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Home My WebLink About8662-zNO. 4 TOWN OF $OUTHOLD BUIIDINC. DEPARTI~,NT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No..Z.7.3.L~0.. ..... Date .......... I~¥. .... .1 ........., 197.6.. THIS CERTIFIES that the building located at . ~/..S. }'.~t, .n..~.o. gc! ........... Street Map No...xT4c. ......... Block No...X4~ .... Lot NolacX .. F,l,ttitnek ................. conforms substantially to the Application for Building Permit heretofore filed in thl, office dated ............ J...m~e...~.l..., 19..7..6 pursuant to which Building Permit No..8..6~..'~... dated ......... ,T.11ne.. 21 ...., 19.76., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to . .I~..i.l.l.l:..arum...~.t.c..k~...e~. ..... . .o~n. e..r .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .N. :.tt.o ............................... UNDERWRITERS CERTIFICATE No...p~t, lzlg .................................. HOUSE NUMBER .... 13.0.1.~ ....Street ~ain ltoad P~ttituek ?: .............. Building Ins/ector TOWN OF SOUTHOLD , Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter aP, ink, and submitted in DUPLICATE to the Building inspector with the following; for new buildings or new use: I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2.Final approval of Health Dept. of water supply and sewerage disposal--($-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: 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 Date .... .~.~..~./~..Z..~ ........ h New B~ilding ................ Addition ...... .Y-~.... QId or Pre-existing Building ................ Vacant Land .............. Location of Property ......... .~..~...t.~ ....... ~.~: ........... ..M...~..Lf.:~..~......L~ ....................... I ._1 __ I. , h I/ , __~- I Owner Or O~,er, O' Property ....... ~.U..".:~.~..~-....~::.:..~..~...~....--.....-- ........................ Subdivision ............................................. ., ................. Lot No ............. Block No ............. House No ............. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ....... ~ .......... Request For Temporary~te ........................................ Fin(zl Certificate .......................................... Fee Submitted $ ....~.... ........................... Construction on above described building and permit meets/all oppl/i~ codes and regulations. ......... ............................................ Sworn to before me this ........... ......... Notary Public ...... ~~ County FOBM NO, ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. ..... Disapproved o/c ::::.~.-~~~.:~.., ................... A~LICATION ~OR BUILDING PERMIT Date Juz'~e 21 19 76 INSTRUCTIONS ~ a. This application must be completely filled in by typewriter o~ in ink and submitted ~ri:~i~a~: ~bi~: ~il~n~ ~ 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 s areas, and giving a detailed description of layout ofproperty must be drawn 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 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 ~ Build ng Zone Ordnance of the Town of Southold, Sulfa k County, New York, and other applicable Laws, Ordinances or -T Regulations, for the construction of buddings, addmons or anerat~ons, or for removal or demolmon, as hereto described. ~-~ The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t6-'~-\ admit authorized inspectors on premises and iN buildings for necessary inspections. William Beebe Builder (Signature of applicant, or name, if a corporation) Cutchogue N.Yo (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Contractor Name of owner of premises ....*?.{.,Z,.~:!.,Z.,a.,~!!..?.'l.,J:,?.~.~.~.a~ ............................................................................................................ 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 ............................................... 1. Location of land on which proposed work will be done. Mop No.: ......... ~ ........................ Lot No.....~.~..~. .............. Street and Number .~r./.~...~.~,T~..~O.a~,....J.~ft.t,.tJJ:lz~k ........................................................................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...];.~.f....o..~..~.i.,.o..e. ..................................................................................................... b. Intended use and occupancy ........ ~g.[t.l.e.....¥..~..~...~...~...~...cl:~..~..~...i..o,,n.. .................................................................... 3. Nature of work (check which applicable): New Building'. ................. Addition ..,,X:T-,,Z ........ Alteration .............. Repair .................. Removal .................. Demolitior .................... Other Work .................................................. (Description) 4. Estimated Cost ............................................................ Fee ..2.~..:..0..0. ............................................................................. (to be paid on filing this application) 0 ,'mb' · ........................... 5. If dwelling, number of dwelling units ............................ N~ cr of dwelling units on each floor If garage, number of cars ............................................................................................................................................ 6. hc business, commercial or mixed occupency, spedfy nature oad 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. Dirnensions of entire new construction: Front ..... ~,~.~ ...................... Rear ...........~;..~..1!1.9. ........ Depth ....... ~..6..gF'...~. ....... Height .................... Number of Stories o~e ...................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ ~0. Date of Purchase ........................................................Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..!!..13..-..1.!!...~.i.,8.~ ........................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ ~..e.~ ......................................... 13. Will lot be regraded .....~.eS ................ Will excess fill be removed from premises: (~:) Yes ( ) No 14. Name of Owner of premises .1FlzL,I.~LJ~a,i~,..~g,i,Q~]3¢~ ............... Address ........ [.~.¢.~.~..J..~.c..~... Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor .k¢~.,...~.e,e]3.e ..................................... Address .~..l$..~..g..h...o.g~.e. ......... Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from propcrty lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner Iol. ETA'I'E OF NEW Y..O_RI(, COUNTY OF ....... ~ .~.~ ~.0.-~]¢. ........ f .... ........................ ..~$.)...~.~..~.~.f~ .................................................. being duly sworn, deposes and says that he is the apphcan~ (Name of individual signing contract) above named. Fie is the ................................ .bt,1,J,~.~e~. ............................................................................................................................... (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 Ihis applicction are 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. .S..w..~i.r,'..t.~..b..~f2.°lr.~ dmaeytho'fs .....~, ............... ..~3,~..,~. ............. , 19..~..6.. ]/~/,~,,///~ ~ , Notary Public, . ................ ~5t,~..Zh]J~ .................... County ..~:~....~....~-._.L.~...// ........ ~,....~ ................................................... ,~. o ~(Signe'ture of applicant) !lam Expires March ~]0,