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Home My WebLink About8073-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No..ZiO3Z~ ......... Date . D.~¢ll~b.~.r..1.0. .................. 19 9.0. THIS C'5RTIFIES that the building ................................................ Location of Property . 2.560.. ~.arad&se. Shore~, .Roart., ........ So~zthol~,..NoY. ...... House No. Street Hamlet County Tax Map No. 1000 Section ....~,0. ...... Block ...... 1. ........ Lot ..... ~. ........... SubdiYJsion ............................... Flied Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... Ju-I .y.. '~ ~, ........, 197..5. pursuant to which Building Permit No ...... t~0.'/.3, g ......... dated .. ~1.11~[¥..'[5, ................ 19.75, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ..... Aace~sor. y. Building .Usa. (Addition .wi.th .Gu~at .Us.e .No. Kitcken-. Co.oking Facilities Permitted). The certificate is issued to ............... ~.OSZl. LI. lcy ................................. (owner,~j~ of the aforesaid building. Suffolk County Department of Health AppmYal .. ~/P~ .................................... UNDERWRITERS CERTIFICATE NO ..... I~1..529S./~ ................................... Building Inspector Rev 4/79 FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 8073 Z Permission is hereby granted to: Gol,g.,,,_,,.~h..~ld.~..&..~oz~.~...Iz~e...,~/~ Joa~ Luecy .............. S,ou.t. hc~a. ............................................... to ..~.~d..~...a~di.tio~...a~..e xis.ting.. ~cca ss.or.y.,b.u~d£ng ...................................... at premises located at ....~.~ra~i~..~o~..;.~.oa~ ........................................................................ ...................................................... ~tkq~.d ........ .~.,-., .................................................................... pursuant to application dated ....................... .~.~...],-Y. ......... .!.~ ........ , 19..~..~.., and approved by the Building Inspector. Fee $.I...O...,RQ ............ Building Inspector TOWN OF SOUTHOLD , Building Deportment Town Clerks Office $outhdd, 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 buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code complience 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. Dote 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 $].00 New BL~ilding ................ Addition ..... ~.'. ...... Old or Pre-existing Building ................ Vecant Land .............. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Underwriters Approval ...,~.~.~...~. .................... Planning Board Approval ........................................ Request For Temporary Certificat~ec~::.,o~. .................................... Find Certificate Construction on above described building and permit meets all applicable codes an,dk:g:lations. '.. ................ .......II Sworn~/to before me this ~ .... ~.~.., day ~f .~~.~ ........... (stamp or ~ta~ Public, S~ate of New Yor~ ' ~o. 52-03~963 Suffolk County,/ ~'~/~/~/~ ~/~ · ' ~ ~ ~ ~mmi~n Expires March 30, TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Examined 19..~...~.. Application No...~...0...?...~. .............. Approved . 19.Z.~.~'Permit No..~.....~..?...~...~ ......... Disapproved a/~.~-..~ APPLICATION FOR~UILDING PERMIT Date .............................................. , 1~ ............ INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building 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 premises or public streets o~ .a. reos, arid 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 buil~i;I,shall be occupied or used in whole or in part for any puq~ose whatever until a Certificate of Occupancy sha~l have beeqg~lrented by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursu.a, nt 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. ' ........ ....... (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... ....................................................................................................................................................... Name of owner of premises ........ ..~...../..~..~t........~.....~...~. ......... ~..~'..~...~;..~... ...................................................................... If applicant is a co,orate, signature of duly aut~rized officer. ..... ........ ~ (Name and tit e ow co.orate office. .uilder's Licmse 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. Map No.: ........................................ Lot No ......................... Street and Number .~4~9~,,~......,,~/4:~.. ........... .~/St~,eg~/.,~.....,..~Y~4~.~.-~ .......,~4~..._. .......... ~.~.......~,~1...--.. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ..~,,~,~-'.....~......,Z4~.~z~.~..~......'~...-~..'~/~'4-t~',~ ............................................... b. Intended use and occupancy ...~..~.~..~'.. ....... ~.O.~...~......'T ................................................................................ 3. Nature of work (check which applicable): New Building .................. Addition ................... Alteration ....~ .... Repair .................. Removal .................. Demoliti0h .............. · ...... Other Work ................................................ . ..... ~) .~,~__ (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 c~rs ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of u~e ............................ 7. D~mens~ons of extstmg structures, If any: Front ....... v.~...('. ......... Rear ........ ~.~ ................... Depth ....~ ........... Height ...... ~.~... .......Number, of Stories .................. /. ........................................................................... Dimensions of same structure with alterations or additions: Froht ......... e~e...~. ................. Rear ........ ~ .............. Depth .......... ~ ...............Height ........ ~,~.... ........... Number of Stories ./. ............................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ....... : .............................................................................................................. Zone or use district in which premises are situated ...... ~,~.~.~ ....................................................... Does proposed construction violate any zoning law, ordinance or regulation:...~.~X~.-. ....... Will lot be regraded. ........... j~.~ ........ Will excess fill be removed from premises: ( ) Yes (/~CNo Name of Architect .............................................................. Address ................................ Phone No ....................... 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 comer lot. · 10. 11. 12. 13. '-'14. ELIZABETH ANN NEVILLE ROTARY PUBLIC, State of New York~ No. 52-8125~50, Suffolk County-- STATE OF NEW~VORI~, //~ ! S S COUNTY OF .. _~~.~.....~' ' ...~,~ .,~'..,~i~. ......... .~'~,/~,,~.~<P;~-...,~. ........................... being duly sworn, d~oses and says t~t he is the applicant (Name of i~ividual signing c~tmc~ above name. .~ He is the ...... ~....~ ....... ~ ........................................................................................................................ (Contractor, agent, co~orate officer, ~c.) of said owner or ~nem, and is duly authorized to perform or h~e performed the said work and to ~ke and file this application; that all ~atements contained in this application are tree to the best of his knowledge and belief; and that the work will be performed in ~e manner set fo~h in the application fil~ ther~ith. Swam to ~fom me this ...... o, ....... .............. ............. ...... ................................. ~ (Signature of applicant) THE NEW YORK BOARD OF FiRE 0NDERWRiTERS ~ ; BUREAU OF ELEcTRiciTY ~ ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 Ya~ch 21, 1977 ~ . - pptlcation,'¥o:onfile 903144 329843 ---- ~-~, ~ o~ore A~., ~outh oz N. Bavvlew A~,,~ ~ T~es°J · ' M Sectton Block Lot ~,,~,~.m~.edo? arch !7, 1977 ar~,lfoundtob~t~compl!a,tce!ttththe~equ.rementsofth~sBoard. FIXTURE ;: 3 DRYERS OTHER APPARATUS: glec. Room Heaters: Panelboards: 1-G.F.C.I. 1-1.5kw, 1-. 75kw. 1-5cir lOOamR. ~ Paul Burns . Town Harbor Lane ..'Southold, N.Y. ' 11971 Lic~282E This certificate must not be altered Jn any manner~ return fo the office of the Board if incorrect· Inspectors ma be ide,,,~,,,~¢,..¢~a~,.,~/~.f¢,,~t~z~ntifie .~~