The URL can be used to link to this page

Home My WebLink About9372-zFOR~I NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No...Z89~.6 .... Date . THIS CERTIFIES that the building located at Map No. ' ~+(5'~0 ...... Block No ........... Lot No. .Feb~.uar~ 9 ............. , 19..7.8 .k,~O .Maple. Lane ........ Street conforms substantially to the Application for Building Permit heretofore filed in this office dated .. Ju~-y .... 22 ........ , 19. ?7. pursuant to which Building Permit No..9.~.~.2Z. dated .. July ..... 22 ........., 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 ...... PRI.'~A'iE, .0[q~. }.AI~IL~, D~/ELLING .................................. The certificate is issued to ..... Bax't..&. Ct~.lstJa~e. P~ll:eo. qcle ....................... (owner, of the aforesaid building. Suffolk County Department of Health Approval .. ?~*.80.-6.8. .... UNDERWRITERS CERTIFICATE No ............ (?,e~q.d.~.l?g) ....................... HOUSE NUMBER ...~y0 ........ Street .... .1~. p.l.e...L.ap.e. .......................... .......................................... ~..r99.n. p9.~.~. ~ I~ Building Inspector !'-SOUTHOLD, N.Y. (THIS PERM[~ MuST BE KEPT ON THE P~,EMISES UNTIL F~L COMPLETIOi~I OF THE WORK AUTHORIZED) N°. 937~ Z Permission is hereby granted to: Ch~..~..~r~.:,.:<~.~: ............................. et premises located at . ..~L~t...8.~ ........ C~Lee~e~t:.l~l;.,~t~ ............................. ~ .................................. ............................................ :..~/I~...Y~t~:~e.. ~,; ......... e~.aea~o~ .................................................. 1 ' pursuont to opplicotion doted ....................:i~.~.:.L.~...,, .......... , Wi-", and °pproved by the Building Inspector. FOItM NO, 6 TOWN OF $OUTHOLD Building Depe~tment Town Clerks Office Southold, N. ¥. 11971 APPLIGATION FOR CERTIFJC:ATE OF OCCUPANCY Instructions A. 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. 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 aT 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: I. 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 ..... ..................... New Building ....... ...~.. ...... Old or Pre-existing Building ............................ Vacant Land ............................ · ocat on Of Property ...... ........................................... Owner Or Owners Of Property ..~t~.~-'L./.<~'.~........~....~..~ .~..t.~...~'/.J..~..~ ......... [.~..~.~.Q.~.c~e ...................... Subdivision CL~.~!..~...~...~..~.;..~.I.'~.....,.~.(.:.C'...~....~ ........... Lot No....~..~... Block No ............. House N o..~.~...~0.. Permit No..~.,~..?.~.... Da're Of Permit ...?/.~.~/2.~..Applican, .~.~...'~../.~ .~T./../~...~....~..L.{..~..0..~.¢J.~_., .......... Health Dept. Approval ...~ ..................................... Labor Dept. Approval .............. ~.....~... ........................ Underwriters Approval//~.~XZ/..?..~ .............................. Planning Board Approval ..... .../~....../~.. ....... :. ............... Request For Temporary Certificate ........................................ inal Certificate .,.~ ................................... Fee Submitted $ ...... ~.~.'..~}..~. ............... Construction on above described building and permit m~e~ts all appli, c, able codes and regulations. Applicant .......... ,~ .................................. Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) ~ TOWN OF SOUTHOLDe~'~"'-~~''~ / ' BUII.DIHG DEPARTMEHT q/~/~ TOWN CLERK'S OFFICE/_' '// Sou'rHOLD~N. Y. /~'¢/~/-'-~' , ,. .......................... . ...... ~, n ,- ,,.,~,.~. · Apphcotlon No ................................. .................. ....... Disap-roved a/c . ~ . .......... ~.? ....... ~...~.~:.....~?~,~ ,~,-o. _ ~.~ .................................................. .. .................. ........... ........ ~ ...... ~.~.~). ................ . APPLICA'rlON FOR BUILDIHG PER~I? a. This application must be completely filled in by typewriter or in ink and subtnittecl in triplicate to the Buildir~_~ Inspector, with 3 sets of plans, accurate plot plan to sca~. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship fo'adjoining premises or public streets areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may nat be commenced before issuance of Building Permit. r'~.. d. Upon approval of this application, the Building Inspector will issue a BuildiKg permit to the applicant. Such permi~.'