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Home My WebLink About7880-zFORM NO. 4 TO~VN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, BI. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at Wes.% .Cove Road .......... Street Map Nolqa. ss,. P.t... Block No .......... Lot No, conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... l{ay .~?. .... , 1975. pursuant to which Building Permit No. ?.8.8.0.Z... dated .......... }lay. 2 ...... , 19.7.~., 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 . .k¢¢esser~ .cleek.~ · stairs, etc ................................... The certificate is issued to . J. ob.n. ~laJ;.t.ery ..... .~e.r ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N.,R, ............................ UNDERWRITERS CERTIFICATE No. l~,t{, ....................................... HOUSE AU3-MBER .... ~60. ..... Street .Wes.~ .~Oy~ .[10~ ........................ ..... /..'~...- ......... .-- ...... ./ ...... Building Inspector / FORM NO. 2 TOWN OF SOUTHOLD 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) 7880 Z Permission is hereby granted to: ............. ~.~C.~C ..... i..,.,., ................................. tO .~:-u&.~'d...~e~...(.ac~ee-~s~ry-)..cl-eel~..~.~-C¢-}~-.z~eps...e~ ....................................................... ui premises located at ....~.~t, Lb .........~[~-S~. -~--F~t~q.~...-~ Y~I~ ........................................................ ................................................... ~'4~-~..-~ov-e-.~oad ............ Cu.t, et~ ..... ~.,,.~... ........................... pursuant to application dated .........................~.~..~.......~. ................ , 19..?..~..., and approved by the Building Inspector. Fee $..~.~.~0~1 .......... ~'O]~M ]go. 6 TOWN OF~ SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUFANCY Instructions A. This apphcation must be f,lled 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 Iocahon of all buddings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage d~sposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar build,ngs and installations, a certificate of Code comphance 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-exist~ng" 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 ............. ./..9 New Building ................ Addition ...~. ............ Old or Pre-existing Building ......... ~ ....Vacant Land .............. Location Of Property ......... .W..e..s..t....C..q.v..e....Rg..a..d.~...qt~hQh~gi~l~.,..N.~,~..llg~5 .............................................. Owner Or Owners Of Property ..... ~9.~...S...Z..a..t.t~.~'.7: ........................................................................................ M1;, #156 Subd,vision ................................................................ Lot No...2..7..4. ..... Block No ............. House No ........... Permit No .?...8.8..0. ........... Date Of Permit Z~,Y..~-.~t.cJ.?~SApplicant .......F..~.~..?..i..c..b...a~...o...v~.'..c.?..~....Z..~..Z. ................ Health Dept. Approval ..... .~...:...~.. ............................ Labor Dept. Approval .................. ./~....;...~....: ................ Unde.r,ers Approva' ...... ........................... P'a.ning Bo. rd ^pprova, ......... ................. Request For Temporary Certificate ........................................ Flncd Certificate ....... ~ ............................... Fee Submitted $ Con st ruction on a bore described building an d er~/~ et ~/~~i ca bleaode$ondregulations Applicant ........ ~...~ ......... ..~-.~...~ ........................................................... .~vom to before me Disapproved a/c ................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in jr~ and submitted in triplicate to the Building Insp~or, with 3 ~ of plato, aocumte plot plan to ~:ale; F~ according to .~hedule. b: ' iPF6t plan showing location of lot and'of buildings on premises, relationship to adjoining premises~or public streets oF areas, and giving a detailed description of layout ofproperty must be drOwn 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: · U~on apprOval of this application, the Building InspectOr wifl issue o Building permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No budding 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 bdildings, additions or alterations, or for removal or demolition, as herein described. The apphcant agrees to comply w~th all apphcable laws, ordinances, building code, hous ng,cede, and regulat.ons, and to admit authorized inspectors on premises and in buildings for n~~i!2~i':L*'~'~'=--'*-~''~'''***''~''':*. I~t~';'~=. h~,., -..._.r : '~'~:~ ':~ "ihn Frank Clchano~cz, ~ Bz-laz, c~Ltff Lan~leca~e, ][nc. Cu~¢ho~ues N,¥o (Address of applicant) · State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..G.e~e~ .~.:]. Coat.~,~cto= . . . Name of owner of premises .....~..q.~l..~,.~'C.t,.q~'3' ............................................. i ................................ i ....................................... If opplicon_t is a corporate, signature of duly authorized officer. Clcha~o~cz, T~I, Preetdent (Nome and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. -~>~f Other Trode's License No. 8~.~-HI Home Im~rove~eat T.~ cerise Location of land on which proposed work will be done. Map No.: ............ !..~..6. ...................... Lot No......~.?.~'. .............. Street and Number ~.?.e...~..~?~..v.~.e~.~?~.d.~.C..u~.t..c~.h..~.~e.~..~.~ ..................... ~. ............................... ................ Munlcipality 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 ..... ~.q.~..,~.~,..,~'.9,~,],~l,.~3:L~.~/ng..~teg~..az~l..~£at~a..~.~o~ .......... 3. Nature of work'(check which applicable): New Building.. ................. Addition .................. Alteration ................. Repair ..... acac ........Removal ..... acz ........ Demolition .................... Other Work ................................................ . .... ~~ ~ (Description) 4. Estimated Cost $1300.00 Fee .$..; ............................................... .' .................................... (to be paid on filing this applicati,on) ,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 ......... l~xJ.~..~a~ ....... Rear ............................ Depth ................................Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ............ ~ ........... Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front .............. ~.8.~ .................................... Rear ...... .1..8.~..~ ............................. Depth h2'St 10. Date of Purch(~se ............ ~.9~ .................................... Name of Fbrrner Owner .....u..R..k~..o.~rA ...................................... 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 ..... .n...o. .................. Will excess fill be removed from premises: ( ) Yes ( ) No · Name of Architect ..............................................................Address ................................Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all lset-b~ck dimensions from property lines. Give street and block number or description according to deed, and show street r~mes end indicate whether interior or corner lot. -- STATE OF COUNTY C li'z.~l~ C~.chanorlcz~ ~[ he nn ................................................................................. ?.....~ ......... ~ duly s~orn, ~poses and says t~t he is )licam (Name of individua~ signing c~tracf) a~ve named. He is the ....................................... ~...~ ...................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly aut~rized to ~erform or have performed the said work and to ~ke and file this application; t~t all statements contained in this application are tree to the best.o~his knowledge and belief; and thor the work will be performed in the manner set fo~h Jn the application~l~r~it~/ Swam to before me this ........................ Nota~ Public, . .............. ~[~ .............. J ....... Coun~ ..... ~~.~ ........................................... / 4Sig~ O' opphco~)