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Home My WebLink About9274-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town (]lerk's Office $outlmld, N. Y. Certificnte Of Occupnncy No. Z7'797 ...... Date ........... Jnly .... 29..., 19.77. THIS CERTIFIES that the building located at .~?/~:, .~.,a~le Ls~.. (P.v. tD, d).. Street Map No...xx~ ........ Block No .... xx .... Lot No .... ~ .... .}.',at~&tmclc · .~i,Zo .... con£orms substantially to the Application for Building Permit heretofore filed in this office dated ....... Apr... 1~ 19.7.7. pursuant to which B,~flding Permit No....9~7~Z dated ............. June -t..., 19.77., was issued, and conforms to ~1~ of the require- ments o~ the applicable provisions of the law. The occupancy for which this certificate is issued is . .P. rl.w~te ~adio,~TV. ~;ower. ac~e~c~.~' u~e ........ (~ .~r(~v. ed. h~..Ld. Appeal: The certificate is issued to . Et~s.tanttne .. F3.outel¥ ... D.~er ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval }~.,R ........................... UNDERWRITERS CERTIFICATE No.. -l{ ,l{, ...................................... HOUSE NUMBER . '605 ... Street ... Ea?te. La · · (*~t. ~ct) · · · ~.;att&.bliek. · · TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, lq. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9274 Z Permission is hereby granted to: at premises located at -JJ.~--~9,~.e---iJ,~'e--.(- '~r~ ......... ~B'~t~ .......................................... , ................................................ ~/s...c;~..~ ............................................................................... ~ ;.. gursu nt t6 application dated ..................... ~liJ~ .... '~ ................. , 19~.~..., ond approved by the -,~ ~ Building Inspector. Fe~' $1[~'..OJ~ ........... 1_ ~- BuddiPrg Insp'~t~ "'? I ]FORM NO. $ TOWN OF ~OUT~OLO , Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled ,n typewriter OR ink, and submitted in DUPLICATE 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, ana 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 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 $5.00,~--~ 3. Copy of certificate of occupancy $1.00 j Date ~.....'~,.,.~.,.. ~...~. .... LNeoc:ti:bl~ld'o;g ;;~;;;~~~`~P~*~:~:~:~;~V~t~:~:~d~~ Owner Or Owners Of Property ..~..?:r~.......~ .................................................. Subdivision ......... ~...,~ ....................................... Lot No.....~,.. Block ~ .~. ..... House No.....~......~.'- Permit No....~.~,-Z....!.~Date Of Permi~,...].~.Applicant ..... C.~..~ ............................. Health Dept. Approval .... ~ .................................... Labor Dept. Approval ....... ..~.....!..~. ............................. Underwriters Approval ...~...r...[...~.. .............................. Planning Board Approval .~...;.J....~... .......................... Request For Tempo_r~rary,~c.~ertif,cate ........................................ FinaJ Certificate ......................................... Fee Submitted $ .................................... Construction on above described building/ov~~all~ applicable x~/es/~nd~.~~~ '~r~ ~ ' /'4" ~ //'x/x~"~'~ Sworn to before me(~F~ Applicant .....'~...[..~..~ ....................... ,,C:~.~o~.~.~.7...~~....... ~...~ day of .~.....~... ...... .C.~..?....~.. .... (stamp or seal)/C~'~'/~ ~"7 Notary Public ......~ County FO~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....... ~h,.-H.-...-.-- ................ , 19 ........ App ica ion --'~ ? ? Ac)proved ...... ~... l , 19 ../Permit No '7~ ~e/~ F-M~ so' ...................... /..V. ....... ~2:.:/ ........................................ · ~ , ....... ~ (Building Insl~ector) APPLICATION FOR BUILDING PERMIT Date 19 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi, Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing locahon of Jot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this apphcatio 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 wdl issue a Building Permit to the apphcant. Such pern shall be kept an 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 Occupan, shall h'ave been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Buil&ng Department for the issuance of a Building Permit pursuant to ti Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances, Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, Housing code, and regulations, and admit authorized inspectors on premises and in buildings for necess, gry inspections. , // ~ // · g .... ;~'~'""~~¥'~'~;;~';~i~;~ ...... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde ............... a.~.~.~ ..................................................................................................................................................... Name of owner of premises ~ .~ .~...'