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Home My WebLink About9442-zFORM NO. i TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No...Z8906 .... Date ...Jarz)Aary..1.2 ............. , 19..7.8. THIS CERTIFIES that the building located at . .11+3~..bl0.o.d.ql~..f;~ .R..d., ..... Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore flied in this office dated ..... . .. ~,/??..., 19.. 7.7 pursuant to which Building Permit No...9.~..2Z. dated .... 9/7/.7.7 ............ , 19.. 7.7 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.vate. One. Family..Dwell~Lug .................................... The certificate is issued to ... T. ed. Gl~iff~ ....................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...... ? '/'6'/'7' 8 ..... 7-S0-~ '19 ........ UNDERWRITERS CERTIFICATE No.. ?.e.n.d.i.ng 119178 HOUSE NUMBER ... ]~3~ ...... Street . Mood~liff..Rd, ......................... ........................................ r~tlttuck ~ .N,Y, .... 1.19~2 ............ Building Inspector Town BUILDING TOWN C~Ri SOUTHOLD, BUILDING 'PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) Permission is hereby gronted to: ~~...~ ........... ,....., ............................ at premises located at ...~...~.,~: ~~~.2~ ......................... pursuant to epplic~tion d~ted /~ ~ . ........... ~q~,~, ~nd ~pproved by the Building [nspe~tor, .: ';~ (} ouild~ng qnspector I~O]Ri~ NO, 6 TOWN OF SOUTHOLD , Building Department 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-c) 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 survewof 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 pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy Si.00 New Building .........~...... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Cacot on Of Property ........... .................................. Owner Or Owners Of Property ...... ~./) ....... ..C..~f.. ~/~....!...F'.~'.../~.../...N'.. ..................... ; ............................................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No..~'..~.,...z:...:.Z.. Date Of Permit .;/..)./7.:?.,...Applicant ~.:/.~...~../..~..~.s,~...~.~..M.,~ ....... Health Dept. Approval ../.'~..~..~..'Z.~.. ........................ Labor Dept. Approval ..,~..~..: .................................. __-~/ -- ~(40 ~ ,, Underwriters Approvo /,~,/7...~. ........ ~.,..~...~ ........ P arming Board Approval .~.:.~.~. ............................ Request For Temporary Certificate ........................................ Fin~ Certificate .......................................... Fee Submitted $ ................ ~..~. ............. Construction on above described building and permit meets oil applicable codes and regulations. .......... ....................... Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) APPLICATION FOR BUILDING PERMIT Date .................. 4~/...~. ................................. , 19. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted ia duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram w~' ich 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 Buildinglnspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of 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 Deportment 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 Lows, Ordinances or Regulations, for the construction of buildings, additions or al!orations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature of oppricant, 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 applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate~offlcer) 1. rolo -- /0'7- f7 Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ Stre~ and Number ....~/.,}. ...... .~:;~.:~.2.~..~L~.~:......~.~/..~.~ .................. ~:~,,~,;~;;~:,, ................................... Munlcl~ll~ 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 occupancy~..~.....~:.~.:::)./..~./ ........ ~..~?~.:~.~/~.~.Z~,~,:. ......................................................... 3. Nature of walk (check which applicable): New Building V~ .................. Addition .................. Alterafi°n .................. Repair .................. RemovaJ .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ~-*~ ~ 4~o o, ~ O (to be paid on fi:ing this application) 5. I~ 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, jf any: Front. ........................... Rear ................................ Depth .................... Height ........................ Number of S~ories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... ~.~ .................... Rear ......... ~..g ............. D~th ..~..~ ............... Height ....Z..~...] ...... Number of Stories ...... ~..;~ .................................................................................................... 9. Size of lot: Front ...... Z.~..~ ............. Rear ~ e ~ .................................... Depth ....... ~..:....e. ............. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 I. Zone or use district in ~hich premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ........ ~.~2. ............................................. 13. Name of Owner of premises ..... :...d~..~.~.CZ%~..~ ........ Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Nam~ of Contractor 2 ...... ~ tA.-,.~...~,...~.~.~.~.....A~ress ...~2..e~..C.~] ................... Phone No. PLOT DIAG~M Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~ck dimensiens from proper~ ~ines. Give street and Neck number or description according to deed, and show street names and indicm'e wheth~r interior or corner Jot. STATE OF NEW YORK, COUNTY OF ................................ ........... /..~..O.~j~.~,~.,~.~..,~.~.. ...... ,~ ........ ./~.~..2.~..~. ................ bein duly sworn, d~oses and says that he is the appiicant (Nome of individual signih~ application) g above named. He iS the ............... J~.Z,....~.~.~.~ ........................................................................................................... (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 forth Jn the application filed therewith. Swor~to before me this __ co.,h. .......... ................. ..................... ~// J~ J / NOTARY PUBLIC, State ol New York VAN ,'ruyL P, <~ DEPT. OF Hi~,LTH POR APPROVAL OF ,~ONSTR, U~TION ONLy DATE: ~ BUFF, ~0. D~I~'F. o~ HIAi11,i III~VI~.,~I 8TAT~urNT Chv IN~ O' ~'~;/~ {' FOR APPROVAL OF ~ffiU~ON ONLY 5J,~? t~, D~NCE WILL ~F~M ~ TH~ H, S. REF. NO.: STAND~ OF SUFF~K CO; OF H~TH. H~:f i APPROVED: ?