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Home My WebLink About8114-zTO~q OF $OUTIIOLD BUILDING DEPARTM~T Town Clerk's O~iee $omhold, N. Y. Certificate Of Occupancy No. Z66~2 ...... Date ............ ~ep~ .... THIS CERTIFIES that the builai,~g located at ~/~. ttuXX. Ealtd. ]mira ...... Street Map No. xxx ........ Block No..xxx ..... Lot No,. m~3r,..Greanpox'~..N,~o... .... conforms substantially ~o the Applieatio~ for Building Permit heretofore ~ed in thi~ office dated .............. ~.uly. 3~J~.Tg pursuant to which BuiI&tng Permit No...81.l~Z dated ...........~u].~... 3~., 197~., was issued, and conforms to an of the require- ments of the applicable provisions of the law. The occupancy for which thts eeztifleat~ is issued is. ~.~J,l:l.l;X .~. s.~oreg~ .b1~l.l.d:h~. f.~ .p~ .b~ .~..(8p~ove~ ,b~ Bd Ap~ea~s) ~e ee~fiea~ ~ ~u~ W .Ho~. h~l. & .8~ .~ .... ~ ....... (o~, 1~ or ~t) of ~ ~o~d b~. S~o~ Co~ty Dep~ent of He~ Ap~v~ 8ep~ .. ~...~97~...by. ~. V~h ..... ~~I~ ~T~ No..I. ~6~...a~t.. ~.7.. ~97~ ............. HOUSE ~ .... ~ ~. .... S~ .. ~1. ~o~. ~ ....................... 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) N? 81 ] Z Permission is hereby granted to: I~ Z~t*'~lu~lrw~t" ~'"St~tZj~ "t~'~' ............. · .1~ .-..1~'~l'~iI~.-~ ...................................... .................. ~~....~,~.....ItTt 7. ........ ..... ~.~) .......................................................................................................................................... at premises located at ..,~.,~...p~.,.~ ........................................ ~ .............. ~; ..................... ............................................................... G~..*--~.,~,, ................... ~ ............................ : ............ pursuant to appJlcation dated ........................... ~....~ ......... , 19,~.., and approved by the Building Inspector. Fee $. ~.0.~.~ ........... TOWN OF $OUTHOLD ~ Building Depmtment 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 buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a~ertificate of Code ~ompliance from the Architect or Engineer responsible for the building. ~'~ ~) $~cF 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 su~ey.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, ~cupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pe~inent formation required to prepare a certificate. C. F~s: 1, Certificate of occupancy $5.00 2, Certificate of occupancy on pre-existi~ dwelling or land use $5.00 3. Copy of certificate of ~cu~ncy $1.00 ~t~ .~.~.;....~..~%~.L~L~.~. .......... New Bqilding .,..~. ......... A~_djtionb~/. z ~ .~ ~ ,-' ~':: .............. Old or Pre-existing ~uilding ................ Vacant Land ....~.~.. Location Of Property ....::~.~....~.T.~,<.~...~.~}/J{Z...Z-.~tf~.....T.....~..~;~.~.~,~.¢,Z..~:. ..................................... ~ ~ ~,~, ~ ~,~ ..~.~.~..~..~.~.~:.,~,:~,.....,z~.~.......~.~.~,.~.L~,.~ ........ ~ ~. ~ ........ ~...~..~.~.::...L~.~.~or ~. ~rov~ ..~q.~ ................................... ~e~est For ~e~ora~ Ce~ific~te ....~. ................................Vin~ Certificate , ~ ................ Construction on obove described buildino ~nd pormit m~t~ oll~blo ~ ond roflulotlon~. ....................................... .......... ....... =,,Cz , . 'THE NEW YORK~BOARD OF FIRE UNDERWRITERS ,:,,. ~ ~ F~)..?, . , , : :} ',, 85; JOHN STREET. NEW,YORK, NEW YORK 10038, Helen Rutkowski, e/s Gull Pond Lane 1t00' s/o Main R~., ~ : ~Gree~nport, ~L~I~. was examined on September ,15, ~1975, OUTLETS ECEPTACLES DRYERS Water ~' Electrician . , This certificate must not be &Jtered in any manner; return to ~he' office of the ~oard if in~orrect,'lnspector~ may be identified b~tfieir credentials] FO~,M lqO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. Examined ............ ~..., 19..~...~. Application No ................. -'~ - Approved {~/ ,,1 ,I 19'')~ Permit No. ( ..C.~. Disapproved a/c ............... ~,~ ......................... (Building ~nspector) ~, APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. 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 or areas, and 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 building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department 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 Laws, 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. ........ ................................ ........ ,.....;,.. ........... .............. i~la~ne and title' ~"~;l~';~'~"~¥ii~'~'r~i"~)/~'L:'-'i'~:/~*r Builder's License No. ('~L'~-?'~-~'O Plumber's License No ................................................. Electrician's License No ............................................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... ................................................................................................ If applicant is a corporate, signature of duty authorized officer. Other Trode's License No ............................................... 1. Location of lend on which proposed work will be done. M~_p No.: ...~.~....~.~.. ...................... Lot No..~...o...~/....~'.../...~. ..... Street and Number 2.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/'~tl/'~..~ ~7' ~__4~c~¢~r ..,~...~..~. ~.7~....~...~..~.-..~....~.~...~.~..~'...~. 3. Nature of work (check which applicable): New Building,. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work .................................................... / ~ ,0 0 (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 ................................Neight ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ ...'~¢' ',. .... ....... ..... Rear ....... ~ ........... Depth ...~.~ ............. 9. Size of lot: Front ....... (~ ......................................... Rear ....... ~ ............. ~ ............ Depth ~.~...~ ........ 10. Date of Purchase ........................................................Nome of Former Owner ~.~~..~.~Z¢.~.¢~~ ~ 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 regrad~ .....~ .............. Will excess fill be removed from premises:( ) Yes ( 14. Name of Owner of premises .................................................... Address .~¢~¢..~ Phone No. Name of Architect ............................ ~ ................................ Address ............... (f ............... Phone No .......... ~ ........... Name of Contractor ~ ~ ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM L.ocete clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~ck dimensions from prope~y lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. (Name of individual signing contract) abow] named. (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 oil 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 fo~h in the application filed therewith. Swam to be~re me this ~ ~ ~ ~ ~8~Y pU~t.16, State al New Y~ ~m Expires ~arcb 3g, .Z' o r /,2