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Home My WebLink About8576-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, BI. Y. Certificate Of Occupancy No. ......... Z?~3 ... Date .............. ~r ..... 7 ....., 19.7.~.. THIS CERTIFIES that the building located at . .t4es.~phal~,a. Boad ........ Street Map No. xx Block No. xx .Lot No, Y~ Matt~tu(~k ~ ~.~ ........ conforms substantially to the Application for Building Permit heretofore filed in this office l,'~a[ ~ ~ ., 19.7~. pursuant to which Building Permit No. dated ............ ~ ~ ....... . dated .......... '~?~...~ ..... , .... was issued, and conforms to ~1 of the requk~ ments of the applicable provisions of the law. The occupancy for which this certificate is issued is Private swlmm!.ng pool with fence a acce-saorl{s (owner, lessee or ten,t) of the aforesaid building. Suffolk County Department of Health Approval . .~ii~ ~.~ ............................. HOUSE BIUMBER ..... 38~ .... Street .. W~.at~h!ia. id ....... ~a.ttitu~k ...... .... /.'??.,'.'.%. , ?':?i 7 ........... Building Inspector 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) 8576 Z Permission is hereby granted t~: at premises located at .................... ..V~..~.~.~,,T..~..~....~...I....I...~,. ........... .?..?...O...A....~.,. ............................................ .................................................. ..m...~ .~ !..., ...u..c...~ .................................... pursuant to applicatlo, doted ...................................... ..[~...~.~f....!.! 19.?....~.., and approved by the Building Ir~poctor. F 5 ............ ~.~r~ .......... ../..Y..../.,/~.., ...... Building Inspector FOIgM NO. 6 TOWN OF SOUTHOLD Building Deportment To~n 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 Bui]ding 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: 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.O0 !/.~....~.. l.~.~ ~/x,i 11~JV~ ~ i0 (r~ [~:~ t~o ~/' Date ....... ~'~ ................... New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .......... .~..~'.~.~.T~.~f~..~...~,.~... ...... Owner Or Owners Of Property ....~.~....~.~.~.~...~ .~.,}.~. ...... ...~......[~;..~...,~.~., ......... . .~..:.~...~.~..~...~.1~ ...... Subdivision .................................................. .] ........... Lot No .............,r~_ .-,,,,~-~,~ ,r-~----~ ,..-----Black No ............. House No ............. No. ~...~..17...~..'."..~..'Date Of Perm t ~.~../..~..~.. App cant ..~.~.,(~..~..~........~.~'..~Z:~.~..~...~.'..~.;:.~..... Permit Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval ..............~ ........................... P{anning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ......~ ............................. Fee Submitted $ ..... ~.~, .................. Construction on above described building and per~ee~ oil ,~R.lid~_~e code~,and~regulations. Applicant ................ Sworn to before me th,s , ........ ~ ....... ~ ~"~'~='~'".~,'-~-..' ..... tstamp or seau ~,-- THE NEW YORK BOARD: OF FIRE UNDERWRITEE5 85 JOHN STREET NEW'YORK NEW(YoRK THIS CERTIFIES THAT : Robert Raacke, ~ls ~testpha~ia Road 400~ 'e/o B~nn.ef~s Pond Lane, qaftjtuc~ L~I. 1~976 ' ' : ' ' ' DRYERS ~ FURNAe (Swimming Pool) Th'lis certificate covers 90~pl~lance ?he date of inspection only. B~ecause of unusual environments it} i~ advisable · o have frequent to~t r~'a~d/°r repairs made~y a quall~led~ person, : Matt tuck, L,I. 952 BUILDING DEPARTMENT TOWN CLERK'S OFFIGE .................. APPLICATION FOR BUILDING PERMIT ..... ............................ , o. This *p~licotion must bo completely {ii[od in by ~ypewri~er lnspector, with 3 s~t* of plans, ~ecur~to plot p~n to ~alo. Fee *ccordino to schedule. b. Plot plon showin~ lecotion of lot ond of buildings on premises, relot~onship to od~oinin~ ore,s, ~nd ~ivinO o detail~ description o{ Ioyout o{propor~ mast be drown on the dioorom which c. Tho wor[ covered by this opplicotion moy not bo commenced before d. Upon opprowl of this ~ppllc~tion, the Cuildinfl Inspector w}l~ issuo sholl be kept on the premises owil~ble for inspection throughout the work. e~ No buildin~ sholl bo occupied or used in whole or in port ~or ony pu~oso whotever unti~ ~ Certi{ic~te o{ Oecup~ncy shell h~ve ~een ~r~nted b~ the Buildino Inspector. 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, 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) ............ ....... ffL ......... (Address of applicant) //~/~.~..~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............. ............................................................................................................................................................ Name of owner of premises ........... ...~....o...~.,~.r.......~......['~i~ .~...~....~. ~ ......... . .~_~.~.-:.~....~.,~ ....................................... if applicant is o corporate, signoture of duly authorized officer. (Nome and title of corporate officer) Builder's License No ........................ ~ ...................... Plumber's License No ................................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No,: ........................................ Lot No ......................... Street and Number .....~..~.~--~,~.'..~..~..~..~..~...~-. ....... .~......O~...,.4~. ...................................... t.,~./~",.~'?..~,L.~..C'~:_~,~ .... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Ex(siting use and occupancy ..... ,':~.?...~?.~.......~.......C~.,~~.: ....................................................... b. intended use and occupancy ...... '~"'~' ~ ................................................................................... I~ 3. Nature of work (c¼eck which applicable): New BuHdsng'. ................. Addition .................. Alteration .............. Repair .................. Removal .................. Demolitior, .................... Other Work ,~..~.lj~....~..~.~....C~.,,..,,.~..~,,..k~, ~?~_.-~'~ (Description) 4. Estimated Cost ...:;~"~..~¢... ........ ~ ....................... Fee ........................ ! ................................................................. (lo be paid on filing this application) 5. If dwelling, number of dwelHng units ............................ Number of dwelling units on each floor ........................... If garage, number of oars ............................................................................................................................................ 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 ................................ 8. Dimensions o'f entire new construction: Front .................................... Rear ............................ Depth ........................ Haight ............... Number of Stories ............................................ ). ................................................................... 9. Size of lot: Front ........................................................ Rear ............. ..~. ......................... Depth ..... .~. ........................ 10. Date of P,rchase ............... Name of Farmer 11, Zone or use district in which premises are situated .................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ...... ]~..C).. ......................................... 13. Will lot be regraded ........ ..~.~ ........ Will excess fill be removed from pre~i.s.es: ( ) Yes (';~,,) No ]4. ]'~ame of Owner of premises ..[~,~..~,.......~...~.~...~ ........ Address ..~'~,~.~'~,¢ .6J~-~,~u.... [:)hone No..'~.,~.~..~.~:).~.7 Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly aH 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 comer lot. STATE OF NEW Y~RK, IS S ....................................'~ /~"¢~ '/.~,~4f,.,~ .¢~. ,~,..z//4'..,~..~.~.~Jz.~¢~.. ........ being duly sworn, deposes and says that he is the applic~m (Name of individual signing contract) 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 end file this application; that all statements contained in this application are true fo the best of his knowledge and belief; and that the work will be performed in the manner set foRh in the application filed therewith. Sworn to before me this ~ .......... ..... ¢' ..... ....................... ............. ~, ~ /~ (Signature of applicant) NOTARY ~g~~v' Ya,'k . Comm[~Os ~r~ 30r Jg.~,~