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Home My WebLink About8280-zFOB~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z7636 Date May 3 lg THIS CERTIFIES that the building located at . .B~. ~S.h. g?.e..Rg.a.d. ........... Street l]ayBlock No ........... Lot No ................................. Map No.P.e.q?.n.i.c. . .. Est a~ended 88/.9.0 GreenDort ~.Y. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. 17o..V ..... .~, 19..~. pursuant to which Building Permit No..8.2.8.(.)z... dated .............. I~9.v.....~., 19 ?.~., 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 Private one /~arnily dwei!±ng with ad~it'ion (deck) ........................................ ........................ The certificate is issued to . !{.e~ .o.1~ .&...0~ .h~?:]:~. ~ .... .0~.;~.e?.s. .............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . NAR..* .............................. UNDERWRITERS CERTIFICATE No..Il. tR.: .............. i ........................ HOUSE NUMBER ....... ! Q3.0... Street..Da~ sho.~e. R~a~l ..... (~l'.aenp.o.r..~; ......... TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8280 Z Permissio~ is hereby granted to: . ~ ~if~...~....O.~.~h~.~.~ ..~..~.~ k~ r. .................... ................ Gz'~e e~p~.t, .......................................... to.uil~, an ad~i.i, tion on ex.~sting dw.~ lJ~E at premises located at .~:;:~t&..i~,.c).o.....P~.c..~a~..~.~;.....~r~de~l, ......................................... ....................................... ;~.a~.ab.~:~..~o~l. ........... ~e~,.or.t ........................................................ pursuant to application dated .................. ~Q.~. ....... .~. .................... , lC~.~...., and approved by the Building Inspector. ............ I ......... ;;'":'; ....... ~'~ ............ T .................... ouiming Inspector / FORM NO. ~ TOWlq OF SOUTHOLD , B.ilding Deportment Town Clerks Office So.thold, 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 compliance 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. Date 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 $1.00 Date .................................. New B~ilding ................ Addition ...... ~ ......Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...~:~....~ ..... ./.~..~..~....~w~... ................. ~ ......... Owner Or Owners~ Of Property i...../.~.:....~....C.: .......... ~.~ ...................................... ~/ u ,s,o, ? t o .. S bdiv' ' V..~ ........... ~ ....................................... Lo lq ........... ack No .............House No ............. Permit No. ~...~....~..m~...~.,.. Date Of Permit ~.~..?.~..Applicant ..~/~..~..~.......~....~ ............................... Health Dept. Approval ............ .~,.../,.~.~, .................... Labor Dept. Approval ....... .,'~,....~.,.~,. ............................. Underwriters Approval .............................................. Planning Board Approval"iv/~., Request For Temporary Certificate ........................................ Fincd Certificate ........ ~,. ,.' .................... Fee Submitted $ ...<~-,.,..~Z~,.LL..;; ............. Notary Public .......~~ County Construction on above described building and pe,~rnit meets al~ applip,able codes and regulations. App,cont-.-..7.: .... Sworn to before me this (stamp or seal) ~.x/~ TOW. OF SOUT.OLO TOWN CLERK'S OFFICE ~UTHOLD, H.Y. ~ ~ ~ ~' tx=mined ..,d~ ............................ , 1~X,...2~ A~~~ ............... , APPLIGATION FOR BU ~ ~ ~ ~:~ ~- ILDING ~PERMIT ' Dine .......... ................. ,19 ...... INSTRUCTIONS ~. This ~pplic~tion must be completely filled in by t~pewriter oe in ink ond submitted Inspector, with 3 sets of plans, accurate plot plan to ~ale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout ofproper~ must be drawn on the diagram which is po~ 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 Inspecto~ 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 Ce~Jficate of ~cupancy 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 constru~ion 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 c~e, and regulations, and to~ admit authorized inspectors on premises and in buildings for n~essa~ i~ections. ~ (5~s~-t- .............. ........ (SignaTure o~ ~p~lic~nt/or n~me, i~ ~ corporotion~" ; ........ ,:.,. ............ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 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 Trode's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ........ c5~'-......., o° ~- ........ ~O. Street and Number .......... ~ .................................................... ........ 2. State existing use and occupancy of premises and i?tended use and occupancy of proposed construction: b. Intended use and occupancy 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ...' ............. Repair .................. Removal .................. Demolition .................... Other Work ' .... (Description) 4. Estimated Cost .......... ''/(~..~ ........................................ Fee /~-~E"C~ . (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Numbcr 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 ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owr;er ........................................................ 11. Zone or use district in which premises are situated ..... ~ ..................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..~ .............................................. 13. Will lot be regraded ...........~ ................ . Will excess fill be removed from premises: ( ) Yes ( ~'No Name of Architect .............................................................. Address ................................ Phon~ No ....................... Nome of Contractor ............................................................ 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 corner lot. 5TAI'E OF NEW~5ORIg,,/ ,9/ ItS ................................................................................................ Being duly sworn, deposes end soys that he is the opplicanl (Nome of individual signing contracf) above named. He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, end is duly authorized to perform or have per~ormed the sold work end to make and file this opplicotionl that all statements contained in this opplicetion ore true to the best of his knowledge end belief; end thor the work will be performed in the manner set forth in the application filed therewith. Sworn tobez[~e me this ¢,¢ ,, ....... ~~'~ ........... davit ..... ~~ 19...~...~ ,/~ f} / , L~lgnature or applicant/ .1O~ITFi T. BOK~'N