work ................................................ . 4~'~ , ~ ~ ~2/ (Description) 4. Estimated Cast ...... ~t./~...~. ...................................... Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units ~..C~C~.~-~. ....... 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 .......ff..Y.""" ................... Depth ...~../?..~. .......... Height .....Q, ..~..t. ............ Number of Stories ......... ,,,-~¢~.....~ .................................................................... Dimensions of same structure with alterations or additions: Front .......... ~.. ....................... Rear ..... .~...~. ................. Depth ......... .~..~..] ................ Height .....~,'~'..~ ............... Number of Stories ~'~...rv'~....~. 8. Dimensions of entire new construction: Front ..... .~..~.. ........................ Rear ....~...~.. ................. Depth ..../..~.' .~ ............. Height .../.~,~..: ...... Number of Stories ........ ~. .......................................................................................................... 9. Size of lot: Front ......... ./~..2 ..................................... Rear ...... ./....~...~...~ ...................... Depth ....~..~...~....x ............... 10. Date of Purchase ..... ~....:......./..~.Z..~ .................. Name of Former Owner ....~'..~...G~.o........~.~ .............. 1 1. Zone or use district in which premises ore situated ..................................................................................................... ]2. Does proposed construction violate any zoning law, ordinance ar regulation: ........ .~...~'. ...................................... 13. Will lot be regraded ..2 ................. Will excess fL[I be removed from premisgs: (~) Yes 14. Name of Owner of premises ~~......~~...¢~... Address ,,4~~ ..... Phone No..'.~.~..~..'...~.~? Name af Address .............. : ............... Phan Na Nome of r .:...'~...~... .......... Address .~.... Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from propc~rty 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,~ /'~7/~,, ~ c c .............. ~(~~'"~signing2 '"~':contrac~) ......................... being duly sworn, deposes and says that he is the applicam above named. 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 all statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this /~ ~__~, ,,//~. ~7/~r,, .............. ~t~"[~ day of ........ /L~I~]' ........................ ' 19'"'~(i ~ Natar,/Pub a,. ................ ................... Co,,ty ..... ........ otlZ3;O.I.I~ ---~(Signa u~ of applicant) ' No. 52-8125850, Suffolk County