The URL can be used to link to this page

Home My WebLink About9454-z TOWN OF SOUTHOLD BUIMJNG DEPARTMENT Town Clerk's O�ice Sorsboici, N. Y. Certificate Of Occupancy No: 7`)4-?.�?. . . . . . Date TIiIS CERTII'IES that the building located at .1130:7?., . . i�'.Q�iX1 .Vi,�+•t �AV:P. Map No. . .xrcxxx . Block No. .xxxx, , • - � .Lot No. . sc�c�c • . . . . . conforYns suhstantially to the Application for Building Permit heretofore filed in this office dated . leu rms t . . I.q . . . _ . . ., 19. 77 pursuant to which Building Permit No. .9454Z. -, dated . dent inber. - .14. _ . . . tins •.7. ., was issued, and confo to all of the require- ments of-the applicable provisions of the law. Th , ccupancy f®r which this certlficate Is 4 issued is . . ... . . . . . . . . Pri:yat r' one I.'amf l ine. . . . . . . . . . . . . . . . . . . . . . . . . . . . certificate is issued to . . J bp. r , La Far Td . .Anithony R in3 . • • .er . . . . of the akeiq foresaid building. (owner, aer, . . ` " . Suffolk County Department of Health .4pproval . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIr,ICATp No. . . . . . ROUSE NUMBER .' 7?a. . . . Street . . . .saitnd. Iriow. . . . . . . fare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sauthol.d. .Naw•York. Building Inspector . . . . County Tax NuMhor TOW BUILDING j~ERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9454 Z Date ............................ S~p.t.....lt-~ ......... , 19,:~.~... Permission is hereby granted to: G,,...~.[.~j.~.~.n..... ~,L/~...~L~.L ~ g.e... ~,.. Z~r~;Le.~ i Box E James~ort at premises located at .,~/..~..~.Q.t~f~....,~,f~..,C,~..e~ ............................................................................... $outhold ~;.Y. .............................................. pursuant to application dated ............................... ..o.~..~.~ ........ ]..bc..., 19...~.~.., and approved by the Building Inspector. Fee $....~.2.:..0...0. ......... ::'.. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall 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 Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of ali buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposel--(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 installa- tions, 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 peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 informa- tion 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 /fz 7 Date ' Clew Building ............ Old or Pre-existing Building ............ Vacant [.and ............. House No. ~ Street ,/~ :~ Ham/et Owner or Owners of Property . .~.~./.~.~/.., .~'. ,/~..~.~..6r?.....'~..'.~..~.../~.fi~.~...~'ff...~.~. · .~../..~..~..~.~(¥¥ / County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Map No ................ Lot No .... ~ .......... Permit No..~. ~-..~... Date of Permit ~, ~.~ ~.~.Applicant ..... ~ ..... Health Dept. Approval ................ Labor Dept. Appr(~j~l ....................... Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ,~ .' ........................ Construction on above described building and p~,~t mee~ts all app~cab, le, code~ and regu,~at!ons. .... .............. 0 ,,q ~Iv'TT-/O 'v' ': _ _ z""/, ,....-:C=/%,tVte,.~/%l. · ¢OUTs¢OZ.D ,% : ..... BUREA ........ s ' SWI~C~S{.';' ~' FIXTUEES OVEN5 FANS FURNACE' MO~/OJ~S [ }? FUTURE APFLJANCJ/ FEEDERS~ ~,ULTLOUTLET DIMMERS NO. OE FEET i. O~,NEbTRALS ' A.w.O. 3/0.,' ~ S lUll. DING DEPAI~'rM~,IT,,,/ ~ xam,n, ......................... ......... , / ~pr~ ......................... i. ......... , 19...C.Z. ~mit No..../....-L..../~...........~.~ ~ ~,, ................................................................... .................................................................. ........ .................... ....... ........... ........ (Buildi~ I~or) ~ .... APPLI~TI~ ~R BUILDING ~IT ~ .~ .