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Home My WebLink About8575-zFO~M NO. 4 TOWN OF SOUTHOLD BU{],DINO DEPARTM~.WT Town Clerk's O~ice Southokl, N. Y. Certificate Of Occupancy No. Z.~.207 ...... Date ................ Sept...~..., 19. V6 THIS CERTIFIES that the building located at .... (hal3..ponc~ .la~* ....... Street Map No-Fordha~. Ae Block No .... I ...... Lot No.. IO' "(i~eenport- t~,~f ~ ......... conforms substantially to the Application for Building Permit heretofore filed in th~, office dated ............. MaT .. 1 ~., 19.~6. pursuant to which Building Permit No.. dated ...... l~ay...~ ~ ......... , 19.76, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which th~.~ certificate is issued is .Pr.~.v&te. one. fuil.y .dwe3,1inl ....................................... The certificate is issued to . .Thomas. Coffi~ ..... ~lter ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .~...~(~..1~75 · .~}'..I~o. ~,la. ·. UNDERWRITERS CERTIFICATE No..pend~n~ ................................... HOUSE NUMBER ..... ~(~ ..... Street... Gull. ~.ol~d. J~a~e ..... G~*~enl~t ...... .... ~'~' ' '~] f:hng ~ ....... (THIS PI~IMIT MUST ~'I¢I~PT O~ Ti'~Si[S UNTIL FULL COMPLETION OF THE WORK AUTHOIItZ'ED) 8575 Z A. Reilly & ~ Ine A~ Thos Coffia Matt~t~k Build new one famil[, dwell .. ___,_. ,__~ _.Lot 10 Fordham Acres I Gull Po~d Lane Oreenport FOEM NO, 6 TOWN OF $OUTHOLD , 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 fallowing; far 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: 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 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 J Date .....~../..~....~. / ...~.....~.. ........... New BHildin*g ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..... .~..~..~...~.....?...~.?....~'...~..........~2.../~......~.....~ .............. .~.~..,.~...~..¢~,~,.~../....~....'~..~...~.~.../ Owner Or Owners Of Property ...... Z~..~..~....'22..41J*. ...... ..~.....0.../.~./..-7/....~.. ...................................................... ..l .~.... Block No. House No ............. Subdivision ...~.., ................................. ~...~[~.~.J~' ...... Lot No ............. Dept. Approval ..... .~./..~..~./.,2....~ .............. Labor Dept. Approval ................................................ Health Underwriters Approval ...................... .~ ................. tqannmg Board Approval ........................................ Request For Temporary Certificate ........................................ Fin~ Certificate ..........]~... Fee Submitted $ ...... ~..~..O. ..................... Construction on above descriF;~,q~il[ing~,~f~t~ets~l, a~ anti, regulations. Sworn to before me th~, ~' ..... ' ..................................................... 7~~" ............ .......... / day of ..~,. ~ ,~.~/ (stamp o~' ~.~ ~UTHOLD, N.Y. ~//~/~ ~' ~ ~ ~ __ ~ Examined ~ ( I / Appbcat.on No ................................. ~proved ..............~.~ ........... [~ ........ , Permit No. ~ ~/ ~ / ~ ~' ~ ....................... ........... ...... ........ ........ - , .x APPLICATION FOR BUILDING PERMIT Date ~/~ ~/~/~ ...... 19 ............ INSTRU~IONS ~. T~is appJication must be completely filled Jn by ~pewriter o~ in i~k and s~mitted in triplicate to the Guilding Inspector, with 3 set~ of plans, accurate plot plan to ~ale. Fee according to ~cheduie. b. Pint plan skewing location of lot and of bu dings on premises, relationship to adjoining premises or public streets o~ areas, and giving a detail~ description o{ o~out o{proper~ must be drawn bn t~e diagram which is pa~ of this application. c. ~he work covered by this application may ~ot be ~ommenced before issuance of ~uilding Permit. d. Upon approval o{ this application, the ~uilding InspectOr w II issue a ~uilding Permit to the applicant. Such permit~ shall be kept on tko premises o~ailab~e {or insp~tlon t~ou~kout t~e work. e. No building shall be occupied or used in whole or in part for any purpose whoever until a Ce~ificate of ~cupancy s~aJl ~ave been granted by the ~uilding Inspector. APPLICATION I~ HEKE~Y ~ADE t0 t~e ~uilding Department for the issuance of a Guilding Permit pu~uant to the Guiiding Zone Ordinance of the TOwn of Southold, Suffolk County, New York, and ~tker applicable Laws, Ordinances or Regulations, {or the constru~ion of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees ta comply with all applicable laws, ordinances, building c~e, housing c~e, and regulations, and to admit authorized inspectors on premises and i~ buildings f~ n~essa~ i~ections. ~ -~f. ~ei'~.