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Home My WebLink About9600-zFO~' NO. · TOW3{ OF $OUTHOLD BIJ~.nI~G DEPARTmfENT Town Clerk'e Office $outhold, N. ¥. Certificete Of Occupency No..Z8987 ..... Date . .ADz,il .... 19 .............. , 19.78. THIS CERTIFIES that the building located at .5..'15...P~c.. :..R0p.d...~.~.2. ..... Street Map No ............. Block No ...........Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .. December.. 2.2 ....., 19.77. pursuant to which Building Permit No..960.QZ. dated .. December-..22 ......, 197.7. ., 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 .......... ACCESS0tLY..BUILDING ......................................... The certificate is issued to ....... Robert;..Zsle~ .................................. (owner, ~a~:~l~) of the aforesaid building. Suffolk County Department of Health Approval ............ N/R .................... UNDERWRITERS CERTIFICATE No ..................... .N.~R. .................... HOUSE NUMBER ... 5~5 ....... Street ........ i~V~;,..R.o.a.d...#.'1.2. ................. ............................................. .~ou.~q:L~,..~'~..Y.~.k ............. Building rn-~pector BUILDINI~ TO~N BUILDING/iPE~RMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE5 UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9600 Z Dote .......................... .=:. .......................... , Permission is hereby granted to: . -~ ~ I~ , ' ~.~ ~ ~...~, A ~..,~.~...~.: ...... ~.....~.....~... ........... 2x~,. .......... :. ........... ~.,/... ......... ................ .................... ........................................ at premises'located at ../~.'..~....~).....~.....2/X ....... -/--~..~..~· .~.~....~C::..~...: ........................................ ................................................ ,,~..~.~ ........... .~....~ ........... .................... .................... pursuant to application dated .....................I~,..2~.....~..: .~v.....i ...... 19..~...'~., and approved by the Building Inspector. Fee $..~(. FO~M NO. 6 TOWN OF SOUTHOLD Building Del)ailment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in triplicate 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. Approvat 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. 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 3. Copy of certificate of occupancy $I.00 $5.00 Date ..... ~..z... 2.~ ...................... New Building ......~ ...... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ../~.O.~-~....~//~:....~.~..,~..~.g~./~.....~...~.],~. ........ ~.,....u..Z:..~.'t.v~.~Jb.....~.y ...... Owner Or Owners Of Property .../..~.~./.~.S~.~..~.. ....... LT.J~,.~.,~. ..................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No..~...~...o..?......~. Date Of Permit/..~/..~....~,/,2)Applicant ...~....'/.~.~..,L/~,~~. ....... .~7~..~..~h./JY~..S ........... Health Dept. Approval .... ~..~; ................................ Labor Dept. Approval ................................................ UnderwriteTs Approval ../..V..,~, .................................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate . .,~... .................................. Fee Submitted $ .....~...J.'. ....................... Construction on above described building and permit meets all applicable codes and egulahons. Applicant Sworn to before me this ................ day of ............................................ Notary Public .................................... County TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. Examined ~ (? - ;~- ~ ~ 7 Approved ............... t',,~:-~.;.C. .......... L., 19..~.~ Permit No ..... , ............................... ~pplicofion NO.../..~.?.".'~ ............... ,*... -2,:,.* **.; .,.: -...,. ............ ~*'"1" .......................... U~ulmaing mspector, [ FOR BUILDING PERMIT Dote ......... · ................... , INSTRUCTIONS ~) a. This application must be completely filled in by typewriter off in ink and s~bmitted 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 lot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty 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 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 Deportment for the issuance of a Building Permit pursuant to the Building Zone Ordinance otc 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 described. 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 i~spections. ~ ...... ............ ........ .v.z ............................. · (Signature of applicant, or nome, if a corporation) ~ - 17- M ', (Address of applicant) ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........ ~...~..~.~.~..~.Z ....... Z..~.., .&.~..~... applicant is a corporate, signature of d~gly authorized officer. (Name and title of corporate offi~r) Builder's License No ..... ~...~... ........................................ Plumber's License No ..... ..~'...~ .................................. Electrician's License No. ..4~.;..J~.:..: .............................. Other Trade's License No ............................................... 1. Location of land on which proposed work w be done Mop No '~'/-~.. ~.~..ff:.~.. ~.4~...~./~ ~t I<~ V'f~- Street and Number 4~..¢...'C....~¢....~...~,.~f.. ./..(.Z/.RJ'.~A/ ~ .~../.~.~....~.<..~..L.....h~.~.X~...'~/.~.~....d~/~:. ................... Municipalily 2. 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 ...... ..~..~..c.~.~.~?'.~..~..`.~..~.~.~./..~..~.~..u../...~.~?..../../..~...~.~.~..~....~.~(~ .................................. proporty lines. Give street and block number or description accordi whether interior or corner lot. 14//~ ~.~_~/~ 3. Nature of work (check which applicable): New Building,. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) 4. Estimated Cost ................... ...~...~.~?..!...o...o.. .................. Fee .../ ..................................................................................... (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 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 Owner ........................................................ 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 . ....... ~./....O. ........... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ....~..:..../...~...4.....~...~'. ...................... Address ................................Phone No ....................... Name of Architect .............................................................. Address ................................Phone No ....................... Nome of Contractor ..~m../..~.~../..~..'m../...'~...:.=....~'...?.....--/-"....-'., Address ..... ..x~....~..~: ......... Phone No. ............ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or p~bosed, and indicate all set-back dimensions frorn to deed, and show street names and indicate STATE OF NEW YORK, ~ c c COUNTY OF ................................ ' ............. /~..~,t(~..../~..~...../~........,~ dt sworn, deposes ondso (No~e of individual signing above ~om8~, ;~ is the oppJicom He is the ................. ~.~...i..~..,Q.~.'S~...,~ ...................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to m~ke and file this application; that all statements contained in this application are tr~e to the best of his knowledge and belief; and thor the work will be performed in the manner set fo~h in the application ~iled therewith. Sworn to before me this ........................ day of ............................................ , 19 ........ .;..~ ~ ~ ~. Nota~ Public, . ................................................... Coun~ ...~.~.~.. .~ ................................... (Signotu~ of ~pli~ont) APPRO~ AS NOTED DATE: L ~-- ~ "? ~ ~:_. I0~- E',': NOT~FY ~iL%.,.: D~PA~Tt~ENT AT ED L ~2~ .... 3. BEFG~t: ~ ......... ;T ~F ANY K ~' NOT RE~'~O~; ' :~ ~' ~ ~ OR C~;~'~'"'~''', 5. ALL CO,~Sl~t..~ ~ ,, ~%LUST EQUIR:M~ .... - :LY. STATE COD~ AND TOWN ~,~ ...... Og~ & ZO~;,~ REVISIONS DATE