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Home My WebLink About8588-zNO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Ot~ice Southold, N. Y. Certificnte Of Occupnncy No.~7760 ....... Date ............... ~]t. '5 ..... , 19. THIS CERTIFIES that the building located at .. id/Il, l~bart~ .]loac~ ....... Street Map No. ~ .......... Block No. ~ .~ ...... Lot No, .. >~ ..... ~o~hoXd .... N,~, ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated . ~(2~73&. '3/10]~'' ', 19 .... pursuant to which Building Pe~it N~&. dated .~]73. ~ .~/~]~ .... lg ...., was issued, ~d conforms to ~1 of the requffe- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .Pri~ate..~ne. f~il~ .~v~e3.!irg .~h. a~t~tio~ .~. A~ee~. ~ldg.. ~approved by ~,A) The certificate is issued to , .~q~D..~. ~.~. T~.~gOu.~k!. ,. ~rs ................... (owner, ~lessee or ten,t) of the aforesaid building. Suffolk County Departmen~ of Health Approval ~,H~ ............................... UNDERWRITERS CERTIFICATE No. M,R, ....................................... HOUSE NUMBER ..... 2~0 ...... Street .. Hoha2~. Road ..... 8oa~ho~ ............ Building InspeCt Sou~rHOLD, N. Y. (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8588 Z Perm~slon is hem~y granted to: J ol~..&..~,~..~l~,~i~, ................................ ............ t s~G.... ~ebe~t, -Re~4. ......... at preml~e~ located at ,~].G....T~O~I~.~.,~I~ .................................................................................... ........................................................... · ~G~t,~u~1, ...... ~.~.o ............................................................... pursuant to applicatkm dated ....................... ~1~......~ ............... , 19~.6..., end apfm~l'~r'jhe B~l~ng Im~ector. FORM NO. 6 TOWN OF $OUTHOLD Building Delmr~ment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF O~GUPANCY Instructions A. This application must be filled in typewriter OR ink, end submitted in triplicate 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 o'f 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: I. 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 Building .................... Old or Pre-existing Building ..... ~ ................. Vacant Land ............................ Location Of Property ....~,...,~.,~,?. ....... ,~.,,°.,.~...a.,,~..',~.. ....... '/"~"?'~"~'"'"'"~'"'~'"'~'~"?'"'~'"'~'"'"'""~'"'7' ................ Owner Or Owners Of Property .....~...o..~,,~....~..../~....~..~...~.,.....~.~...~...~....~....S.....~....[ ........................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No..~..~...~.....~...... Date Of Permit ..~..I.!,~.(.']..~,...Applicant ..~,.O.~..~..S..,~.)~.,~..~.,~.,~.0,.,,~,.~J..~,.! ..... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ........... ~ .......................... Fee Submitted $ ..~.....' ............................. Construction on above Sworn3before me~ ................ day of~ Notary Public ~,.~ / described building and,~ __ ~permit meets all applicable, c~odes and regulations. ...... ...... County (stamp aT seal) a. This c~!icatton must be W fllled~M.by ~ w in ink ~ submittod in ~ to the Building ·areas, ar~ngG a~mma amcript,on ot Rlyout otlm~er!y mu~t oe arawn on ~ o ag~ ~ ~ ~ ~ ~ c. The work covered by this application may nat ~ commenced before immnce of Building Pem~/. d. Upa~pprava! of this application, tt~ ~1..eql3e~. ?fl Issue a Building Permit to the applicant. ~Such permit e. N~ bulldtng dlall be occupied or used in whole or in pe, rt ~or any puq~w~ whatever urltil o Cefflflcate of Occupancy shall ha~ gmntld by the Building Inq~. APPLICATION IS HEREBY MADE to the Building Degartment for the I~UonCe of a Bul _ld_ing Permit _pu~mant to the oamit authorized irmpocto~ on premises and in oulwlngl Tar nocelsoly mlpacTmns, .~ (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of pm'nises ....~.°...~.....~...~.~...z:.~....~?...z:.g....°..~..~k.~ .............................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name i3nd title of corporate officer) Builder's License No ............. ; ............... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade'e Liceme No ............................................... j~ .a, I'~t Ne~· ..~ I. Location of land on which prapoeed work will be done. Mc~p No.:t .................... .......... .................... Street and N~mber ,~ Hobart ~d.-Southolc~, N.Y. ; · ............................................................................................................. ........ 2. State existing use and occupancy of I~emi~es and intende~, use and occupancy of proposed construction: a. Exi$iting use and oocW~cy ....~...~.~LL~...=...~ .......... ~ ........ : ........................................................ b. Intended use and occupancy ................................................................. 7.7..~, ................................................... 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ........ ~....~ .... Repair Removal Demolition .................... Other Work Sun Deck ~7~ (Description) $30,.O. ! 4. Estimated Cost. . ......... Fee . 1.. ........................ (to be paid on filing this application) 5. If dwelling, number of dwelling units one ............................ 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 ............................ 7. Dimensions of existing structures, if any: Front Rear ................. Depth Height ................ ........ Number of Stories t;?..o .......................... Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of S~tories ............... T~V...~...~8, 8. Dimensions of entire new construction: Front .................................... Rear ...... ~ ................ Depth ........................ Height .................... Number of Stories ........................................................................ ; ............................................. 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 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: ? 13. WII lot be regraded ........ ~ ............... Will excess fill be removed from premises: ( ) Yee ( ) No 14. Name of Owner of premise~.Q~3~l..~:....~.~.~.~'.~.~..~:~.~..o.~...s..k..~... Addre~ ..3,~.0 ............ Eob{~......~...tR. Phone No. ..~.6.. ~.;-1116 .......... Name of Architect ............(..~..e...]:.~..).....'i ................................ 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 d mensions 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~YOI~ ~, ( S S COUNTY OF ..~.i,L-%n~...LLK. ...... I ' ........................ ..'~,~..u2..~..~: ........ . .~,~.~'~..1~. '.'/~...~....~.....being duly swam, deposes and says tl~t he is the applicanf (Name of indJvidum signing contract) above named. He is the ................................ ~.~.,/~.~,(~ ......... ~r, ......... .~.~t...~..~, .~.. ...................................................................... (J (Contractor,.ag~ corparote 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 bit, knowledge and belief; and ~w~°r~t}~°cfrk°;iLbetthl~:rf°rmed'in..,~ t Ithe Tnner set forth in the appl~.~on~ Uf.~ ..... ..... of ...... , 19.~ ta Pu Ii ...... '~ --~'~'~/'~' .......................... NOTARY PUBLIC. State of New York NO. 52-812~850, Suffolk Count~ ,~ tg ?