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Home My WebLink About8650-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerfi[icate O[ Occupancy No.Z.7.~- -I~- ....... Date ............. ~O.¥... ~ ...... , 19. THIS CERTIFIES that the building located at l)~.~'~p. Hale. l)~.lve .......... Street Ck Est Map No. Deep..Hole.. Block No ........... Lot No, . ~[8 ........ Natti.t~tek .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .. June. ~ 6 · .& Attg. t 9 19..715 pursuant to which Building Permit No.85~07,. & 8801Z dated ...... J. ,un..e..1.6...& .Au. g..1,919.~6.., 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 isl.~.l¥~te. Ort~. family..dwelling .wi.th .em. ~ddi.tio~. & .accessory..Boil_ding The certificate is issued to N.i~h.ola$..C.e. les.t.e ..... 0~aer .......................... of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) · .............................. UNDERWRITERS CERTIFICATE No.i$,R. ........................................ HOUSE NUMBER...~21 .~ ....... Street..De~.Ia .t~ole .Drive ..... '['a.t. tituck ...... .... . ..... Builaing Inspector ( FOI~FI NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT 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? 8650 Z Date .................... ~tme......16 ................ , Permission is hereby gronted to: · ~ickol~s..~......Ce-le.s~ ................................ ........... · ~.1.~ .......... ~eep..,Hete,-D.ri,~e ............ ~a t t ituck at preraises located at .32.1.~....~.~;.~p..Mo~e...Dri.vm ........................................................................ ...................................................... ~ia.~.~lt.~c~ ................................................................................ pursuant to application dated ....................... ~13z).e......1.6 ............. , 19..~.6., and approved by the Building Inspector. Building Inspector FOl~Vl NO. 6 TOWN O~ $O~THOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Insfructions 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: I. 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 ]957), 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 os 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 .............. Location Of Property .... ~,,.~..,?~.'7'.:':~Z.~..~ .............................................................................................. Owner Or Owners Of Property ~..~,.¢/.~:~.~ ~,~ ~ ....... ~ .......... ~/./,~.~,~./,.~..~7~ ................. Subdivision ................................................................ Lot No. Block No ............. House No...~...?%/. ,~ Permit No, ~.~.~ ~ Date Of Permit .~*.~'~7(~Applicant ...~../..G..~....~..~..~f:.~.......~.;~.....~..~..~.:..~.,...~ '7~*',,~'~* Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate z~ Fee Submitted $ ..f.,?........... ................... Construction on above ~ ~ ~ . described building and p~ermit meets all appJi~able ~ocles and reoulations. Applicant....~, .~,..~..~,,~.......~~~~ ....................... Sworn to before me this .......... dayof ..... ......... Notary Public ....... ~ ~~ .~._.. County (stamp or seal) ....... /~q,,(7~. 7kJ) ~ .~ O'<icao, -~- TOWN CLERK'S OFFICE SM/THOU), N. Yo Appiicotion No. ~...~..~....~....C~... ............. Disapproved a/c .........~....~....~ .~...~-' -- ~-"-~- ~' (Building Inspector) APPLICATION FOR BUILDING PERMIT ............. ./.d....., I. . loNs o. This ai~lication must he completely filled in,by typewriter or in ink and submitted in triplicate to the Buildinl~F1't InSpector, with3 set~ of plan~ ~ccurate plot Man to ~cale. Fee according to schedule. -~'~ b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giving o detailed description of layout ofpraperty must be drown on the diagram which is part 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 o Building Permit to the applicant. Such permi~ 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 o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o 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, os herein described. The applicant agrees to comply with oil applicable laws, ordlnonces, building cede, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ....... ....... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..................................... ..~... ............ · .................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. ~ ............ ~ ..... Plumber's License No ................................................. Electrician'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 ..~.../.~.... ......... ~.~..~... ,~.. ........... ~...~../..4~'. ................ .~....~.. ................. ~..~..'"~....4~....~;....~.. Municipality State existing use and occupancy of premises and in~ended use and occupancy of proposed construction: ... ~ ~ ~,¥, / /~ ~,~///, . a. Ex,s,t,,g use°nd occu,on~y ........ ..'Z. .............. ................. Z:.. .......... ~. ........... ~...; ....... .¢. ....................................... b. Intended use and occupancy ..... /~. x~..../~.....~../..../~....~.''~//' ............ ~.....~..../~....4.4~....~.. ............................................... 3. Nature of work (check which applicable): New Building.. ................. Addition ........ .~ ....... Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work .................................................... (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 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 ....... .?....O...~.....,~.. .... Rear ........ Z.o..~.....-~.. ........ Depth .~'..'...~....~'...~ Height ....... /.~.../.'...~..... Number of Stories ........... ./.../...~;~... ................................................. ; .................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ....... ~ ................ Depth ................................ Height ............................ Number of Stories ................................ ,~ ._ x~! / 8. Dimensions Qf entire new construction: Front .................................... Rear ........ ~ ............... Depth .,/~.......~...../_q..... Height Number of Stories ........ 10. Date of Purchase ......... .................... Name af Farmer Owner 1 1. Zone or use district in which premises are situated .................................................................................................... '"2'7' 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... /.~..~. .......................................... 13. Will lot be regraded ............................ Will excess fill be removed from.Dremi~es:.~ ) Yes, ( ) No 14. Name of Owner of premises/J?./.:.....c~....~....~...~..~;~...'~.. ................. Address,~)~--~~.. Phone ................ 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 YOrICk/. ~ / ~ ¢ 5 COUNTY OF ..~...~o. ................................................................................................. being duly sworn, deposes end s~ys that he is the epplicanl (Name of individual signing contrac~ - above name. He is the ................................................................................................................................................................................. (Contractor, agent, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained Jn this application are true to the best of his knowledge and belief; and tha~ the work will be performed in ~e manner set foffh in the application filed therewith. Sworn to before me this ........... ...... Notaw Publi~~~~~ ~...C~..~~ ............. ~ ' - ~ (Signa ute o applicant) Nol~ry Public, Sta~e of Ne~y