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Home My WebLink About8304-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy N Z71~+% ~'uly 29 1976 o ............. Date ............................ , .... THIS CERTIFIES that the building located at .8..m.!~h.. Bg.a.d ............... Street Pk Map No.In~liar~..m;.. Z~ock ........... Lot No. ~. ~.~... kqq9D.~q ..... ~ ~.- ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ~0~ .... !7, 19..7~ pursuant to which Bmlding Permit No.. ~. dated Nov ~ 7 19. ~, was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is Private one family dwelling with an a~taition The certificate is issued to . ~.~gh .~$~. ~9~9~ ...... ~9~. ................ (owner, lessee or ten,t) of the aforesaid building. Suffolk County Department of Health Approval ~ 'R' UNDERWRITERS CERTIFICATE No.~.~}~ ........................................ HOUSE NUMBER ..... ~ ~.~ .... Street ... ~}~. ~q~ ..... ~.q~9 .............. Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, bi. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8304 Z Permission is hereby granted to: .................. 4~e~m~e ....................................... ~o..~..~,~0,.. ~A. a0,.~lt,~on., oA..ex~s.t~J~.. ~ell~$ .............................................................. at premises located ot ...~;..~ ......... ~L~a~..]Jl~k..~l~ll; ............................................................ ................................................. Gm~t~..-Rox~ ...... t:~e, eo~l~.e -.- ..~.,.¥-, ................................................. pursuant to application dated ..................... WO~ ....... ~l,~- ............... , 19~.~[...., and approved by the Building Inspector. Fee $.1...~. ~ ~ ............ ............... ....... FORM lgO. 6 TOWN OF SOUTHOLD , Building Deportment 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, IndustriaJ 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), Nan-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey~af property showing all property llnes, 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 .... New Building ................ Addition ...~............ Old or Pre-existing Building ................ Vacant Land .............. --,- ,' ..... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No. ~.~..~2..y Date Of Permit ..~../..~...Applicant ...,~.,c/~..~.'....~.'.,-~....~"..,,~-. .... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning BOard Approval ........................................ Request For Temporary Certificate ........................................ Find Certificate ........ ~ ....................... Fee Submitted $ .....~.',~.,~...,..~,~ .............. Construction on above described building and permit meets all Opplicable~codes and regulations. Sworn to before me this ~LIZABETH ANN NEVILLE NOTARY PUBLIC, State'of New York NO. 52-8125850, Suffolk Cot!~L'J ~. so. TOWN OV SOUTNOLD BUILDIHG DEFARTME~ TOWN CLERK's ' UT,O O, Approved " 1~7 19'~.~.. Permit No. '~ 30 ~ ~ Disapproved a/c ,~~~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ir~k 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 10t and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which Js 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 c/' Building Permi~ to the applicant. Such permit shall be .kept on the premises available for inspection throughout the work, No building shall be occupied or used in whole or in port for any purpose whatever until a Certificate of Occupancy e. shall have been granted by the Building Inspector. APPLICAT ON S 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 bud ngs, additions or alterations, Or for removal 0r demolition, as herein describ(~d. The app cant agrees to comply with all applicable laws, ordinances, bui,ldirig code, housing code, and regulations, and~,~. admit authorized inspectors on premises and in buildings for necessary inspections. , ..................... .......................... ........ (Signature of-applicant, or name, if a corporatio ) Sk~k La~e:, C~tcke~me~ N.,~.~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. B~ilder . .................................................... Name of owner of premises ....~f~E. aD...SmLtd~m..S.e,J~tm~l,e,,he~l~ ........................................................................................ If applicant is a corporate, signature of duly authorized officer. _,1 (Name and title of corporate officer) Builder's License No .......... ~ ...................................... Plumber's License No..Q,.~.*....r~P.~.~t-~.~ .................. Electrician's License No. Ru.],e~d..~,eo.t~.~e ......... Trade's License No ............................................... ~'~' ~ ~ / ~' Other 1. Location of land on which proposed work will be done. Map No.: ..~,~¢I,,~.~...]~.~.t~T,..~.~,3?J~ Lot No..2~.~.~[ ........... Street and Number ....~&e~..;~zd~..~/.th...~d.-.y...~?e~et~e .................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...... OJ~e...~.~t. Gt.Cq.~,,.~.~.t.~::L.~.~ ............................................................................ 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 .~;3-~.~.~.~.~,.(~.~ ................................... Fee ..... ~.....1.5.~.~ .................................................................. (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 eAa~h type of use ............................ 7. Dimensions of existing structures, if any: Front .....4'.~..~.~.'.t. ............ Rear ...... .~..~..~.~. ............... Depth .....~.~!. ......... Height .,3,~ ............... Number of Stories ........ ~a~l .................................................................................................. Dimensions of same structure with alterations or additions: Front ~&~ ~" Rear ~/*~ ~" Depth ..,~.~?. ...................... Height .....,l,.5.t ................ Number of Stories ....... ~.~ .................. 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ I-bight .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district Jn which premises ore situated ...... &..~n® ................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ~. ........................................... 13. Will lot be regraded ....t%O ................... Will excess fill be removed from premises: ( ) Yes ( :~ No 14. Name of Owner of premises~a.~.aD....~qati.,~,h..,g~.]~tult~a, Address ...t~l.~)~z~.i~- ............ Phone No ....................... Name of Architect ~N,3~..~(IZ~%%~I~[~.~IA~.~_X..X...:~f..~~~:~I~..X. .......... Phone No ....................... Name of Contractor l~4:~[®~..&..~O'~t,~. ..................... Address C~uC,~)~.~Jg~ .......... Phone No. ~'3'~'~'" PLOT DIAGRAM 7)¢-~)71 Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-bock 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. ~ STATE OF NEW Y~)RI.~,~,'~ .~/ I~ ~ ................................................................................................ being duly sworn, deposes and soys that ho is the opplic~m (~ome o{ individual sionin~ controcf) obow~ named. He is the ................................................................................................................................................................................. (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 ali statements contained in this application ore true to the best of his knowledge and belief; and that the work will be performed in the manner set foffh in the application filed therewith. Sworn,~to ~re me~~~this ~ ~ ................. ~ ~ r~m T, :¥'~K~N (S gnature of opphcont)