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Home My WebLink About7975-zFO~ NO. 4 TOWN OF SOUTHOLD BUW.DING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy No. 7~6~,3. ...... Date ............. Jul-~:.. · ~ .~ · ·., 19.7-~. THIS CERTIFIES that the building located at ..... ~[af, n. Road ............ Street Map No.. xx ........ Block No...x~ .... Lot NoZ~x..East. l~.r~.on..E,X, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Pay -30., 19~.~.. pursuant to which Building Permit dated ........ June... ] .... , 1975.., 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 .Pr;kv.a .t.e .o.n..e..f..~..i.ly..d..w.ej.l.~. g..wlt, h...an .ad:a.i.~..~o.n. .................. The certificate is issued to .1,~.ehaet. 8 · Athena. 8el.~.s ..... OWners ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .]~ ~R o ............................ UNDERWRITERS CERTIFICATE No..l~enc~ing ................................... HOUSE NUMBER ... ~ ~ 800 ..... Street ..... l~ia.ln · .~oac~ .......................... Building Inspector FO~ NO. 2 TO~VN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 7975 Z Dote .......................... .~t~ ....... 3 .......... , ~9..~,. Permission is hereby granted to: ', ..... }~ha~l..&.~sna ..... ~.eIlis ................ ..... 222~...?....1.1 ...... ~9.~h.....t~.%~.~l~..&v.~ .......... ............... ~y.~,d.e ....... ,~,.¥ ...... ~.1.36~ ........... to ...~buXld..&..anlar~e...e~/s.ting...po~.~h...or~..e~i~tin~..~well~n~ ....................... at premises located at ..40~O.--.~a.i.n-..R~a- ................................................................................. .......................................................... E~ s.t ..Marion.... ~...Y.. .............................................................. pursuant to application dated .........................~.....~O .............. , 19.,.7.~, and approved by the Building Inspector. Fee $..1.[~,.Q0 ........... FORJ~I NO. 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, 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 inspechon 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 ......... ,'"7' ................. ~/ ............. New Building ................ Addition ................ Old or Pre-existing Building ............. (... Vacant land .............. bl / u o ^ z3 2:-,4 .... Location Of Property ........................................................................... 7 ........................... Owner Or Owners Of Property ............ .~.~L...r::..:./:I.../.~.L.~...~. ...... ..~......LT}J..~..L.7....~...../~.. .............. Subdivision ................... ..-~.....~ ..................................... L.o_LNo ...... ~ock No ............. House No ............. Permit No...?....-..'~'..Z..~.Z. Date Of Per t~.......~../...L?...7..~Applicant ................... ..~..../..~..Z.../;..,..~.... .......................... Health Dept Approval ;~ Labor Dept Approval ....................~........~. ................. Underwriters Approval ..................... . ..-.~....t........~... ...... Planning Board Approval ........... ..~...%....~....: ............ Request For Temporary Certificate ........................................ Fincd Certificate Fee Submitted $ _~ .O,,.V.~ Applicant ~'"~-~....~~... ........................ :~ ...... :"i'"'""~--' Sworn to before me..~..../.......this ~~ ................ day of ....................................... (stamp or s~l) / ~ Notaw Public ...... ~. ............ Coun~ ~ ,'~'/01 ~ Examined .... I~......~... ........... , % Approved .......................... ~ ........... , TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. APPLICATION FOR "UILDING PERMIT Date .../~.~.~.~./~.....;,~...(.~ ................ , 19...?..~.... INSTP, UCTIONS a. Th~s apphcat,on must be completely filled :n by typewriter or in ink and submitted in triplicate to the Buildin. Inspector, w~th 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b Plot plan showing location of lot and of buddings on premmes, relationship to adjoining premises or public streets o areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of th~s applicatior c. The work covered by this application may not be commenced before ~ssuance of Building Permit. d Upon approval of this application, the Building Inspector wdl ~ssue a Building Permit to the applicant· Such permi shall be kept on the premises available for inspection throughout the work. e No bu,ld~ng 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 Budding Department for the issuance of o Building Permit pursuant to th Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describec The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t admit author, zed inspectors on premises and ~r~ buildings for necessary inspections. (Address of applicant) -~. _ State whether applicant ~s owner, lessee, agent, <~rch,tect, engineer, general contractor, electr,c,an, plumb' re~/c~r buiide If applicant ~s 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 Trade's License No ............................................... 