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Home My WebLink About8505-zFOB~I NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at . .~.O~.s.s. 9. ~.ll. .............. Street Map No..:c~ ........ Block No .... ~ .... Lot No .... ~..~V~hO~i..~ ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... AOrJ~],.. ~, 19.?~. pursuant to which Building Pemit No...~ dated ............ AP~II. ~.~., 19~.., was issued, and conforms to all of the requffe- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. P~lv~.e .9~..f~.ily. ~]~e$l~g ..................................... The certificate is issued to .. FD~.~ .~ ~. ~. ~~ ................ (owner, lessee or ten,t) of the aforesaid building. Suffolk County Department of Health Approval .. ~a.. ]~.~ ~.. bY .1)~. ~!.~p.... UNDERWRITERS CERTIFICATE No... ~.~.~6~ ~ ..... ~ee...2~. ~.~ ............. HOUSE NUMBER 2~ ... Street . .~b~.~o. ~.~ ....... ~,~h~.~ .......... lrOB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8505 Date Apz':L1. 16 19..~..6.. Permission is hereby granted to: ....~.Lo.~.~.e.,~ ~...~..o.~.e...s....z...n..e .................................. ............... ~.~?J~.~ ~.....]~ A ~. ~ ............................... at premises located at ..~/.~..~ob~.~.O..~ .............. ~,,~,~l,l~..~.t~$...IT~ ..................................... .............................................. ~..9.~.~,...~, ............................................................................................... pursuant to application dated ...................... ..~.~.~..~. ....... ~..6. ......... , 19.~..6..., and approved by the Building Inspector. Fee $..~..~..e...0..O.. .......... Building Inspec~ TOWN OF , Building Depo~tment 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 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 1957), Non-conforming uses, or buildings and "pre-existing" land uses: l. 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 formation required to prepare o certificate. C. Fees: l. 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 .............. Owner Or ~ners Of Property ....... ~..~.~.~. ......... ~.~.,~ ...... /M.~.,; ..................................................... Subdivision ...................... Lot No ............. Block No ............. House No.~.~ Permit No~;~..~.,.. Date Of Permit(~,..4fZ~Applicant Health Dept. Approval ~.l~,....~..i.~.~.~ .......... Labor ~pt. Approval ................................................ Underwriters Approval ~..~.~.J..~.2.~ .............. Planning B~rd Approval ........................................ Request For Tempora~ Ce~ificate ........................................ Find Certificate ...~ ............................... Fee Submitted $ ....... ~'" ....................... Construction on above described building and permit meets alt applicable codes a~nd regulations. Sworn to before me this ]-o c~,,,/)L'----/~ .r /-/c ~ ~ /~ ....... ~..~. day of ..~....(..~. 2.. ~. ........... (stamp or seal ~~ Nota~ Public .................. ~ Coun~ ~ ' J -~'/~7~--~ .THE NEW YORK BOARD OF FIRE UNDERWRITERS ak ~ '~' ~" ; BUREAU OF ELECTRICITY ' ' ~: ~._;:~ ' :~[I 85 JOHN STREET, NEW YORK, NEW YORK 10038[ only the el~tr~al eq~ip~nt ~ ~scribed beJow and introduced by the applicant named o~ the able appllcatio~ number i~ the premises of locatlon~ ~ B~e~e~t l~rl. ~ ~.d ri. o ut~'S~de- ~ ~io. ~ ~loo~ rot ~..~,"~do. December 2~, 197g, ~d~oundto~ei~compllanc~ith the~equire.ien~tsofth~Bo~rd, RX~URE FIXTURES RANGES , OVENS DISH WASHERS OUTLETS F[UORESCEHT ! DRYEg$ NO OF pER J~ 1 OTHER APPARATUS~ Motor/s :. 1-1Z~hD 1 G.F.C.I; :t:>' b"~~: :~ ,' 1 Smoke 'Detector .~: , Charles M. Hall,~ I ~ ' z 760 Longcreek Drive,m' ," GENERAL~NA~R Southoid, ~.I. ' Lic.65?E "'~r'-A~~ This certificate must not ~e 'altered in ~ny manner~ re~urn fo th~ office of the 5cord i~ ~ncor~ect. inspectors m~ be ~ ~y th~ credentials. / (Building inspector) 7 TOWN OF SOUTHOLD TOWN CLERK'S oFFICE SOUTHOLD, N. Y. Application No..~.~..~ ............... APPLICATION FOR BUILDING PERMIT Dote ...~..,,~,~.,~.,,~, ......... ~.~ ................. , 197~.....? INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and aubmitted 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 of property must be drawn on diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. 