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Home My WebLink About7820-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ................................................ Location of Property .....~.~.~..O.v.~.~.~. Plo 9~q ~&'~ ~.VCl t-tou** No. ' ........ '$tre~i .......... Ham/et County Tax Map No. 1000 Section ....'l.~.O. ..... Block . ...0.1 .......... Lot ....... Q1. ? ....... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application, for Building Permit heretofore f'fled in this office dated ....A.I~ .l'~.l...~.~ ........ , 19 .'~pursuant to which Building Permit No ..... 7.~. ~.0.~. ........... dated .... .~.1~ .l'~.]...~. ~ .............. 19.7.~., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .................. 9.;~ .~.~..~..~.~...~. ~ .~..~.~.o.. ( .~.a.~. ~..t.Lo.n. ) .......................... The certificate is issued to .............. ~'.0]~..I~O~./IQ. ~t~ .~.. ........................ (owner. of the aforesaid building. Suffolk County Department of Health Approval ................ .N./~.. ...................... UNDERWRITERS CERTIFICATE NO ..................... .~I..~. ............ Building Inspector Re* ~77S I~R~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTI~OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE Pi~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 7820 Z Date ........................ 'ApTi'~ ....... '11% ....... , 19...~;~ Permission is hereby granted to: T .................. BI~L ....... L~ur. el ........................ to .B.uild..ad~i.tiom~o~me.r...~n...r.e.~r..).....en..ext. s-~-~.n.~.-d.~e%-~-n~ ........................... ~t premises located at ...~ ./.~..~t~.g.Q~Lig...J~q.~...~l.~.~ ......................................................................... .......................................................... L~.el....~ ...~; ........ 1..t~$. ........................................................ pursuant to application dated .................... Apz'~L~L ....... :IL~ ........... , 19..~..~.., and approved by the Building Inspector. Fee $.....1.,~..a~ ........ Building I nspe/~or FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N,Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions Th~s application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor 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 featu res. 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 s~te 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 peoperty showing all property lines, streets, buildings and unusual natural or topograph ~c featu res. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of bu Hdings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent'informa- t~on required to prepare a certificate, Fees: 1. Certificate of occupancy $5,00 2, Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Octobez" 22, 1980 Date .......................... New Building ............ Old or Pre-existing Budding . .~ .......... Vacant Land ............. Location of Property .. ~.~.~.~...C?.e.~..t..~.e.c, .o.~.~c...~.~.~..~..~.v.~.: ~ ........ .~.~..~.r.e.~. ~. !,~..~.. ....... House No. Street Ham/et John Longo and Wf. Owner or Owners of Property ..................................... : ...................... County Tax Map No. 1000 Section 128 Block 01 Lot. 01? ....... Subdtvision... ~. Y..~. Y. ~ ................... Filed Map o ........... Lot ~o .............. Permit No.'-~..~.~.0..? Date of Permit .~.//.'¢/~. ~ .Applicant..~..~..~... ~ ~ .................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ~ .Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...~, ................... Fee Submitted $...~. *. ?.0 ......... e. ............ Construction on above described buildlng/~ Applicant Rev 10-10-78 .~i~.p, plicable codes and regulations. TOWN OF SOUTHOLD .~.~..-~--~/~.~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~../~/ SOUTHOLD, H. Y .... , ~.7....~.= ^p~,cation~ No ..... ./..~.~. ............... ~.?.~.. Perm,t No. ~.~...~.a...~ .... D,sopp~oved a/c "~'"'~,'"'i ........................ ................................................ iiiiiiiiiiiii.'iiiiiii.'i.'ii/i ........................ ................................... · INSTRUCTIONS Examined ................ , Approved ................. .~} ......... L..~. ...... , a This application must be completely filled in by typewriter or in ~nk and submitted in triplicate to the Buildin, 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, relahonsh~p to adjoining premises or public streets o areas, and gwmg a detailed description of layout of property must be drawn on the diagram which ~s part of this application c. The work covered by this apphcat~on may not be commenced before issuance of Building Permit. d Upon approval of this application, the Building Inspector will ~ssue a Building Permit to the apphcant. Such permi 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 Occupanc; 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 th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances o Regulations, for the construction of buildings, additions or alterations, or for removal or demohtion, as herein described The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and h admit authorized inspectors on premises and in buildings for necessary inspections. J,/(Signature of~applicant, or name, if a corporation) ~-~, ~ L~ ,Y. II~r,~ ......... :~..