~ shall be kept on the premises available for inspection throughout the work. ~r~& 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. B .A,P,.PLIC~ATION !S HEREBY MADE to the Building Department for the issuance of a Building Permit oursuant to the'" una~ng Lone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Law~, Ordinances or I 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 laws, ordinances, building code, housing code, and regulations, and to,M admit authorized inspectors on premises and in buildings for necessary inspections., 108 Broad 5t Greenport (t~? q~/ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. O~ner - builder Name of owner of premises ...~,~..1~...~......0~..~.~...~.~ ~"~O~e ' ~'- ................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ............. ..~.....e.~ ............................. Plumber's License No ........ ~..AV~elX'. ..................... Electrician's License No .... .~.~l~.~....~..]-...s..O.. ........... Other Trode's License No ............................................... 1. Location of land on which proposed work will be done. Map~o.:. · : ................................... Lot No. 81 Street and Number .....~'.L~........~.~3..~..e....~.e... ..G. reen~.ort Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy 'VaCn'nt; b. Intended use and occupancy ...... ~..f~x,t.~,~...~e~ ........................................................................... 3. Nature of work (check which applicable): New Building.. ...... ~... Addition .................. Alteration ................ Repair .................. Removal .................. Demolitia~ ....... ~ ............ Other Work ..................................................... /... 4. Estimated Cost ....... .~..~..Lg....O~......-+ .............. : ...... :.....:.,Fee 0 ~' ~ (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ 0~{I ............. Number of dwelling uqJts on each floor ............................ If garage, number of cars ....~'.0. .................................................................................................................................. 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 ...~.~..-..8 ....................... Rear .............. Depth .313/.22 ........... Height .................... Number of Stories ..I~W.O. ............................................................................................................ 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 1.0. Date of Purchase; ......................................................... Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..... .t.~J~.~.~...f~1, S.~- ............................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... ~f) ............................................. 13. Will lot be regraded . .......~..~1. ............ Will excess fill be removed from premises: ( ) Yes ( ~ No ]4. Name of Owner of premises .~.~.~..~..~A~;~.t~.....~l~ss ,.,...~3~e~,]3~QZ'ot~,.. Phone No. ...................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ...,~13e;~. ........................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back 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. see file~ plans STATE OF NEW Y~DRE- . _ [ c S COUNTY OF ....... ~] .z~.o...~..~. ......... ~'~. ............. .C...~..?..~.~..~..~..]3...e...~g.t~.~.~ ...... i.~....] ............................. being duly sworn, deposes and says that he is the applicam (Name of individual signing contract) above named. He is the ..................................... .o.:~t~....e..~' ................................................................................................................................ (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 all statements contained, in .this application are 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 ................. ..~..2... day of ................ ~.3'~... ................. , 19..~..~.. Notary Pu~ic, . ................... .¢:~....~....U~.. ~ .0. ~ ........ County ....... ~....~.~~ ! ~ MAI~Y E. DAWSON NI~T~,~tY PUIILIC, State at Hew Yorl~ RO, 524164372], Suffolk Term Expire8 March 30, The sewage disposal and water Supply facilities for this location have been inspected by this department and found Chie~ o~ General Engineering ,/ H.$ R[F NO.: APPROVED AD NOTED 111 i ,I-- I j I L.t ,' LJ I I '1034 · p-sWi~;H ' THI I WIRING SYMBOLS PUSH BUTTON SPECIAL PURPOSE OUTLET CHIMES FAN TELEPHONE ill / /,% 1034 THE IPSWICH TOTAL--$ ?~/ 7 ~'/j/"/ ,/ .J