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Home My WebLink About9400-zFOII~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's O~tice Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .~.~. K. P. ~l .M-A-.~*~..D.C( .fi-Street Map No...~..q .~. ~... Block No ........... Lot No, .. ]..0. ........................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ~.ff.f.. ~./]., 19 ?~'. pursuant to which Building Permit No. 9.~/z~. ~. dated ............ ~.~..~....(I.., 197.~.., 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 . .~.... [.~.~[d..g~..E ..... (A~. ..... F/~.I'3. I ¼Y. ....~.~/Et L L .~l.~' ............... The certificate is issued to .x/.~.~( ~( ....Pr/./:~. (~!.0..~./~..0..U. ........................... (owner, ~es see-or--tm~a~ of the aforesaid building. Suffolk County Department of Health Approval .~/! ?/7.~. .... ~k.-~ ............... ~*' .~_ ~ ~ - // O.. UNDERWRITERS CERTIFICATE No...{b~.. ~..~..1. ~-,..~. ~. ......................... HOUSE NUMBER . ~ .'~]. ?..!~... Street ...~. ! .L.~./~..T.(~ ..... ~b K~).~E ........... ......................................... .z.v. ...... .............. Building Inspector o~ SOUTHOLD, ~ Y. · ~ ~ · BUILDING pERMIT (THIS PERMIT MUST BE KEPT ON THE pREMISES UNTIL F~LL, COMPLETION OF THE WORK AUTHORIZED) 9400 Z Permission is hereby granted to: ~...~.:.~.:...~,.o.~..,.~..~.~A...C..o.~ AZ.c. ,,T..o~m~ ~.~glu & ~ ............ ~.. 2.3 ~..,...]~dsm$.~.~...I).~ ......... ~4e~[ek. ]~zlld new one. ~amil~..6...u..e.!l.~g ..................................................................................... at premises located at ..~;...~JJ~ ....... ~/bO~..~a~lBO~· ....................................................................... ............................ .G~Ll:Le:l;.te..J~. ........ E,..~.~c.~on ............... ~ ....................................... pursuant to application dated .......................... ~J,ll, J~ .......... :J.~ ........ , 19...~.~, and approved by the Building Inspector. ......... TOWN OF $O~THOLD 8u~dln9 D~mvtmant Town Clerks Office Southoid, H. ¥. 11971 APPLICATION FOP. 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: 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, o 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 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 prmexisting dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Dote ................ New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ ocotion of Property ........ ........................ Owner Or Owners Of Property .~...~.....~......~1..1~..~ ......... ..~...~..~...~. ....... ~.~.J~.:.~......~'...~..?.....~.. ....................... Subdivision ~,..~..,,~..,~,~..?..t~,~,,.....,¢~-....,~.,...~....~,.,~....~.. ........ Lot No./.?... ...... Block No ............. House No..,,"~,,.,~....'~ Permit No..~..~...~..?...-'~, .. Dote Of Permit ..~...'..t./..~...~.....Applicont ~.....~...../~..........~.,.~,. ,~...~.~....~...*.......~?~.....,~,.,!~..:.., Health Dept. Approval . .~..~.~.....~-...:..../../....~.. ............. Labor Dept. Approval ................................................ Underwriters Approval ~ '~ ~ / '~ ~ ~ Planning Board Approval Request For Temporary Certificate ........................................ Final Certificate ~ ...................................... Fee Submitted $ .................................... Construction on above described building and p..er~nit meets all applicable codes and regulations. Applicant "~/~ ~ ~'~'~" ,Z~..: .................... Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) C;OUi~-~TY OF SUFFOLK DEPARTMENT OF HEALTH SERVICES The attached approval was issued sub?ect to the notation contadned below .our approval stmnp, Would you please type the £ollowing condition of approval oi~ the final C of 0 as this will ensure that amy l~ture will be made aware of the nitrate problem. ~Private w~'ell with high nitrates - see Health Department note o~ final survey", Thank you~ Pobert A. Villa~ P, E, .,,::, -:, ,; Josept -~t! ~: ~ ~ 'ct-~'~,as''~' :~o'r t , ~il ,This c~dificate must not be altered in ony,mbnner? return to t the- Board i[ incorrect. Inspectors may be Identified Examined ................... ........................................ , ~.~,~ D~pp~ a/c .~ ............ ~ ............................ ................... . I~tor, wi~ 3 ~ of ~, ~um~e pl~ pIo~ ~ ~. F~ ~o~ ~ ~ule. '~ b. Pl~ plon sh~in or~s, ond oiYi~ c. ~e wo~ c~er~ ~ ~is o~li~ofi~ ~ ~ ~ c~ ~fore i~uonce of Building Pe~it. d. U~n ~pp~ol sholl ~ k~t ~ the preml~ ~il~le for i~i~ theft ~e ~rk. e., No buildi~o ~holl be s~oll fi~e ~e~ O~nted ~ l~e Building Ink,tot. 