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Home My WebLink About8570-zPOKM NO. 6 TOWN OF SOUTHOLD BU~ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupancy No.Z.7_~39 ....... Date .......... 5!o.¥ ..... .~ ......... , 19.7.6. THIS CERTIFIES that the building located at ..~.a..~.a. ~.e.r.s.. ~!D.r.~.v..e.)... Street Map No. ~ ........ Block No...Z3~ .... Lot No.. ~:~C....Clltchc~gtle .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. hay.... 9., 19.7.6. pursuant to which Building Permit No.. dated ......... ¥~ay ....9 ..... , 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 p.r~.v.~te one family, dwelling with garage addn The certificate is issued to . .L..o.u.~s...&..B.e.~.t~,.~q .e..P.a. lr~.zl .... 0..w~..e~,.~. ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N UNDERWRITERS CERTIFICATE No..p~p.d.l.r~g ................................... HOUSE NUMBER .... 2.25. ...... Street ....H.a. lr¥.a.t.e.r. ~. p.r..~.v.e ..................... 6~ Oak Drive ..... /(~BBui? "'"" "'~':" ' ' '~?lding Inspect~ FO~M NO, ~1 TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN a. ERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8570 Z Permission is hereby granted to: · /~.D....~.~,~c.~... ~b~..~ .... F~ '~L ' ... ~E[L~ ........... E~.~.~.~.Z.~ D~[.~- ~' ~ ' at p~i~ I~at~ at .................................. E........~...~....~..[.[ .... ................................................................................ g.M..~..~.~.~..~.M.~ ......................................... Building In.rector. F. .............. Building Inspector FOI~I~I NO. 6 TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY ~nstructlons 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 .............. Locat,on of Property ..... .............. Owner Or Owners Of Property ....~..~,...~..~......~../..~.....-~...r..~ ...... ,~.~,~.t./<..f.?/... .................................................. Subdivision ................................ ~ ......... , ............ Lot No....:~. BIo~ck No ..... .~,~... House ' o, ........................... Heolth Dept. Approval ......... .~.......~... ....................... Labor Dept. Approval ................ ~,.....,~-. .................. Underwriters Approval .~~.~. .................. Planning Board Approval ......... ..~....!...~.... ................ Request For Temporary Ce~icate ........................................ Fin~zl Certificate .......................................... Fee Submitted $ ...~....~~ ...... Construction on above described building and permit meets oil applicable codes and regulations. Applicant ......................................................................................................... Sworn to before me this ...... ...... TOWN O~ IOU~I~OI~ ~UII.DIN~ ~&R'rMINT · rowN a,iBit~ OI~K~ / Examin~ ......................................../' ' , 19 ........ ~)~'L / t"~ ;: I/' ~. .... ~ ........................................ , 19..-.. ~lt ~ ..................................... Application No ................................. Disapproved a/c ................................. :~ ................................. (Building Inspector) APmCA,TIOH FOR IUUlNG PERMIT INSTRUCTIONS a. This application must be camplately filled in by typewriter o~ in ink and submitted in triplicate to the Building~i Inspector, w~th 3 ~ts of plans, actuate platplan to male. Fee aoc~ding to r~mdu~. b. location of lot of od joining or/~, Plot plan showing and buildings on premises, relationship to premises or public streets areas,and d giving a detailed description of layout ofpra~e~/must be drown on the diagmm which is pert 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 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 B uiil*dir~.. Zone. Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulah.o. ns, tar 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 cnde, housing code, and regulations, and to admit authorized inspectors on premises and irt bulldingl for necessary inspections. (Sl~ndture of 6~pplicant,/Or name, :f a corporation) .......... ...... ~ (Address of applicant)/ State whether applicant is owner, leSSee, agent, architect, engineer, general contractor, electrician, plumber or builder. · ~ ~ e ,~a,~r,~,~-~ ~ Name of owner of premises .......... ~....(<'..~ ....... ; ............................. . .~....~.~.. ............................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's Licease 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.: ........................................ Lot No ......................... Street and Number ........................... ~- ............................................................... ~ ................ ~. ................................ Mu~icipallty State existing use and occupency of premises and intended use and occupency of proposed construction: o. Exisiting use nd oc upe cy ....~....~..~.'.~.. .......,.~....: ....... ~. b. Intended use and occupancy~..~ ....... ~...~...~...4.~.~...~., ~ ............................................................................ 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolitior. .................... Other Work ..................................................... (Description) 4. Estimated Cost ...................... ~A'~e"crO ' 2'~...; ............................... 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 ............ O/J(.~...,[../J .............................................................................................................. 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 ......... ..~..'~..,~.~..~.. ...... Depth ......'~..~..q..~..f- Height ....../..~.:~...~ff...~....-- -- Number of Stories ............... ~...~...~. ...... .('~.). ............................................................................ ---- . Dimensions of same structure with alterations or additions: Front ..... ~...~..~...T... .......... ' ...... Rear .......7~/~,?..._ ........... ~{~..~.....~. ~. Depth ........ .~..~.~'.' .~.~ ............ Height .....Z~.~.: .............. Number of Stories ...... ........ 8. Dimensions of entire new construction: Front .......... ~.~..~..,~. ............... Rear ..... ~..~..~...--J ........... Depth .....~..,~.~,.~.f,.,., Height ...../.,,9..~4'..7~..... Number of Stories .~ ...... ~.e'......./'.~.: ......................................................................................... 9. Size of lot: Front ........ /..~?../;.~.~..~...7.,..~....~...~.~...~..---- ........... Rear .~...~/...~4.~..~...~.4.~..~.. ....... Depth .~.,.f~,..~..~..~,,.,.~.z 10. Date of Purchase ............................................ ~.~./'~'-/~.~'f~' ..... Nome of Former/ Owner .../~..~...../~...~....e..~..~'.-- ................................. ~'~'~'~ ~'~ 11. Zone or use district in which premises are situated . ..:.7~.~.t../..~.~.~./.. ......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ~.1. ............................................. 13. Will lot be regraded ......~..~'..s. ................ Will excess fill be removed from premises: ( ) Yes ( ) No ' 14. Nome of Owper of prem,ses .~..~(.~..~..~..'f.~..~.~f..~...~.~...~...~. ....... Addre 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 lot. STATE OF NEW YORK ~ ~ c COUNTY OF ................. :~, J..:.:~.;.L.) ..................... L.L.I..!..~ ............. .L;..~..;~..E...P.J. ............................. being duly sworn, deposes and says that he is the applicam (Name of individual signing contract) above named. 'He is the .............................. (..a ............. ~. ............................................................................................................................. (C~ntractor, 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 ................... of ....... :., ................. Notary Publ~, ............................... ~ .................... C°Unty~- ~ ........................................ ~ ...................................................... (Signature of applicant) JUDITH T. BoKEN 4otary Public, State of New York No. 52-0344963 Suffolk Coul~ ~omrnission Expires March 30, lg~-~