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Home My WebLink About7883-zFORM NO. 4 TOWN OF SOUTHOLD BUH,BING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~9.02 ..... Date ............ F~b... R~. ...... , 19. THIS CERTIFIES that the building located at . .~elm~l. &. J~N[. I1.~ ....... Street Map No... ~ ....... Block No...~ ...... Lot No. X~l:.. ]~W. ~fo~..],~- ...... confoms substanti~ly to the App~cation for Build~g Permit heretofore filed ~ this office dated ............ ~...~. , 19.7~. p~su~t to which Build~g Permit No..~.. dated .......... ~...~.. ., 19.7~., was issued, ~d confoms to ~ of ~e req~ ments of the applicable provmions of the law. The occup~cy for which this certificate issued is .~-va~. ~o. f~$1~ .~vett~. v.~th, a~ditlon. &. ~t~ · · ~ by ~ A~eals The certificate is issued to .~ .~t$ ...... ~ .............................. (owner, lessee or ten,t) of the ~ores~d building. S~olk County Dep~tment of He~ Approv~ ].R, .............................. UNDERWRITERS CERTIFICATE No .... ~. 2~%~ .... ]~. ~.0.. ~% ............ HOUSE NU~ER .... ~ ....... S~eet .. ~rd .St ............................ ~7~ T~r5 8t B~d~g Inspector TOWN OF SOUTHOLD BUILDING DEPARTARENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7883 Z Date .......................... l~r .......... .~. ........... 19..*~,~.. Permission is hereby granted to: g~t~.. }T.O~ ~.0~3...~ ...sO~ .. ~,~C......A ./Q .. ;% .~ ~ Ho~nett ............ ~.~...f~'£.~ k ....................................... to ...r..~h~..~nd...a~...t~...exis.~i~g..~.iwe~ng.~.aa.~&~p~.~.v.ad...b~...~..Ap~e~. .. at premises located at ..T:hi;r.d...~:~...~,..O~.~bn, rJ...S.~; ....................................................................... .......................................................................... ;.~e.~,z. ~.£~t~ ........................................................... pursuant to application dated ........................~.,~ ...... .~ .............. , 19.~.~..., and approved by the Building Inspector. Fee $..1.-~..'.,~..d~.. ........... Building Inspector FORM NO, 6 TOWN OF SOUTHOLD , Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcation 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 Arch,tect 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: I. 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 Rte .............. New Budding ................ Addition ....~ ...... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..... ~ez`...~J~..~`~1`~.~'c~`.~.~..~.~.e..'e...~.~...~..e.~...~..~.~'~.t~.~.~.~ ..... Owner Or Owners Of Property .....~.~.9..~.....~..°.~.~..e...~..~. ....................................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ........... .................... 5/5/75 Permit No 788.5 Date Of Permit .................... Applicant Health Dept. Approval ............................................ Labor Dept. Approval ............................................... Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Find Certificate .......................................... Fee Submitted $ .~..QQ ......................... ~ I~p~codes and regulations. Construction on above described building ermit me~.~al Applicant . ~.~.~..~.~....~~ ...................................... Sworn to before me this ~/ ~,~"/,'~ .......... .. dayof ......... .......... Notary Public ........... ~//!x4~,.. County (stamp or seal) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premi_ses, relationship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproparty must be drawn 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. Upon approval of this applicationl 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 the 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 desdribed. The applicant agrees to comply with all applicable lows, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. E~gene Horto~ & Sons Inc (Signature of applicant, or name, if a corporation) New Suffolk N.Y. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................................................... .................................................................................................................... Name of owner of premises .,T,,.~'~J...~D~I3ZLe,~.~. ..................................................................................................................... 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 .... D.e,.~.t~B.l~ ........................ Other Trode's License No ............................................... I. Location of land on which proposed work will be done. Map No.: ........ .~ ........................ Lot No......~..~ .............. Street and Number ....0~..~1LB~CI..~...~I.~'~I,..~ .............. }]'e~..~l~..~.~1.1~ .......................................... .......: ........... I~0~ /~7~ Munlc,pal,ty 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ....~.~..~.ht'.e.~.~.:LO, gs ............................................................................................... b. Intended use and occupancy ..... .r..~.b...~.~..~.~....~...~..~....~...~.~..e.~..~..~..~..[....~..~.....~..~...e......~....~)~.~..~ ........... Board of Appeals 3. Nature of work (check which applicable): New Building'. ................. Addition ......~ ...... Alteration ~ ......... Repair..................~ Removal .................. Demolition .................... Other Work ................................................ . .... (Description) 30, 000 + . ~.00 4. Estimated Cost ........................................................ ~ee ........................................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... ..O..~..e.. ............... 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 ~torJes ................................ 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 Owner ........................................................ 11. Zone or use district in which premises are situated ...~l.~.....8...~..S...~. ............................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... J~ ................................................ 13. Will lot be regraded .....~[. ................. Will excess fill be removed from premises: (:Z) Yes ( ) No 14. Name of Owner of premises .]~.~t~..]J~D~l~e.~,f, ...................... Address ....~......~..~...~.o.~...... Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor .l~.e...]~O:~.tOZ~..&..J~O--"~S...I:a ..........Address ......~J,...J~:l~f. Qllr. Phone No ....................... PLOT DIAGRAM ~ ~ Locate clearly and distinctly all buildings, whether existing or proposed, and indicate 91l set-back dimensions from property lines. Give street and block number or description according to de,ecl, and shag( street names and indicate whether interior or corner lot. STATE OF NEV~ Y,.Q,RK ~ c c COUNTY 0 F- ~.~..~.~.P~.~ .............. f '"'"" ................................... ~Ig.~...T-Toz'.~,O~ ................................. being duly sworn, deposes and says that he is the applicam (Name of individual signing contract) above named. C ontrac tot He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this application; that oll 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 forth in the application filed therewith. Sworn to before me this ................. do,, of .................... ................ . (/4/I Notary Public, ..~ .............. Co~lnty ...~Z~l,l~...:j~.~..; ....... ; ...................................... ,~'~' ~ / ~5iandture or applicant) NOTARY PUBLIC, State of New York . No 52-4522026 - Su[fo'k County Comrnmsmn Exp res Mar=h 30, 19,,,n~,~