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 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~ admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· Name of owner of Premises ............................... ~..~..~.. .................................................................................. If applicgpt is a corporate~.signature of duly authorized officer. ...... Builder's License No ..................................................... Plumber's License No....'7-....,,~...~. ...... .~... ...................... Electrician's License No..~../.~.. ...... ..~.."'-·, ....................... ~-?'~. x'~- ~ 7- _~ o - I I O ~her Trade's License No ............................................... ~~ ~" L~ation of la~ on which p~ ~rk will be d~.. Map No.: .~..~.~.~. .................. Lot No.../.~. .............. stra.t and Num~ ......... ~l.~b.~.~Z~...&.~.~.~ .................................................. ~.~..~d~Z~ ........... ~uflici~li~ Store existing use and ~cu~n~ of premis~ and intended use ond ~cu~ncy of p~ construction: Exislting use and occupancy ................................................................................................................................. Intended use and occupancy ~.../~...~. ...... --.~.~..I.~..~ .......... ..~....~.!~...~...~...~..~ ................................................ · . ..... Addition Alteration ............. 3. Nature of work (check which applicable): New Budding. · ..................... Repair .............. ~... Removal ............. Demolitio~ .................... Other Work ..................................................... ~-~ - -- (Description) 4. Estimated Co~ ...~..~,.~ ................. ~ ....................... ;....Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling unit,s, ....... ..~....~......R~T.. ....... Number of dwelling units on each floor ............................ if garage, number of c~3rs .........~......~. .............. j. ....................................................................................................... 6. If business, commercial or mixed occupancy, specify nature end extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ P, eor ................................ 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 ~. ~'~- ' g. Size of lot: Front .... ~..~..~.. ........................................... Rear ..../.~...~. ............................ Depth .../..~...~. .................. 10. Date of Purchase ........... .~.~..~./. ................................ Nome of Former Owner ....... ......... ...................... ]1. Zone or use district in which premises ore situated ....... ~.~....~..~...~....~....'~-.J.-.~-....~..~- ..................................................... ]2. Does proposed construction violate any zoning Iow, ordinance or regulation: .... -~.....~.. ......................................... 13. Will lot be regraded ~...?. .......... Wil excess f be removed from premises: ( ) Yes ( I~No ........... 159-3, 7o~ 14. N ...... fOw .... f..e....ses~.?.....~ ................. .~. ...................... .:':'.'_'[' 'Tr' · ? ...... Name of Architect ...~...,.~aM~....-~.3.~..~. Address~g~..~:.~3f..~..~ ..... Phone No.~.?.~.~.4..7...~. ..... Nome of Contractor~"-..d-...P-~.-..-.~.5.---q--'~..-...'.-.-.-C~-.---.~'~'....~. ................ ~3~'~ ~'*~-'~.~-~- ... · Address :.M.~:~&.~.%~.~.,..... rnone ~o ....................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate oil 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. qTATE OF NEVf~I~J~/~" t S S COUNTY GF .............. ..~ ................ . ...~...{J. ll..~...~.. ....... ~t~..O~,~t ............................................. be,n (Name of in.dual signing contracf) above named.~ ~ p~ He is the ~ ...... :....l.~.: ... ~. ........................................... ~ ............. : ............................................................... ..... V (Controctor, egent, corporote officer, etc.l o~ soid owner or owners, ~nd is duly outhorized to perform or hove performed the soid work end to m~ke ond file this ~pplicotion; thor ~11 stotements contoined in this epplicotion ere true to the best of his knowledge end belief; end thet the work will be performed in the menner set fo~h in the opplicotion filed therewith. Sw~ ~fore me this ::": ....... z':::'" ....... ' ...................... ............................. - ;HIGH N~T[~TE - W~ter ~ot t01'be used ,.or creparat~ of ~ ' bab~ ~=la~, ¢~ ,use by ~f~ts un¢~ ~ ~ 6 ~s. or age. ,~ . , ~ . ,: / ..... ~,~,, O' ~ " ' q : ~C~ ~ ~A~ SUPPLY AND -- - ~Tz O T~: ; -' ~ : ' O I APPROVED: ': ' i : ~" ~¢ ' ' (~ ' ' ,, , ,,~ , ........ ~, ,. ': ~ '(3 ~TAMP ~rA'i~.MENT OF INT~N¥ OF ,t__ SUFFOLK CONSULTANT & DESIGNERS P. O. BOX 6~ EAST MORtCHES, N, Y. 1 ~ 940 878-9~7 ~7..-7._ ......... -$ ~0 -¼ ,,% I '0