0 d. UI)on approval of this ~application, the Building Inspector will issue e Building Permit to the applicant. Such permit,shaH be kept on the prerhises available for inspection throughout the work. e. No building shall b~ occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have beer~ 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 inspections. (Signature of applicant, or name, if a corporation) ....... (Address of applicant) State whether applicant is own:~er, lessee, agent, architect,.,, ,engineer's, ~neral contractor, electrician, plumber or builder. Name of owner of premises ~ ,, t~, ,~ ~,,? ~Z ~ ~ ~ ~ J/~¢ . ,ej~ of duly ~uthorized officer. If applicant is a corporal, naturel (Name and t~tle of corporate officer) Builder's License No ..... ~.~ .............................................. Plumber's License No ......................................................... ~ ectr c art's k cerise No ............... ; ................................. Other lrade's License No ................................................... 1. Location of land on which proposed work will be done. Map No ............................................... Lot No ......................... Street and Number ...... ~-. ........ ; ................................................................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................................................................................................................... b. Intended use and occupancy ................................................................................................................................. ..~ 3. Nature of work (check which applicable): New Building ..... ~ .......... Addition ..................... Alteratio~n..'..:...~. ..... Repair ......................... Removal ......................... Demolition ........................ Other Work (Description) 4. Estimated Cost ..~..~..~ .~. ~ ........... Fee ................................................................................................. / ....................... (to be paid on filing this apptication) 5. If dwelling, number of dwelling units ....~. ..........Number of dwelling units on each floor ...Z...~./.~...~...:('.... ................ If garage, number of cars ...{~l.~.t~.l$~ .......................................................................................................................... 6. If business, commercial or mixed occuDancv, 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 .................. v ..................... Numb~er of Stories ................. ; ...................... 8. Dimensions of entire new construction: Front ..... ..~.~.. ............. Rear ....Z~.~. ................... Depth ~..~. .......................... Hei ht Z .~. ....... Number of Stor es .? .~...~'.?......L/. .............................. .~ .............................. g .................... ~ ' 3 9. Size of lot: Front ..../..a~...~, ........................ Rear ..... /..,~q~. ............................ Depth ..~......~. ....................................... 10. Date of Purchase ~...P.~2...~......L~..?...~, ......... Name of Former Owner .~..~..~......~....k.~...~.~...~.~.~ ................................... 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 .... ~..0.....~ .................. ~ill excess fill be removed from premises: [ ] Ye~., ~ ] NO 14. Name of Owner of premises ..~..9. ............. ~.f.4,.~......l~ ........................................................ ~.~..~....~..~......~. ............. (Address) (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 wheth- er interior or corner lot. STATF OF NE~W~v-)oP~ //%/ ) ,.):..., ........... bein, d.l swom, deposes.nd sa s that (Nazne of individual ~gning contract) (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 that the work will be performed in the mannem set forth in the application filed therewith. ffcal~: 40 '= 1" TO ADDITIONAL INSTITUTIONS OR SUBSEQUEnt/ BY BUIL[~ING DEPARTML~ ~T 660 9AM TO 4PM FOP, R~ iib ,$~bCTIONS: FRA lNG lNG PIPLLh F: CODES ALL FEDERAL, STATE AND LOCAL ~CODES,-'ORD,q~ICLeS, REGULATIONS ETC., SHALL BE CONSIDERED AS PART OF SPECIFICATIONS FOR THIS BUILD- lING AND SHALL TAKE PREFERENCE OVER ANYTHING SHOWN, DESCRIBED OR IMPLIED WHERE SAME ARE AT 'VARIANCE. ST00~, GRADE LINES SHOWN ON PLANS, ETC; ,&RE SUBJECT TO CHANGE TO MEET TOI~OGIb~I- lC, AL CONDITIOI~LS. t