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Home My WebLink About9517-zFOB, M NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy ........ 'RoOo THIS CERTIFIES that the building located at 30.5..D.e.~v. Pa~l~. (20 ...... Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .October.. 25 .... , 19..77 pursuant to which Building Permit No.. 95..TT.Z dated .... .October.. 27 ..... , 19.77., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .......... .A.q .c?.s!~.o.~:7' .~.u. ~..1;~:~n. g..~..~:d..d~.~O.n. ........................... The certificate is issued to ......... .IL].~u..s. ~ ?.~,ga...B.e$.eM ........................ ( of the aforesaid building. Suffolk County Department of Health Approval .............. N/t~ .................. UNDERWRITERS CERTIFICATE No ....................... ~.~/~ .................. HOUSE NUMBER . ~.QS. ......... Street .... .D.e..e~..P.a.~.~ .(2. Q.*. ~...0:.~: ) ........... .......................................... .............. Building Inspector County Tax Nun/0er 1000-106-10-001 (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FuLL COMPLETION OF THE WORK AUTHORIZED) N? 95 7 Z Permission is hereby granted to: lL~a. ~$..&..aiar. ge..aeSe-z, ..................................... ..................... ~:a **.t,$:t, uol ..................................... at premims lacated at '~*eWw-'~'~..~T'-.~.~'e~ ........................................................................ ............................................... ~a~.~ .~.~ue~....-~.~. ............................................................................... pursuant to application dated ............................. 0~/'"'~6 ........... 19r~ .... and approved by the Building Impector. Fe~ ,~.tO~ ........... TOWN OF $OUTHOLD Building Delm~tment 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: 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 electrica~ 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. C. Fees: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelting ar land use $§.00 3. Copy of certificate of occupancy $1.00 Date .....~.!?..~.J~.Z... ,~..~., .~.g.?..8 ................... Addition on existing accessory building New Building .................... Old or Pre-existing Building ...*.~ ................ Vacant Land ............................ R 0 g off Deer Path Rd. (Hide Away Estates)Matt±ttuck Location Of Property ..................................................................................................................................... Owner Or Owners Of Property ...]f~.~..&..~..Be.ie~ ............................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No...9.5.L2...Z ...... Date Of Permit ..lQ~.26/.lC~2~pplicant ..... tf~. au~..~a.~..~.i~ ........................ Health Dept. Approval ............................................ Labor Dept, Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ *** Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ....... .~.6.,.0.0 ................... Construction on above described building and permit meets all~J~pllcable~:odes and regulations. Sworn to before me this (stamp or seal) ~©TAR¥ PUBL~ ', {,t~te e~' NeW ~e~. No 52-46654~I Qualified in Suffolk ~fl~ ~mm~slon Expires March 30~ 19~ FOII~ NO. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'$ OFFIGE ~OUTHOLD, N. Y. Examined Y ~proved ............~k ...... ~.Z ........ , 19 ........ Permit No. Disapproved a/o; ................................................................................. ............................. ~.~ ~~....~; ...; :/.~ ................ ^pp icotion ................. 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 Deportment for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, end other applicable Laws, Ordinances of 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, end regulations, and to admit authorized inspectors on premises and in, buildings for necessary inspections. (Signature of applicant, or name, if o corporation) ~.Z~...r.;~7....77., ~ .c..~.<:...,....A../.,..?.Y. ........ t..f.~.}..:.s.:.~.~ ..... (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 officer) Builder's License No ......... ~.~..(~..'~.'~.C...~7,..~,. ............ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... _ MoNo Location of land on whic. la~roposed wor~, ~il~,l?e done. ),p .: ....................................... ~,~.o,t No ......................... Street and Number .... ~'v...~.,..~...~.~..*......~..~./.i...~...J].-~..Jtr~....~......~,~....~sm<.~..~.=..~:..:::.--~.. ............. /I Municipality State existing use and occupancy of premises and in.*e~nded use and occupancy of proposed construction: a. Exisiting use and occupancy ....~../~..'~...~.....?,... b. Intended use and occupancy (~ ~-/~.f.~.~/ ~XZ~.', gf¢-~ ~/~'- . . .. 3. Nature of work (check which applicable): New Building. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .......... . ......... Other Work ..................................................... (Description) :]000 aa 4. Estimated Cost m..~ ........... : ......................................... tee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number ,~f ...... ) C,c~ ...... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front [O ~ Rear / a ' Depth '~o' '~fl~ ~ ~ ............................................................................ Height ...~ .................. Number of Stories ..................... Dimensions of same structure with alterations or additions: Front ........ ~.¢~ ..................... Rear ...... ~ ................ Depth ........ ~..~ .................. Height ............................ Number of Stories ..J....~ ................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 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 ...... ~.~.~.L~..~..[L.~.~. ........................................................ 12. Does proposed construction viofate any zoning ~aw, ordinance or regulation: .... ~ ............................................. 13. Will lot be regraded ....J~'~. ................ Will excess fill be removed from premises: ( ) Yes (~) No 14. Name of Owner of premises ]~.~A.~.~....~.~.~ ............. Address .~l.~.~:YPhone Name of Architect .............................................................. Address ................................ Phone No Name of Contractor ............................................................ Address ................................ Phone No PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ail set-~ck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicqte whether interior or corner lot. ~ A ~ ~' ~'.o~2 STATE OF NEVA/ YQL~I¢.- , t~' I c S COUNTY OF ~.M..2~..~L.~,~.-..f''' ', .................. ~m.~'.~.~.....~:.Z.~.~ ..........................being duly sworn, deposes and says that he is the applicam (Name of individual signing contract) 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 all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set foah in the application filed therewith. Sworn to before me this da~ of~d:.f......~~.~-~ , 19 ~ JJ'/~ ~ ~.~~ ~-~.. ..................... ~ - ~Z Notary Public,. ......... .................. CounW ........ I..,.-' ......................... ................................... WILLIAM I'. n[:ItNARD (Signature of applicant) NOTARY pUBLIC, Stah~ of New York No 03 0267600 Qurdlfied in S,,Fr,lk Cmrdy