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Home My WebLink About9472-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy Z9062 June lb~ 78 No ............. Date . "~0; 5'1'5 ' ' 0~egbh' R6~l' ' '" 19 .... THIS CERTIFIES that the building located at ............................ Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in September 28 77 dated . S.e.p~bm]se/~. . ~8 ..... , 19.77' pursuant to which Building Permit No ......... dated ....................... , 19 ...., was issued, and conforms to all of the require- ments of t_h~..a~pp_li.c, ab.l_e_p.r_ovisio, o~s_of, ttlc. J~a,.Y/...~tlc occupancy for which this certificate is issued is ........................................................................ Frank McBride The certificate is issued to ................................ xy~J~oL~o~x ......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... UNDERWRITERS CERTIFICATE No ............................................. 10,515 Oregon Road HOUSE NUMBER .............. Street .......................................... Cu.t.~e, New York ................................. ~f///~ ..................... ~3' ~ · Building Inspector l~Oll~ NO. ~ BUIIJ)INt~ TOWN CLERK'S OFFICE BUILDIN~ I~RMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9472 Z Permission is hereby granted to: ~.!.~.~.~.'/....~.,.,../:/.~...~.....~..~ ...................... ~.....~.,u/~. .......... !f.~. . at premises located at ~k~/: ~C/~/ ..'~....~A/~ ..................................................................................... :.,...,.:....:.,...:....~...~..=:..%.....~.C..c.e.....~...u..~".,"~'"~'-"' ,',' -r ~, - pursuant to application dated S£/~7 ~'~ 19.7.~...., and approved by the Building Inq~ctor. F. .............. Building Inspector TOWN OF~4~rHOLD BUlLDIN~ DEFARTMGI'I' TOWN CLERK'S OFFICE SOUTHOLO, N. Y. Exam,n ................ .... 7..-- App ............. ~'.... :.. , , ............................................. '... Disapproved a/c ..............~ ~ ......... ... .................. ...... ....... ~' ~(Building I/~sl~tor) ...................... APPLICATION FOR BUILDING PERMIT Application N .................................. ! ................................................ ,19 ............ INSTRUCTIONS a. This application must be completely filled in by typewriter oe..in ink and submitted in triplicate to the Building Inspector, with 3 set~ of plans, accurato plat plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to odjo n ng prem ses or nub ic streets areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram which is Pa~t of 'this application. c. The work cOVered by this application may nat 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 port 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 Bu ding Permit pursu..ant to the _Build!r~... Zon,e Or.clinance of t. he '1', ,o~.,o,f. Southo. l,d., Suffolk County, New York, and other applic.uble Laws, Oral,nonces or ~.~geUmt~,o. ns, .tar the c.onstr~t~on aY. au.rungs, add,hans or alterations, or for removal or demolihon, as here n described. e appucant 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 inspections. S gnature of opp, nt, or o (Address of applicant) /! State whether applicant is owner, lessee, agentl 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 officer) Builder's License No ..................................................... Plumber's License No. ................................................ Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: .......................... , ............. Lot No ..................... ., -- ~tf(~,) /-t/,,b, /~ : ('/Ir'r:-~ i' '"' Street and Numoer .................. ..................... 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 '~/~ / ~ t /~/ !- I, A / / ,.--. , i, i Nc~ture of work (check which applicable): New Building.. ................. Addition .................. Alteration ................ Repair .................. Removal .................. · Demolition .................... Other Work ..................................................... /// ~* /~' O /,~- (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 ................................ Depth ....... ............. Height ........................ Number of Stories ................................................................................................................. Dimensions of some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Nu/n~e~/f Stories ................................ ~-- / 8. Dimensions of entire new construction: Front .../. .............................. Rear ............................ Depth ........................ Height .................... N u rr~e/) c/f~ ~o~ies ...................................................................................................................... 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 ........................................................... .A,.¢~.~ ................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................. ~ ........... 13~ Will lot be regraded . .............. fTrj;7¥~ Will exces~t t~ll ~ rJm~o~ed from l~gr~ir¢,/)lYes ( ) No 14. Name of Owner of premises .................................................... Address ................................ Phone No, ...................... Name of Architect .../~t~.F.;~.l./..¥....~..../J~..~...;.,-.~.;[ .......... Address ..~..~*.~l.~.l~*.~.u.~,'-... Phone N~-~.'/..::..~.~.~.7 Name of Contractor ............................................................ Address ......~ ......................... Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street end block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ~/ t''/~ ~ ¢ c COU N'i~ tO/F ........ ~..,..~..::-v<..l ../-.. ................................................................................................. being duly sworn, d~oses and says t~t he is the applicam (Name of individual signing contrac~ obovenamed. /~A ~,'~ ~ ~ He is the ................................................................................................................................................................................. (Contractor, agent, co~orate officer, ~c.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this application are tree to the best of his ~ledge and belief; and thor the work will be performed in the manna[ set foRh ig the application filed therewith. Sworn to befp~ me this I' 7 ~ i / 'r~' dayof ......................... ~.( ;-19 H ~' /~ / ',. iriS. ........................--'~ .. C.n " ,~. ~.~. Nota~ ~u~, · ................ ~ .............................. ~ ............................. :~. ..... 7-.-...~;.-.~.Z. :~- ............................ ' ~/ ~ I ) , (Signature aT applicant] Term ~res March ~, 19~ ~0u-M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ................ ................ Disapproved a/~ .... ~. .................................................................... ......... ........................... ............ ~i~din~ APPLICATION FOR BUILDING PERMIT 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 pla.ns, 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 premises and in buildings for necessary inspections. ............. (Signature of applic~'t, o/nq~e, if a corporat ~i ...... ................................ .......... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~-~ ~Jl~ ~[ ~ ~ ~/~ 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 which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number ~..1~-(~01~ ~6A~ ~4/7'C/..IOGi.,,~z-- Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ~- /=///~h'f ~'/JIL. Z) I N,( ~_~ b. Intended use and occupancy ..~'AA~/s.~ ~&//'~'"/'~ 7~ Z~J~)/ -77 O ..~./. ..... 3. Nature of work (check which applicable): New Building. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) 4. Estimated Cost ................................ r .......................... ~ee ....................................................................................... (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 ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ Height .................... Numberr__^ ~,~ ---°f Stories ............ [.. ....................................................................................................... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ........................................................... ~ .................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .............. '......'..~.......n. ......................... 13. Will lot be regraded . ........................... Will excess fill be re.~oyed from premises: ( ) Yes ( Nome of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ....................................................... Address ..~.ZEE,t~.L.E_.. Phone N ................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, 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 ~vhether interior or corner lot. STATE OF NEW YORK, ('~/~.-----------------~- lc S COUNTY OF ................. .'4'...¥ .......... f '"" ......... ...~..../~. .......... ~.?..f...~....~....~....~..i./.. ...................................... being duly sworn, deposes and soys that he is the applicon, (Nome of individual signing contracf) above named. He is the ............. ~.~,..~-~.~.~ ....................................................................................................................... (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 oil statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before~..~ me this 19~.. ~~~ ~, Z ~ ~ ................ o, ................................ G% n .................... No. 5246~37U, Su~ lg ~ ~.rm ~gires M~rch ~. FOBM NO. $ TOWN OF $OUTHOLD Building Department Town Clerks Office Southold, N. ¥. 11971 APPLIGATiON FOR CERTIFICATE OF OCGUPANCY 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 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: I. 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 Date .................... New Building ./.~.../.~..~?.~ ....... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property .~.,/..'~ -f~ ~o(?.. /.:~o(.~/.~ C~..?(',,~/od,..~..r_~ Owner Or Owners Of Property .....~.~-./.'~..//../,~'../~'........~./,...~.~.~./.~..~./.~../Z~.~ .............................................................. Subdivision ................................................................ Lot No ............. Block No ............. House No Permit No..~....~.~...2 .~..2-~ Date Of Permit ~Z.~...~*.~..?..7....App icont ~'~../.'.~.~..'../../.~Z~....~,..??.,,(~.~..&4..~.~.-.,~.~....E~4: Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ '-f~ ~'"0 . Construction on above described building and permit meets oll applicable codes and regulations. Applicant ......................................................................................................... Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) ur-/~' ' 7