The URL can be used to link to this page

Home My WebLink About9394-zFORM NO, ~ TOWN OF 50UTHOLD BUILDING DEPARTMENT Town Clerk's Ot~iee $outhold, N. Y. Certificate Of Occupancy No. Z. 9201 ...... Date ........... Sep.~eraber..11~.., 1978.. THIS CERTIFIES that the building located at 79.0.Q .Naasea. Roint..Roa~. ~xe2~kx Map No... 15.6A ..... Block No ........... Lot NO.. Easter~Ly. 1/2.122.,..123.,..12&. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... Auggat. iX, ..... , 19.7.7. pursuant to which Building Permit bio. 93.94Z.. dated ...... September..11,.., 19.7S., 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 P. RIVATE,. D~E.-FAMILX..DWELLING..-. I~IITH. ADDITJiON .................... The certificate is issued to ...I~YB.~LLF~..CARD~ .................................... ( owner,:~~ of the aforesaid building. Suffolk County Department of Health Approval ...~J/A ............................. ............ .... HOUSE NUMBER...7.9. 0 0 ....... Street... No,~au..g. oin.t, .Boa~,.. Cu.t, cho~e, .... ....................... .~..~.o.~]5 ............................................... Building Inspector (THIS PERMIT MUST BE KEPT ON, THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 939 Z Permission is hereby granted to: ...... ~.T.~he:L~e..... ~rd~ .............................. ...... Ita~ ~a'~. ~.~u~...l~ad .......... ~utcho~u~ pursuant to application dated ............................ ~k~,-.-.J(~.-... ...... 19..~.~.,., and approved by the Building Inspector. TOV~t~ OF SOUTHOLD Building Deportment Town Clerks Office $outhold, No Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructiuns 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 of property showing all property lines, streets, buildings and unusual notura~ 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 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 .............................................. New Building .................... ?d or Pre-~existin~ Bu, ildin~g ~ ........ ../~...: ............ Vacant Land ............................ Locat on Of Property ..............~ ........ ( ........... ~ .......... ~Tc: ............... Owner Or ~ners Of Property ...... , ........ .,.r,. ........ 2:;~:;.:..>>..::..:..:..~;.~..~.;: .................................... Subdivision ................................................................ Lot No ............. Block No ............. House No..~.~.6 Permit No...~.2. Z.~ ......Date Of Permit ...~.~'~...Applicant ~ ~/~ Health Dept. Approval ............................................ Labor ~pt. Approval ................................................ Underwriters Approvol ...............'5 .~ ~ ..............Plonnmo Board Approvol ........................................ Request For Temporory Ce~ificote ........................................ Finol Cortificote ............ ~ ...................... Fee Submitted $ ....~.:~ ................. Construction on above described building and per, it meets all applicable c~es and regulations. . ,. Apphcant ............... ~k~....~ ....... r. .................. ~,,r,..>,~.Z¢ ...... ~ ............................. Sworn fo before me this ................ day ~{ ............................................ (stamp or Noto~ Public .................................... County ~ '~ B ~/ Approved ,t /0 19..?.~.. Permit No ...... .C~..,..~..~....j ................ ~l-'~/t*/ TOWN OF BUILDING TOWN GLERK'S APPLIGATION FOR BUILDING PERMIT ~',q Date'..A."ub'~"~..~.l.~;,k..1.~.7..~. ................ , 19 ............ o INSTRUCTIONS o. 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. Plotplan show ng ocat on of lot· and~ of buildings on premises, relatmnshlp to. odlmmng, premises, or pubhc streets oz r~, areas, and giving a detailed description of layout ofproperty must be drawn on the dmgram whmh ~s port of th~s apphcahon~/~] c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspecto~ will ssue 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 Occupancyr'~ shall hove been granted by the Building Inspector. APPLICATION iS HEREBY MADe: to the Building Deportment for the issuance of o 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 aJterations, 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 admit authorized inspectors on premises and in buildings for necessary inspections. ............. ............. .......... ,. ........ (Signb~re bt~ap~c~t, or nome, if o corporation) ' ~-'(~dc~'~s aT opphcont) 11935 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............. ,O.