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Home My WebLink About9437-zFOI~M NO. 4, TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at [~.~ W~.,,~ f(/.~,~, . . . Street ~ap ~,o~.z~v ~,~ ~o.l~ ..... ~o~ ~o../.~ .... ~,.~.~.~,~ ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... ~ ~ ., 19~ pursuant to which Building Permit No. ~Z~ dated ........ ~.. ~ .... , 19~., was issued, ~d conforms to ~1 of the requffe- ments of the applicable provisions of the law. The occup~cy for which this ce~ificate is ~ ~ .... ~'~'~"~' ~1'"~~ ................... The certificate is issued to ~.~. ~~ ............. ~ ......... (owner, lessee or ten.t) of the aforesaid building. s~o~k County ~epartme~t o~ ~t~ Arpro~ ~ .~. ~.~f.y.;... ~. ~. p.~. U~DE~W~IT~S C~RTIF~C~TE No. '~'~'O~. 0 ~ ......... ~. ~.~.?.~f.( ~ ....... ~ous~ ~u~s~./. ~ a ..... s~a.. ~ ~..~ ~.,~,,.~ .Z.~ ............... ......................... ~. o... ~~,~ .... ~.~ ........... ~~ ~t;; .......... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT fi'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9~37 Z Date .......................... ~.~?,.....~ ............. , 19.~,. Permission is hereby granted to: ....... .............. ~a.t,t,.:l..~k ............................................ Io ...b~.Zc~... r..~,~...ol~ ...~:~)~..)_.y .. ~w~l..3.4.n~.. ................................................................................... at promises Iocoted ot Lo4,~.?.~, ....... C,~.::L~e.~..~y..~,~.~. ................................................................ ........................................ ,l~.a,,L..L":~e. ......... East..>,4am. i~m ....................................................... pursuant to application dated ........................;~:~ .......... (. .......... , 19.~.~..., and approved by the Building Inspector. Building Inspector FOI~M NO. ~ TOWN OF $OUTHOLD Building Deparfmenf 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 DUPLICATE 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 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: 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 New Building ...~/. ......... Addition ................ Old or Pre~existing Building ................ Vacant Land .............. Location Of Property .................................................................................................... ~...~ ................... Owner Or Owners Of Property ....... ~.fJ.~ ....... ~ ~.'Z~.~ ............................. ....................................................................... Block No ............. House No ............. Permit No. .~.~.~.... Date Of Permit. ~..Applicant ~ Health Dept. Approval ..~/(~/~..2 ..................... Labor Dept. Approval ................................................ Underwriters Approval ~¢~./.~.~ ..................... Planning Board Approval ........................................ Request For Temporary Certificate Final Certificate ~' Fee Submitted $ ...... J..~..~..~? ............... Construction on above described building and permit meets all applicable codes and regulations. App,ican, ........................ Sworn to before me thisn ......................... z"'"'~ .......... ~. ~ amp or seal~ ~ . TOWN OF SOUTHOLD /~.*.~,~.c~/:? BUILDING DEPARTMENT ~ · ~ ~ ~,-/~/~' TOWNCLERK'sOFFICE /~/~~'.~ ~ ~,~ SOUTHOLD, N. Y. J~ , E;~ ~ ............................... .................................................. .. .Z,~ . , INSTRUCTIONS a. This application must be completel~ filled in by typewriter or in ink and submitted Jn duplicate to the Buildin~)~ Inspector. b. Plot plan showin~ I~ation of lot and of buildings on premises, r~lationship to adioinina premises or ~ublic streets or~ areas, and ~iving a d~tailed description of layout of prope~ must be drawn on the d a~r~m whi-ch is ~rt of t'hi~ ~ppHcation.~ c. The work covered by this application may not be commenced b~for~ issuance of Buildin~ Permit. d. Upon approval of this application, th~ ~uildin~ Inspector will issue a Buildin~ P~rmit to the applicant. Such permit shall be kept on the pr~mises available for inspection throughout the progress of the work. e. No building shall be occupied or ased in whole or in p~rt for any purpose whot~v,r until a Ce~ffJcat~ of Occupancy~ shall haw been granted by the ~uilding Inspector. APPLI~TION IS HEREBY MAD~ to the ~uildin~ Department for th~ J~suance of a Buildin~ ~rmit pursuant to the . .B~ilding Zone Ordinance of the Town of Southol~, Suffolk County, New York ~nd other applicabl~ Law~, Ordi~nces or ~egulations, for the construction of buildings, additions or alterations, or for removal or d~molJtion, as h~r~in described. The applicant agrees to comply with all applicable laws, ordinances, building cod~, h0usin~ code, and r~ulations. / ............. ..................... ................ (Signature cf applicant, or nome, if a corporation) ................. ~:.~,:z...: ................ ~..:...:..,,,,:....,:z::r:: .... (A~dress of applicant) Stote whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder, ....................................... Z~..~::/...~. ../)..<:.~. ....................................................................................................................... Nome of owner of premises ..................................... ~ ...................... 2, ................................................................................ If applicant is a corporate, signature of, duly authorized officer. ................ <Nam'""'"";'~';itl'"'e':c~;':orp"'"';;;;;':~i;;;; ................... Location of land on Which proposed work will be done. Map No.: ,,~..,~,'~,.?,.~,.,¢,,,-~../~,A/i.., Lot No.: Z.~ ............... ....... ~ ............................... /.~,~..~ .............. .~,.~.~ ............... ~. ............... Z,.,.~ ..................... Stre~ and Number ~ ~/) O~C ~ ~ ' ~ O/ , ...... Munici~li~ State existing use a~d occupancy of premises and intended use and occupancy of propos~ construction: a, ~isting use and ~cupancy ...................................... ............................... ? ............................................................ b. Intended use and ....... , ....................... ~ ................................................................................... 3, Nature of wo~k (check whici~ applicabJe): New Building .................. Addition .................. Alteration .................. Repair .................. Remora! .................. Demolition .................. Other Work (Describe) ........................................ (to be paid on fKing this application) 5. IF dwelling, number of dwelling umts ............................ 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 a,lterotJons or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8, Dimensions, of entire new construction: Front ......... {~..~ .................... Rear ........ ,l~,..~,. ............. Depth ...~..~ ................. 9. Size of lot: Front ...... .J..L.~. ............ [),ear ................................... Depth ..... ~../....~.. ............. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ! 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construct;on vJobte any zoning Iow, ordinance or regulation? ............................................................ 13. Name of Owner of premises ........................................ Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimerisions from property lines. Give street and block, number or description according to deed, end show street names a~d indicate whether interior or corner Jot. STATE OF NEW YORK, COUNTY OF ................................ .................~'..~.,O....~..~..~...M.......,~..'.....,~'~.f~..)..,~,..l~..7 ......... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above nomed. He is the .................. ~.~..l..~....t,~..~.i~,..: ........................................................................................................ (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 tl'.a~ the work will be performed in the rnanner set forth in the application filed therewith, Swam to. before me this . Notar/ Public,. ........................................................... ~Cou.h, (Signature of ~r~Yf .... ~7' ............ Term ExCres March 30, 19~,~ ~'/ ~'~ < 0~x ~<~ SURVEY FOR JEANNE POLAND AT EAST MARION TOWN OF SOUTHOLD SUFFOLK COUNTY, NoY. SCALE: 1"=40 ' APRIL 15, 1977' OCT. 3, 1977 DEC, 15, 1977 M/O ~ARDIN~R$ BAY ESTATES SECT. 3 FILEDAPRIL ~4~ 1968 FILENO. 6095 SOUTHOLO SAVIN6S~ BANK A ME RI CAN TI TLE INSURAN CE COMPAHY JOHN A. POLAND 8 JEANNEPOLAND t.o'~ . sect,[on 7209 Of the New York Stato Education Law. ; 0 sUFFOLK COUNTY DEP~RT~EN~ OF tfEALTH SERVICES FOR A APPROVED SURVEY FOR ,JEANNE POLAND TOWN OF S OUrH OL O SUFFOLK CO~NTY~ N. ~ SCALE ~ 1"~ 4 0 ' APRIL 15~ The :water supply '~em~ for this [c~idenc~ stm=~rds of the Su[folk County merit of Health Services, ESTATES SECT. Ii FIE. NO.