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Home My WebLink About9446-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate O[ Occupancy No.. Z~)~8 .... Date ...~anua. ry. - ~6 ............ , 19..~.8 THIS CERTIFIES that the building located at . 8200- ~9o~md..V~.ew..Ave .... Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated '3~./2~lb~X' ..... 9 ...., 19 .~,?. pursuant to which Building Permit No..9~6Z - dated . ~e~'cembe~ ..... 9 ..... , 19. ?~, 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 .... ,r~RIVATE ' OI~E' 'F;J4TI~Y' 9i~Lkll~Cr ................................... The certificate is issued to ..... ~aek' ff~rtg' ~ .Les..G~'aham ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....... N/~ ......................... UNDERWRITERS CERTIFICATE No .... Penc%]~l~g.., .~...~..~..~../..~. .............. HOUSE NUMBER.. '8200 ....... Street.. Sound..V.]:e~. t. ve ....................... ........................................ Sou~ho.ld ~ · DrY. ......................... .. ............. Building Inspector BUILmHG FERMrr (THIS PERMIT MUST BE KEPT ON THE I~EMISI~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9446 Z Root L, ]~.at~ Ine A/C Robe~ B~yl~y ............... ~A~t~:..iA ............................................. build ~n a~.~ition on existing dwelling at pNmism located at J/~$ Jound View Ave 8outhold N.~. pursuant to application dated ........................................................ , 19. .., and approved by the Building Inspector. FORM NO. 6 TOWN OF $OUTHOLD 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 triplicate to the Building Inspector with the following; for new buildings or new use: i. 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--iS-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 Q. New Building .................... Old or Pre-existing Building ~ Vacant Land .... i n ~' ~/ Lot' BI k' ' ' Permit No..ZZ .~..~....:Date Of Permit .~.~.~..'7..~Applicant ...~.~...~.~c~..~......~...,..~°.~../~..~../..~. ......... Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ -...~..' co ~2 Construction on above described building~.~_P~rermit meets~~. ____c.~ocle.~s and regulations. Applicant x.. -'~....~_ z~.~ ...¢. ~.,~....~.. ............. .'; .......................................... Sworn to before me this ~'~ ................ day of ............................................ Notary Public .................................... County (stamp or seal) I FIXTU~"~t:- - -' J - : rP F~RES RANGES [C~KINGD~K$1 OVEH$ ~DISflWASHERS EXHAUST FANS ':~' Hatti+uck~ L.I. i~1952 -: Lie 2~2E ~ v~'~/' '''] ~ (edific~t~ ~f nor ~e ~ltere~ in on~ mo~er; return to fhe o~i~e o~ fhe Boord ~f , ( ~O I~q'~T. K~T'CH, ~. L~T. ~ Ir2Eg~.J:;ON1 . ~,/~,LL STATE OF NEW' YORK } COUNTY OF SUFFOLKJ, ss: Office of the Clerk of the TOWN OF SOUTHOLD (I~EAL) I, JUDITH T. TERRY, Town Cleric of the Town of Southold, DO HEREBY CERTIFY thet I hove compared the attached copy, with the endorsement thereon, of the ............................................ Certlficote of with the original now remaining on file in this office, and that the same ore correct transcripts therfrom, and of the whole of said original. IN TESTIMOHY WHEREOF, I hove hereunto set my hand c~nd affixed my official seal, this ................ day of .................................... 19 ........ Town Clerk FOI~M TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×am,ned b ................... , ....... ........... , ..... ................................ ~proved Disapproved a/c ................. ............................ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. 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 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 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 premj~es and in buildings for necessary inspections. ..... : .............................. iX~J~'~'~'g(a~ii:~'~ti'""~;;~ "' ................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........ .~.~./¢'~..~:/.~.. ~7/...4~.1:.(~.~.~.. ~ ~ ~.}~. ~..[~..~ .............. 'fapplicant is~orporate, signature~duly,~dofficer..: /G ~ '}~:':~ ': / ') / .................................... : ......... ¢.~..~. .............. ~ ............ ~b ~6; (Name and title of corpor~t~officer) -- ,- Builders License No ...... ~.~ ....................... '. ............... ~ ~ ~ 7 Plumber's License No Electrician's License No....~.J..~(~.~.~.g~ . Other Zrade's License No ............................................... 1. Location of land on which proposed work will b~ done. Map No.: ..~ ........................... ~ ...... Lot No. ~ ..................... Street and Number ......................................... ~. ......................................................................................................... Municipali~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ~ ~" ~zl~Z~z b. Intended use and occupancy '~ ~ ~: L L j ~ 3. Nature of work (check which applicable): New Building~· ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior~ .................... Other Work ................................................... (Description) 4. Estimated Cost ............................................................ Fee .......................................................................................... (to be paid on fi~ing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If business, coramercJal or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Froot ............................ Rear ................................Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same shucture 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 ,/ .... '~ ¢" ' .................................................................................. :, . Depfli ...~,>,.,., .................. 12 .... 10. Dote of Purchase ........................................................Name of Farmer Owner ........................................................ 1 1. Zone or use district in which premises are situated .............................................. ~:~..._' ................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ F.::" .......................................... 13. Will lot be regraded ....... ~ .................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Narne of Owner of premises .................................................... Address ................................Phone No ....................... Name of Architect ................................................... : .......... Address ................................Phone No ....................... Nome of Contractor Address ................................Phone No ....................... property lines. Give street and whether interior or corner PLOT DIAGRAM Locate clearly and distinctly ill buildings, whether existing or proposed, and indicat~ lock number or description acc~ord~ag to~Jeed, a~d .sh lOC) all set-bacl4 dimensions from }w street na ~es end indicate N-fY'OF,. ........ .>./ ........ ........ '.'..:.'.i ............... ....... ' ................... [ ...................................... being (Name of individual slgmng contracf) duly sworn, deposes end says that he is the applicant He is the ........................................................................................................................................................... ...................... (Contractor, agent, corporate officer, etc.) of sa d owner or owners, and is du y author zed to perform or have pe.r..f~rmed the said work and to, mgke and..file . th s a lication' that a I statements canto ned n this applicat on are/tf'u~/to the best,e~ h~/(nowledge that the wor¢ w be performed m the manner set foRh n the app cat on,f ed therewfh. ,,- Sworn t~ before me this :.~ ..................... , 19~. .......... ..... Not. ........ ...................................... Co,, .............................. ............................. ~01~ ~SUC, State d ~e~ No. 52,4643721, Suffolk Cou~ lerm [x~ires Marc~ 30, 19