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Home My WebLink About8123-zTOWN OF $OUTItOLD BUIT.I~ING DEPARTMENT Town Clerk'~ O~iee $outhold, N. Y. Certifi te Of Occupency No. ~6~1 ...... Date ............ Avg .... ~ ....... ,19.7~. T~ CERTIFIES that the bug&~g located at .~, 0.,~.. ~ r~ge. ~.~. ~ Map No. ~ ........ BI~ No.. ~ ..... ~t No.~..~Ut~g~...~ ......... co~o~ ~~y ~ ~ ~a~ f~ B~t-~ P~t h~f~ ~ ~ ~is o~ ~ ............. A~...~., 19. ~ p~t W.w~ B~ P~t N~ . ~l~. da~ ........... $~... ~..., 19~., w~ ~, ~d ~om ~ ~ of ~e ~ men~ of ~e ap~able p~ ~ ~ hw. ~ ~ for wM~ ~ ~ ~ ~ h. ~lwte. one .f~lly. l~el~ .~.~ addllloa .................. ~e ~ h ~ ~. ~ .BobS. ~ ....... %~. ................ (.~, l~ or ~t) of ~ ~o~ ~i~ S~o~ C~ ~ent of He~ ~vd .. H.H, ............................. ~~ ~T~ No. ~.~2~ ..................... ' .................. HOUSE ~ ... ~01 ~ ..... S~ .... ~agon. ~o~d ......................... TOWN OF $OUTHOLD 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? 8123 Z Permission is hereby granted to: F~t~tuek at premises located at .~0.,.~.....]~/.~..~,L'~gQI~..~I,../..~r~&[,~...~I%...~IL~ ................................. r ............................................................ ..~..~ .e...h..e. ~...e. ....... ~.~.~.~. .............................................................. pursuant to application dated ...................... .A,,~...~..,?~......-~. ............ , 19.....~and approved by the Building Inspector. Fee $..1.~..e.~ ........... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This application must be filled in typewriter OR ink, and submitted ~ I1~ to the Building Inspec- tor with the following; for new bulldings 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 installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. 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. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 DA.~28 Jan.ary 1985 New Building ............. Old or Pre-existing Building ~ Vacant Land Location of Property 15,015.0reg. on,.Ro, ad/, CutcboBue House No. Street Hamlet Robert D'Urso & Stewart Kauffer Owner or Owners of Property ............................................................ 73 2 3.1 County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision .6(~y.2r~ Z- <~/~¢~ ...Filed Map No. ,Lot No, 8123Z ~ ~,¢'.31 Peter Wo Kren Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for~Temporary Certificate ..................... Final Certificate ....................... 15.00 Fee Submitted $ ............................. Construction on above described building and permit r0eets all applicable codes and regulations. Applicant .... ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved .............. !: ......... ~.l ........... , Application No. OC / ~'~ ~' Disapproved a/c .......... ~.....~~ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .....~.~'~.'~'~.'~'$ ...... --~ ............ , 19..~..~.. ..... INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Buddmg~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. P at plan showing location of Jot and of buildings on premises, relationship to adioining premises or public streets or areas, and giving a detailed description of 1ayout ofproperty must be drawn on the diagram wh ch is part of this appl cat on. ~'~ 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 theE, 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. , .... ......... (Signature of applicant, or nome, if a c ~}poration) ........ ................... (Ad'dress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· .................................................................. e., ......................................................... Name of owner of premises .......... .~..~ ........J~l~.~...J~.--..-f~/~-~'~l*..~-..~. .~.~/~.?'/¢~'~' '' .... ~~;;;~ ';dt'l; o('corp'~';ate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be dane. Map No.: ........................................ Lot No ......................... Street and Number~..~"~/~.~.~r~.~t.~.~.!~v~..~:~.~.~'.(...~L~.-~...~.~...~..~1~.~iL~..~.~.~.~.~ MUmClpOHry State existing use and occupancy of premises and in,~ended use and occupancy of proposed construction: a. Exisiting use ond occupancy ......... ..~.~.,~..q~....~..,.~....,~,L~,~-~ ......................................... ,, ,: : b. Intended use and occupancy · " 3. Nature of work (check which applicable): New Building,. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ~.O...M~l~....~... (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 ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... ~..~ ................... Rear ........ ~.~-.~ ............ Depth ...J.~l .............. 9. Size of lot: Front ..... ~...~...~. ............ .. ................. Rear ......... ;3_..~..~ ..................... Depjh....~...~_...~.-- ................. 10. Date of Purchase ..... .~'.,..~.../~.1~...~. ............... Name of Former Owner ..~.~..:.,~.~.~"~-I~.~,~..,.~,~" ............ 11. Zone or use district in which premises are situated ........ ~..11~.~'~.~t..~.l..~ ...................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ ~ ....................................... 13. Will lot be regraded .....1~1..~ ............... Will excess fill be removed fram p~remises: ( ) Yes ( ) No Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor~)...&.*.~.~.~..~..~..~..J ........ Address ~.l..'D~..~,~,... Phone No.~l..~...~...~l~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorn 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 ¥OPd<, ~ t c ¢ COUNTY OF .,~,1~,~,~.~..~,.....,['-' ............................. ,~Jt~."~'~....ll~"....,....[...~.%'~,. '~..~~. .......... being duly sworn, deposes and says that he is the applicam (Name of individual signing contract) above named. He is the .................................................... .(m~.-~..~.-l~..~.~..~.~/~ ................................................................................... (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 applicction 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. Swam to before me this -- / ........Z ~ ......dayof .......~ ' ........... ,9 ' '~-~ ' ~fl i/ Notary Public,. .................. ~ ..... County ......... ~,,~,~...~....,....,.IL~ ....................... ~_ ~, / ,~ ~ 0 ,--,_ ' - ^ _ %, '~ (Signature of al~licant) (9 NOT^i~¢I~UBELI,~,/~,a~eNoE;V~eLwE ¥oH~ J ' Te~m Expires ~arch 30,