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Home My WebLink About9439-zNO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Ottice Southold, N. Y. Certificate Of Occupnncy No. Z8002 ....... Date ............ .N.o.¥ .... Il!. ...... , 19 .7.7.. THIS CERTIFIES that the building located at . .Cedar..Point. Dr..Wes.i; ... Street Map No..C../! ~ !?.'. ..... Block No ........... Lot No...137 .... Sou. l;hol/[..I~ ..~.,. ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. Sel~t...~ 19.77. pursuant to which Building Permit No.. dated ............ ;;e.pt.. 6..., 1977.., 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 . Pr. ivai;e..one..family, d.~.~.l~.~g..~Lt~..b.r..e~.z.e.w..ay..8.., g.a.~.a.g.e..a.d..d.i.t.i.?on The certificate is issued to .. Sy. dney...Soy, ere~. ..... .v.~m.e.r. ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. }(;R.; ............................. UNDERWRITERS CERTIFICATE No... 1~6~.~.1+}+. .... ~ov. ~.. · 19-7.7. ............... HOUSE NUMBER .. 97.5 .... Ced~trt~tint .dr. Ne st ........ ~ou~h~ld ............. ' ~Building Inspector · . . . ,.. :, .. ,~'. ,..-:., ;, . ...., . . ~,'. '.t~'~: ;,...;, , ~ ',',~.:.' ~. - - .~... ~: .: :. '.'.' . .' ..,..', ..... .: - ...... ,.'~'..' :,.:.;.~. ,, ,. ,, ,:., ,~ ... ,...'.,' ,.. -. ,~]'.. ,. .~r.',:~.,/;'.~,~"' ";..,'". "."..'.~: ~'... ?.. ",~ ...... .'~ ,, .' ': ,.~.~', ~.: ,..,', '-.- .'-":';:'. ,' .,.. ' .',. ,' '.':~'J:.' '."~; '"- ,' ,.:'," ,' . ' ·' . - ' ',.' ' . ' - ..- -' '. ..... · ' . ,"" . .- - : '. ' . '.. : .. '.' .: .'~ ,~::.:':', ',~::', ;- ,:~t~. · ~.~.,,,.~....,,,,~:~,,?..,..,.~ ~,,.- .,.~.,.....,.,._,... ,..,,, ,,,~ ..,, .~,; ,,.,..,.:,..~,. ~.......~,~.., ,,..,...,:: ;.., ,,,,.~..,,..~. ,,~,.,~ :.. .,.., , ,. . .. :.,.. ,~. ... .~. ... ; .... ,.. .... .. ... -. ,- . . . _ .. r. _,. . ..,,..,, .. .... :. , ..... ,:,,_..,, ...,-,~. FOItM NO. 6 TOWN OF $OUTHOLD Building Deportment 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: 1. Final su~ey 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 disposol--(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, §. Submit Planning Board approval of completed site plan requirements where applicable. 5. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey aT 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 3. Copy of certificate of occupancy $1.00 $5.00 New Building ...... .~.. .......... Old or Building ............................ Vacant Land ............................ Location Of Property ..... ................ L7 Subdivision ................................................................. Lot No../.'~...~... Block No ............. House No ............. Permit No ......... :~Date Of ~mi, ..~...~.~.~. ~-....Applicant ..,~...~...~ .................... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .... ~ ..................... Fee Submitted $ ...<2~...~!~::'~ .................. Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me this_ / ........... day o, ...... ,...,.:....;;;,./:;...i. ......... Notary Pubhc ............... ~~: ..... ounty THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~:5 JO~1~4 STREET. NEW YORK, NEW YORK 10038 Sove~el.,.cedar ~int dr., & Main Bayvlew. Rd., Southo[d' L.I. x ~, ~'~. x~ ~,~ ~. garage,outside No~embe~ 3.1977 ,,.ayo.,,a ,,, ~,. ~. ,.~,,,~,,,.~ ,,.~,~, ,~,~..~,,,.,.,..,~ ,~r r~ ~3W ~-~4W NO O~ CC ~ONg' 9. 7 - ~ ~O C~F N~L~G ] Cus~av. Bar, fa 227 East Break~.zater Rd. Mattltuck,L.I.l1952 Lie. 1529E Per ~ st not be altered ,n any.m,~nnen return to the office, of the Board if incorrect. Inspectors may be ;dentified by MAPOF LAND TOWN OF SOUTHOLD TowH CLE,.C'S O..CE APPLICATION FOR BUILDING PERMIT 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, occurete plot plan to scele. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets of Qreos, and giving o detailed description of Ioyout 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 opplicQnt. Such permit shall be kept on the premises Qvoilable for inspection throughout the work. e. No building shall be occupied or used in whole or in po rt for any purpose whatever until o Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION I$ HEREBY ~LA, DE 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 ,~pplicob · Lows, Ordinances or Regulations, for the construction of buildings, additions or ,~lterotions, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable I~ws, ordinances, building code, housing code, and regulations, and to edmit: out, horized inspectoj:s on i~remise$ c~nd in buildings for necessary ~spections~,~ ~ ~ c k" applicant, or nome, if ~ corporation) .. ' .......... '"-~(Address of applicant) State whether opplicont is owner, lessee, agent, architect, engineer, general contractor, electricion, plumber or builder. ................. ............................ ..................................................................... Name of owner of premises If applicant is a corporate, signature of duly authorized officer. Plumber's License No ................................................. Electrician's License No ............................................. ~ ~ Other Tr~de's License No ............................................... //~ ~./~ (/~ /~unicipQlity 2, State existing use and occupancy of premises and intended~use and occupancy of prepc~ed construction: 3: N~re Of work (check which applicable): New Building'...~ .............. Addition .~.. ...........Alteration .v ............. Repair .................. Removal .................. Demoliti°n ........... ~ ........ . Other Work ...................................................... ~'~., ; ,~ (Description) 4. Estimated Cost ...~./....~.~...O..!....~....~.. ............................ Fee ~/..~..~ ........................................................ : ........ (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 ....... ~...~f,~...: ................................ t .............................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structure, 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 .................................... Rear ............................ Depth ........................ Height .................... 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: ........................................................ 13. Will lot be regraded .....~.~.~ .............Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ,~l[,~-~)~..../'~..:.J~ddress .~wv~....... Phone No. Z.~...~...~.~.~7~, Name of Architect ...........................................................~. ~ Address ................................ Phone No ....................... Name of Contractor~..~-~el~.,.. Address~ .J .~..~.......C...~..d'.~-~l;[r~,. Phone No.~..~...~..: .~....(..~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-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. STATE OF NEW YORK, lc S COUNTY OF ..s~,;~;r;o,l~ ............. ~' ................ .~..~..i~..~....~.~..~..g.~j~..~.; ........ ~ ............................... ...being duly sworn, deposes and says tho? he is the applicom (Name of individual signing contractO above named. He is the ................................... ~.c~.f;...~..D,O~;~'~:~.t,O~ ............................................................................................. (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 .......... ~,13~. ...... day of ......E, eZ3~e~=]3.e~' ................ , 19..7..7.. Notary Public, . ........................ ~,;~,~4).~..~ ....... County No. 52-8125850, Suffolk COUD~y~ Tram Expires March 30, ii 4 67, ,< 10 't / ?-0 eIx7 L {- D.,.f:. A ~: t: LEVAT/ON - - ./'C4~,.CZ' ~..,~ 0 .i /G