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Home My WebLink About8655-zFOlh~ NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No... Z~980 .... Date .... April ..... .~.0 .......... , 19.78. THIS CERTIFIES that the building located at .7980. Sound. V.£ew. A.v.e .... Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... June.. :1.7 ....... , 19.76. pursuant to which Building Permit No.. 8~55Z. dated ..... J~ue.. 47 ........ , 19 .?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 is ..... PRIVATE .ONE .FAMILY. DWELLING..WITH DECK .ADDITION ............ The certificate is issued to ........ .~{[enl~f .Jacobt. F~: ............................. (owner~~t) of the aforesaid building. Suffolk County Department of Health Approval ............ Nf.R .................... UNDERWRITERS CERTIFICATE No ..................... .N/.R .................... HOUSE NUMBER ... '70@~) ...... Street ...... ~o~nd- .¥iew .A¥~ .................. ............................................ Se .~tt'~ot~h~..New. Y. ork .............. · ...... Building Inspector FORM NO. 2 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) N? 8655 Z Dote er1~.e ~7 19 ~6 Permission is hereby granted to: Henl~' Jaeobi ~:[ 8outhol6 Build ney private swim~ing pool with fence PVT Road S/S 8ound View Ave at premises located at ............................................................................................................................ Bou~;hold pursuant to application dated ......................... ~.t~....e.......1.~.. ............ 19...Z.~., and approved by the Building Inspector. 15,00 Fee $ ........................ FOltM NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application musl 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-g 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, o 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 oil 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: t. 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 ........... ..... .//~.~.. ~..... t.~(~:~_4/~..~-' -~ ~//~ ~/~/~C~ ~ ~ , Location Of Property ...... ,, ............ ¢.~.~......~..~.,~..~ .............. Owner Or ~ners Of Property ............. ~...~/.C~.g~,( ...... ~ ............................ Subdivision ................................................................ Lot No .....~ ....... Bilk No..~.. House No ............. Health gept. Approval ...................~ ........ ~bor ~t. ~provaJ .......... ~.~ ......................... Under,liars Approval ............. ~ ................... PJa,m,g B~rd App,ovaJ ...~ ........................... Request For Temporaw Ce~ificate ........................................ Fin~ Ce~Jficate Fee Submitted $ .................................... Construction on above described building ~~r~eets all applicable codes and regulations. Sworn to before me this Applicant .~.,~.~.~..~':: ~/'.?.:~./.~.~,~ ................ day of ............................................ Notary Public .................................. County ~//~ 0/7 ~mp or seal) 'I Jo /-~ BUILDING DEPARTMENT /~ ~ C 4~_.~ ~ TOWH CLERK'S ffFIC, E ~,~ ~/ /z>/'~ ~ ~:~..~ ~ Application No, ,u,,.~,,,,,: .................. APPLICATI~ FOR BUILDING PE~IT ......................... INSTR~IONS ~. lhi~ ~pplic~tion mu*t ~ compl~l~ fill~ in b~ ~p~writor o~ in ink ~ ~mi~ in ~riplic~ ~ ~ b. Plot plan ~in~ I~tion of lot ~nd o{ buildin~ on pr~mise~, relotion~hip to ad~oinin~ pr~mi~ or public ~r~s, ond ~ivi~ o d~t~il~ d*~cription o{ I~out o{pr~*~ mu~t be drown on th~ dio~mm which i~ ~ o~ thi~ opplication. c. Th~ wo~ c~*r~d by th~ ~lie~tion m~y n~ b~ comm~nc~ before i~uonce o{ Buildin~ ~rmit. d~ ~pon ~ppmv~l o~ ~i~ ~pplication, ~ Buildinfl Ink,tot will i~u~ o Buildino ~rmit to the ~plie~nt. Such ~hall be k~pt on th~ pr~mise~ ~v~ilabl~ {or in*~tion th~hout th~ work. e. ~o buildin~ ~h~ll b~ ~cupi~ or u~ in whol* or in Pa~ for ~n~ pu~ose ~v~r until ~ C~ificote o{ ~cupancy ~holl hav~ ~n omn~d ~ ~h~ Buildin~ In~p~tor. AP~klC~TIO~ I$ H~RfiBY ~Dfi to th~ Buildin~ D~ment {or th~ is~u~nc~ of ~ Buildinfl ~i~ pumuant Buildino Zone Ordin~nc~ o{ th~ Town o{ ~uthold, Suffolk Count, ~ew York, and o~er opplic~bl~ [~, Ordin~nce~ R~ulotions, {or th~ con*tru~ion o{ buildino~, oddition~ or olt~mtion~, or {or removal or d~moliti~, ~ h~min ~e opplicont ~r~** to comply with ~1~ ~pplicobl~ law~, ordinonc~, buildino c~, h~i~ ~, ~ ~ul~ti~*, odmit outhori~ in~ctom on pmmise~ ~ i~ buildin~ ~r n~e~ i~tlon~. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................ ................................................................ ........................................... " ' ' r ' Henry Jacobi III ~lame or owner aT p em,ses ................................................................. ::.1 ....................................................... ~ .......... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... .o....~...e..~ ................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's License No ............................................... Location of land on which proposed work will be done. Map No.: ....... ~ ......................... Lot No ....... ~ .......... Street and Number .....~[..t....~.~.....~.../..~.....~...o...t~....d.....~.~..e..~.....A..~..e. .......... ..~..o..~.~.~..o.~.~ ....................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ......... ~.~...e..1...]:.J;..~.~. .................................................................................................... b. Intended use and occupancy .....s....a~...e.....~..~.t...~...~.~.~.~,~...~.Qg,~,..~..~,.¢.g~.~SD.l~s ..................................... 3. Nature of work (check which applicable): New Building. ................. Addition .................. Alteration .............. Repair .................. Removal .................. Demolitia~ .................... Other Work .....s..~..~.J:~fLP.~°.~....~.....A...e..c~'. (Description) $ ~. 00 4. Estimated Cost ............................................................ Fee .......................................................................................... (to be paid on filing this application) one 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, Jf 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 of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ........ .1...0.? ......................................... Rear ............ .1...0..0. ....................... Depth ...... ..2..0..0.. .................. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ...'.t.~.l.f...~.s..-t. ............................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation: ............. ..~..O. ...................................... 13. Will lot be regraded . ....... ~r..e.~ ............. Will excess fill be removed from premises: ( ) Yes (3:) No · Henr Jacobi III Address Southold Phone No ....................... 14. Name of Owner of prem,ses ........... ~. ....................................................................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............ s..a...m..e. ....................................... Address ................................ Phone No ............. ; ......... PLOT DIAGRAM LocQte dearly 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. see attached plan STATE OF NEW ..¥Ogl~... ~-~- COUNTY OF ..... ~..[...Z..O....I~.. ........... f ~-.~ Henry Jacobi III ................................................................................................ being duly sworn, deposes and says that he is the applicom (Name of individual signing contract0 above named. Owner - builder 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 and file this application; that all statements contained in this applicction ore 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 Notary Public, . ................. ~.~.;~.Q~]~; ................. County NOTARY PUBLIC, State of New Yor~ Term £xpi~es M~rch 30, C~ignat~,9~ applicant)