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Home My WebLink About8407-zlrOK~ NO. 4 TOWN OF SOUTHOLD BUH.DIN(~ DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No..Z. 69~-9. ..... Date .............. Ma..r.c.h.....2.2..., 19..7..6 THIS CERTIFIES that the building located atAnehor..La. ~ .Brigan~.. Street Map No..H~y.I~ .or. ,L.~$ Block No ........... Lot No...!+ ..... So~_tho~& ............... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... l~roh .Lt .... , 19.76. pursuant to which Building Permit No. {~-07Z. · dated ........ ~ar...~ ....... , 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 . Pr. iva~:.~, or~e..Eal~;t,ly. ~l.w.~ll:~tg..~$~. ,&~.~,9~ ...................... The certificate is issued to .Jer. ome.· .Carol. Balger ..... u.~:s .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N. :.R.: ............................... UNDERWRITERS CERTIFICATE No. p.e.n.d.~.n.g .................................... HOUSE NUMBER .... ~330 ..... Street.. Anch~=. La ............................ 800 9rtgantine Dr Building In,~pector FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT O'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8 107 Z Permission is hereby granted to: at premises [o~:oted o, ...,;.0.~.~.-~.~..~,.....~..~. ..... ~..~..:,..,..~....~.,I.,.~....~....~.,.T..!..~..~7. ....... .?.,..~.. .......................... ..................................................................... : ......... : ~?C'"':'*'~""~" -': ....................... ~.? ............................ ' ................................... ~ ............................ ~;' ' '; ..... ;'. '~'""7 ..................... 7: ........................................... Building Insp~or. FOI~M 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 follow~ng; 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--(5-9 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 far 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, buddings 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 af buildings or premises, or other pertinent in- formation required to prepare a certificate C. Fees: ]. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $].00 Rte New Building ................ Addition ~ Old or Pre-existing Building Vacant Land Permit No..Z.~...~....~..~ Date Of Permit~-x ...~.Z~"'./Z~..Applicant ~~.'.~.~.. ~ .~.'~.~~ Hearth Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicab~le codes and regulations. Applicant ........ ~ ....................................... Sworn to before me this ~__~ ~ ...~...~..~:.. day of .... ../~....~.../'~...~.../~.. ....................... (stamp or seal)~-4~¢/~zJ 'Ii FLOYD F. KING, JR, Notary Public State mc New York No. 52-7267800 Suffolk County '~errll r,, · ~. ptros t,".trch 30, ~97~ TOWN CLERK'S OF,ICE ~-~"~~/ r~ ,. .- / -- Examined ............... . .~....c~..........~......, 19.....~....~, Application No. ~ ~proved ~ ~ !~.. Pe~i, No. ~(/~ ~ ~ Disapprov~ a/c ~ ~ .................... ..................... {Buildinfl In*~tor) ~ o~ .......... ........... , 0 o. lhi~ ~pplicotion mint be compl~t~¥ filled in by ~p~writ~r o~ in i~k ond ~mitt~ in ~rlplicot~ ~ lh~ 8uildin~ Insp~tor, with 3 ~t* o{ pl~, ~ocumt~ pl~ plan ~ ~1.. F~ ~ccordi~ to ~chedul~. b. ~lot plon showin~ l~otion of lot ~nd of buildings on premises, r~lat on~h p to edjo n n~ prem ~s or public ~treet~ o~ ore.s, ond ~ivin0 ~ d~t*iled d~cription of ~out o{pr~ must b~ drown on lh~ die, rom which i~ ~ o{ thi~ ~pplic~tion?~ c. ~ wor~ cowmd by this ~lic~tion moy not b~ comme~ed before issuonce o{ guilding Permit. d. Upon oppmval o{ thi* opplic~tion, th~ Building Inspector wiU i~*ue, Building Permit 1o th~ oppllc*nt. Such ~rmi~~ sholl be kopt on th~ premises ~v~il~bl~ {or inaction three,out th* ~ork. - ~ e. ~o building ~hall ~ ~cupied or u~ in whol~ or in pa~ {or ony pu~o~* wh~l*v~r until ~ Ce~ificot~ o{ ~cuponcy sholl hove b~en ~mnted by th~ Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment 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 Lows, 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. ~ ..... ,, (Signa~re ot app,i~ant, or name, if a c;~)'~i~i ........ ..~ (Address of applicant) '" State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............. .............................................................................................................. Name of owner of prem ses .~:-.-~,,~ ~ ~ -- ; t ~ ;'* ''= 'r~ ~ If appliccnt is a co~orate, s~nature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........ ~..~. ........................ 'i ......... Plumber's License No ...... ~...~....~.....~... ...................... Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed wore will be done, Mop No,: ....~..~....~...~.. ............ Lot No .... "t~ ' ~ ~ 'u ...... ~s~....~.~. i~,~.~e:~ ~-~,~-~...~*,-4. e ........... ,~.~.~-~,;~;~.~,-r~a(,.~l~.. ............. Municipality State existing use and occupancy of premises end intended use and occupancy of proposed construction: o. Exisiting use and occupancy b. Intended use and occupancy ..... ~'~. ............................................................................................................. 3. Nature of work (check which applicable): New Building .................. Addition ~ Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work ...................................................... (Description) 4. Estimated Cost~/'/L) ~), ~6 r',) Fee .......................................................................................... (to be paid on filing this application) §. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ......... If garage, number of c~rs ......................................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each b/pe of use ............................ 7. Dimensions of existing structures, if any: Front ....~....~.. ................. Rear .....~....~.. ..................... Depth .....'./......; ....... Height ! 7 ~ / ........................ Number of Stories ........................................... ... ................. Dimensions of same structure with alterations or additions: Front ..... ..~....&'....~ ..................... Rear ..~....~.....~ ............... Depth ....... 'J..~... ................... Height .../..Z ................... Number of Stories ....... ./.. ...................... 8. Dimensions of entire new construction: Front....! ...... .~/.'..... ....... ............. Rear ...../..~....~. .............. Depth ...~..../. ................ Height ..../. ............... Number of Stories ...]. ....................................... -_. ................................................... .; .................. 9. Size of lot: Front ...... ~/.~.~.~ ......................................... Rear ............ ~ .......................... Depth ................................ 10. Date of Purchase ..........-....~.. ..................................... No_me of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ..~ ........................................................................................ ° 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ~ ........................................ 13. Will lot be regraded' .......'~....~(~T.... ............. Will excess fill be removed from premises: ( ) Yes (~) No 14, Name of Owner of premises~,.~...~..:..:..~.'~.~gz..~ .............. Address .'~...~..~.'~.... N o.~..4..,~..:../..~..~'~,, Phone Name of Architect ...................................... __ *~',c.~;"'~ .................. Address ..................... ........... Phone No ....................... Name of Contractor ....~...~.....?.~..~.~ ......... Address ..~..~..-~...~.~.~.. ........... No.~..:.~.~l. Phone 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 YORK, t, S S COUNTY OF ..J'.~.~£~..~. ..........~ ' .................. ?~,./~...~.......~..~.¢~.~...~.~.../~.. .................................... being duly sworn, deposes and says that he is the applicant (Nam~ ~f i~ividual signing contrace 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 in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fodh in the application filed therewith. Swam to before me this ..... ....... ....... .......................................... , ..... . ........... ............. ~(Signature of applicant) FLOYD F. ~G, J~ Naif ~blic State of N~ York No. 52-7267800 Suffolk Count~ Term Expires ~.~rch 30, 197~