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Home My WebLink About8656-z# . ~ FOK~ NO. · TOWN OF SOUTHOLD BUII,I)ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z. 73.8.~. ..... Date .............. N. 9.v.....23 ..... , 19.~.6.. THIS CERTIFIES that the building located at ~a¥. Ave ................... Street Map No.X-~. ........... Block No...x.x. ...... Lot No..x~......l'ia..'c.t.i.t.u..c.k...~:.Y.'. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ~..u~.e....1.?, 19. ?.6. pursuant to which Building Permit No. ~.~ ~.6~.. dated ......... : .June...1.7..., 19..7.6, 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 . P.r. iya.t.e.. ~.e..f. ~l~J, ly..d.w.¢l~ iPg .w:~ .th..aB. ~.~d. ~.t.i.i.Q~ ................. t Hanson The certificate is issued to . Ar..hut. k~ ..... °.~rner. ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~ :.R.: ............................... UNDERWRITERS CERTIFICATE No... p. end$~g ................................. P.O. Box 994 HO] ~SE NUMBER .... .... Street ..... ..B6~ .A¥.e.,.i; .-l:~.a,~ ~ ~.t.qck ............. Building Inspecfr FOE~f NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8656 Z Date ......................... ~lzl~e ........ %7. ........ , 19..~.6.. Permission is hereby granted to: Ja~ohs..&..Z.~"aw~k:l. ....... A/g ....... &~.thur..Hanson ................... ~w...~ f..o.~ .................................. to build an addition on existing dwellin at premises located at ..]3a,~'..~,~r~ ......................................................................................................... ....... .~.~.$,.$.~ $..t..u..c..~; pursuant to application dated ........................~11~e.....1~.~, ............. 197.6..., and approved by the Building Inspector.1 FOItM ~0, 6 TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLIGATION 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 following; for new buildings or new use: 1. Final survey of property with accurate location of oil buildings, property Fines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposolm(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. Dote 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 pete L.L ............ New Building ................ Addition ...... ~. Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .... ..~..,.~.....~. ....... .~...~...~...~.3..~...,¢.~.....~...~..'~.....~...~'../.~.,j.'..~....~....~..,~,.~.~.~.:....~:..~..,.. Owner Or Owners Of Property ......~....r~....:...'~...~..(/...~ ....... ,~..~..~..~..'Z ........................................................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No. ,~.....S~...?....~....., Date Of Permit ..~Z?Z.~..~....Applicant .. ,~..'...~.(.:..~?.'.~.~....~...,..'.?.-....~..~?~94~/i- / Health Dept. Approval .... /~...'.../..~. ........................... Labor Dept. Approval ...... ~k'.....J~, ............................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificate ~ Fee Submitted $ ...:~..~L~ ...................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ....~..~ ....... ..~..~ ..~..,~. ........................... ,, ....................... Sworn to before me this ~ ,.~. day o'. ~. /;.Z ~ (stamp or ~ )~)~ ~'~°~ ...................................................... Co.. FO~M NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19. Permit No. ~ ............................... Disapproved .~..~~ .......................... a/c. ............................................................ ...................... (Bui di;.~ APPLICATION FOR BUILDING PERMIT ~:~ Dote ...... INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving O detailed description of layout ofproperty must be drawn on the diagram which is port 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 a Building Permit to the applicant. Such permit 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 a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department 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} .......... ..................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..~.....~.... .........~....N...t:..~...~....~...~.7 ........ :/..~..~...z.y...f.:.¥~.~?...: ......................................................... If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No...~..'~.;.'.~..~.~.~...~...%.!:S......L~.~.~?J~'~) 'y , Electrician's License No. '7'~v I~./-Z Other Zrade's License No ............................................... ~ ~ kocotion o{ I~nd on which proposed work will bo dono. ~p No.: ................... ~ ..............ko Mo ......................... ....... ............ ..................................... Municipali~ Store existing use ond eccuponcy o~ premises ~nd intondod uso ond occupancy o{ proposod construction: b. Intended use ~nd occupancy ...... ~.~ .................. ~..~. ......................... ~,,~ ......................... 3. Nature of work (check which applicable): New Building~· ................. Addition .................. Alteration .............. Repair .................. Removal .................. Demolit~or. ................... Other Wor~fi~, ............. 4. w, Fee /.Ii . Estimated Cast'S..,-(.!../ ................................................................................. ...~.,~,...!.,'zc'''_ ........... (to be pard on ..... 5. If dwelling, number of dwelling unils ....~,. ................. 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. D~me~.s~ons of ex~sting structures, ~f any: Front ..-1~.---- ................. Rear ./.~.'' ......................... Depth ..~ ......... Height ..? .................... Number of Stories ..... ~ ......................................................................... ..~ ~, D,mensions of some structure w,th a,terations ar oddit,ons: ront ..................... Depth ...... ~.. ....................Height ............................ Number of Stori,es ................................ ~. D,mens,o,,s of ent~e new constr,,ct,ar,: ~:'ront ....~..~..:; .......... i'..... ~ear...Z.,.~..... ........... Depth ...~....~..... ........ Pleight .................... 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 ore situated ..................................................................................................... 12, Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ ~a. w~u ~ot be regraded ..../J.~ ................ W"~ e~ess f~ be removed fram .prem~s?s: ¢ ~.¥es Nome of Architect .............................................................. Address ................................ Phone~ No ....................... Nome of Controctor ............................................................ Address ................................ ~hone 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 .CTATE OF NEV~"~F6RI(, ..... ' ~c S COUN'FY OF ......... ........................... ~.O~..~....ZL~.a.~i .............................. being duly sworn, deposes and says that he is the applicam (Name of individual signing contract) ' ' above named· ~ Fie is the ................................. ¢O~;Z'~c.'kOr. ....................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, a~d is duly authorized to perform or have performed the said work and to make and file ?his application; that oil statements contained in this application ore true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ~ ~ · Suffolk ' ~ ..... ~i~nature of applicant)