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Home My WebLink About9467-zTOWN OF $OUTHOLD BUILDING DEPARTmO~T Town Cl~k', O~ie~ Southold, N. Y. Certificate Of Occupancy THIS CERTIFI~ that the buildJn~ locat~l at .~..o.l.~..~....L~..q .............. Street Map Nol~,..Go~d~.. Block No ........... Lot No, .¶0. & .ptSs9 ~ 1 Il ~.. 8~nthol~.. I~, ¥ o conforms substantially to the Application for Building Permit heretofore filed in this office dated ..........8®llt .~0 .... , 19. ~. pursuant to which Builtlt~ll Permit No..~Z. dated ............~.ep.t...~....., 19. ?.~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which thi~ certificate is ~sued is P~.t,v~..t.e..aC.e.e.~.o~'y.. ~.t.o.r. mg.e..b.u.~ ............................... The certificate is issued to. 8.~.~.~.1. JY..~. ~n. E~p~. .... 0~e~er$ .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval It,R, ............................... UNDEI~WRITEES CEETIFICATE No...N.:~: ...................................... HOUSE NUMBER .... 2~0 ......Street...Gol~ln..~& ....... ~outhold. ........... Building ;nm, aector mNO.! TOWN OF SOUTHOL~ BUI~IMN~ DEPARTMENT 'rowan CLERK'S O~FICE SOUTHOLD, N.Y. (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9467 Z Permission is hereby granted to: S t am/~..~...An~....~mprm =. ................................ ...... .1..~.~......§Z.C..ra....~9.~.e....~.v...e.....t.....~......~.e...r..r..~.ek N.Z. 11~66 m ....~I~..~ ~ = ..~¢ c~ .~o~.~..~ e.~:e...buil~n~ ................................................................. at premises located at ...~,o.t,s-..~.~..-p~-.&/.9~.l.~.....mep..<)g...N.~..Ge3.~,$m ............................... ..................................... G~33~.~.r....L~a-~ .............. Southo14 ............................................................... pursuant to application dated ............................... ;~p~.....~.O......, 19..~.., and approved by the Building Inspector. Fee $1~).~.QJ~ ............ ........ ~ ......... ~ ...... ~ ............... ~ ..................... Buildit~g Inspectbr I FORM 1~0. 6 TOWN OF $OUTHOLD Building Delm~tmo#t Town Clerks Office $outhold, N. Yo 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 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 farm ar 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 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. Fees: ]. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $].00 $5.00 New Building ...........I¢~..: ...... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of property Owner Or ~ners Of Properly ~~ ~ * ~ ~ ~~ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No..~.~.~. Dote Of Permit .......... .~..Applicant .~...~ .................................... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. PIonning Boord Approvol . ....................................... Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ Construction on above described building and perj:~t meets .GII applicable codes and regulations. Sworn to be{ore me this ....... >~.)..... day of ..(.~'..~..~..(....i~7. ................ Notary Public v.~.-~..t..~ m/. County TEL. '7 ~ 5-:~ 6 6 E3 TEIWN OF SOUTHE]LD [3FFI~E OF BUILDINI3 INS~PEE:T~ T~WN E:LERt(.'S r~ffl~E SOilTHOLD, N. Y. 11971 Sept 16, 1977 Mr. Stanley Kempner 1~9 Sycamore Ave ~orth ~e~ick~ N.Y. 11566 Dear Sirs Received a completed application form for accessory storage shed and your note. Please be advised~ I have rechecked the file on your addition permit ~9161Z and find no indication of any accessory structure on the plot plan or application for permit. There was no fee with the application dated Sept 10 for the accessory building - the plot plan is O.E. - please remit fee of ~10.00 and we will issue the permit for storage shed. Yours truly ~' Ins ector ~ Sr Build~ ng p Permit No. ,~,.' .............................. (Building Inspector) / INSTRUCTIONS a. 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, 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 m areas, and giving a detailed description of layout of property 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 annlicable Laws Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as h;rein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to~ admit authorized inspectors on premises and in buildings for necessary ~spections. - (Signature of api~icant, or name, Cf a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................................... ................................................................................................................................... Name of owner of pram ses · 5~..':.~-:..~'.-.~. ·~.~.. · : ....... ~.~.~, ......~...~,~......::~..~:~C~:::~.~ ..... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..............~~. .......... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on whi~ro~.sed w~ork wil}~.~ne. Map No.: ........... ~L..~.,~,. ............... Lot Street and Number .... ¢.~..~.....~..~ ......... ' ....................... ~~...,~.. ............................. .'. ....................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...................... ..~..?,.~.~..~..,~...~.'~.. ........ ~:'~??..~..~-~:,.,.~,~ .................................................... b. Intended use and occupancy -~ 3. Nature of work (check which applicable): New Building'. ............... Addition .................. Alteration ................ Repolr .................. Removal .................. Demolitior, .................... Other Work ................................................... .~,~. (Description) 4. Estimated Cost .........~ ................................... ............ 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 ............................................................................................................................................. 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 ...... ..,~,...O,..~ ............... Depth .....~..~...~. .... · Height ...... ~,... Number of Star,es ....... .~....~., ............................................................................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... ..~..~ ..................... Rear ........ ~[.f. ............. Depth ..... .~...~.....~. ........ Height .......... ~ ......Number of Stories ......... ~. .................................................................................. ~ ..................... 9. Size of lot: Front ...............~..~.~ ................................ Rear .......... ~ ............................. Depth ...~..~......~. ................. 10. Date of Purchase ...... ~.~..~..¢.~..~.*~.~../..~..?...~. ......... Nome of Former Owner ...~'..~......~,../~..f.~.. ..................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ......... ..~...~ ....................................... 13. Will lot be regraded . ...... ~,..~. ............ Will excess fill be removed from premises: ( ) Yes ( '1"No 14. Narne of Owner of premises .....~..:..~.:,./~..~'....~...~....~....~....~ ...... A,14,~/~I~F ~,~'~/~g/~1~1~,,,~ l,j~l'l t~-/'t~J' J'J- ~J ...... ..... -' ........................... Nome of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorn 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, IS S COUNTY OF ................................ ............................... .~....~....'~....~/,.,~.,,~'...~. ...... ..~..., ...... .,~t,.,,/~,..~?..~/,.~. ,,,.be ng duly sworn, deposes and soys that he is the opplicom (Name of individual signing contract) above named. He is the 0 ..l~.j~.~...~ ......................................................................................... (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 thor the wark will be performed in the manner set forth in the application filed therewith. .s..=:.:..,..o..b..:.,. ~ignature Of applfcont)