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Home My WebLink About8418-zNO. 4 TOWN OF SOUTHOI,D BU~,BING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No.. Z.~.~9 ..... Date ............. ~,2g... 29..., 19.77. THIS CERTIFIES that the building located at .~2~t. l:.qfn.t..2o.C.~l ....... Street Map No. 1lass.,..Pt,. ~ No ......... Lot No.. ~.~ .... CuLchogue.. ~ .,J ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ Ilar...$~., 19 .7.6 pursuant to which Building Permit No.. dated ..... ~a~'...%~ .. , 19 .~.~., 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. ri~ate one fami!F..d~,ellin~ .wi.th ad~it~llm .................... The certificate is issued to l'%r ~. ~'.~8. ]~anne.%h .Collins ..... 0Whats ............. (owner, lessee or tenant) of the aforesaid building. : Suffolk County Department of Health Approval l~..~ ............................. UNDERWRITERS CERTIFICATE No .... pe.~;i~lg ................................. HOUSE NUMBER .... 712~ . .. Street ...t~as.sau.. ,~oi~t .!~oa~ .... ~utc?~gue.. Building Inspector FO]EM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLI~RK'S OFFICE SOUTHOLD, N:. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) L Permission is hereby granted to: ~. - -- . a tO ........... t .... '~ .......... ' .............. at premises located at :..~- : ......... .~---, ---~....x~.~.~'~ ............ '~.:~.~:~' ' ' ~:.~....~...~ ~ ~~ .....; .................... .................................... ..... ..... pursuant t~, oppiicoHon'd6ted '.....~.:;.:~...././...., 192~, ond opprov~;' by the Building In~or. - Fee $ ..... FOl~f 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 OP, ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: ]. Final survey of property with accurate Iocohon of all buildings, property lines, streets, eno unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal--(S-0 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Mulhple Residences and similar buildings and installations, o 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 buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings end 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 .....~......c~...?. ...... 7..?.. ...... \/ New B~tilding ................ Addition .../~ ...... Old o~J~re-existing Bj~ildjng .......... ~ .... Vacant. Land .......; ...... Location Of Property ...... /V'~*"*~*'~*'~"'"'" *~'**~**/*/~'~"'*'7~'*'"- "~"'*'~'-~ ~ -,~ /~ // ' .......... *~*~"~' '~'"~*'*~'"~~""*~l Owner Or Owners Of Property ......... .~.-~.~.fl.~./- .~'.......~..~..../...//....~."..~.. ................................................. .'. Subdivision ................................................................ Lot No ............. Block No ........... House No ............ Permit No ..~..../../.~ a~t~ Of Permit ~.~.~..~.../../.'..~p~pplicafl, ....... .~~ ..~........~....~..~...~..~. ...... Health Dept. Approval ..;,.~....~.. .............................. Labor Dept. Approval ................................................ Underwriters Approval ...~.~...'~.....~.,.~..~. .......... Planning Board Approval ....... .~,.:..!..,(~.. .................... Request For Temporary Certificate ........................................ Fino] Certificate ............... ~i .................. Fee Submitted $ ........ .~.../..~.~ ........ Construction on above described building and permit meets all .applicab~ cod~ and regulations. Applicant ............ ~/' '~'~A' '~ ': ';' "",z' ............ ...... a'7' ....... ....... Notary Public .........~.~..~.~. County ~ TOWN ~ ~U?HOLO BUILDING DEPARTMENT ~ C~K S ~ I~ ~,pp~ a/c ........... Pr' :'~ ~ ~-~ ~"~ (BuJldi' In~°r' E~ ~~ ~/ ,PPLl~T,. FOR 12~; ' ~ G P ~T IN~U~I~S a. This a~lication mu~ be completely fill~ in by ~writer o~ in ink a~ ~miff~ in triplicate ~ ~e Buildi~ I~or, with 3 ~ of p~, ~cum~ pl~ plan ~ ~le. F~ ~co~i~ to Kh~ule. b. Plot plan shying I~ation of lot and of buildings ~ premises, relationship to ~joining premiss or public stree~ ar~s, and givi~ a detail~ d~ripti~ of I~ ofpr~ must be drown ~ the diagram which is ~ of this a~licoti~. c. The work c~ered ~ ~is a~licati~ may n~ ~ c~menc~ before issuance of Buildi~ Permit. d. Upon a~mval of ~is application, ~e Building Ins~tor will issue a Building Pe~it to the ~licant. S~h permit shall ~ kept on the premises available ~r inaction ~h~t the work. e. No building shall be ~cupi~ or u~ in ~ole or in ~ for any pu~ose whm~er until a Ce~ificate of ~cu~ncy shall have ~en granted ~ the Building In~or. APPLICATION IS HEEEBY ~DE to the Building Depa~ment for the i~uance of a Building Permit pumu~nt to Buildi~ Z~e Ordinance of the T~ of ~old, ~lk Count, New York, and ~er ~plicable ~, O~ or Regulations, for the constru~ion of buildings, additi~s or altemti~s, or for m~val or de~liti~, as heroin ~ri~. ~e applicant agr~s to comply with all applicable laws, ordinates, building c~, h~si~ c~e, a~ ~ulati~, a~ admit authoriz~ in~tom ~ premiss and in buildl~ ~r n~e~ i~tions. ,.