-~q, .~...~..~;/L/F--~ .~..~':.. 0 ~...'~'.. ~.. ~-~..~... if applicant is a. com~orate, signature of duly authorized officer. ..................... AZ . .................................................. (Name and title of comorate officer) Bu,d.~'~ Uc~e No ............. ~.~ ............................. ~ m /O~- ~ = /V Plumber's L,cense No .............. ~. ....................... Electrician's License No ........... ~ ..................... Other Trade's License No ................. ~.~ .................. 1. Location of land on which proposed wor~,will be done. Map No ......... v ..... ~..~ .... Lot No ~ .......... Street and Number .6.~.~ ...... ~~ ...... .~/...~~.~.~.7.~.: ............................. Municipali~ 2. State ex~sting use and occupancy of premises and intended use and occupancy of proposed construction. ~ ~,~,., .~. ~., o~c.,~.c~ .......... ~ ........ ~.LfX ....... ~.~.~ ............................................... b Intended use and occupancy ............ ~~ .......... .~. ........ ~.~ ................................................ 3. Nature of work (check which a able). New Buffdtng .............. Ad n .................. Alteration .. Repair .................. Removal ................ Demohtlor .................... Other Work ~J~.~...~...T.......~..~........~..... . · ~_ ~") (Description) 4 Estimated Cast .~....?..(?..~,,...¢.,,~...,~.. ............................. Fee .... Z.,~,,...,~ ................................................................. (to be pa~d on filing thru applicahon) 5 If dwelling, number of dwelling un,ts ...... ..~../t~.... ......... Number of dwelling un,ts on each floor ....... ...~'.....~... ....... If garage, number of c~rs ..... ...~..~ ................ 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ...... ~..~:'.. ......... 7 D,mens,ons of ex,st,ng structures, if any: Front ........~'....g'...~. ......... Rear ........ .¥~.....'~......'.. .......... Depth ......~.....'~.,../..... Height .....f...~. ............. Number of Stories ...............~... ............................................ .~. .............................. .~, ........... Dimensions of same structure with alterot,ons or add,t,ons Front .............. ~.....-~.. ............. Rear .....,~--~.' ............ Depth ....~..~....~. ............ Hmght ........l~...../. ...... Number of Stones ........ ~ ............... 8 D,menslons of ent,re new construct,on: Front ........... . .~.....'~... ............. Rear .... .~....~.... .......... Depth .....~.....~.... ........ He,ght ......~.../~... Number of Stories ..... ..~...~ ............................................................................................... 9 S,ze of lot Front ...... ,(..~. ~ ................................ Rear .....~..C~...~...r......~... ~-~ D,ep~Lh dntz~'q--~' 10. Date of Purchase .... ./.~..ii...~...~....~... ..... /....~..~.~.'..'.~.'i ....... Name of Former ' ..zT-. 11 Zone or use distr,ct ,n wh,ch prem,ses are s,tuated ...... t..~...~. ...~.. ..................... f~..J...~. .......... 12 Does proposed construction wolate any zoning law, ordinance or regulation ................. ~..~. ............................ 13 W~II lot be regraded .....~...~.. ............ Will excess fill be removed fromm premi, ses:( ) Yes ( ) No 14 Name of Owner of premises ..~. M.~f'. ~..~.J.~.]'.J~...ffi-.....~d:~..~.~ff./-~dress t,~ ~,~.~.f.~~.... Phone No. Name of Architect .... J L r ~ Address ~ I ! t Phone No. Nome of Contractor .......... ~. ~. ............. I../ ........ Address ......... (...t ....... (..! ....... Phone No .......r...~ ...... ./.~... PLOT DIAGRAM Locate clearly and dmhnctly all build~ngs, whether ex~sting or proposed, and red,cate all set-back dimensions fror property hnes Gwe street and block number or descnphon according to deed, and show street names and ind~cat whether interior or corner lot 'FL STATE OF NEW~YQ~I~, , _ t c ~ COUNTY OF ..~:..,/'/~.....~...t.~ ...... ~ ----~~'.~ ..... ---- ~----' '~..V~..~Z. ................... be,rig duly sworn, deposes and says that he ,s the applica (Name of indiwdual s~gning contract) above named. He ,s the ....~.~.~.~ ............................................................................................................................................... (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to perform or have performed the said work and to make and fi th~s apphcahon, that all statements contained m this apphcction are true to the best of his knowledge and behef; tha~ the work w~ll be performed m the manner set fo~h in the apphcatiqn filed therewith. _ _ Sworn t~before me this ~ ' ~ ~ /7 J ~ /] / o, ..................//// ........ .......... ................. ~d~3;] .,. ~. (S,gnature of applicant) Cert filed m Suffolk Co~n~ ~ ~m~s~on Expires March ~0, 1~ /