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Home My WebLink About8539-zl~O~ NO. 4 TOWN OF SOUTHOLD BU~.DINC DEPARTMENT Town Cle~k'e O~ice $outhold, N. Y. Certificete Of Occupency No. Z.7.c~?~ ...... Date .............. 0.ct.. 26 ..... ,19. ?7. THIS CERTIFIES that the building located at .. F.~.~he~..]~ach ...... Street Map No.P. eco. J~ay. P. rB]~ck No ........... Lot No ....k~.../lutchogue ....N.~.. ..... conforms substantially to the Application for Building Permit heretofore filed in thi~ office dated ............. Apr...2~., 19.7.6. pursuant to which Building Permit No. dated ...........Apr...27..., 19.76., was issued, and conforms to an of the require- '-'~"----ments of the applicable provisions of the law. The occupancy for which this certificate is --"'"-~/~sued is ~.rlvate. one. family, dwelLln~ .wl~h · (d~r. mer.)..a~d.itie~ ........... The certificate is issued to . .J..a~.?.~..P. :..~.~,~1. ..... .~.~r .......................... (owz~er, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... N. :.~.: ........................... UNDERWRITERS CERTIFICATE No..N.:~:..(.n.q..n,:?~..~.c~'.k.). ...................... HOUSE NUMBER ..... 20~ ......Street ... F:Lahermans. ~[~aach. ~oad ..... Cutcho~e ............ " ...... FORM NO. (' TOWN OF SOUTHOLD BUILDING DEFARTMENT 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) N.o 8539 Z Date ................... Ap~'.t,:L....27 ............... , 19...7.(~. Permission is hereby granted to: ,T q¥~U .. ~=~r. Ua.... A/.Q 'J. ~m~.~...g..'. [,'.e ~,~ ................ ......................... .Qg,.t,.~.l't..~.~.g..e. ................................. .. ~.j~..i.H...a.n..a...d. dit .i. on on..e.x.i..s.t~.n.g ~we] lmng ........ to ..' .'. '~ ..... .~ ................................... ' ..... ~....,,,...! ......................................................... at premises located ..................................................... ,[~ ~'~'~.t~ .~.T. ~.. J ~ ~. ~ ~ ......... .g.~'~.~ ~.'~C .......................................... pursuant to application dated .......................~fi.'.il...2~. ............. , 19.fJ~'.., and approved by the Building Inspector. Fee $..1 .~.~.L.g. .......... FOEM N'O. 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 jn 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: ]. Accurate survey.of property showing ail 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 Date ..... ................... New Bctilding ................ Addition ................ Old or Pre-existing Building ...,.....~..... Vacant Land .............. Owner Or Owners Of Property %.......~f/r:~:.;_..:.~...L~.: ...... ~ .......... :......~..%..~....... ............................................. Subdivision ...... ~ ........................................................ Lot No.....~,.,.... I~lock No ............. House No ............. Permit No...~.~.~...~.~... Date Of Permit ...~..~....~...~'~..Applicant ....;~/~c.~/~.....~...-..../..~..,.~/..~',.~..~..~7. Health Dept', Approval . .~......Z~.~...~ ............................. Labor Dept. Approval /~"./.~ ~ Underwriters Approval ........................................ Planning Board Approval ..... *. .................................. Request For Temporary Certificate ........................................ Finc~l Certificate .......................................... Fee Submitted $ ....~'L:.~...~.~. ........... : ...... Construction on above described building aq~d permit meets all applicable codes and regulations. Applicant ..J~..~'.~ ...... ~ .~..~'~: .t~..; ........................................... ="' Sworn to before me this~ ~' , /'~ ~ ~.~/~7 ~ d~of~ /~ / (s~ , Note'""'"'*" ..... Pub i ~'" ...... '""*'""""*'"'" ' ~°A~~l~e° )' ' ............. 'Y No ~* 4022902 I.~511 uoht ed ,n Suffolk Coun~ TOWH OF SOUTHOLD BUILDING DEPARTMIEHT TOWN CLERK'S OFFICE ~UTHOLD, H. Y. Examined ........ ~ ...... a Z ...... , 19..~.~ opp,o ed .................... z' ............................................................................ ..... APPLIGATIOH~~FOR ~ILDING PE~IT INSTRUCTIONS a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. F,ee according to schedule. b. PI0t plan showing location of Iht and of building~.~emises, rel0tionship to adjoining premises or public streets or areas, end giving a detailed description of layout ofprO!~r.~'y must be drawn on the diagr0m which is part of this application. c. The work covered by this application may not b~;'L'~6mmenced before issuance oh Building Permit. d. Upon approval of this opplico{ion, the Building Inspectoi~ 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 i ~t'for any purpose whatever until a Certificate of Occupancy I~J shall have been granted by the Building Inspector. n~ . ~ APPLICATION IS HEREBY MADE to the Building Deportment 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, ordindnces, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ' ~' ~ (~ignatur~ of applicant, or name, if a corporation) ......... Z State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~_~j If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) Builder's License No. ~~....~..~....': ..... '~/x~' Plumber's License NO .......................... ;~);~.~ ...... Electrician's License No..:..~.,.'...,~..;.....~. ~ Other Trade's License No ............ ;......--'-7 ........................... State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. ExJsiting use and occupancy ....... ..~..~"'~"~' ........ /.. ........................................................................... b. Intended use and occupancy ..... ~.~,.,..~.~.~..~...~.......c;~' ~/'/ ~/-- .......................................... ~ .......... 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ... ............ .../~....., (Description) 4. [sdmated Cost ............... .0,.~..0....~. ............................... 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 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 .................................... Rear ............................ Depth ........................ I"[eight .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. 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 fro, rpp, tre~ises: (,) Yes (~'~o 14. Name of Owner of prem,ses ....~....f ,~.,......~ 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 frora 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~;YORK, [ c c COUNTY OF ...~..g..F...~..e..~..~.. ......... ....................... ...~...O....~.....~.'. ...... ~.I..,....'~...~...~...~....L~..~......' ............. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the Z'0 IA~'J(''~ (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 ali statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to befor, e me this ,, _ .,1.. ............ ...... day of ......... .................... Notary Public ~ ..~.~...~...,v .. County ............. ~........~..:. ....... /~ ......................... '~/¢~"~ /'.J "[ .~ ///~ // ' (Signature of applicant) (~/VINC[Ix~T J~I~UJ~KI JR, NOTARY CUB~.IC, S~e of ~v York Ne. 52.4612740 Qualified in Suffolk Counly ~rnmission Expires Moreh 30,