~.~.~L[.~ ....... ~[.[..~:~ ...................................... (Signature of applicant, or ~me, if a co~i~) .............. ~..rc..fi.~...~..~ ....................................... (Addm~ of applicant) State whether applicant is owner, les~e, agent, a~hitect, engineer, general c~tractor, electrician, plumber or builder. ................................................... ............................................................................................................... ...... ................................................. (Name and title of corporate officer) Builder's Liceflse No..~6,1..~..~ ................. Plumber's,License No ......"-./..~.~.~..~ ............... Electricians License No.....~......~.~ .... Other Trode's License No ............................................... Location of land on which pZ, oposed work will be done. Ma p No.: ...~..(~::~.f0.4~t ............. LotNo .........~.....~.. ......... Street and Number ......~.'.~...i......~...~....~...~..;......i~0.o..~ .......... ~/-~ ....................................... MunicJpalily State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ....~ ........ ~, ....................................................................................... b. Intended use and occupancy ................ :?. .............. ~...~Z~...~...~. ..................................................................... 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................. .... 4. Estimated Cost ................. -- -~"~..~...Q>,.~"~ Fee (Description) (to be paid on filing this application) 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, if any: Front ............................ Rear ................................Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth .................. i ............. Height ............................ N~mbe~r~of, Stories ....... ,~.~.,/,, ............... ~O 0 ~-' 8. Dimensions of entire new construction: Front ..... ~..'~....,..O....~. ......... Rear .....~...~......-'~ .............. Depth ........................ Height .................... Number of Stories ...~ ...................... O ................................................................... 9. Size of lot: Front ..J...O...! ............................................. Rear ...... !...~.. ............................. Depth ..?..?..?....~.. ................. 10. Date of Purchase ..................................................... .,.~l~rn,e~f~Fo~. er Owner ........................................................ 11. 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 . ....... ..~.....~......._.......~Vill excess fill be removed froj~ p~qr~ises: ( ) Yes ( ) No Nome of Owner of ,,rem'~ *~'' ~ A"r ~ a~-~ __ _. 14. Name of Arch te~'~ ~"~['"~ ........ aa ess ..~~Phone No ....................... · ..&/..':. .......... '.~,~ ......... /~ .......................... Address ....~.,~.~....'"'""'.. Phone No ....................... Name of Contractor ~'! G ~ Address[~'~r-Y'~l'~'~' '" . ..................... ............................................................................................ ~none No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock 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. COUNTY OF ........ ................................................................................................. being duly sworn, deposes and soys that he is the oppliconl (Name of individual above named. 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 application are true to the best of his knowledge and belief; and thor the work will be performed [~'tlpj~ manner se)) forth in the application filed therewith. Swam to before me this . ~/'~f' ~ ~ ~7 ~ ' ........................ day of .............................. , 19 ........ Notary Public, ..................... ~ County ..~...~ .................................................. .~.'..~ / (Signature'of applicant) ~ Notan/ Public, State of New yoek ~, No, 52-0344963 Suffolk County "'-- Commission Expires March 30, 19~iI pllzsq FL.oo~. LOT '~ LOT PLUVial kl~ PLoT PL&M __ APPROVED AS NOTED PLoT P L A,l'4 PLU M.151 h,t C~ P~-j'~R. I:::'~UL MULLEIZ.-/~,P.,C44il 'TZ MEETING, H~OI)GF-. $ -A Z4~O" UP i A 2.u ~¢tD 1145~ · '4" Z.- z-/-6/~ v. Fi~T pLoocz. T~{cKF-..HI kJ~ II M,q., ¢ M~5. KEH COLLINS ~ESIDEkIC...F_.. I '-- - :"---- FodkiO~TI okL Dg'[AI LG LI~ Et,~ 4¢ ~ FLGOR. t flLTgRATION.5 ~,MD ADDITIOM5 TO FI P-..'YT FLoo'P-_ PtgfELp... D~UL MULLEt. L- Ai~CI4.1TE&T 50OTHAC. PIoM~ Id~' 11964D EAS~ F_.,LF=..VATI OP,J ?;OF'F t f VP-~ ~'~ ~ :24 -L' .AGE, ¢ ~5. KEKI COLLie5 dOt)T~ 4. ~As"l" IPETED. PAt)L 50 u"ft4 At, APTOM.., M'-f .l AND ADDtTIOI45 TO ' 72- ~/~,EET~qG dodgE. F- F F 'Z/~ ~,L4 ~ LL '\ ~* F[OOFZ PL/~tq ALTEI~ATiOkL,~_ AMD /,,DD,~T~Ok~ TO ' .Ntd~, 4 M~S. KEN COLLINS ~ESIOEMCE