1 Location of land on which,,,,,~ ~,, /~ .,~,--r-, //~,,~ ,~ ,--pr°p°sed work wdl be don~L Map No ....................................... Lot No ....................... Street and Number /.~'~.L~....~.~//./~.`~..~'~.~[~'~)~..~.~..~/.~.~.~i~./..~...A/.~.~.~.~.~. .................................... / Municipality 2. State existing use and occupancy of premises and m~,ended use and occupancy of proposed construction: a Ex,siting use and occupancy ~'~.,'~.~./~. .~/"~t ~).4~.../V.{~'..~... .................................... b Intended use and occupancy iiiiii~.i~.~i~.~ i'..ii iii~ ~.'i.~..t..~.~....r~.~..~..~.~ ~.0..~.~....~...~..~..*.[~ ................ 3 Nature ofw/~check which applicable). New BuHdmg ............. Additfon ......... .~...~...~-.~ Alteration ~ ........... Repo,r . ................. Removal .................Demolmor. .............. Other Work ..~...~/...~..~.. ...... ~....~....~..~..~...~. ......... (Description) 4 Estimated Cost .... ~~,...c..~2~... ........................ Fee .*~..~.....~.... .............................................................. (to be paid on filing this application) / 5. If dwelling, number of dwelhng umts ...................... Number of dwelling units 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. Dimensions of ex~stmg structures, if any. Front .................... Rear ................................ Depth .................. Height ........................ Number of Stories ............................................................................................................. D~menslons of same structure with alterations or additions Front .................................. Rear ........................ Depth ................................ Height ......................... Number of Stones ............................... 8~ D~mensions of entire new construction Front ................ , ............... Rear ............................ Depth ...................... Height .................... Number of Stories ...................................................................................................... 9 S~ze of lot Front .................................................... Rear ..................................... Depth ............................... ~.O../~....~. .~...'~.. For e ~..,~,~r~ ,~;~ ~,~ , 10 Date of Purchase . I ................... Name of mcr Own r ...... '~"'";"-'/'"t" ..... ................. 11 Zone or use district in/-/''which prem,ses are s~tuated ... ~..,~../...A~. ........ ~.0.....~..~. ................................... ,2 Does propo,ed construct,on via,ate zoning law, o lnance or regular,on ................. ........................ 13. Will lot be regraded ................ ..~...~. ..... Will excess fill be removed from premises: ( ) Yep,,. ( /,-~z~Xlo ~,~/ 14 Fdame of Owner of premises .~. I..~...~j..~ .~..j. ........ .~. ~/~.~.. Address ~r.~..~..ff~...~.~...,~.... Phone No. Name of Architect ................................................Address ............................... Phone No ...................... Name of Contr, lctor ~..(.~... ..A..~ .~. ~.~l o¢ ...e.e .......... Address ............ 7~?; ..........Phone No.('./....~...?..T../.~..~ /~ PLOT DIAGRAM Locate clearly an dlstm~:tly all braidings, whether ex~sting or proposed, and red,cate all set-back dimensions fron property hnes Gwe s feet abd block number or description occordmg to deed, and show street names and indicot~ whether interior or car er lot STATE OF NEW. YORK, COUNTY OF .J .~w.~...~r~.~.f. ..... ............ ..~...~¢.~.~..: .......~.~ ...................... be,rig duly sworn, deposes and says that he ,s the opphc (Name of md~vidual s~gnmg contrac~ above named He ,s the ................................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the smd work and to make and th~s apphcabon; that all statements contained m this apphcat,on are true to the best of his knowledge and belief; thor the work wdl be performed m the manner set fo~h m the apphcation hied therewith. Sworn ~o before me th,s ......... ..... of .... ................. , Nota~ Public, . ......... ~4.~ ............... Coun~ ............ PATRICIA A TOUGH~ NOTARY PUBLIC, ?t t' o~ New Yor~ Qual~hed *,~ Q-~"~ s b ~unty Commms~on