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Home My WebLink About8444-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ...Village. Lane ........... Street Map No.V. il~L,..Marm~Block No ........... Lot No. 2 ..... ~fa~.tit~lek .. ,.":.,.¥, ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... r. ar 2~., ~9.7.6. p~rsuant to which Buil0~ng Permit No..S!+}~.~.. dated ........ l~r. 2~.. , 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 issued is .Privat.e..one. £aml~ .dw.ellir~g ................................... The certificate is issued to ...Cha~.les. A. Na~.le. Hawkins...0wn.e~'. ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Sept..t. ~ 976.. by. R...V. ill. a ..... UNDERWRITERS CERTIFICATE No..T.e~r. ~~. ~/.2~./7.6. ................... HOUSE NUMBER ...~1 ~... Street . ...V. illage. Lane ....... ¥~att i.t.uck ..... ...... ...... Building Inspector FOn~W NO. ~ TO~N OF $O~THOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby grant_ed ~to: FORM ~0, $ TOWN OF SOUTHOLD , Building Department Town Clerks Office $outhold, H. 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 oil 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 mstallahon from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and simdar buildings and installations, a certificate of Code comphance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s.te plan requirements where applicable. B For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: i. 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: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $!.00 New Bqilding ..~ ...........Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property 3~,ZS...~iila,$a..Lat3.e.....3~2.!...N/.0..3~....~..2.5 ......... ~a,t.CAtu, ck.,....~[~...¥.~ Owner Or Owners Of Property ..... ~...,...f.;... '~-t~.~......0~%,~;L.~.S..~,~k!~s ................................................... Subdivision ................................................................ Lot No....~. ........ Block No ............. House No ........... Permit No...~..~.~ .......... Date Of Permit .~/.2,.~,~..~.~...Applicant . ................... Heaffh Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval ...~.S .................................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .....~. .................................... Fee Submitted $ .................................... Construction on above described building aD~t--pprrnit meets all applicable codes and regulations. Applicant .~...~_ ....................................... ................ day of ..~.~%~..t~ ....................... (stamp or seo~. Notary Public ........................ ; ........... County' ~,uts. ry PtJLffe St-re oF New YO~ "-~ h' ~2 ,+2~ .3 ~ :2-',,J.~ ~ ~ ~ o /7 / ,ff. 70 '0 O' i JNAUTHORIZED ALTERATION OR ADDITIOt~ TO THIS SU~¥EY IS A VIOLATION OS SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW COEIES OF THIS SURVEY MAP NOT BEARIHG I / / APPLICATION FOR BUILDING PERMIT ' ~9.2..6/.. ..... INSTRUCTIONS ~,.~'-~/_~' ;~.~ .__/~- ~,~ ~c c, d- a. This application mu~ be completely fill~ in by ~pewriter o¢ in ink a~i~ m mpi~cam ~uildi~ Insp~tor, with 3 ~ of p~, ~cUm~ pl~ plan ~ ~le. F~ acco~ing to ~ule. b. Plot plan showing I~ation of lot and of buildings on premises, relationship to ~joining premiss or public stree~ areas, and giving a detail~ de~rlption of I~o~ ofpr~e~ must be drawn ~ the diagram which is c. The work c~er~ by this a~lication may n~ ~ commenc~ before issua~e of Building Permit. d. Upon a~roval of ~is application, ~e Building Ins~tor will issue a Building Permit to the ~plicant. Such permit shall be kept on the premises available for insp~tion thr~hout the work. e. No building shall be ~cupi~ or u~d Jn ~ole or in pa~ for any pu~e'~m~er until a Ce~if~a~ of ~cu~ncy shall have been granted by the Buildi~ In~ector. B .A,P,.PLIC~ATIO~N .IS HEREBY MADE to the Building Department far, the issuance of a Building Permit pursuant to the u~amg Lone grainance at the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances or Regulations, for the construct)on of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, end to admit authorized inspectors on premises and in buildings for necessary inspections. ...................... (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises-.-..~... -~...~..~-/).:...~:'....~....:..~.¢~/~e':.~...y~~.~. 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 ............................................... Location of ,and on which prol?osed work wi'~-~e done. Map ,N,o.: ..3~-~.-*~. ..................... Lot No.....~... ................ Street and Number ...... .~.~:~...c~x~/,~.. ................ "-_:'* ......................................... ; ......... ~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..... ~.e'~L.~. ......................................... ' ................................................................ b. Intended use and occupancy ....... ~~.....~: .......................................................................................... 3. Nature of work (check which applicable): New Building' ......~.......... Addition .................. Alteration .............. Repair .................. Removal .................. Demolition .................... Other Work .................................................... ..~.~./- -- Fee (.~. ~_ '...~....~... (Description) 4. Estimated Cost .... ,~....~7,~P. ..................... ................ ........................................................... (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 ..........' / .......................................................... i ....................................................................... 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 ................................ Height ............................ Number of Stories ................................ ~ Rear ...~........~. ........... Depth ..,~.....~ ...... 8. Dimensions of entire new construction: Front ....... ~).~ff..../..~..~! ........... Height Number of Stories ,~. Size of lot: Front ..... .~..~.,.,.~.~.....~.. ..................... Rear ..../../..6...~....~.. ................... Depth ..... ~..~.2.........~.. ..... Date of Purchase ...... .............. No_~_~me of ,Former,~Owner ........ ~ ...... ~~-~.. .......... Zone or use district in which premises are situated ...... ~./~~¢(--, ............................................................. Does proposed construction violate any zoning law, ordinance or regulation: ..... ~ .......................................... Will lot be regraded ......~.~-,,¢~., ........ Will excess fill be removed from premise_s: ( ) Yes C>~ No v ,.ll, Name of Owner of premises .k~x.~,,,.,t.,.~¥.e~,,x.,.ww~..u.,, Address .~.,o6~zu~.~.'~t Phone No. Name of Architect .............................................................. Address ........ ~ ...................... Phone No ....................... · ~.~/4~- /74 ~~°C?~Ph~ne No..~.,~...~'.,.,-,..~ ~.,,~-o Name of Contractor . .,~4~./ ................ Address ........... f/ PLOT DIAGRAM ""~'" Locate clearly end 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 10. 11. 12. 13. 14. whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ....... ~5'13.t'1~ '~ ~ ........ ........................... ~,.~,~,~.,,~,..~.....~m~w~ ......................... being duly sworn, deposes and says that he is the applican~ (Name~'~m~v~tEl~ si~lmr![~L'43~ roc f) above named. He is the ........................................... ~;';;~';;';"~'(l';~¥~"~:~'~;;;'~;;';~'~i~:'~'r':';;~i ............................................................... 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 tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........... ~.-~Z'" day of ....~L~¢~ ........................... , 19~... Nato Public,. ........................ ~ .......... County ~. · .~~ .. · --'~../'. ~..~.... ~~ ....... . .~...~. (Signature of ~dpplicant) NOTARY PUBLIC, State of New Yort< No. 52-81~5350, Suffolk County Term Expires March 30, 19~p