HomeMy WebLinkAbout9067-zFORM NO. 4
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
$outhold, N. Y.
Certificate Of Occupancy
No..Z~.2.55 ...... Date . ...0.ctob.er. .... 1.7. .......... , 19.78.
THIS CERTIFIES that the building located at . 27D..Be~al~woo.d
Map No...72.7. ...... Block No ........... Lot No ..... 1 .............................
conforms substantially to the Application for Building Permit heretofore filed in this office
dated . .Mg~'.a.h... ~ .7. ........., 19.7.7.. pursuant to which Building Permit No....9.QG. 7.Z
dated . .Mo?9.h.....7. .......... , 19..7.7, 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 .... Seasonal. Private..One. Eamily. D~elling. with. additinn ........
The certificate is issued to Russell K. Perrine Jr.
(owner,
of the aforesaid building.
Suffolk County Department of Health Approval ....... N/.R .........................
UNDERWRITERS CERTIFICATE No ..... N. 3~.0~.~..0 ................................
HOUSE NUMBER ...2.7.5. ........ Street ...... .B.c..n~.h.w.o. 9.d..R.~, ....................
............................................ ,o,~. t~ho,~,,..~..Y, or~ .............
...... ~.~ .... . .~.. ~_~x~.~,. ~.~ 'xx~ ........
Building Inspector
County Tax Map Number
1000-116-4-27
FORM NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 9067 Z
Permission is hereby granted to:
Zurowski & Jacobs k/C Russell Perrine Jr
New Suffolk
.................................. ~.~.o..~...~...~..~.~.~.~.~..~z..~.! .............................................
at premises located at ..... ~..~. .............. ~.~.gb~q~.~ .......................................................................
Beachwood La off Dean Dr Cutehogue
pursuant to application doted ...................... .~...~.~.....~. ................... , 19....~.~.., and approved by the
Building Inspector.
Fee $15.00
...... ........ ...................
Building Inspector
TOWN OF $OUTHOLD
Building Deportment
Town Clerks Office
Southold, iq. Y. 11971
APPLIGATION 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--fl-9 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings end
installations, o 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 ]957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey o( 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 end 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
3. Copy of certificate of occupancy $I.00
$5.00
..........
New Building .................... Old or Pre-existing Building ~ Vacant Land
...........
Location Of Property ........................... ~, .... ~ ............
o
Owner Or ~ners Of Prope~y ~ ~ ~ ~ L L
Su~ivision ~ '. ................................................. Lot mo ............. ~OCK mo ............. mouse mo .............
· ~. ........... ~p 7~7
Permit No..~..~.~.~ Date Of Permit ......... ;/ ......... Appbcant ..................................................................
Health ~pt. Approval .................... ; ....................... Lobar ~pt. Approval ................. ~..z~ ...................
Underwriters Approval .............................................. Planning Board ~provol .......... ~%.'~ ...................
Request For Temporo~ Ce~ificote ........................................ Final Ce~ificote ..........................................
Fee Submitted $ ............ ~. .....................
Construction on above described building end ~~y I. ~l: :~e: D regulations.
Applicant ......... ~M~~~ ............................
Sworn to before me this
................ day of ............................................
Notary Public .................................... County
(stamp or seal)
r-i
CO 7__ q.2
FOB~M NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
E×om,ned .......... .~.~....~Z.....,
~proved ............................. .Z. ....... , ,9~.. Perm,t No. ?~ ~ ~
^pplication .~.... ........................... ~
Disapproved a/c ..................................... J ,~ ,~...~.~_ _~/~ ~
........................ (Bu'il'~li;'~ Inspector) ~'~'~'""7" ......... '"' ~
/
APPLICATION FOR BUILDING PERMIT )~
Dote ...................... ~.~...Z ............. , ~ ............
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 o~
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 ~ssuance' 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 ir', buildings for necessary inspections.
name, if a corporation)
..~.:......~..c..o.,..,~_~ ...... ~.~..,,~/~..~...~ ..........
(Address of applicant)
State whether appli,~nt is owner, lessee agent,/g~chitect, engineer, general contractor, electrician, plumber or builder.
......... ........................................
Nome~/of owner of premises ...~..~..~--.~....~.'...~..~...~'..~..~......~..~.... ...........................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No...~...~.~...~...z~../..~.~......,~...,~...
Plumber's License No...~.,.~.',~....~./../.. .....
Electrician's License No..~../...~ .................
Other Zrade's License No ............................................... ~'c~c~%~'~-~O~r~ ~/~''~ ~"~/~ ~ .~:r-~
Leca~ion of land on whi¢ propo~ work withe ~ne~ Map No.: ...TZ7 ......................... Lot No. ~ I
Street and Number ~..~..~~ ........................................................................ ~;~
Municipali~
State existing use and occupancy of p/emises and in~ended use and occupancy of proposed construction:
a. Exisiting use and occupancy .~~'...~~~.:....Z..~~ ............. ., ...................
....... ...... ......
b.
Intended
3. Nature of work (check which applicable): New Building'. ................. Addition ................. Alteration ................
Repair .................. Removal .................. Demolition .................... Other Work .....................................................
.~.....~. ~.~.~.., - ,-- O~:D (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, specifyznature and extent of eac~h type of use ............................
7. Dimensions of existing structures, if any: Front ...... ,~.4.(... ......... Rear ...... ~..~,.~.. ............ Depth ...~.,.~....L ....
· Height ........................ Number of Stories ...... ./.. .......................................................................................... ? ...........
D mensions of same structure with alterations or additions: Front ..; .~.....~.....~Z.. .................... Rear ......~....~ ............
//...~ { ,/ x'
Depth~....~.. ..................... Height ............................ Number of Stories ...../. ..........................
8. Dimensions of entire new constructions: Front ....... .~...~.~ .................. Reor ......~7~_,...Z... ............. Depth ...~.....~r. .............
Height .................... Number of Stories ..... 4 ............................................................................................................
9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................
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: ........................................................
13. Will lot be regraded . ............... .,~ ......... )/~'ill excess fill b~ removed from pre, this?s: ~ ) Yes ( ) No
14. Name of Owner of premises ...~~..~,. Address ~.~..//. z/~,, ,~ . ~ ~ z/~//,/~/,/~,~,, Phone No .......................
Name of Architect ~. ................... "~i'":~';'~'; ...........~' ........ Address ................ ~'7 ......... Phone No .......................
Name of Controctor~.....~'/~-.~.PLOT .................. DIAGRAMAddress~/'~"~/~" ........... Phone No. ,~...~..~7...~...~..2'~
Locate clearly and distinctly all buildings, whether existing or proposed, end 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 Iol,
.... ~=..~~ ................................................. being duly sworn, deposes and soys that he is the applican~
~ (N~e ~of i~dividua] signing contracf)
~bove nomed.
He is the ....~:~ ....................................................................................................................................
(Controctor, 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 aH statements contained in this application are true to the best of his knowledge and belief; and
tha~ the work will be perfor~e~ in thez~anner set fo~h in the application filed therewith.
SweeP.fore/ y I
Mo~ ~ublic ....... ~.~]...~ ............. ~. ......... ~ ~C~un~ ~.~.~..: .................. ~X ........ :'"'r ....... : ...... ;[' .............................
NOTARY PUBLIC. State of N~w York
No, 52-8125850. SHffolk
Te~m Expires M~rch 30.