~z~e~, ............................................................................................................................................... Name of owner of premises ~8,t,y~e.t.te....g.a.z~le ................................................................................................................... applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) BuildeFs License rqo..~ ........................ '~ ....................... Plumber% License No ................................................. £1ectricion's License No. 1~...§05 .................................. Other Trade's License No ............................................... E ½ 1. Location of land on which proposed work will be done. Mop No.: ...t56~..~r0.ezzd. ................. Lot Street and Number ............. .~9,J~,~....~.giiq..tL...~P~ ................................................................................................ Municipality 2. State existing use and occupancy of premises and in:ended use and occupancy of proposed construction: a. Exisiting use and occupancy ........ J~f~;i~r;.¢,~,~,l .................................................................................................. b. Intended use and occupancy .Re~;~d,,,~.~,~t ...... ~ ................................................... 3. Nature of work (check which applicable): New Building'. ................. Addition .....~. ............ Alteration ............... Repair .................. Removal .................. Demolitior ..................... Other Work .................................................... (Description) 4. Estimated Cost ...... $.~.0.0.0 .......................................... Fee ......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... .0..~..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 ":4~"~'; .............. Rear2~'"'" ........................... Depth¢~'?'&"'"3"O"~' .... Height .3~! ................. Number of Stories ..~:~e ........................................................................................................ Dimensions of same structure with alterations or additions: Front ..~.0.t ............................. Rear .7.Q ....................... Depth ..~-8'..~..~.9~9. ............... Height '18' ................................ .... , ....................... Number of Stories oz~e 8. Dimensions of entire new construction: Front ......... 28" ...................... Rear ..2...8.'. ..................... Depth .....2../t.'...~.&.~..~.!.. Height .t8.! ............. Number of Stories .O...~..e. .................... ' .......................................................................................... 9. Size of lot: Front ........ .2.28.~..{~,pz,oz.). ....................... Rear ...2../'t..0..'..(.a::]g.~.°..z../ .................. Depth2.0..O..'....A.~).~..°..z.. ............. 10. Date of Purchase 1D/2~.D.7. ....................................... Name of Former Owner ..~..Dar.¢:~.o~. ............................. 11. Zone or use district in which premises are situated .~.e..s..J:.8..e.~.5.~§.Z. ............................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ..~ .................................................. 13. Will lot be regraded ....~9. .................... Will excess fill be removed from premises: ( ) Yes ~) No 14. Name of Owner of premises .......... ..~....~,?'.b..e..1...1..e....0...~..r..c]..e. ........... Address ~.s..s.E.q..[.o.~.t:...~.. Phone No.?,,3/~....5..0.?..6. ....... _,, Cutc~og~e NY ~_ Name of Architect .............................................................. ,~aaress ........... , .................... I~none No ....................... Name of Contractor ....~.....~.'?~.~,-,~ ............. Address ....~..,~,~ ...... Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate oil set-back dimensions from propc~rty lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEV~x/O,~, 0,~ ~ S S COUNTY OF .. '~¢.~./. ......... f ' ..................,,-~zz ~n~ ~O~d:.... ,~..~..;~. ..................being duly sworn, deposes and says that he is the applicam (N~m~6f individual signing contrac ) above named. He is the .................................................. ~~ ................................................................................... (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 .................. /'..0. cloy of ................ Not,a/n/ Public,. ....... ~.. ~~.~'... ......... County ............. .., .....~,,-.: ,, ...,. ,..,; ....... ¢..~. ........ ............... ~1// ~ _,c~ I VI ' //~'~'* ' / (SF~noture of applicant) %// m~RJ?_PUBLIC, State ot New Yorlt