Loading...
HomeMy WebLinkAbout8377-zTOWN OF SOUTHOLD BU~,r~ING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the b,,i]ding located at . ,l~.o.r.~..h...B~...y/~..e.w...R.o.a.d. ..... Street Map ~o..I,.~.e..v~.z'..~. AC'Block No ........... Lot No...1.O. .... .S.o.u..t.h.o.l:.d....~.:Y.: ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... f.?Ll~....~.~?.6., 19.~.6. pursuant to which Building Permit INTo..~, .~..~.Z.. ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to . .R. 9~..C, ?..~.o..I~..~.o.n. ..... .(~...e .r ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .Au. g..2.6.., .%9. 7. .6. . .blt . ~.: .V..t.l.l.~. U1NDERVVRITERS CERTIFICATE No. 1~30037~+ Aug ~ ~ 976 Building Inspector I~OEM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT El'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8377 Z Permission is hereby granted to: ~e~r-.~...~Tehs~e~ ............................................ ............ 6.1......~x~..e..l!eml ....... {L~mZe~,t~emuiJ.. to ~-l.a.. nma.. rv:L~ta~;e...gazagL,~tLt;h...s~a~ag~...~r~ .................................................... Building I~spe~or. Fee $. ~JO~l[~.. J ........ '~ at premises located at .~m~i~..iO....~.~..~,t'~.,~ ..... : ................................................................. ................................................. :.-:..J~.,..~-.' ~ .a~ ......... a~t~,~ · ~, _ .' ,- . ' : ~ ' ................... : ............. .................................................... .~ ....................... ~,.~ .... ,~.?~. · ;:.~.-.:~. ....... , ........................ : ........................... ....plJ,rsuant to applicati~on d0ted_ ~-~ ...................... , _ -~"~'"":"~ii~', ~,~# ........... .., 1~..; and approved by the FO]R~I NO, 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION 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 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 bud&ngs, Industrial buildings, Mulhple Residences and similar buildings and installations, a certificate of Code comphance 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 buddings 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 inspechon 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 .....8../...~.~ ./..?. ~ ............................ New Building ....'~.~.~ ..... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .... .~.2-,8~)...~.,~..~'.V.J..~Z~.....~.,...~.Qk~'LO.~.~,....~r.~ ............................................... Owner Or Owners Of Property .... ..R..o.~...~......~..o.,h...n..s.?.,n. ................................................................................. Subdivision ....~...e..e..w..~..ct......A..q.z'...e..s. .............................. Lot No..?..0. ....... Block No ............. House No...?.?.~..©. Permit No .~3.7.7..~ ........ Date Of Permit ~/.J.Z~..~....Applicant ..~0.~f...~.,...~T.o.h~tD23 .............................. Health Dept. Approval ...... ~ .................................... Labor Dept. Approval ........ --. ....................................... Undenvr~ters Approval ........ z. .................................... Planning Board Approval - Request For Temporary Certificate ..~..q ................................... FinaJ Certificate .......~.9..s. ........................... Fee Submitted $ ...~ ..... 5 ........................ Construction on above described building and~rmit meets all applicable codes and regulations. Applicant ....... Z...~4~....~...~ ............. .~ ...... ....: ............................ Sworn to before me this ................ day o, ................ (stamp or seo, ( p Nota~ Public ....... ~,~';,/ ?~' c, ~'at~ of New York t~o ~- ~'14263~ Su~,olk C~ullty L O~/// # / 40/ AUG 25.~ 1976 DISTANCE TO hEAFEST WATER MAIN- 2.~ MILES UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECT ON 7209 OF THE NEW YOBK STATE EDUCATION LAW -- COPIES OF THIS ~JRVEY [MAP NOT BEARING THE LA/~D SURVEYOR S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. -- GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF TO THE TITLE COMPANY~ C-OVERNMENTAL AGENCy AND LENDING INSTITUTION UBTED HEREON~ AND TO THEASSIBNEEB OF THE LENDING INSTITUTION. GUARANTEES ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD OI~SERVATION$ AND/OR FROM DATA OBTAINED FROM OTHERS~ THEWATER BUPI~-Y AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO/JNTY DEPARTeMENT OF HEALTH RERV ICES APPLICANT ADDRESS_ ~__TEL. NOTES SURVEY FOR ROY G JOHNSON 15 SHERRY A dOHNSON LOT I0 "LEEWARD ACRES AT BAYVIEW" AT BAYVIEW mWNOF SOUTHOLD' SUFFOLK COUNTY, N Y. I~-- MONUMENT (3 = STAKE ELEVATIONS SHOWN THUS: 35.0 SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON JUNE 4, 1971 As F,LE .0. ALDEN W. YOH~ PROFESSIONAL ENGINEER AND LAND ~RVEYOR NYS. LIC NO. HOWARD W YOUN~ LAND ~RVEYOR NYS LIC NO 45893 YOUNG & YOUNG, LAND SURVEYORS 400 OSTRANDER AVENUE RIVERHEAD, NEW YORK )AT E FEB, 3, 1976 SCALE I" =GO' NO 76 -70 Lr ff h .L 70' :/~ I76