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Home My WebLink About9392-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certific; te Of Occup; ncy THIS CERTIFIES that the building located at .. ~a..s.s.a.u...P.o.~.n.t., ~ ....... Street Map No. l~as.s,. P~... Block No ........... Lot No...~....~1..t.e..h.o .g~l.e....N,.;~.., .......... conforms substantially to the Application for Building Permit heretofore filed in t. hi~ office dated ............tug..9. ·., 19.77. pursuant to which Building Permit' No...9.3~.2.Z. dated ............Aug..9 ...., 19.7.7., was issued, and conforms to all ~fthe require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. P~.i.vS~.e..O.Zlg..f..a~.i. llr..d.w.e. 1..l! .rig..w.i..t.h..(.q.e.c.~.)...a.d.d.~..~.:L.o?. ............ The certificate is issued to .. ~.°..~.. e. ~e.a. ~ ........ . .U)~n..e? ............................ (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval ....~.:~.: ............................ UNDERWRITERS CERTIFICATE No. ~ :.R., ........................................ HOUSE NUMBER ..... 2195 ....Street ...N.~.s.s.a.u...P.o.~.n.t...R.o.a.d. .... C.u..t.c.h. qgg..e ..... Building Inspector TOWN (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9392 Z Date ............................ A~ .......... 9 ......... , 19....~/ Permission is hereby granted to: ....... ,l'oaane.....~a3, ............................................ ........... ~e~s.,...~.t..Rd ........ ~teho~ue ............. at premises located at .~O:t,.~....,. ............. ,N&.sa...P,t-..~la .............. ; .................................................. ............................................ l~aSsa~z.P.~.. ~oa~L ........... C~t~h~u$ ........ :. ....................................... pursuant to application dated ................................. ~,tt~ ....... '.:~..., 19..~..,' and approved by the Building Inspector. F~',~.'....t.~[~ ....... TO~N OF Buil~ing Depofimenf 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 triplicate to the Building Inspector with the following; for new buildings or new use: ]. 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-g 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 ]957), 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. Fees: 1. Certificate of occupancy $5.00 2, Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 New Building ..... i~...~,.. Old or Pre-existing Building ............................ Vacant Land ............................ Owner Or Owners Of Property ..~..'.~..r~i.~ ......... ~,.; .............. ~....~ ......................... ........................................... Subdivision ....... ~...(.~...~...~....¢.%~ ......... ~ .............. Lot No ............. Block No ............. House No ............. Permit No...~...;~..Z..~ate Of Permit ..~//~pplicant .................................................................. ..,,~ .e~,. ~,.o~, .......... .(~;,,~.., ................... ~.~o, ~,,. ~,,rovo, ............ ~'¢...'.¢~ ....................... ~.~,~.,,er, ~,,row, ........ ?...'~ ................. ~....,,~n.,n, "o~ ~,,row, ..... ':~...~.~. ...................... Request For Tempor~ Ce~ificote ........................................ Finol Certificate .......................................... Fee Submitted $ ....~ ............................... Construction above on described building and~_ rmit meets all applicable codes and regulations. Applicant.... ~.~,~.~¢.~...i ,~.~6/,~. ,~., .~, ,~: Sworn to before me this (stamp or TOWN OF $OUTHOLD ~~ '/~/~}_ , BUILDING DEPARTMENT _ /~/~,~ ¢--~/~**~'//~ ~'~ TOWN CLERK'S OFFICE ~UTHOLD, N.Y. ~ ............ ........ ........ x .................. , 22. ..... ...... (Braiding I nspecto/r~ APPLICATION 'FOR BUILDING PERMIT INSTRUCTIONS ate ........................ .pp'. ............... a. This application must be completely filled in by typewriter o¢ in ink and submitted 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 iot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is port 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 o 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 Regulati~?ns, for the construction of buildings additions or alterations or ,for removal or demolition, as herein describedq~ The appqcont agreeb to comply with all applicable laws, ordinances, building code, housing code, and regulations and tab admit aGthorized inspectors on premises and in buildings for necessary inspections. (S,gna~;f ap~, or name, if a corporation) (Address of applicant) .......... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. agent~ister Nome of owner of premises .....J..O.eXo,~$...~...e.,.8.:~. ..................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........ x. ........................................... Plumber's License No .... 7~ .......................................... / [?cO P ~ /E ~/~/~ '+/ Electrician's License No. ~I ........................................... ~ ~ ~ ~ Other Trade's License No...x. ........................................... Location of land on which proposed work will be done. Map No.: .......... ~.p.t~.t~.~...; ............. Lot No ......... )4, ....... Street and Number .... 10.O.O....-.~.ZOl4-.~..13..-~.., ............................................. ......... ~.~¢.?.~'~..~.O.&...n.~ ................ N~.-- ~-- ,/xc4~/~__ ~-c~,.~l~._.*..~.,.' Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy .....~...~..o.]g..o..~..~...,9.,~.,.]:~...~.e...ct:.~,,,o.,o.~. ......................................................................... b, Intended use and occupancy cl~¢,k . 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration .... .-...-..-..~.~T Repair ...... .-..-...-..-..-..'Removal ...... Demolition......'..-.;.-..-...'.... Other Work ...... .~..?..~..°.,,~....D.?..O...~. ........ ~ .............. (Description) 4. Estimated Cost .... ..~..~..0...0..e...0..0. ....................................... Fee .J.~....~... ......................................................................... (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 ............ ~ ....................... J~ear ............................ Depth ................................ Height ........... .,~ ............... Number of Stones ................................ ' i 9 8. Dimensions of entire new construction: Front ....... ~ ........................ Rear ....... ~.~ .................. Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front .......... ' ................... .1...0..0,. ................... Rear ................ ~.0...0. ................... Depth ,,~.0..~..,~.3~.3:..~. .......... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ......... ~.&~I:LcJJ~:J:;~L,I~ ............................. ~.; ................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ..~..0. .............................................. 13. Will lot be regraded ......A.~...~.,~. ........... Will excess fill be removed fr°m premises: ( ) Yes (x) No 14. Name of Owner of premises .................................................... Address ................................Phone No ....................... Nome of Architect ............ ..~..O..~..?. ........................................ Address ................................ Phone No ....................... Nome of Contractor .......... ~.°..~...e....."t..,.~.e.l..~. ....................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all ~ IJim~n~ions from property lines. Give'street and block number or description according ta deed, and sl~w ~ ~ and i~clicate STATE OF NEW~ev,~ w~ ,~S~ e'~ . ~: .... CO.UNTY __, ................ ~~.....' ......................................... being d~ul~worn d~oses and ~ays t~ ~ iS t~ ~onl (Na~ of in~i~al signing contrac~ ' ' -~'.--~,: He ~s the ....................................................................................... of said owner or owners, and is duly aut~rized to perf~m 'or ha~fo~ed Jh~said work and to ~ke and file this application; that all statements contained in this application are'~m~,~o the bestir his knowledge and belief; and thor the work will be performed in the manner set fo~h in the application ~led there~th. Sworn to bede me this ~ ~2 / .................. ..~-. day of ........ ~..:...~...~.....~ ........ , 19.....x.. ~~~ ................ .................................................. /