~.~..~..~.d.~. . ........ ~ .~ .................... ~ ...... '~'~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of If apphcant ~s a corporate, signature of duly authorized officer. (Name and t~tle of corporate officer) Builder's License No...~..~.~.Z.~.! .................................. Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's License No ............................................... ~ ~. Location of land on which proposed work w~!l be done Map N .............................. Lot No..~..............o Street and Number ~..~.fX~..~.~.~: ....................................................................S ..~0..~ ............... Municipality State existing use and occupancy of premis, es and intended, use and occupancy of proposed construcbon' o E×,s~t,ng use an~ occupancy :~ ~. '~""%i--~'~U"~' ............................................................................. b Intended use and occupancy .... .~J~.'..'~(~J .......................... Nature of work (check which applicable). New Budding ................. Add~tionV[./.~..~3~b~. Alteration ........... Repair .................. Removal .................. Demolmor, ............ Other Work ~ (Description) / ~" 4 Estimated Cost .9'~,.¢~.0Jb! ......................................... Fee .... ./..~....: ......................................................................... (to be pad on filing th~s applicabon) 5. If dwelhng, number of dwelhng units ........................ 'J- ..Number of dwelhng umts on each floor .......................... If garage, number of cars ................................................................................................................................... 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ................ 7 D,mens,ons of existing structures, if any: Front ..~.~ .~ '~ ............... Rear .... w'..~...%~. ................ Depth .~..~..:.~.....'i' Height .~(Z~,).-- ............... Number of Stories ~ ....................................................................................................... D,mensions of same structure with alterat,ons or add,t,ons Front .i~.~.~...~. ....................... Rear ..~i~.*.~. ........ Depth ..~..~..:.~) ...................Height ..4.0. ................. Number of Stones .............................. 8 Dimens,ons of ant,re new construction: Front .~;.0.,..,~ ..................... Rear ~:0.~..~. ................ Depth ..~...'~...~....O. ........ He,ght""'.f~.L) ........... Number of Stones .~Li. .................................................................................................. 9 Size of lot Front .- '~.~.q ......................................... Rear .... .9.0./- ............................... Depth'"'.~.~..'. .... .X. ............... 10 Date of Purchase ....~¢Z~.~'~" ..................................... Name of Former Owner .~..~4~/72~...(....~..,Ck-~..~ 11 Zone or use d~strsct m which premises are situated ............................................................................ ' . ....... 12 Does proposed construction violate any zomng law, ordinance or regulation' . ....................................................... 13 W~II lot be regraded ........................ Will excess fill be removed from premises:.( ) Yes ( ) No , 14 Nome of Owner of pram,sas . J'~ ......................... Acfdress ........ ~ ................... Phone No.'~ Name of Architect ........................................... Address ................................Phone No ....................... Nome of Contractor~3~..e~.¢..~-~. ~.~.~..~_-¢q~.S.~.oAddress ~¢~ ........... Phone No.7.C~/.~7..~.~....~..~... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~stmg or proposed, and red,cate all set-bock dimensions from property lines Gwe street and block number or description according to deed, and show street names and indicate whether mter~or or corner lot r,J ,3?¢· ~ 3?0 ~' 3o"~ STATE OF NEW~,/ fi/ lc c ~'Z:nom;~: '~- --'"[~;~ ~ ,;~]:;~[.~~;~)_____~ -~~---- ............. be,ng duly sworn, deposes and says that he ,s the oppl,com ................................... ........................................................................................................ (C tr~ctor~ o~ent, corporoto officer, etc.) of sold owner er owners, and is duly outhor~zed to per{otto or h~vo performed tho sold work ~nd to m~ke ,nd file th~s opphc~hon; ~hot dl statements contained m th~s op~hcohen ~re true to tho best o{ his knowledge ~nd behe~ that the work w~ll be per{ormod in the manner set {o~h in the o~phcotion filod therowith. Sworn to beforq ~e th~s ' ~ ~ ~ ~