~y a~d So:o_'~ .tm_c, (Signature of applicant, or nome, if a corporation) ~attJtuck, I~.]. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Builder Thomas Ooffin Name of owner of premises .................................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name an orate officer) Builder's License No ..................................................... ~ay ~lambing Plumber's license No ................ 1 ................................ ~ectrician's License No ............................................. Other Trade's License No ............................................... ,. o.0.# .~519 .... 10 1 Lecation of land on which oropased work will be dane. Mop r~o.: ........................................ Lot ,~o ......................... · For~bam Acres (~ull Pond J,ane. Town of ~ou'thold Street and Number .................................................................................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................ b. Intended use and occupancy Oonstruet 1 fa,~i~..~ .~.wel].in~. .... 3, Nature of work (check which applicable): New Building......~9.~. ...... Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ..................................................... 2 .~. ~ (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 o 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 ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ B. Dimensions of entire new construction: Front ..f~.~. ............................. Rear ............................ Depth ..,~ .................. Height ....1.~2 ............ Number of Stories ....... .l ............................................................................................................ 9. Size of lot: Front '100 Rear 100 . Depth 202 10. Date of Purchase ...... ~ .............................................. Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...~..o. .................................................. 13. Will lot be regraded ...~.0. .................... Will excess fill be removed from premises: ( ) Yes (~c) No 14. Name of Owner of premises.......................,....._.....................~]q'°r~a's Co~':('~.t~ Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ...~..'....~:.e.~..~.?:.~....(~,~...~.o.~?..L..~.~?.: Address ....~r~:~¢..~ ................. Phone No~. ~..8.....8..§.~..~. ..... 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 c COUNTY OF~,~.~,,~.,,, -. ~._,..__"~"~Z"Oi'~ ............. f""~ · , ....................... ....... du,y s,,,orn, deposes c, nd soys thet he th,, opp,cen, (Name of individual signing contract) above named. hie is the .............................................. ~B~O~,,~ ...................................................................................................... (C~n~t?T~}'o-F, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make end file this application~ that ell statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........... · '1.1.~,t~.-. dm, of ""~a7 ................................ , ]~'"76 /"'"j~. ,. /3 ,CD' ~/~ Notary Pubhc, . ........................... .c~t?.ff~'~J¢ ....... County ....,-_/.~.~...u. ........ ...~........~j,~...~ ............................. · ........ , /' ' (Signature of applicat~') ELIZAOETft ANN NE¥ILtE NOTARY PU~LI£, Slgle of ~ew Yor,~ Ne, 52-8125858, Snffolk Count~ OWN : SUFE CO. NEALTH THOMAS E, COFFIN 2130 PADDOCt4 ROAD TEL, 516- 785- 6522 N. 66°01'~0"E. ,4 60. 5.66'01' 2D' V~, ./SCALE- // ~u-~Tr I 1 C4JAI2AN TE F.D TO THE U,$,LIFE TITLE INSUI;~ANCE CO. DATE: - COP. NEll. OF BULKHEAD LSF..I 0.15, ELEV. - 2,8 TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. CO~IE$ OF THIS SURVEY ~AP NOT BEARING J THE LAND SUEVEYOR'~ iN;~ D 5!AL OR STATEMENT OF INTENT rile ~,/ATE~ SUPPLY ,~ND SEWAGE: ~ESIDENCE WILL CON~ 5TANDAP. D.~, OF ~UF'FQLI< COUNTY DE P,~f<T,~E~':,~T O[ HEAL T H. EXCAVATION INSP~TION REQUIRED //~'~~ APPI2.O'v'ED, C ~ OOql¢l ~ ~o.'" ......, , -Z' ck. ,? / Z.Am~-,/). '