~ 1 This o~licmi~ mus~ ~ c~pl~ly fill~ in ~ ~ewri~er o~ in inL ~ s~mi~ in ~riplicate nsp~or, wi~ 3 ~ of pl~s, ocourate pl~ plan ~ ~ole. F~ ~ing ~o ~h~u · PIo~ plo~ shying I~ofio~ of Io~ ond of buildi~s ~ premi~S/~lafionship ~o ~joining premises ~nd givi~ o de~il~ d~ripfi~ of I~ ~pr~ taus* be d~wn ~ the ~i~m which is ~ The wo~ c~er~ ~ ~is o~li~afi~ m~ n~ be c~menc~ ~fore i~u~nce of B~ilUing Permit. ~n opp~ol of ~is Opplicofi~, ~e Buildi~ Irish*or will issue ~ Building Permi* ~o the opplicon~. ~ ~p~ ~ the premis~ ~ilable ~r in~i~ ~h~h~ ~e ~rk. ~o buildi~ sh~ll be ~upi~ or u~ in whole or in pa~ for ony pu~e ~er until ~ Ge~ificme h~e bee~ gmme~ by ~he Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ssuonce of a Bud na Permit oursuant B il ......... ,.u d ~ Zon.e O.,rd,nonce. of the T.o?n ,of. Southold, Suffolk County, New York, and other opplicob · Lows, Ordinances or Kegu ar~ons, rot rne construction or oui~aings, addit ons or a terations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicoble laws, ordinances, building code, housing code, end regulations, and to admit authorized inspectors on premises and ir~ buildings for necessary inspections. Glenn Heidtmann & Son Ine (Signature of applicant, or name, Jf a corporation) Box E ~amesport ~.~. (Address of applicant) State whether applicant owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.~ is Name of owner of premises ....~I~J~...~.iI~..~.IL~ .~.~.~. ~[.~.e...z~...~.~..~...~. ........................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......... ~..q.~t~.l~ln~ ..................... Plumber's License No. ~ ? Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Mop No.: .............. ~ ..................... Lot No ...... ..?.. ............. Street and Number .]i/8..Se~__.~_...~X,l,e~...A~.e .......... 8.o.a,'~,~,~l. ...... .~.~X.,. ......................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ~.~...~..~.~.e:~.e..~..~.~..e~.a..?~...~..~..~..~.e.~.~.~.A..~...~.?..~.~.~.~.~..~.~ ............................ b. Intended use and occupancy O~..e. family dwelling with beach house & pump house 3. Nature of work (check which applicable): New Building,. ................. Addition ...... ~ ..... Alteration ~ ......... Repair .................. Removal .................. Demotitior, .................... Other Work ..................................................... (Description) 4. Estimated Cost ................................................ ; . Fee ..1~.~'1~1 ............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... Q~I ........... 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 ..... .~. .......................... Rear ........ ~. ............... Depth ..... 80/.~ ....... Height .................... Number of Stories ..... .~.~ .......................................................................................................... 9. Size of lot: Front ..... .1.Q0 ............................................ Rear ...... .1.00. ............................ Depth ~0.0/.~0~. .............. 10.' Date of PurchaSe ........................................................ Name of Former Owner 11. Zone or use district in which premises are situated ......"J~.~.t...f~J,S.~i ............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ,1~.~. ........................................... 13. Will lot be regraded ....... ~. ............. Will excess fill be removed from premises: ( ) Yes (~r) No 14. Name of Owner of premises ..T.a,tt.&;r.~e...&,..~,,,~e~k.4.... Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor .~.,...]~L~i~IJ;~,Z~.....&.S .................. Address ...~T~.II~S.]~Q.~..~ ....... Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or p~oposed, and indicate all set-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. see filed plans STATE OF NEW YORI~,, ,_ I ¢ c COUNTY OF ....... ~...1~.. ~..O.....1:~.. ........ ~.~' ..................... .~,~,f~l~..J;[eJ.~cjll~l::L...i ................................... being duly sworn, deposes and says that he is the applicam (Name of individual signi~ contrail) above named. He is the ........................................ ~.~.~ ........................................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfoFmed the said work and to make and file this application; that oil statements contained in this application ale true to the best of his knowledge and belief; and tho~ the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this ........................ day of ............................................ , 19 ........ Nota~ Public, . ........................ ~.q~ .......... Coun~ (Signature of applicant) c~