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Home My WebLink About9417-zFOR,M NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z.8025 ..... Date ............. l~.ov .... 29 ..... , 19..~.~. THIS CERTIFIES that the building located at . Albo. Drive ............... Street Map No. ~ .......... Block No...~:~ ...... Lot No... om ..... Laud. el .... I~.¥~ ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. A'ag· .19.., 19.??. pursuant to which Building Permit No..~17~ · dated ............. Al~g .19..., 1~7.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .P. ri.v. ate. acces.aory..ator&ge, buli~c[ing ............................... The certificate is issued to . .M.i..c.~l~e. 1..~..PhY~,I$~..~ .... Owners .............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval · .NoR.o .............................. UNDERWRITERS CERTIFICATE No...I~,R~ ...................................... HOUSE NUMBER .... ~ 28 .~. .....Street .. Alho. Dr~Lve ..... Laul~e 1 (.~.~) ........... " "" ' ' ...... Building"' ......... Insp~o' ' ' 'r ....... TOWN OFFICE SOUTHOLD~ N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FOLL COMPLETION OF THE WORK AUTHoRIzED) N? 9417 Z Date .................. ......................... 1 ........ Permission is hereby granted.to:. -- ~('~ A: ~) ~o ,~ ~:i ....... '~'; ............................ ~~' ,~ at ~remises located at ~....~.: ................................................... Building Inspector. Fee $ ........................ FOP~M NO. $ TOWN OF $OUTHOLD Ruildlng Dep~ ffmeflf Town Clerks Office Southold, N. ¥. 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 {,me: 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 o~ 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 ar 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 .....~.. ............. Old or Pre-existing, Building ............................ Vacant Land ............................ Location Of Property ~?.~..~:~....L.~..~.~:~.:.%:~/:.~.~..~;.~...L.~.~.~...`~;~L~ ............................. Owner Or Owners Of Property .~.,.~...*..~..l.~£....../~...i.c..I.~/~-Z.L~.:...~....~..~...~...~.~.. .......................................... Subdivision ................................................................ Lot No ............. Block No ............. House Permit No.~.(~.!..~..2.~'~::.. Date Of Permit .~l./~.]..~L?......Applicant ...~. :...~.!...'~...(¢...~.."~'...~..~;~...'2~. ................... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ .~ ........................... Construction on above described building~an~d' permit meets~all q~icable codes and regulations. Applicant ............................................................................ Sworn to before me this / ~/,~() Nota~ Public ; t Ho~TO~ ~tOdS8 LIL8 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned ........... ,;:2. Approved ............... .~.~, ........ (..~ ....... , 19../..~.. Permit No....~f.~....~..../...~...,~ .... Disapproved a/c ....... (Building Inspector) / APPLICATION FOR BUILDING PERMIT Date August-~'Z~ ! ~ 1977 INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building~kl Inspector, with 3 sets of plans, accurate plot plan to scale. Fee acCording.to schedule: b. Plot plan showing location of tot 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 is 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 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 app cable Lows, 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. ......... ............................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. , Name of owner of prem ses ................................................................ if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... .5.9...5...-.1~.I.. ................................. Plumber's License No ...................~../..~...~..~. .................. Electrician's License No ..............f..f..~....~...,~ ................. Location of land on which proposed work will be done. Mop No.: .......................... Lot No .................... Street and Number ~A.]:~.b..~.~.)..r.~.~:..v.~.e..~.L.?.~u..r.~e~.~..N..e..w.~.~.Y..~..~.k. ............ .'./. ........ ..~.; ............................ i.~.. .................. Municipality State existing use and occupancy of pr,aqnises and intended use and occupancy of proposed construction: a. Exisiting use end occupancy ..... .~..z:..l.~t. ............................................................................................... b. Intended use and eccupancv ....~..~.9..r,g.g.~...~.~. .~.g~. ................................................................................................ · 3.' iqature of work (check which applicable): New Building. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ..S.~..o..=..~g..e...~..h..e..d. ...................... (Description) 4. Estimated Cost $37.5.00 ~' / ~ (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 8 ~ , . . Rear .......8..*. .................. Depth 8 * Height.. ...... ? e.. ......... . 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: ..~...O. .................................................. ]3. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No · Miche, el J. & Phyllis Ge~c~j:a_Albo Dr.., ..L.~.n..r~dn~NYN. 14, Name of Owner of premises: ................................................... ~uu,=~ ................................................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorn property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot STA-FE OF NEW YORK, [ S S COUNTY OF .... ~, .......................... ~ ' -'~'~..~/Jl_C ....... ~...~.~..c1..£.~.. ...................................................... being duly sworn, deposes and says that he is the applicam / (Name of individual signing contracD above named. ~e 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 tha~ the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this ~ ....... day of ~'......U~.Z... ................. , 19.'Z[Z ~ ~...~ , ............ ................................ Co.. ......... ........................................ ¢//~. ~~ -- (Signature of applicanf) / ~RY L DAWSON . . NOTAR~U~g~ State of New York No. 52-464372L Suffolk Cou~ T~m Expires March 30, [~